Demand for GP consultations will increase by at least 23 per cent by 2040, according to a new report from the Economic and Social Research Institute (ESRI).

ESRI projections find that this significant rise is mainly due to population growth and “to a lesser extent”, population ageing

On the basis of this growing patient demand, the report finds that there will be requirements for an additional 943 to 1,211 GPs by 2040. In 2023 there were approximately 3,928 GPs in Ireland.

The report also concludes that there will be a requirement for an additional 761 to 868 general practice nurses (GPNs) by 2040 are projected, relative to a 2023 headcount of 2,288 GPNs.

“Population growth and ageing will result in a significant increase in the demand for general practice services in the coming years,” according to the ESRI. These increases come in addition to increases in demand arising from recent policy reforms including the introduction of the chronic disease management programme and an increase in the number of people eligible for a GP visit card.

Minister for Health Jennifer Carroll MacNeill welcomed the report, stating that it highlighted the challenge in ensuring that the Irish population continues to have access to quality GP services.

“We are already expanding GP training places by 80 per cent since 2019, now offering 350 places annually,” said the Minister. “Through the International Medical Graduate programme, developed in cooperation with the ICGP, we are recruiting GPs internationally, particularly for rural areas.”

The Minister also noted that the ongoing strategic review of general practice, due to complete its work this year, “will outline new ways to ensure we have the capacity” to provide GP services.

In response to the report, the IMO has said that Ireland’s “critically low” GP numbers will not rise without significant systemic change.

It added that a lack of supports to both establish and maintain GP practices was deterring doctors from entering and staying in general practice.

The Organisation has been warning for many years of the need for ongoing and sustained support for general practice to match the needs of a growing and ageing population.

Dr Tadhg Crowley,Chair of the IMO GP committee, said: “While we acknowledge and welcome the fact that more GP training places have been made available in recent years, this has not been matched with supports for new and existing GP practices which is a major deterrent for doctors and is having a significant impact on recruitment and retention. This has led to our critically low GP numbers today.”

He said that the impact of the Financial Emergency Measures in the Public Interest (FEMPI) Act in 2009 was still being felt.

“General practice was decimated by the FEMPI cuts during the recession and has not yet fully recovered some 16 years later. As a result, we have a severe lack of younger GPs and those who do enter the specialty are hampered by a range of factors – in particular, the costs associated with setting up and running a practice.”

He said that more undergraduate medicine places were needed as a realistic starting point. “If we just increase the number of GP training places, we will only be robbing Peter to pay Paul as other specialties will suffer. Ireland has a lack of doctors across the board, and as such we need more undergraduate places to be made available as a priority.”

Dr Crowley said that along with boosting the GP workforce, it was imperative that the physical infrastructure was also built up to reflect growing demand.

• The report ‘Projections of national demand and workforce requirements for General Practice in Ireland, 2023–2040: Based on the Hippocrates model’ is available here https://www.esri.ie/publications/projections-of-national-demand-and-workforce-requirements-for-general-practice-in

HIQA is “very concerned” at practices at nursing homes described in a recent RTÉ Investigates programme. The Authority was reacting to the RTÉ investigation that focused on two nursing homes, The Residence Portlaoise and Beneavin Manor in Glasnevin in north Dublin.

HIQA noted that inspection reports on both of these centres are currently being finalised and will be published shortly. But it said that admissions to the Portlaoise home had been stopped “as part of its escalatory action”.

The Authority added that following the programme it had “engaged directly” with those responsible for the operation of the nursing homes.

“Our function as a regulator is to ensure that providers are protecting those who use services and ensuring residents are receiving safe, quality care and support. Accordingly, we will be taking the necessary actions with the provider to ensure safe and effective care and support to all residents.”

In its statement HIQA added that its recently published report on findings from nursing homes over the last 15 years of regulation highlighted “how the vast majority of nursing homes are now providing good quality care”.

“It also shows that a small number of nursing homes struggle to maintain compliance with the regulations. Where there is persistent non-compliance with the regulations or where there is risk to residents’ safety, HIQA’s Chief Inspector takes the necessary enforcement steps which may include attaching restrictive conditions to a centre’s registration, such as stopping new admissions to the centre until improvements are made, or in some cases cancelling the registration of a designated centre.”

