The Department of Health today (19 th December 2011) published Health in Ireland: Key Trends 2011 . This is the fourth edition of this report which presents, in booklet format, a range of data on significant trends in health and health care over the past decade. The booklet is downloadable from the Department of Health website: http://www.dohc.ie/publications/key_trends_2011.html
Health in Ireland: Key Trends 2011 covers population and health status as well as trends in service provision. It is designed as an easy-to-use reference guide to significant trends in health and health care over the past decade. A number of new tables and graphs have been included on specific topics of importance and/or where new data has been made available. Each section of the booklet has a brief introduction summarising key statistics.
Continuing improvements in health status and life expectancy are evident in the tables and graphs of this booklet. Death rates from all major causes have declined significantly over the period, and life expectancy remains above the EU average. Increased and improved healthcare provision has contributed significantly to these gains. Recent data on expenditure and staffing reflect the effects of continuing economic constraints, and the clear challenge will be to continue to improve health outcomes through better models of care, higher levels of efficiency, and a focus on the patient. A good example of an improvement which can deliver both improved outcomes and higher efficiency can be seen in the acute hospital data where day cases now account for 60% of all hospital admissions having risen from 37% just ten years ago.
Examination of trends over a decade also helps to identify the challenges facing health and the health services in the coming years. Issues such as childhood obesity, smoking and alcohol consumption present serious problems and have the potential to undermine many of the gains achieved in recent years. The ageing of the population is already occurring and will increasingly impose additional demands on service capacity and the management of chronic conditions. Ensuring that health inequalities are reduced and that access to services is maintained and improved are major aims. In an economic climate where resources will be severely constrained, improved efficiency, effectiveness and equity at all levels of the health services will be essential in successfully managing these demands.
Key trends include:
· Total hospital discharges continue to rise but an increasing proportion (60% in 2010) of this activity is now carried out on a day case basis. There has been a 119% increase in the number of day cases seen in public acute hospitals since 2001. Improved and less invasive medical practice is largely responsible for the rapid growth in day patient activity. Average length of stay in hospital for inpatients has fallen to 5.9 days for the first time.
· Over the past decade, Ireland has achieved a rapid and unprecedented improvement in life expectancy. During a period when the average life expectancy in the EU has continued to rise, life expectancy in Ireland has increased from nearly 1 year below the EU average life expectancy, to just above it. Much of this increase is due to significant reductions in major causes of death such as circulatory system diseases.
· Ireland is now beginning to catch up with other European countries in terms of population ageing. The numbers of people over the age of 65 years is projected to more than double to over 1 million by 2040. The greatest proportional increase will be in the 85+ age group.
· Ireland continues to have the highest levels of self-perceived health of those countries in Europe participating in the EU Survey on Income and Living Conditions. 84% of men and 83% of women rate their health as being good or very good. This compares with 71% and 65% for males and females respectively across the EU. The survey also shows significant chronic health problems in the older age groups, with around half of those aged 65+ reporting a chronic illness or condition.
· The results of the Growing Up In Ireland Study indicate that 26% of nine year old children were found to have a body mass index (BMI) that was outside of the ‘healthy' range. Of these, 19% were defined as overweight and 7% obese.
· 36% of the population is covered by a medical card. Numbers covered have increased by almost 35% over the decade and by over 9% between 2009 and 2010.
· The number of prescription items dispensed under the General Medical Services has increased by over 5% between 2008 and 2009, while the average cost per item has also increased.
· Immunisation rates have been increasing since 2002 and are now approaching the 95% rate as envisaged by the ‘Immunisation Guidelines for Ireland', (2008).
· Total public health expenditure has risen from €8.4 billion in 2002 to €14.8 billion in 2010. Estimates for 2011 indicate a decline of 5% on the 2010 figure, down to €14.1 billion.
· Public capital expenditure on health was €366 million in 2010 representing an 18% decline on the previous year.
Dr. James Reilly, TD, Minister for Health said:
“I welcome this publication. It provides an overview of health status and the health services during the past ten years and shows real improvements. Mortality rates from circulatory system diseases, for example, have declined by 39% since 2001. Better health care continues to contribute significantly to better outcomes and gains in life expectancy.
