Dr. Conor Keegan:

On the question on demand increases for particular types of care, for example, for paediatrics and maternity care, in our acute analysis of public hospital care, given the scope of this report, we have not focused on particular areas such as paediatrics, rather we have focused on demand increases, for example, for day patients cases, inpatient discharges, inpatient bed days and so on. We focus on maternity services as a separate area of activity, the reason being it involves all women, they are in a particular age range, they report particular diagnoses and they generally have a lower average length of stay than the rest of those reporting to hospital in terms of discharges. Maternity services is an interesting case as it is one of the areas of activity under one of our assumptions where we see a reduction in demand by 2030. The reason for that is that in one of our population scenarios there is an absolute reduction in the number of women aged 30 to 39, who also have the highest specific fertility rate, which leads to lower births over time, although the positive effect of migration helps dampen that effect. When we model higher population growth through time, we see an increase in demand for maternity services, but it is in an interesting area in that in one of our main projections we see a decrease in demand.

Deputy Durkan had another question related to the age groups that experience most demand for health care services. That will differ across our different activities and in all our different sectoral chapters in the report we provide graphs of activity rate distributions across the age distribution. The Deputy can note that relationship between age and activity or demand. In general, as most of the members of the committee can probably guess, as individuals age, there is an increase in the intensity of use of most services. That is particularly strong if we consider examples of measures such as inpatient bed days where much of that activity in captured among older ages, partly because that is a combination of both older people reporting to hospital more often and they stay longer in hospital. There is quite a amount of activity located among older age groups. Also, in terms of services used mainly by people such as home care services and long-term care services, much of that activity is concentrated among those in older age groups.

Regarding general practitioner, GP, services, we see an increase across age distribution but also in the middle of the age distribution there is quite a high level of activity. That would also come across for emergency department care, where we see activity increasing as individuals get older but there is quite a relatively large bulk of activity in the middle of the age distribution.

In terms of these projections, as a general rule, the more activity tends to be concentrated in those in older age groups, all else being equal, the larger we are seeing projected demand increases as the population grows and ages through our projection horizon.