Health Challenges for Irish Society

Dr Eibhlín ConnollyDeputy Chief Medical Officer

Department of Health and Children

IPHA Conference12-11-09

Role of DoHC and CMO Office

• DoHC – Policy framework, Legislative Framework, Health system accountability

• CMO Office – Executive responsibility for public health and quality and safety

• Structured enagagement with the organised medical profession

• Communication with the public

Challenges

• Economic • Demographic• Epidemiologic and Lifestyle trends• Quality and Safety Considerations• New technologies• Global trends

– Environmental

– Communicable Diseases

TOTAL PUBLIC HEALTH EXPENDITURE, 1999 TO 2008

Sources: "Estimated Non-Capital Expenditure 1999-2004" www.dohc.ie. From 2005, Revised Estimates for Public Servicesand HSE Reports on Capital Programme

NUMBER OF PRESCRIPTION ITEMS DISPENSED UNDER PRIMARY CARE REIMBURSEMENT SERVICE, 1998 TO 2007

Source: General Medical Services (Payments) Board/ National Shared Services Primary Care Reimbursement Service

CONSULTANT AND NON-CONSULTANT HOSPITAL DOCTORS EMPLOYED WITHIN THE PUBLIC HEALTH SERVICES, 2000

TO 2009

Source: Personnel Census, Department of Health and Children

The economic context

• 22 Billion euro deficit

• Deficit 12.5% of GDP

• National Debt has doubled to 76 billion euro

• Hospitals 49 Million overspent in August PR

• Health budget savings of 800 million euro

McCarthy report

• Proposes €1.23 bn savings

• 6168 staff reductions – 30% DoHC reduction in 3 years

• Drug co-payments

• Hospital charges

• Mandatory generic prescribing

Demographic Projections

• Total population increase with changing age structure

• By 2021 there will be an additional 300,000 people in Ireland over the age of 65

LIFE EXPECTANCY AT BIRTH FOR IRELAND AND EU, 1980 TO 2006

Expectancy in Years at Birth for Ireland and EU, 1980 to 2006

Source: European Health For All database, WHO Regional Office for Europe, Copenhagen, Denmark.

AGE-STANDARDISED DEATH RATES FOR SELECTED CAUSES, 1970 TO 2008

Source: Central Statistics Office and European Health For Alldatabase, WHO Regional Office for Europe,Copenhagen, Denmark.

IHD and stroke projections

Expected number of prevalent self-reported cases of IHD and stroke (adults aged 15+ years), in Ireland 2005 -2015

0

50000

100000

150000

200000

250000

2005 2010 2015

Year

Nu

mb

er

of

ca

se

s

IHD Stroke IHD or Stroke

Chronic disease trends

• Approximately 60% of the disease burden in Europe is accounted for by 7 preventable risk factors including high blood pressure, tobacco, alcohol, high cholesterol, overweight and obesity, poor diet and physical inactivity

• Diabetes prevalence projected to increase from 4.7% to 5.7-7.9% in 2025 (dep on BMI and pop changes)

• Cancer will increase by 14% F and 8.5% M 2020

Lifestyle Trends

• Smoking

• Alcohol

• Overweight and Obesity

• Illicit Drug Use

• Needs multisectoral response

ALCOHOL AND CIGARETTE CONSUMPTION PER ANNUM, PER CAPITA

OVER 15 YEARS OLD, 1986-2006

Source: Revenue Commissioners Statistical Report 2007, CSO (populationdata)Note: (i) Alcohol is measured in terms of pure alcohol consumed,based on sales of beer, cider, wine and spirits.(ii) Smoking ban in workplaces was introduced in March 2004

Projected BMI distributions in 2010 and 2015, by gender

2005 2010 2015

Males

Obese (BMI 30+) 23.10% 28.80% 33.30%

Overweight (BMI 25-29)

43.40% 44.20% 43.10%

Normal (BMI <25) 33.50% 27.00% 23.60%

Females

Obese (BMI 30+) 24.80% 28.50% 31.90%

Overweight (BMI 25-29)

32.90% 34.50% 34.60%

Normal (BMI <25) 42.40% 37.00% 33.50%

Health Service Implications

• PA Consulting: over 19000 extra beds required by 2020 under current model of care

• Potential to significantly reduce this through shift to primary care provision

• Implications for primary, community and long-stay services

• Manpower planning and skillmix

Quality and Patient Safety

• 4-16% of hospital inpatients suffer adverse events, of which half are preventable

• Estimated costs $17-29bn per annum in the US

• Causes– Medication safety HCAIs– Surgical complications Falls

Irish Context

• The Lourdes Inquiry

• Cancer diagnosis delays and errors

• Health care associated infections

• Establishment of the Commission for Patient Safety and Quality Assurance

Quality and patient Safety

• Commission report being implemented• Focus on licensing, governance, standards,

audit, adverse events, education, information and credentialling

• Implementation involves patient and professional representatives, Colleges, HSE, HIQA, MHC, professional regulatory bodies

Commission implementation• Well underway• HSE Directorate of Clinical Care and Quality• HIQA work on standards and licensing

commenced • CMO lead on patient safety• Information bill protection for audit and event

reporting• Medication Safety Forum working• Service user involvement being implemented

New technologies

• Pharmaceuticals, vaccines, genetics, miniaturisation, new imaging and process technologies, ICT and telehealth, tissue engineering all offer major opportunities in prevention, therapeutics and diagnosis

• New technology a key driver of health expenditure growth

Technology challenges

• Societal and ethical challenges

• Horizon scanning

• Assessment costs and benefits

• Adoption and diffusion of cost-effective technologies

• Health Technology Assessment

Global Trends

• Environmental diseases – impact of climate change, food and water borne diseases

• Communicable Diseases – MDR and emergence of new threats: HIV, SARS, VHF, bioterrorism, pandemic influenza

Future challenges

• Budgetary pressures • Sustain population health improvement• Demographic and risk factor trends driving up

demand by 60% in 2020• Respond to challenges of new technologies and

global trends in environment and Comm disease• Reorientation of health services and manpower• ICT and information deficiencies

Conclusions

• More for less

• Evidence-based planning

• Better performance measurement and management

• Improved value for money

• Clear identification of priorities