In 2024, HIQA refused to renew registration or cancelled the registration of 10 nursing homes.

“HIQA will continue its programme of work in nursing homes and encourages residents and their family and friends to engage with us directly about their experiences so that we can support the delivery of safe and effective care and support. HIQA will continue to engage with all nursing home providers, the Department of Health and representative bodies to drive improvements in the sector.”

In 2023, a total of 15,152 admissions for 14,363 patients were recorded to adult intensive care units (ICUs) across Ireland. That is according to the new National Office of Clinical Audit (NOCA) publication National ICU Audit Annual Report.

Other key findings in the report, include that only 33 per cent of admissions from wards or emergency departments occurred within one hour of a decision to admit, although 87 per cent were admitted within four hours.

In 2023 the national average ICU occupancy was 95 per cent, well above the recommended 85 per cent, indicating ongoing pressures on capacity.

Some 80 per cent of ICU patients survived to hospital discharge, “a satisfactory performance” according to NOCA considering the severity of illness of patients who were admitted to ICU.

NOCA said that the report showed that despite sustained pressures on ICU capacity, “Ireland’s ICU network maintained high-quality outcomes comparable to international standards”.

Commenting on the findings, Professor Rory Dwyer, Clinical Lead for the Irish National ICU Audit, said that the report “highlights the resilience and quality of care delivered across Irish ICUs, despite significant resource challenges”.

“While our overall outcomes are encouraging, the data underline persistent issues, particularly in terms of bed capacity and timely admission to ICU. Continued investment and system improvements are essential to ensure critically ill patients receive timely, appropriate care.”

The report recommends investment to expand ICU and high dependency unit capacity, maintaining a focus on timely access to critical care, and further development of ICU outreach services to support deteriorating patients outside of ICU settings.

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A new plan aims to “forge the way towards accessible, affordable, high-quality, healthcare”, according to the Government.

The document, Sláintecare 2025+, was published today.

Critical views on Sláintecare were expressed the recent IMO AGM in Co Kerry. Doctors passed a motion calling on the Government to “clarify” its plans for Sláintecare. During the debate IMO President Dr Anne Dee questioned the implementation of the policy, however, she said the original aims of Sláintecare, such as multi-annual funding, are worth pursuing.

Today, the Minister for Health Jennifer Carroll MacNeill  described the Government’s commitment to health reform as “unwavering” and that the new document Sláintecare 2025+ provides a path to universal healthcare. 

“The full implementation of Sláintecare remains one of the most significant reform programmes ever implemented by the State,” said the Minister.

She added that the success of this new action plan will be demonstrated by “waiting times continuing to fall, the number of people on trolleys continuing to fall [and] the cost of healthcare for families decreasing.”

The Minister today also published the Sláintecare Implementation Progress Report 2024.

As already reported in the Medical Independent last month, this new report shows a reduction in the cumulative daily 8am trolley count over 2024, with numbers down 11 per cent compared to 2023, despite an 8 per cent increase in the number of patients presenting to emergency departments. The volume of weekend discharges (Friday – Sunday) from acute hospital beds increased by 15 per cent in 2024 compared to 2023, while total discharges increased by approximately 12 per cent.

The CEO of the HSE, Mr Bernard Gloster, has confirmed he will step down at the beginning of next March. He will retire from the public service after almost 38 years, including three as HSE CEO.

Mr Gloster said: “I continue to be privileged to serve in this very important role and for the coming months I will be working hard with the board, the Minister, and the Department to advance many improvements and responses to challenges.

“I wanted to bring certainty to the future leadership of the organisation as I am now in my third year as CEO. I have today submitted my resignation to the Chair of the HSE Ciaran Devane and Minister Carroll MacNeill, allowing time to prepare for the next phase of leadership of our health and personal social services.

“I particularly want to thank the Chair and the Minister for the kindness shown to me during this significant personal decision. I will retire from the public service on March 5th, 2026.  I also want to express my deep appreciation to all of our staff for the work they continue to do every day to serve the public.”

