Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

First, we need to be careful about how we use statistics. One month's figures do not make a trend. We also need to be careful of using figures from unofficial sources.

The CSO publishes quarterly reports on vital statistics, which include births and deaths. Quarter 1 figures for 2023 were published on 25 August. As regards death registration, they correctly point out that many deaths occurring in a particular quarter may not be registered until the following quarter. They indicate that of the 10,205 deaths registered in quarter 1 2023, only 59% or 6,062 deaths occurred in quarter 1. The remainder of the deaths registered in quarter 1 occurred in the fourth quarter of 2022. A similar pattern emerges for every quarterly death figure.

The CSO has now produced figures for its best estimate of deaths occurring in any one quarter. Its estimate for deaths occurring in quarter 1 of 2023 is 8,413; in quarter 1 of 2022 is 8,858; in quarter 1 of 2021 is 10,037; and in quarter 1 of 2019 is 8,618. The CSO figures indicate that there is no great difference between the first quarter of 2019, which was pre-Covid, and the figures for the first quarter of this year.

However, there are two figures which will contribute to rising death numbers in the years ahead. One is a changing age profile of the population. CSO figures show that between census 2016 and census 2022 the number of people in the group aged between 75 and 84 increased by 28% and the number aged 85 and more increased by 25%. Figures released in the past few days show that the average life expectancy in Ireland was 71 years when we joined the European Union. According to HSE figures released in August this year, life expectancy in Ireland is now 84.4 years for women and 80.8 years for men. People may be living longer but, of course, death comes for everybody sooner or later. An ageing population will result in higher annual death rates over time.

The other factor which will over time also contribute to higher deaths is the overall growth in population. The Irish population has increased by 1.5 million people since 2000. That is a 40% increase in 23 years. A rapidly-rising population will inevitably see a rise in the number of deaths from the wide variety of illnesses and conditions which can occur.

Some people are using RIP.ie as an accurate measure of deaths in any one month. I am not aware of any research by any academic institution on the accuracy of RIP.ie figures. RIP.ie figures may well serve as a useful measure of monthly deaths but, I repeat, one month does not make a trend. Of course, many people in older age groups dramatically reduced their social contacts during Covid while others may have delayed medical check-ups. When Covid restrictions were eased, an increase in deaths might be expected. For a variety of reasons, there are always higher deaths during the winter months. However, every winter the flu kills many people and causes hospital overcrowding. Getting the Covid vaccine and the flu vaccine and following public health guidelines on the prevention of infection will reduce the number of deaths and reduce hospital overcrowding in the winter months ahead.

It is important as well to acknowledge the work that has been done in the health service over the past 20 years. I note my colleague, Deputy Cullinane, acknowledged the part the health service has played in making sure that we have increased life expectancy of 11 years in the past 50 years - our life expectancy has gone from 71 years to on average 82 years. A huge contribution to that is people being more aware of how to mind their own health but also the contribution that the health service, GPs, doctors, nurses and hospitals make. In fact, when one looks at the changes that have occurred in healthcare in the past 20 years, for instance, where long ago one went in for a procedure and one could be four or five days in hospital and now many of those procedures are day procedures and people are in and out faster, the volume of patients who are being seen in the hospitals and clinics has increased dramatically.

On an average day people will give out in some way or other about the health service but they do not realise that there were over 3.5 million outpatient appointments last year, which is over 65,000 or 66,000 people a week, going into our hospitals for care in some form or another in clinics. It is important to acknowledge the work being done in that area.

We have a great challenge, however, and it is important that we note it. The latest CSO figures show there are over 805,000 people aged over 66 years. That is a huge growth in the population in that age group. It also means that by 2030, which is only six years away, there will be more than 1 million people aged over 66 years. We need to be sure we can plan for that and that we deal with the whole area of home care and step-down care from hospitals. I find it frightening that while we discuss this matter here, there are over 600 people in hospital who we could be discharged but we do not have a co-ordinated mechanism in place to get people out of hospital in a timely manner. That is one issue with which we need to deal. We need to built step-down facilities so that someone can get into a step-down facility for three to four weeks and out of hospital care because the cost of hospital care is extremely expensive. It is up to €7,000 or €8,000 per bed per week whereas a step-down facility will cost €2,000 per bed per week at most. Much work needs to be done in the area. Much work must also be done on home care. We need a more attractive package to be available to get more people into providing home care. Take the figures in the Cork and Kerry south-west region. Over 1,800 people were employed by the HSE to provide home care two years ago. We lost 400 of those. To be fair to the HSE, it has recruited more people but we have not recruited a sufficient number of people to provide the packages they require. One lady was on to me in recent days. She is 90 years old and has to use a walking frame to move around her own house. She is living on her own. The best I can get for her is one hour a week of home care. That is not sufficient. We have to look at the whole area of how we provide an attractive package to bring people into that area and give them the support that they can help people live in their own homes, to live there securely and to have the additional support they require.

We will also have many more people living on their own where families have moved away from their own location. They might be working in Dublin or in other parts of the country and it is not as easy for them, especially if they have young children themselves, to give the time to their parent as they would wish. The importance of home care needs to be further looked at and delivered on. It is about how we attract people in and how we can try to attract those who were providing home care but who left the sector back into the system. What do we need to do to make that attractive?

We need to examine the whole issue of step-down facilities. I am not satisfied that we have a sufficient capacity in the area of step-down facilities. Going into the October bank holiday weekend, will we have administrative people on call during that weekend to assist doctors? If a doctor comes in on the bank holiday weekend to discharge a patient from hospital and if that person does not have the necessary supports at home to go back home, are there administrators there to ensure the suitable step-down facility can be identified in order that such a person can get out of hospital on a Saturday or Sunday of a bank holiday weekend or during Christmas? It is fine to say that consultants have to work on Saturdays and Sundays to discharge people but we also need to ensure the administrative support is in place as well to ensure we can deliver the step-down facility that the person requires. These are the things on which we need to start focusing.

I mentioned the population rising by 43% in 23 years. We have not grown the number of hospital beds by 43% in the same time. Part of the reason is, as I said earlier, because we have many procedures now that do not require admission to hospital but are daycare procedures. But that means we still have a huge growth in population and we now need to plan to cater for that growth and to deliver the infrastructure in a timely manner.

I thank the Minister of State for bringing this debate forward. It is important that we get accuracy in the figures in this area.

See this speech in context