In addition to measuring our progress, this report also helps to identify the considerable challenges we face in the coming years. The population continues to grow and to age. Each year an additional 20,000 people are added to the total of those aged over 65 years. To meet these demands in an environment of reduced resources, we must change the way we manage and deliver our services. The data on acute hospitals shows one of the ways in which we are achieving this. 60% of hospital admissions are now for day care treatment, compared with 37% in 2001. This is an example of care which provides both better and less invasive treatment while at the same time increasing volume and efficiency.
The report also serves to emphasise the importance of having good data as the basis on which to plan and deliver our services. Policy decisions must be based on evidence of need, effectiveness and best value.”
Notes for Editors
Further key trends, by section of the booklet, are presented below:
Section 1 – Population and Life Expectancy
· The 2011 Census preliminary results show that the population on census night, 10 th April, 2011 was 4,581,269 persons. This represents an 8.1% increase on the 2006 Census. (Table 1.1)
· The numbers of births in 2010 have shown almost a 1% decrease on the previous year, 73,724 being born in the year, but this still represents around 15,000 more births annually than a decade ago. (Table 1.3)
· The Total Fertility Rate has remained steady at 2.07. However, Ireland continues to have the highest rate of fertility amongst EU countries, the EU average being 1.57. (Figure 1.1)
· The numbers of people in older age groups is beginning to increase significantly. Numbers will more than double within the next 30 years to over 1 million people, with the largest proportional increase in the 85+ age category. (Table 1.4 and Figure 1.2)
· When life expectancy is expressed as years lived in good health (i.e. healthy life years), the difference between women and men is much less significant, indicating that women live longer but with more health problems. (Figure 1.5)
Chapter 2 – Health of the Population
· In 2009, 84% of males and 83% of females rated their health as being good or very good. This is the highest in the EU and compares with an average of 71% and 65% for males and females respectively across the EU. Self-perceived health is related to income levels with 20% more people in the highest income group rating their health good or very good compared with the lowest income group. (Table 2.1, Figures 2.1, 2.2)
· 29% of people who report having a disability stated they have felt worn out all or most of the time, compared with 11% of those without a disability. (Table 2.2)
· Almost 47% of males and 54% of females aged 65 and over reported suffering from a chronic illness or condition. In the 75+ age category, 44% and 59% of males and females respectively reported some limitation in activity due to health problems. (Tables 2.3, 2.4)
· 7% of adults reported having ever been diagnosed with asthma. (Table 2.5)
· Over the 10 year period 2001-2010, age-standardised death rates for all causes fell by 28%. Most recently, death rates declined by almost 9% between 2009 and 2010. (Table 2.6)
· Diseases of the circulatory system accounted for almost 34% of all deaths registered in 2010. A decline in the age-standardised death rate of over 39% occurred between 2001 and 2010. (Figures 2.3, 2.4)
· There has been a 15% decline in the age-standardised death rate for malignant neoplasms during the period 2001-2010. The female breast cancer death rate declined 24% during the same period. (Table 2.6)
· Death rates from suicide are down 19% since 2001, and have decreased 6% between 2009 and 2010. (Table 2.6)
· While Ireland's age-standardised death rate in 2009 was 1.5% below the EU average, the death rate from all cancers was 7.7% above the EU average. (Table 2.7)
· 5-year relative survival rates from selected cancers remain lower in Ireland than the average for OECD countries. However, the gap is significantly narrowing particularly for breast and cervical cancers. (Figure 2.6)
· Both alcohol and cigarette consumption have declined over the past decade. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the decline. However, alcohol consumption has risen between 2009 and 2010. (Figure 2.7)
· Mothers in professional, skilled and management occupations have higher breastfeeding rates. (Figure 2.8)
Chapter 3 – Hospital Care
· Inpatient discharges from publicly funded acute hospitals have increased by almost 10% since 2001, but have remained static between 2009 and 2010. Day cases have increased by 119% since 2001 and have also increased by 4.7% between 2009 and 2010. (Table 3.1)
· Since 2008, the number of day cases (excluding dialysis) treated in publicly funded acute hospitals has been higher than the number of inpatients. This gap has increased ever year since 2008. (Figure 3.1)
