Transcript Dr Eibhlin Connolly 2 Eibhlin Connolly

Health Challenges for Irish
Society
Dr Eibhlín Connolly
Deputy Chief Medical Officer
Department of Health and Children
IPHA Conference
12-11-09
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
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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 Services
and 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 All
database, 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
Number of cases
250000
200000
150000
100000
50000
0
2005
2010
2015
Year
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
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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 (population
data)
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
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%
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%
Males
Females
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
– Surgical complications
HCAIs
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
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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