Minister for Health Jennifer Carroll MacNeill stated:  “I extend my enormous thanks to Bernard, an extraordinary public servant, who has dedicated himself, seven days a week, to improving the health service for everyone in Ireland.

“Since he took over his position in 2023, Bernard has brought over 30 years of public sector experience to advance leadership across the HSE organisation and I have greatly appreciated his work, his expertise and his friendship in my short time as Minister. I look forward to working with him in the coming months to continue our good work to advance a health system that works better for all.”

The Irish College of GPs has welcomed the “highly positive” findings of a new report on the GP led chronic disease management (CDM) programme, issued by the HSE.

The report found that the programme was achieving a “high level of impact” on the health of the population and freeing up capacity in the health service – reaching over 400,000 patients, with 91 per cent of these now receiving routine chronic disease care within the community. 

The report stated that participants had 30 per cent fewer emergency department attendances, 26 per cent fewer hospital admissions, and 33 per cent fewer GP out-of-hours visits.

“This GP led programme has been transformative for eligible patients [those with medical cards or doctor visit cards] living with Type 2 Diabetes, COPD, Asthma and cardiovascular illness – and is a very positive step forward for the provision of care outside of hospitals,” said Irish College of GPs’ Medical Director, Dr Diarmuid Quinlan.

“The findings also demonstrate the power of general practice to deliver whole country large population health impacts when appropriately resourced.”

He added that the “success” of the CDM stems from a strong sign up by GPs with 97 per cent providing the service.

The CDM has been in operation for five years and this is the third report the HSE has published on its impact and reach within healthcare system.

The report Structured Chronic Disease Management Treatment Programme in General Practice showed a decrease in unscheduled admissions to hospitals among patients in the programme.

Dr Quinlan also highlighted the impact on prevention and early detection. “Since 2020, 51 per cent of new chronic disease diagnoses have been made through GPs in the programme. This prevents the need for more intensive hospital-based treatments – this is transforming people’s health journeys and promoting sustainable healthcare practices”.

The full report can be accessed here: https://www.hse.ie/eng/services/publications/primary/third-chronic-disease-report.pdf

The IHCA has launched its position paper outlining concerns and a number of strategic considerations in relation to key elements of the recently published Mental Health Bill 2024.

The IHCA “strongly supports” the Minister of State for Mental Health and Older People, Mary Butler, in reforming mental health legislation. The IHCA engaged with the previous Joint Committee on Mental Health, providing a detailed submission to the pre-legislative scrutiny of the General Scheme of the Bill.

While many of the Association’s contributions are reflected in the published draft Bill, the IHCA believes that several critical amendments and considerations are needed in order to ensure effective and timely care to those who need it most, who can be among the most vulnerable people in society.

Launching the position paper, IHCA Vice-President and Consultant Psychiatrist Prof Anne Doherty said: “While we welcome the broad principles of the Mental Health Bill, we, as an Association, have some concerns in relation to ensuring that legislation is workable in practice so that patients can access services in a timely and care-focused manner.”

“We are keen to see these elements within the Bill addressed as a priority to mitigate against impractical legislation which may only serve to create barriers to treatment and result in an overdependence on the intervention of the State for patient care. We are concerned that if left unchecked, the legislation will undermine the patient’s Right to Treatment in a timely and care-oriented manner.

Overall, the IHCA remains “committed to constructive engagement” with the Department of Health and Minister Butler on legislation that can transform psychiatric care in Ireland, bringing it in line with international best practice.

 “We commend the efforts of the Department of Health to enact positive change in this extraordinarily difficult area of health policy and are keen to see a sustainable framework implemented that avoids delays in treatment and excessive legal burdens and costs being placed on patients within the context of parallel legal processes. Consultant Psychiatrists will accordingly need to allocate additional time to dealing with legal and procedural processes, rather than providing urgent care to patients in an already strained system.

