1. Health Challenges for Irish Society Dr Eibhlín Connolly Deputy Chief Medical Officer Department of Health and Children IPHA Conference 12-11-09

2. Role of DoHC and CMO Office DoHC – Policy framework, Legislative Framework, Health system accountability CMO Office – Executive responsibility for public health and quality and safety Structured enagagement with the organised medical profession Communication with the public

3. Challenges Economic Demographic Epidemiologic and Lifestyle trends Quality and Safety Considerations New technologies Global trends –Environmental –Communicable Diseases

4. TOTAL PUBLIC HEALTH EXPENDITURE, 1999 TO 2008 Sources: "Estimated Non-Capital Expenditure 1999-2004" www.dohc.ie. From 2005, Revised Estimates for Public Services and HSE Reports on Capital Programme

5. NUMBER OF PRESCRIPTION ITEMS DISPENSED UNDER PRIMARY CARE REIMBURSEMENT SERVICE, 1998 TO 2007 Source: General Medical Services (Payments) Board/ National Shared Services Primary Care Reimbursement Service

6. CONSULTANT AND NON-CONSULTANT HOSPITAL DOCTORS EMPLOYED WITHIN THE PUBLIC HEALTH SERVICES, 2000 TO 2009 Source: Personnel Census, Department of Health and Children

7. The economic context 22 Billion euro deficit Deficit 12.5% of GDP National Debt has doubled to 76 billion euro Hospitals 49 Million overspent in August PR Health budget savings of 800 million euro

8. McCarthy report Proposes €1.23 bn savings 6168 staff reductions – 30% DoHC reduction in 3 years Drug co-payments Hospital charges Mandatory generic prescribing

9. Demographic Projections Total population increase with changing age structure By 2021 there will be an additional 300,000 people in Ireland over the age of 65

10. LIFE EXPECTANCY AT BIRTH FOR IRELAND AND EU, 1980 TO 2006 Expectancy in Years at Birth for Ireland and EU, 1980 to 2006 Source: European Health For All database, WHO Regional Office for Europe, Copenhagen, Denmark.

11. AGE-STANDARDISED DEATH RATES FOR SELECTED CAUSES, 1970 TO 2008 Source: Central Statistics Office and European Health For All database, WHO Regional Office for Europe, Copenhagen, Denmark.

12. IHD and stroke projections

13. Chronic disease trends Approximately 60% of the disease burden in Europe is accounted for by 7 preventable risk factors including high blood pressure, tobacco, alcohol, high cholesterol, overweight and obesity, poor diet and physical inactivity Diabetes prevalence projected to increase from 4.7% to 5.7-7.9% in 2025 (dep on BMI and pop changes) Cancer will increase by 14% F and 8.5% M 2020

14. Lifestyle Trends Smoking Alcohol Overweight and Obesity Illicit Drug Use Needs multisectoral response

15. ALCOHOL AND CIGARETTE CONSUMPTION PER ANNUM, PER CAPITA OVER 15 YEARS OLD, 1986-2006 Source: Revenue Commissioners Statistical Report 2007, CSO (population data) Note: (i) Alcohol is measured in terms of pure alcohol consumed, based on sales of beer, cider, wine and spirits. (ii) Smoking ban in workplaces was introduced in March 2004

17. Projected BMI distributions in 2010 and 2015, by gender 200520102015 Males Obese (BMI 30+)23.10%28.80%33.30% Overweight (BMI 25-29) 43.40%44.20%43.10% Normal (BMI <25)33.50%27.00%23.60% Females Obese (BMI 30+)24.80%28.50%31.90% Overweight (BMI 25-29) 32.90%34.50%34.60% Normal (BMI <25)42.40%37.00%33.50%

18. Health Service Implications PA Consulting: over 19000 extra beds required by 2020 under current model of care Potential to significantly reduce this through shift to primary care provision Implications for primary, community and long-stay services Manpower planning and skillmix

20. Quality and Patient Safety 4-16% of hospital inpatients suffer adverse events, of which half are preventable Estimated costs $17-29bn per annum in the US Causes –Medication safetyHCAIs –Surgical complicationsFalls

21. Irish Context The Lourdes Inquiry Cancer diagnosis delays and errors Health care associated infections Establishment of the Commission for Patient Safety and Quality Assurance

22. Quality and patient Safety Commission report being implemented Focus on licensing, governance, standards, audit, adverse events, education, information and credentialling Implementation involves patient and professional representatives, Colleges, HSE, HIQA, MHC, professional regulatory bodies

23. Commission implementation Well underway HSE Directorate of Clinical Care and Quality HIQA work on standards and licensing commenced CMO lead on patient safety Information bill protection for audit and event reporting Medication Safety Forum working Service user involvement being implemented

24. New technologies Pharmaceuticals, vaccines, genetics, miniaturisation, new imaging and process technologies, ICT and telehealth, tissue engineering all offer major opportunities in prevention, therapeutics and diagnosis New technology a key driver of health expenditure growth

25. Technology challenges Societal and ethical challenges Horizon scanning Assessment costs and benefits Adoption and diffusion of cost-effective technologies Health Technology Assessment

27. Global Trends Environmental diseases – impact of climate change, food and water borne diseases Communicable Diseases – MDR and emergence of new threats: HIV, SARS, VHF, bioterrorism, pandemic influenza

28. Future challenges Budgetary pressures Sustain population health improvement Demographic and risk factor trends driving up demand by 60% in 2020 Respond to challenges of new technologies and global trends in environment and Comm disease Reorientation of health services and manpower ICT and information deficiencies

29. Conclusions More for less Evidence-based planning Better performance measurement and management Improved value for money Clear identification of priorities