Dr. Conor Keegan:

I would like to respond to Deputy Kelleher's comments about the demands that are being placed on services due to population growth and ageing. He spoke in that context about where we plan to invest. At a broad level, the overarching findings of our report are that due to population growth, where an increase of between 14% and 23% in the population is expected, and population ageing, the number of people over the age of 65 is expected to increase dramatically. It is important to note that we are speaking on the basis of no change in the models of care when we say we envisage that there will be increases in demand for health and social care services across the board, particularly services predominantly used by the older population, such as home care services and long-term care services. We are seeing increases of 54% or 55% in such services. This gives a broad idea of where investment may need to be allocated.

I will speak about the skill sets that will be required in primary care as we move forward. Our results suggest that by 2030, general practice visits will increase by between 20% and 27% and practice nurse visits will increase by between 26% to 32%. All of our projections factor in the relationship between increased life expectancy and health. In primary care and general practice, we adopt quite a pessimistic view of the relationship between ageing and health. This ties in with the whole notion of what is known in academic circles as the epidemiological transition. Fifty or 100 years ago, people were not living that long and were dying of infectious diseases. Nowadays, people are living a lot longer and the mix of reasons for death has changed. People are living longer and often die with a number of chronic diseases. It is important to appreciate that as we move forward, we will need primary care workers who are able to deal with individuals who present with a number of co-morbidities or who are on a number of different medications.

I would like to pick up on what Dr. Wren said in response to Deputy O'Reilly's question about the expanded role for public health nurses. In our projections, we have not looked at changes in the models of care. This is a very important issue as we decide how best we can allocate resources as the level of demand for primary care increases and as we consider the expenditure implications of this. There is work to be done on substitutability, not just between acute and non-acute services but within primary care as well. We hope to do this work in the future. The Hippocrates model we have developed has the capability to look at these questions.