• IMO’s pre-Budget submission launched today (Wednesday)
   
• Urgent action needed on funding, capacity and workforce planning
   
• Public health campaigns required on dangers of social media and vaccine hesitancy

 

Wednesday September 4, 2024. The Irish Medical Organisation (IMO) has warned that a consistent failure to properly fund and resource the health system has left it at a “critical juncture” and facing a number of persistent and worsening crises in medical staffing, bed capacity and infrastructure.

The IMO launched its pre-Budget submission today (Wednesday) in Dublin (see editors’ note below for summary of recommendations).

The IMO acknowledges that funding for the health system has never been greater; however, this funding is merely allowing the health system to just stand still.

It has not been sufficient to adequately address the bed capacity and staffing levels needed to effectively meet the demands of a growing and ageing population with ever more complex needs and to build a resilient health system for the future.

Selected key statistics:

• In the last decade our population has grown by 14.4% to 5.3 million in 2023, with 15.3% of the population now aged 65 or over
• There has been little or no increase in in-patient beds in the last 20 years
• Hospital waiting lists have almost tripled to over 896,000 in the decade between 2013 and 2023
• 20% of consultant posts are either unfilled or filled on a temporary/locum basis
• 83% of NCHDs routinely work more than 48 hours a week, leading to unsustainable levels of burnout and creating an unsafe working environment for doctors and patients
• Despite the major population increase, over the past decade there has been a net increase of just 136 GPs with GMS/DVC contracts.

Speaking today, Dr Denis McCauley, President of the IMO, said: “Decades of insufficient planning and investment in our health system have left us at a critical juncture. In our hospitals, the system’s capacity has not kept pace with demand, resulting in overcrowding, patients on trollies, and prolonged waiting times in emergency departments.

“General Practice requires targeted measures to help doctors set up and grow practices while a comprehensive plan is needed to increase the number of consultants and non-consultant hospital doctor (NCHD) training posts in line with workforce requirements to ease the burden on overworked and burnt-out doctors who are doing their best in extremely difficult conditions.”

He added that a number of public health campaigns were needed as urgent priorities, including a well-funded public health strategy modelled on successful “tobacco free” policies to combat the harms related to social media; and a coordinated public health campaign to tackle vaccine hesitancy.

 

 

Summary of recommendations

Health service funding

• Health service funding, both capital and operational, must be based on a comprehensive assessment of current and future population needs ensuring timely and equitable access to care.
• Funding to address existing deficits in services must be provided.
• Income from private care in public hospitals must be replaced with exchequer funding.

Health service capacity

Acute bed capacity

• Increase the number of new inpatient beds from 3,438 to 5,000 under the Acute Hospital Bed Capacity Expansion Plan to meet the needs of our growing and ageing population.
• Provide sufficient capital funding and planning to support the expansion of acute inpatient beds in full and on time.
• Develop and implement an adjacent plan to increase psychiatric inpatient beds to meet population needs.
• Healthcare planning must include a detailed assessment of diagnostics, radiology and laboratory service requirements across acute and community care to meet current and future demands.

• Increase the number of rehabilitative care beds, long-term nursing home beds and the financing of home care packages.

Support the independent GP contractor model

• Targeted measures are required to enable GPs to establish and sustain GP practices through an independent GP contractor model including:
  • Additional targeted supports and grants are required that aid newly qualified GPs in establishing themselves as GP partners/principals.
  • the current cohort of GPs should be supported with options to take on young GPs with a view to partnership.
  • Provide tax incentives to GPs in to develop their practices in line with the recommendations of the Indecon Report 2015.

Investment in electronic health records and IT infrastructure

• Provide a full economic impact assessment of the Health Information Bill.
• Publish and resource an investment plan to fully digitalise the health service over the next five years.

Medical workforce planning

 

• Update the current and future medical workforce requirements taking into account:

• predicted geographical and demographic changes in population
• new clinical programmes and models of care
• strategic requirements such as laid out in Sláintecare
• demand should be based on Whole Time Equivalents (to take into account part-time working) and predictable attrition rates.

 

• Develop and fund a comprehensive medical workforce plan with actions laid out to: increase the number of consultants and training posts in line workforce requirements. (The NCHD Taskforce recommended a target ratio of 110 consultants per 100,000 of the population and an increase the number of NCHD postgraduate training posts to a minimum of 5,800-6,000) 

• Address ongoing challenges in recruitment and retention Urgently address issues of on-going chronic staff shortages and workload pressures that impact on safety and well-being of patients and doctors
• Ensure all additional supports are in place to so that consultants can deliver safe, quality and timely care.
• Deliver on the recommendations contained in the Report of the National Taskforce on the Non-Consultant Hospital Doctor Workforce.
• Increase the number of training posts to ensure access to training programmed for our International doctors.
• Raise the Standard Fund Threshold (SFT) to encourage doctors who are nearing retirement age to remain in the medical workforce. 

 

• Transfer of tasks from doctors to other healthcare professionals, including pharmacists and physician assistants should only take place where there is evidence of improvement to quality of care and never a substitute for the employment and training of highly trained medical specialists.

 

Improve and Enhance Services in General Practice and the Community

• Expand the Chronic Disease Management Programmes on a universal basis to all patients with specified chronic conditions over 18 years old. 

• Invest in a comprehensive women’s health programme in General Practice to include:

• Advice on Contraception to all women in their reproductive years, 
• Advice on sexually transmitted infection (STI), screening and testing for STIs
• Advice on fertility and pre-conception
• Advice on menopause

• Undertake an urgent review of the current model and governance of community-based mental health services to:
  • ascertain its impact on staffing levels and patient care; and
  • facilitate better integration of specialist mental health services within the larger health system.
• Reverse FEMPI cuts to the Community Ophthalmic Medical Treatment Scheme (COSMTS) and increase the fee in line with inflation in the intervening period to 2024.

 

Public health campaigns

• Urgently develop a well-funded public health strategy modelled on successful “tobacco free” policies to combat the harms related to social media.
• Develop and fund a coordinated public health campaign to tackle vaccine hesitancy.
• Ring-fenced funding must be provided to ensure that effective sustainability and adaptation actions laid out in the HSE Climate Health Strategy are implemented in full.

Medical negligence and tort reform

• While legal provisions have been made to support reforms regarding pre action protocols, case management rules, and greater use of periodic payment orders, on-going barriers preventing the acceleration of these key reforms must be identified and addressed.
• Efforts must continue to promote resolution of disputes through mediation and other alternative mechanisms. Recourse to the courts should be a last resort.
• Detailed assessment of No-Fault Claims Systems and their implementation in different jurisdictions could address concerns and ensure the development of a no-faults claim system that is fit for purpose.
• People with disabilities should have automatic entitlement to health care and social supports including access to community therapy services so that patients and their carers are not required to take legal action to secure appropriate long-term care and support.