 “The IHCA also acknowledges and supports the principles in the draft Bill in relation to admission of Children to an Approved Centre as outlined in Section 60, however, there will be considerable resource implications given existing staff shortages in Child and Adolescent Mental Health Services that requires immediate address.

“Finally, it is also the view of the Association that the form, timing and content of Care Plans should not be legally prescribed, as these elements need to be negotiated between the clinician and the patient in a co-produced manner for optimum treatment and care pathways.”

The IHCA Psychiatry Symposium is taking place today (Wednesday 16 April).

Government “priority” projects, such as the New Children’s Hospital (NCH), dominate the new HSE’s Capital Plan 2025, while funding is also provided across a range of other areas.

The plan promises to make available €173.29 million to continue the expansion of the surgical hub programme.

This will include the complete construction of the North Dublin Surgical Hub in Swords, Co Dublin.

It also earmarks €35.41 million for primary care in 2025, including specific projects in counties Offaly, Waterford and Monaghan.

In 2025, €17.8 million will be provided to expand and maintain the ambulance vehicle fleet, as well as the provision of “new infrastructure and the modernisation of existing ambulance bases”.

In the section on ‘women’s health’, some €25.71 million is promised to fund projects, such as the New National Maternity Hospital and other areas such as the women’s health hub at the Coombe Women’s Hospital, Dublin.

However, according to the plan, there are a number of “challenges” facing the HSE this year.

These include the impact of current and future construction inflation on all projects and the transition to the new six health regions.

Increasing costs associated with new building standards and building regulations are also flagged, as well as having “sustainable levels” of skilled resources within HSE Capital and Estates required to oversee the delivery of the plan.

The plan provides €200 million towards the completion of the NCH.

However, it is noted that any “fluctuation” in expenditure on the NCH would have a significant impact on the remainder of the capital programme.

Funding for specific programmes include critical care, local injury units, urgent emergency care, elective hospitals, specialist disability services, enhanced community care, older persons and the multi-annual mental health capital plan, currently in preparation.

“Significant investment is made in the acute inpatient bed capacity expansion plan, prioritising patient safety, with developments at varying stages of delivery and a pipeline of additional projects in progress or at design stage,” according to the document.

The 2025 plan contains total funding for the construction and equipping of healthcare facilities of €1.33 billion.

“The continued significant investment in infrastructure underlines the Government’s commitment to improving quality healthcare in a sustainable way,” said Minister for Health Jennifer Carroll MacNeill.

“By increasing capacity in our hospitals and developing the necessary infrastructure to enable greater provision of care in communities, we are getting closer to making the vision of Sláintecare a reality; delivering a quality healthcare service to everyone in Ireland.”

*For full document see https://www.hse.ie/eng/services/publications/capital-plan-2025.pdf

The Irish Doctors for the Environment (IDE) have joined medical professionals from across the Nordic region in issuing a stark warning about the dangers of climate change, declaring that “the climate crisis is a health crisis.” The joint statement, made in collaboration with the Nordic Doctors for Planetary Health and Climate Action, calls for urgent measures to protect public health from the escalating effects of global warming. It was published in the Scandinavian Journal of Public Health.

According to the statement, the medical professionals emphasise that climate change is already exacerbating existing health issues, increasing the spread of infectious diseases, worsening respiratory conditions due to air pollution, and contributing to mental health problems. “The health sector must take a leadership role in addressing climate change,” the statement asserts, highlighting the need for rapid policy action to mitigate environmental damage.

The doctors also stress the need for governments to transition away from fossil fuels, citing the health benefits of cleaner energy. “Reducing emissions will not only slow climate change but also lead to immediate health improvements, including lower rates of heart disease and respiratory illness,” they argue.

In addition, the statement calls for increased investment in sustainable food systems, active transport, and policies that prioritise both human and planetary health. “A healthy planet is the foundation of a healthy population,” the doctors warn, urging policymakers to act decisively.

The joint statement comes amid growing concern within the medical community about the link between environmental degradation and public health crises. The IDE, along with its Nordic colleagues, are urging healthcare professionals worldwide to advocate for urgent climate action as a matter of public health policy.

Posting bowel cancer screening kits directly to people who are eligible for BowelScreen can boost participation rates, according to a new RCSI study.

