2019 Health Budget needs to increase hospital capacity to provide care to patients without unacceptable delays

 27 September 2018: The Irish Hospital Consultants Association (IHCA) said that the 2019 Health Budget must increase the funding for public hospitals if the Government wishes to avoid record waiting lists and an increasing trolleys crisis next year.  The Association said that each year over the past decade the health budget, and especially that for public hospitals, has been inadequately resourced to treat the growing number of patients that require hospital care. Both inpatient and outpatient waiting lists have increased by 40% in the last four years, which cannot be addressed properly without significantly increased funding to expand public hospital capacity.

Dr Donal O’Hanlon, President of the IHCA, said that Ireland’s population has increased by over half a million (13%) since 2006, including an increase of 187,000 (40%) in the cohort aged 65 years and over. However, it appears that the State is unaware of the obvious need to provide the essential capacity and resources in our public hospitals to cater for this increase. As a consequence, the health budget, and the acute hospital budget in particular, have been underfunded each year over the past decade.

Dr O’Hanlon said that “it is important to remember that the continual increase in waiting lists and the ongoing rationing of healthcare is created by insufficient capacity. The problem of unrealistic forecasts, which have been the basis of health budgets for the past decade, need to be fully addressed in the 2019 Health Budget. Otherwise, the mistakes of the past will continue and a record number of acutely-ill patients admitted to hospitals who receive some or all of their treatment on trolleys will be an annual occurrence.”

In this regard, he said: “It is unacceptable that the number of patients being treated on trolleys has increased by 67% in the past decade to almost 100,000 last year. This unfortunately is likely to be exceeded this year as the number of patients treated on trolleys increased by 14% in the first six months of 2018.’’

Dr O’Hanlon said that “the required expansion in acute hospital bed capacity has been acknowledged in the Capacity Review published in January and the subsequent National Development Plan provides funding for an additional 2,600 hospital beds. Despite this, there is a lack of urgency in putting in place additional hospital beds even though there is a record number of patients being treated on trolleys year-round and around 20% of the population on waiting lists for acute hospital and other care.”

Dr O’Hanlon said that acute hospital and mental health services will increasingly fail patients due to the large number of approved permanent consultant posts that cannot be filled as a consequence of the discrimination against new Entrant Consultants by the State.  He said: “Public hospitals are operating in crisis mode. The discrimination against new consultants is proving extremely damaging for patients due to the unacceptable delays in the provision of hospital care and the ever-increasing waiting lists levels. It is not surprising that 514,000 people are now on waiting lists for consultant outpatient appointments and that over 74,000 patients are awaiting essential surgical appointments.”

“The Government position is illogical as ending the discrimination would be cost effective, resulting in significant health service benefits and cost reductions when considered fully. It would reduce health service costs through the provision of earlier patient care, better patient outcomes, reductions in outsourcing costs and shorter waiting lists. It would also reduce agency Consultant costs which are up to three times the salary being paid to permanent newly appointed Consultants.”

He said: “Over the past three years the health service has failed to fill up to one third of the hospital consultant posts advertised, which is having an adverse impact on practically all medical and surgical specialties and most hospitals throughout the country. The current two tier pay system for consultants must be ended and pay parity restored to ensure that our hospital and mental health services can provide the type of care that patients need and deserve.’’

ENDS

For further information contact:

James Dunny, FleishmanHillard 086 3883903

Background information:

• The number of people on inpatient/day case waiting lists (74,189) is 39% above four years earlier.

• The numbers on outpatient lists (514,585) is 41% above four years earlier.

• The number of admitted patients being treated on trolleys increased to 98,981 in 2017 which is 67% above 2008. A further increase to 58,771 patients on trolleys in the first half of 2018 (+14.5% on the same period 2017) has been confirmed.

• There has been a 53% reduction in the number of elective surgeries carried out in our public hospitals between 2012 and 2017.

• Acute hospitals are failing to deliver on the basic cancer KPI targets.

• Ireland’s hip replacement surgery incidence is 25th lowest out of 34 OECD countries.  Knee replacement is 30th out of 33 OECD countries.

• The 2018 health budget of €14.5 billion included an increase of €608 million (4.4%) compared to the 2017 budget allocation.  However, when the 2017 supplementary budget is taken into account, the 2018 budget is about €238m (1.6%) above 2017 outturn.

• The 2018 Acute Hospital Budget of €4.7bn is €37m lower than the actual expenditure incurred in 2017.

• Health Expenditure in the first three months of 2018 was 3.3% above budget, an overspend for the full year that could be equivalent to €500m.  Expenditure for the first half of 2018 was €606m (8.6%) above the same period in 2017 and the Government concluded that supplementary budget funding will be required.  More recent estimates by the Minister for Finance and the HSE suggest the full year over budget amount may be between €600m and €1.1bn.

• Ireland is ranked 24th out of 34 OECD countries on health expenditure as a percentage of GDP and is in 23rd position in terms of the percentage of overall health expenditure allocated to hospitals. 

• Ireland spends 35% of its total health expenditure on acute hospitals compared with an OECD average of 38%.  Ten of the original EU 15 Member States are spending a higher percentage on acute hospitals than Ireland, with most of the ten members spending between 40% and 45% of total health expenditure.

• Our relatively low number of acute hospital beds and hospital consultants means that the Irish health service is not “hospital centric” despite claims to the contrary.

• We have one of the lowest number of medical specialists per 1,000 population at 1.29, 40% below the OECD average of 2.14.

• Currently we have around two thirds the number of Consultants recommended in the Hanly Report over 15 years ago. –

• Acute hospital bed capacity at 2.8 per 1,000 population is 25% below the OECD average of 3.7. Bed occupancy at 95% is 25% above the OECD average of 76%.  

• Significant deficits exist in ICU capacity, access to endoscopy and diagnostic imaging, and access to operating theatres and outpatient clinics.

• The National Development Plan (NDP) provides €10.9bn in capital funding for the health service over the next decade

• The 2018 Mental Health is 10% (€104.2m) below 2009 expenditure.  At 6.6% of the total health budget it is low by international standards. –

• Staffing in the Mental Health Service is 22% below the levels recommended in A Vision for Change when revised for population growth.

• The Health Budget for 2019 needs to provide a significant increase in funding for mental health services. This is essential to provide improved and timely care to all patients and to ensure that children and adolescents are admitted to age appropriate units.

• The rising cost of clinical negligence claims is driving up the cost of providing care in public hospitals and jeopardising private practice in surgical and other specialties, forcing consultants to cease practice and emigrate.

• The relevant provisions of the Legal Services Regulation Act 2015 should be commenced without further delay so that the Pre-Action Protocol is implemented thereby ensuring more intensive case management of medical negligence cases and resolving claims more efficiently.

• Proposals on the lowering of the indemnity caps and the provision of indemnity on a commercial basis by the State Claims Agency should be advanced as a matter of priority.

• Substantial improvements in governance are required to ensure more effective and efficient management and utilisation of resources and to strengthen and integrate Hospital Groups and CHOs.

• The full merger, instead of the proposed geo-alignment, of Hospital Groups and CHOs is required to reduce administrative layers, duplication and overlaps thereby increasing efficiency and effectiveness in the delivery of care.

About the IHCA

The Irish Hospital Consultants Association was established to promote, encourage and support the advancement of the practice of Medicine, in all specialties and areas, and the improvement of the Health Services in Ireland. It also seeks to promote and protect the interests of Medical and Dental hospital consultants in Ireland. There are over 2,700 members of the Association and it is widely recognised as the leading representative voice for the profession in Ireland.