The lack of capacity within the acute system, the chronic problem of doctor retention and the challenges of delivering community-based care, were some of the themes discussed at a session at the IMO AGM on the future of the health service.
The first speaker was Health Economist at University College Cork, Dr Brian Turner (PhD). He highlighted the shortage of beds and medical specialists per head of population in Ireland compared to the OECD average. In 2019, Ireland had 2.9 hospital beds per 1,000 population compared to 4.4, which is the average in the OECD.
Ireland had 3.3 per cent practising doctors per 1,000 population, compared to the OECD average of 3.6. However, only 45 per cent were specialists compared to the OECD average of 65 per cent.
He pointed out that the 2,600 additional beds recommended in the Health Service Capacity Review, and to be delivered under Sláintecare, were not likely to be sufficient to meet demand. The Economic and Social Research Institute has said that by 2030 between 3,200 and 5,600 additional hospital beds in the public sector, and between 780 and 1,200 in the private sector, will be required.
Dr Turner said the time had come for a review of Sláintecare, which was published five years ago.
Senior Lecturer at the RCSI Graduate School of Healthcare Management, Dr Niamh Humphries (PhD), spoke about her research into doctor emigration and retention. She pointed out that Australia had issued 402 work visas to Irish doctors in 2022 to date. This compared to 272 in 2019, which was the last year before the pandemic. Dr Humphries stressed that Australia was just one of several destination countries for Irish-trained doctors.
She said while doctors have always emigrated for educational opportunities and to gain experience, recently many are leaving Ireland to escape difficult working conditions.
“Emigration is just one form of exit in order to better cope with difficult working conditions,” Dr Humphries said.
Others included early retirement, career breaks, and reduced working hours.
According to Dr Humphries, doctors should not have to sacrifice their physical and mental wellbeing to do their job and require better support.
She highlighted how many doctors feel an absence of hope about the future.
“For myself and the team, this is the part of the research we found most difficult,” said Dr Humphries. “…. Without hope doctors will continue to emigrate, retire early, opt for reduced hours, and try to find individual solutions to health service problems.”
The final talk of the session was delivered by Consultant Psychiatrist and Clinical Director, Dublin North, Prof Matthew Sadlier, who spoke about the problems encountered in delivering care in the community, with reference to his own experience within the mental health sector.
Prof Sadlier said that currently “delivering care in the community leads to a greater degree of fragmentation”.
While the majority of cases can be treated effectively in the community, he said there is a difficulty in diagnosing unusual presentations and patients with rarer variations of illness.
For doctors, there is the danger of professional isolation, “with little peer support within primary care other community-based centres.”
In conclusion, he said no consultant or NCHD should be responsible for patients across multiple sites simultaneously.
“Governance of co-located services needs to be integrated and services need combined targets and patient-centred outcomes to avoid ‘othering’,” according to Prof Sadlier.
Irish Medical Organisation, Annual General Meeting, Aviva Stadium, 28 May 2022.