Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Ageing population a time bomb for surgical services

07 September 2018

Ireland’s health system is facing a demographic time bomb which will have serious consequences for the delivery surgical services if not addressed now, according to RCSI President Mr Kenneth Mealy who will deliver the State of the Art lecture at the Freyer Meeting which takes place tomorrow in Galway.

Speaking ahead of the Freyer Meeting, Mr Mealy said that “the numbers suggest a very clear trajectory that we simply cannot afford to ignore. 3,000 beds per day are currently occupied by surgical patients. By 2046, if the system remains as it is and with Ireland’s projected population and age profile, 5,500* beds a day will be required".

“Greater efficiencies are necessary because of the absolute imperative presented by our aging population. We have a choice to make. We can either start building more hospitals or we can make more efficient use of the bed days we currently have. We can see what’s coming down the line here and we can plan for it,” said Mr Mealy.

Mr Mealy welcomed the publication of the Sláintecare plan saying that the system has suffered because of a lack of long term planning and Sláintecare offers a positive step forward in providing a more strategic approach to healthcare delivery in Ireland. He said, however, that it is surprising that there is little in the plan about the huge variance in surgical services across the country.

“When we see that one hospital can deal with gall bladder surgery as a day case whereas other hospitals admit patients overnight, we have to ask why,” said Mr Mealy. “We need to look at the funding model and make sure that it’s dis-incentivising inefficient practices. The rollout of an activity based pricing model over the next number of years would go a long way to incentivise hospitals to manage their beds efficiently.”

Addressing the plan in Sláintecare to build elective only hospitals, Mr Mealy said: “There is an inescapable logic to the separation of acute and elective care. Putting the patient exclusively at the centre of our planning means there is no other outcome that makes sense. Patients with life threatening conditions must be treated by the right team with access to the appropriate equipment and diagnostics.”

Mr Mealy said that: “Clearly there are considerable challenges facing the Irish health service. Notwithstanding these, Ireland ranked 11th out of 195 countries in the 2016 Healthcare Access and Quality in the Global Burden of Disease Study (Lancet May 23rd 2018). As healthcare professionals, we strive every day to put our patients are the centre of our work and to provide the highest standard of care. We also have a duty to make the most efficient use of the finite resources in the system so that it has the capacity to provide sustainable high quality surgical care into the future."

RCSI is ranked among the top 250 (top 2%) of universities worldwide, and the top 1% for clinical, preclinical and health in the Times Higher Education World University Rankings (2018). Its research is ranked first in Ireland for citations. It is an international not-for-profit health sciences institution, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide. RCSI is a signatory of the Athena SWAN Charter.

*Based on CSO population projection by set and age combined with Hospital Inpatient Enquiry (HIPE) actuals for 2016.