Dr. Maev-Ann Wren:

I thank the Chairman and we thank the committee for the opportunity to present on our research. I am here in my capacity as senior research officer at the ESRI. I am joined by my colleague Dr. Conor Keegan, research officer at the ESRI. We are both health economists and are the leading authors of the ESRI research series report, Projections of Demand for Healthcare in Ireland, 2015-2030, which was published last October and which the Chairman, Deputy Michael Harty, has invited us to discuss with the committee.

This report provides annual projections of demand for public and private health and social care services in Ireland for the years 2015 to 2030. These projections are based on new ESRI projections for population growth, the first projections to be published based on the 2016 census of population. The report contains the most comprehensive mapping of public and private activity in the Irish health care system to have been published. The main findings are that, over the years 2015 to 2030, the population of Ireland is projected to grow by between 14% to 23%, adding 640,000 to 1.1 million people; the share of population aged 65 and over is projected to increase from one in eight to one in six; the numbers of people aged 85 and over are projected to almost double; demand for health and social care is projected to increase across all sectors, with the greatest increases for services for older people; demand for home help care and for residential and intermediate care places in nursing homes and other settings is projected to increase by up to 54%; demand for public hospital services is projected to increase by up to 37% for inpatient bed days and by up to 30% for inpatient cases; and demand for GP visits is projected to increase by up to 27% while demand for practice nurse visits is projected to increase by up to 32%.

New analysis in the report of the mix of public and private provision in 2015, which is our base year, finds that public hospitals delivered approximately 85% of total inpatient bed days and private hospitals delivered 15%, public hospitals delivered approximately 69% of day patient cases and private hospitals delivered 31%, and people paid privately for 27% of total home help hours.

The report also provides projections of demand for inpatient and day cases in public and private hospitals, maternity services, public hospital emergency department and outpatient services, pharmaceuticals, pharmacy consultations, home care packages, public health nursing and public community therapy services. The report includes the effects of unmet need and demand where possible.

There are important policy implications from this report’s findings of substantial projected demand increases for health and social care in the years to 2030 due to projected population growth and ageing. These projected increases in population and demand come after two decades of rapid population growth, a decade of cutbacks in the public provision of care, and a consequent build-up of unmet need and demand for care. The additional demand projected in this report for the years to 2030 will give rise to demand for additional expenditure, capital investment and expanded staffing and will have major implications for capacity planning, workforce planning and training.

Additional investment will be required in most forms of care to meet the needs of a rapidly growing and ageing population. The projected population growth will, however, also lead to an increase in the numbers at work and contribute to national income and the revenue base.

In future analysis the ESRI will examine the expenditure implications of the report’s demand projections. While it assumes no change in models of care, further research is examining the potential effects of policy developments which could reduce projected increases in demand and capacity need in some sectors but increase projected demand and capacity need in others.

This is the first report to be published which applies the Hippocrates projection model of Irish health care demand and expenditure which has been developed at the ESRI in a programme of research funded by the Department of Health. The programme applies economic analysis to explore issues related to health services, health expenditure and population health, to inform the development of health policy and the Government’s health care reform agenda. It is overseen by a steering group which comprises nominees of the ESRI and the Department which agrees its annual work programme. Research studies produced under the programme are public goods which are published following national and international peer reviews.

The full report has been circulated to the committee and is available on the ESRI's website.