the health challenges facing irish society
DESCRIPTION
Presentation delivered by Dr Eibhlin Connolly, Deputy Chief Medical Officer at the Department of Health and Children at the Irish Pharmaceutical Healthcare Association Annual Meeting 2009.TRANSCRIPT
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