Staffing and resources of health service vary widely across regions, according to report

Infrastructure capacity and staffing in the health service vary widely across different regions, according to new reports from the Department of Health.

Patient access to critical care beds, day procedures and X-rays can often depend on where they live, and trolley numbers are lowest in one area, covering north Dublin and the northeast, the reports show.

Massive increases in the number of nurses trained in Ireland, and in the number of hospital beds and GPs in some parts of the country, are also highlighted in the reports.

The biggest variation is in access to day procedures, with the reports describing the number of patients on waiting lists per ambulatory beds as “highly skewed”.

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The reports were published by Minister for Health Stephen Donnelly and Minister for Public Expenditure and Reform Michael McGrath as part of the spending review process, with a view to improving the evidence base for policy decision-making.

Local needs

Six regional health areas are being set up next year, replacing the current structure of hospital groups, and funding will have to be adjusted according to local needs.

The regional health area covering Donegal, Sligo, Leitrim, Roscommon, Mayo, and Galway has 36 patients waiting per ambulatory bed, compared to just 12 patients in the Limerick/Tipperary/Clare region, one of the reports found.

North Dublin, Meath, Louth, Cavan, Monaghan, Longford, Westmeath, Offaly, Laois, Kildare, parts of Dublin and Wicklow, Limerick, Tipperary and Clare have “significantly more” critical care beds relative to population than the rest of the State.

Galway and northwestern counties have access to 8.4 X-rays per 100,000 population, compared to 5.5 in the mid-west.

The reports note that 47 per cent of X-ray machines are more than 10 years old, “implying the need for investment and replacement strategy for these assets”.

One in three hospitals is operating at 100 per cent capacity, the reports say, with Galway and Sligo hospitals recording 110 per cent capacity earlier this year.

Another 550 hospital beds are required to reduce occupancy levels to a safer 85 per cent, but most of these are needed in the midlands, west and northwest.

Meanwhile, 832 GPs are needed to even up coverage across the country, but about 650 of these are needed in the midlands, north Dublin and northeast alone.

The findings will serve as an important input for further investment considerations, according to the Ministers, though more analysis will be required to determine the appropriate level of healthcare infrastructure by regional health area.

The papers also analyse the physical infrastructure of HSE facilities.

The age of both community and acute (hospital) facilities varies significantly, with a large proportion of both being more than 40 years old. “This likely has negative associated impacts on maintenance costs, patient safety and efficiency in healthcare service delivery.”

While the overall quality of community care buildings was found to be good, the state of hospitals was “much more varied”.

Only 28 per cent of the top 120 energy users among HSE buildings exceeded a B3 energy certificate rating. The reports say it is likely significant investment will be required to achieve Government carbon abatement targets.

The next 20 years

A further report highlights the need for a big increase in the student nurse intake in Irish colleges. Based on current trends, it notes, the proportion of domestically educated nurses will fall from 54 per cent to 38 per cent over the next 20 years.

Gradually increasing the production of graduates by 87 per cent over a 14-year period to the level of The Netherlands would mean the proportion of home nurses climb to 50 per cent.

A sharper increase, aimed at matching Australia’s record, would increase numbers by 250 per cent, thereby increasing the share of home nurses to 70 per cent.

Mr Donnelly said the papers present a detailed understanding of healthcare infrastructure and capacity across the country for the first time.

“We have a planned investment portfolio of €5.7 billion under the National Development Plan to 2025. Capital investment is a key enabler of reform, ensuring the right care is delivered in the right place at the right time. I am committed to achieving the maximum benefit to the health system from this expenditure while also delivering on our commitments under the Climate Action Plan and the National Planning Framework.”