Irish Medical Organisation

IMO warns of massive challenges facing health services in coming decades

“The challenges for our health services today are significant – but they are dwarfed by the challenges coming over the horizon” – warns Dr Padraig McGarry of the IMO
IMO calls for strategic investment in General Practice to deal with demands from inevitable rise in chronic illnesses.

Wednesday 13th January 2016.   A rapidly ageing Irish population and the dramatically increasing medical demands that follow will dwarf the problems facing our health services today according to speakers at a special seminar organised by the Irish Medical Organisation (IMO). 

The seminar, which was opened by the Minister for Health, Dr Leo Varadkar TD, took place in Buswells Hotel in Dublin this (Wed) evening.

Dr Padraig McGarry, Chairman of the GP Committee of the IMO, said the seminar had been organised to try to encourage policy makers to see beyond current problems to the “storm that is gathering on the horizon.”  

He said; “People are crying out for a vision for our health service.  The IMO vision is clear; resource General Practice and empower it to play a full role in tackling a crisis which we know with certainty is coming.”

Dr. McGarry said the scale of the problem is enormous; “An ageing population directly leads to increased demands for expensive chronic care management and we are woefully unprepared to cope with the demand that is coming down the tracks. Given the inescapable increase in the elderly population, longer life expectancy and everything we have seen occur in similar populations in other countries, we may end up regarding our current health care problems as “the good old days”.

Dr. McGarry said there were three key messages that the IMO wanted to get across:

The Irish health service is facing a double whammy of a rapid increase in the proportion of people over 65 needing expensive health care and fewer young, working people to pay for it though taxation.

The Irish hospital system – already at breaking point – is unsuited to chronic care management and will never be able to cope with the inevitable increase in demand.

The proven international solution requires a strategic resourcing of General Practice to take a lead role in chronic care management.

Dr Austin Byrne, a GP from Tramore in Waterford, presented an analysis of population changes that are coming down the line and the impact they will have on health services.

Dr Byrne said that the percentage of the population over the age of 65 was forecast to increase from 11% in 2006 to 26% in 2026 and with an ageing population would come a massive increase in demand for treatments for chronic ailments and illnesses.  Dr Byrne also highlighted that not only will more people reach 65 than ever before, but more will live beyond 80 than ever before; “the number of people aged 80 or older will double in the next 20 years and the older old pose huge challenges in terms of chronic care.”

Chronic Conditions are conditions which last 3 months or more such as Heart Disease, Lung Disease, Obesity, Arthritis and Diabetes which required ongoing, prolonged treatment and which often arise at the same time in older patients. 

The percentage of patients who suffer from multiple chronic illnesses increases from 1 in 4 for the population under 65 to 3 in 4 for the population aged over 65.  Most are preventable or the risk of developing them can be dramatically reduced by interventions in areas such as lifestyle or dietary modifications.

Dr Byrne warned that within that over the coming years, the demand for acute hospital beds for patients over 65 alone will be greater than the total of all acute and day case beds currently in the entire hospital network.  He said; “The total bed capacity increase required to maintain current service levels in our hospitals will be in excess of 50% more beds in the system.   Therefore we simply have to invest now to move chronic disease care out of the hospitals and into General Practice.”

Dr William Behan, a GP in Dublin, addressed the seminar on the challenge of rising health care costs. Dr Behan said that the international literature was unanimous on the cost effectiveness of treating patients through General Practice as opposed to a hospital setting.  Chronic Care Programmes set in General Practice enhance patient experience, improve health outcomes, reduce referrals to hospitals, reduce outpatient visits, in patient admissions and emergency department presentations.

Dr Behan calculated that for every €10 million invested in General Practice there will be a corresponding freeing up of €50 million in hospital resources so as to allow the acute system to deal with cases of greater acuity.  He compared the UK experience where General Practice receives 9.5% of the total public health budget with Ireland where the comparable figure is just 3.2%.

Dr Tadhg Crowley, a GP in Kilkenny, spoke of the potential of Chronic Care programmes in General Practice.  Speaking on the experience of treating heart failure, Dr Crowley said that in 2012 heart failure cost €660 million with 50% of these costs relating to patients being hospitalised – accounting for 7% of all hospital beds used in that year in the system.

Dr Crowley said that an integrated structured programme through General Practice could reduce outpatient attendances by 25% and hospital admissions by 16%.

The IMO is calling on all political parties, the Department of Health and the HSE to commit to a programme of sustained investment into General Practice so that we can start treating patients with chronic disease and offer a modern, quality service to our citizens.  

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