The research, supported by the HSE National Screening Service’s BowelScreen, showed a 6 per cent increase in screening uptake among people who were sent a postal kit, a strong improvement given the simplicity of the intervention. 

The study, which was funded by the Irish Cancer Society, offers a strategy to enhance prevention and early detection efforts for one of Ireland’s most common cancers.

With Bowel Cancer Awareness Month starting today, the publication of this study is timely, highlighting the need to increase screening participation across the country. In Ireland, bowel cancer is the second and third most common cancer among men and women respectively, with around 2,500 new cases each year. Screening can help prevent bowel cancer and detect it before the cancer progresses to later stages when treatment is not as effective. Despite the proven benefits of screening, BowelScreen’s screening uptake is approximately 10 per cent below comparable bowel screening programmes in Europe.

The BowelScreen approach requires first-time invitees to request a home screening kit on receipt of their invitation to take part – an important step to confirm consent to participate in screening and personal details, and reduce potentially costly kit wastage, but a step that may deter participation.

The study, led by Dr Nicholas Clarke at RCSI’s School of Population Health, tested two interventions to encourage more people to take part. 

Rather than waiting for people to request a kit, the study sent kits automatically to those who had not responded to the initial invitation letter. This intervention alone resulted in a 6 per cent increase in participation rates.

Additionally, the study introduced a more personal reminder letter co-written by a patient and public involvement (PPI) panel. This revised version of the letter addressed common concerns about the screening process identified from previous research conducted by Dr Clarke and incorporated personal insights from the panel aiming to reduce hesitation and improve response rates.

Findings indicated that this intervention had the most impact on women from lower socio-economic areas when sent alongside the screening test kit. 

The study highlights the need to remove barriers to bowel cancer screening, particularly among men and those in socioeconomically disadvantaged areas, where participation remains lowest. Participation in screening can reduce the risk of a cancer diagnosis and even prevent it by detecting polyps that could progress into cancer if left unchecked. 

“This research highlights simple yet effective changes that can significantly increase participation in bowel cancer screening,” said Dr Clarke, Research Fellow and senior author on the paper. “By making the process easier and addressing concerns upfront, we can save more lives. However, based on 2020/21 data, which was the latest available when the research was carried out, overall screening uptake still remains lower than the EU’s recommended uptake levels of at least 65 per cent. Indeed, evidence has shown that few screening programmes in Europe have achieved uptake rates above 50 per cent. Continued implementation of screening and further refinements to understand what works best and for whom are essential to ensure more people benefit from cancer prevention and early detection.”

“The continued implementation of these small changes can increase bowel screening uptake and ultimately lead to better bowel cancer prognoses and mortality outcomes overall. It is hoped that further research will help improve understanding of the lack of participation among certain groups, so that all communities can access the lifesaving benefits of BowelScreen across Ireland.”

BowelScreen Programme Manager, Ms Hilary Coffey Farrell, said: “We are marking Bowel Cancer Awareness Month in April by encouraging all people aged 59 to 70 to reduce their risk of bowel cancer developing by choosing bowel screening. 

“Uptake rates in BowelScreen are a priority for us and we are focused on working to remove any possible barriers to bowel cancer screening, particularly among men, and those in socioeconomically disadvantaged areas, where participation remains lowest. 

“Our partnership work on this research project will add to the evidence that supports our decision-making around measures to increase equitable uptake, whilst continuing to ensure we meet our population health aims; balance the benefits and harms for our participants, be cost-effective, and enable more people to choose screening.”

The HSE’s BowelScreen programme offers screening every two years for people between the ages of 59 and 70. Visit hse.ie/bowelscreen to register for your screening today.

The research is supported by Irish Cancer Society and the National Screening Service through the Research Grant SCR20CLA and supported in part by grants from the Health Research Board and Research Ireland.

The College of Psychiatrists of Ireland has called for a major overhaul of the management and governance of HSE Child and Adolescent Mental Health Services (CAMHS) across the country.

