As the political focus moves beyond the election campaign and into government formation and negotiation of a programme for that government, the focus in the healthcare system turns towards winter pressures.
During the election, much of the healthcare debate focused on current challenges, including emergency department overcrowding, waiting lists and capacity issues. However, with one of the fastest growing and fastest ageing populations in Europe, we must start to think much longer-term.
The scale of the challenge is enormous. In the two decades leading up to the Covid‑19 pandemic, spending on health across the OECD increased steadily from around 7 per cent of GDP in 2000 to almost 9 per cent by 2019; without a big policy shift, this is expected to reach 11.2 per cent in 2040. In Ireland, funding for the health service has increased by 70 per cent since 2019; health spending is expected to account for 24 per cent of government revenues in 2040.
Despite increased spending, health systems globally are struggling to keep pace with demand. In England, a recent analysis noted that the NHS is in critical condition, with public satisfaction at a historic low. In the United States, the demand for healthcare workers is outpacing supply, with a projected deficit of 1.2 million nurses and 120,000 doctors by 2030. In Canada, today, more than 6 million people are without access to a GP.
Put simply, the track that many health systems globally are on – including here in Ireland – is unsustainable. Solving this problem is highly complex, but at least part of the answer to this challenge must lie in reframing population health as a key driver for sustainable economic growth and prosperity. This means moving from a view of health as “a cost to be managed” to instead understanding it as “an investment to be made”.
The economic case for investing in health – and prevention of ill health in particular – is compelling. The adoption of digital solutions in healthcare can equip care providers to increase efficiency, deliver improved patient care and drive better value from existing resources.
In the first instance, investing in the prevention of ill-health can help protect the health system itself. Chronic diseases now account for a substantial proportion of healthcare expenditure in Ireland, yet many of these are preventable or can be significantly delayed and mitigated by investing in vaccination and screening, and prioritising primary care and early intervention.
Second, investment in a healthy population can foster innovation and drive a more dynamic and resilient economy. In the UK the impact of ill-health on the workforce is now at crisis levels, with an estimated 2.8 million people deemed “economically inactive” – not in a job or looking for one – because of long-term sickness. In Ireland, the cost of mental ill-health alone has been estimated at more than €11 billion annually.
Third, addressing the drivers of health inequalities – income, education, housing, gender, age, ethnicity, disability and social inclusion – will improve societal cohesion. There is a difference in life expectancy of five years for men from the most deprived versus the least deprived areas of Ireland.
Tackling these issues cannot be the sole preserve of the Department of Health, HSE and other health agencies. Instead, if the next government is serious about building a healthier nation, then collective action across government will be required. For example, Wales enacted a Wellbeing of Future Generations Act in 2016 that forced public bodies to assess the long-term impact of their decisions.
Of course, the health system itself has a role to play in increasing access to care and improving efficiency, but that challenge is shaped by the environment in which care is delivered.
We saw during the pandemic that our health capital infrastructure is no longer fit for purpose. The last public hospital completed in Ireland was Tallaght in the late 1990s, and 30 per cent of the square footage of our health system is more than 100 years old.
While the development of several new elective hospitals and six new surgical hubs is a welcome first step, an enormous programme of deep retrofit and renewal will be needed to protect, optimise and improve the almost 2,500 health facilities in which services are currently provided.
Even then, we cannot hope to build our way out of the capacity issues we face. For Ireland to achieve EU27 average bed occupancy of 4.7 beds per 1,000 population, we would need to increase our stock to more than 24,000 beds from the 15,000 we have today.
[ HSE uses AI in trial to reduce winter admissions, says tech headOpens in new window ]
Fortunately, we are at a unique juncture in the history of medicine, with digital technologies and artificial intelligence set to reshape every part of healthcare, offering an opportunity to completely redefine care delivery. The outgoing Government recognised this opportunity and the recent publication of its digital health strategy Digital for Care, together with the HSE’s digital implementation roadmap, suggests an integrated and joined up approach to transforming care delivery in Ireland over the next decade.
The prudence of this approach has recently been affirmed in a World Health Organisation analysis which estimates every $1 invested in digital health provides a return on investment of up to $24. This must be a central plank of any programme for government.
As the programme for the next five years of government is being debated over the coming weeks, it is essential the focus in healthcare extends beyond the many immediate challenges and looks to the longer term. We need to anticipate and get ahead of the socio-demographic pressures impacting our health system. This requires a strategic 2040 vision for our health system that sees investment in health and wellbeing not just as a necessary expenditure but as a pivotal driver of long-term economic prosperity.
Dr Ronan Glynn is Health Sector Lead at EY Ireland and was formerly deputy chief medical officer of Ireland
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