· Emergency Department attendances have decreased by nearly 2% between 2009 and 2010. Over the same period, outpatient attendances have increased by 5%. (Table 3.1)
· In 2010, per 1,000 population, older age-groups accounted for a higher number of bed-days used than younger age groups. (Figure 3.2)
· The percentage of adults using the health services increased with age for all services except Emergency Department services, where a higher percentage of younger age groups used this service. (Figure 3.3)
· Ireland continues to have slightly higher Caesarean Section rates than the EU average. (Figure 3.4)
· The number of admissions to psychiatric hospitals and units has continued to decline with a decrease of 3% between 2009 and 2010. There are now almost 20% fewer admissions than in 2001. (Table 3.2, Figure 3.5)
Chapter 4 – Primary Care and Community Services
· Levels of unmet need for a medical examination at just under 3% are low by EU standards where the average is almost 7%. (Figure 4.1)
· In 2010, 86% of those with a medical card reported visiting a GP at least once in the previous 12 months, compared with 73% for those with private health insurance and 57% for those with neither. The average number of GP consultations was also higher among medical card holders in all age groups. (Table 4.1, Figure 4.2)
· Between 2009 and 2010 there was a 9% increase in medical cards to over 1.6 million representing 36% of the population. Numbers of GP Visit cards increased by 19% to nearly 118,000. (Table 4.2)
· The number of prescription items dispensed under the General Medical Services has increased by over 5% between 2008 and 2009, while the average cost per item has also increased. (Fig 4.3)
· The number of children in care increased by 28% between 2000 and 2009. The percentage of these children in foster care also increased over the same period by 16%. Nearly 90% of children in care are now being fostered. (Table 4.3)
· The proportion of those aged 85 and over in long stay care as a % of all those in long stay care has increased by 21% during the period 2001 to 2010. All other age groups over 65 have shown declines over the same period. (Table 4.4, Figure 4.4)
· The immunisation uptake rates of children aged 24 months in 2010 was 94% for most immunisations, with the exception of the MMR, Meningococcal and Pnemococcal Conjugate. Hepatitis B and Pnemococcal Conjugate vaccines were introduced in 2008 and show immunisation rates of 94% and 88% respectively. (Table 4.5)
· The number of people registered with the National Physical and Sensory Disability Database was 25,190 in 2010. Over 57% of these had a physical disability only. (Table 4.6)
· The number of persons with intellectual disability availing of day services has increased by 15% for day attendees and decreased almost 2% for full-time residents over the period 2001-2010. (Table 4.7)
· The percentage of establishments inspected for food safety where infringements were found has declined steadily over the period 2001-2010. In 2010, 20% of establishments inspected were found to have infringements compared with 55% in 2001. (Table 4.8)
Chapter 5 – Health Service Employment
· Since 2007, total numbers employed in the public health services have shown a gradual decline. Between 2010 and 2011, the largest fall in numbers has been in the Management/administration category. It should be noted that figures for 2011 refer to September, and do not therefore represent the end of year position. (Table 5.1, Figure 5.1)
· Nurses make up the largest grade category in the public health service, with 35% of total staff employed. Medical and Dental were the only grade category to show an increase between December 2010 and September 2011. (Table 5.1, Figure 5.2)
· The number of consultants employed by the public health service increased by almost 45% in the period 2002-2011. They also increased by almost 3% between December 2010 and September 2011. (Table 5.2, Figure 5.4)
· The number of non-consultant hospital doctors increased by almost 16% in the period 2002-2011. They also increased slightly between December 2010 and September 2011. (Table 5.2, Figure 5.4)
· The number of agreements between the HSE and GPs for the provision of services under the Primary Care Reimbursement Service has increased by 48% in the period 2000-2009. The number of agreements also increased by 2.5% between 2008 and 2009. (Table 5.3)
Chapter 6 – Health Service Expenditure
· Total public non-capital expenditure on health has increased by 72.7% since 2002, however it has decreased by 5.2% between 2010 and 2011. (Table 6.1)
· In 2010, public capital expenditure on health decreased to 2001 levels. It has also decreased by 18% between 2009 and 2010. (Table 6.3)
· In 2009, Ireland's total health expenditure on health was 9.5% of GDP and 11.4% of GNI. This compares with the OECD averages of 9.6% and 10.2% respectively. (Table 6.4, Figure 6.4)
· Ireland's per capita total health expenditure has increased steadily in real terms between 2001 and 2008, and has decreased between 2008 and 2009. (Figure 6.3)