CAMHS provide mental health treatment services for children and young adults with moderate to severe mental illness.  The service has been involved in significant controversy in recent years, including serious allegations of children being harmed in the care of certain CAMHS services and widespread concerns that lengthy waiting lists are leading to unacceptable delays in the provision of vital care for young patients.

In response, the College formed a special working group to study reforms in the services which has led to the publication of a comprehensive policy document today.

Dr Patricia Byrne, Chair, Faculty of Child and Adolescent Psychiatry, said that reform of CAMHS was now critically urgent.

“CAMHS in Ireland has been beset by chronic underfunding and under-resourcing.  There have been failures to provide fit-for-purpose governance systems to facilitate CAMHS development in line with the Government’s mental health policies (A Vision for Change and Sharing the Vision).”

“The Mental Health Commission reports identified national deficits in team staffing, lack of minimal required resources to facilitate service delivery, failure to implement national policy objectives for comprehensive CAMHS provision, and failures at a national HSE level to respond to risks escalated through the HSE systems,” she said. 

“This has led to variable and, at times, a suboptimal service for children and adolescents who suffer from severe mental illness.  Sadly, this has resulted in negative impacts in service experiences for young people and families who require our services, and for the frontline staff trying to deliver care. As such, a major reform of the service is of critical and unparalleled importance to the wellbeing of those patients and their loved ones.

 “As a developed nation with a healthy budget surplus, it is unconscionable in 2025 that Ireland cannot adequately treat our very vulnerable young people who need help so badly.  Mental health problems in childhood and adolescent are associated with detrimental impacts on developmental outcomes in young adulthood.  Patients, their families, and the doctors and other healthcare staff who work within CAMHS deserve so much better.”

 Key recommendations that the College is proposing include:

– Specialist (Consultant) child and adolescent psychiatrists must lead each CAMHS team.

– A new senior management role, the Clinical Service Manager (CSM), should be created at a team and regional level. The CSM would have a critical role in team co-ordination, service audit and performance review and in facilitating service development at a local and regional level.

– A nationwide network of CAMHS Clinical Directors is needed to fulfil clinical and managerial roles for teams, support regional development of services, and establish two-way links with national management teams.

– Both the Clinical Director and a Clinical Service Manager representative must have membership of the Regional Area Mental Health Management Team to represent CAMHS.

– All staff working in CAMHS should receive specialist CAMHS-specific training to ensure optimal standards of care.

– All members of the CAMHS multidisciplinary team must have clearly defined roles and be clinically accountable to the specialist consultant psychiatrist as the clinical lead.

 Dr Lorcan Martin, President of the College and Consultant in General Adult Psychiatry, said: “The recommendations proposed outline radical new governance and management structures, and they will lay solid foundations for the development of a world-class mental health service of which we can all be proud.”

The College called on the Government to act urgently to implement the recommendations contained in the proposal.

The paper is available here: https://mcusercontent.com/ea59553be3355b7972cbfa3a1/files/4fe3a851-21b3-1961-8ea311328ad7dd8a/CPsychI_A_model_of_CAMHS_Governance_amp_Mgt_Structures_final_.pdf

The publication of the EU Regulation on the European Health Data Space (EHDS) is an “important milestone” according to Minister for Health, Jennifer Carroll MacNeill.

The EHDS is set to provide individuals with better access to their personal electronic health data and enable health professionals to access relevant health data for healthcare delivery across the EU.

This will be achieved by providing a common governance framework and harmonised infrastructure for the safe and secure exchange of electronic health data across the EU.

“Publication of the EHDS Regulation is another important milestone in creating a fit for purpose national health information system that enhances patient care and treatment as well as supporting better planning and delivery of health services into the future,” said Minister MacNeill.

“In preparation for the EHDS Regulation, Ireland has been proactively working with our European counterparts to provide the foundations for this regulation.” 

Implementation of the EHDS Regulation will place obligations on member states beginning in 2027 and continuing through to 2031.

“While giving full effect to the EHDS Regulation will take a number of years and follow a phased implementation timeline, the first steps have already been taken through initiatives such as the recently launched HSE Health App and the procurement of a shared care record.”