PLANNING FOR HEALTH TRENDS AND PRIORITIES TO INFORM HEALTH SERVICE PLANNING 2017 FOREWORD FOREWORD I am pleased to welcome the publication of Planning for Health: Trends and Priorities to Inform Health Service Planning 2017. This is the second publication designed to support service planning in the Health Service. It was our intention in this report to build upon and augment the data and analyses in the 2016 report setting out current and future healthcare demands and needs. The objective of this report is to build, over time, a robust evidence base that will support a more evidence informed approach to estimates and resource assessment linked to service planning and resource allocation decisions. As with last year’s report, it provides a detailed population focused analysis of current and future needs and demands in terms of demographic pressures for 2017 and also provides a five year forecast to 2022. The Health Service in Ireland will see a rise in demand of between 20% and 30% over the next 10 years. Ireland continues on a trajectory of significant demographic change, with people living longer than ever before. Our population aged 65 years and over is growing by approximately 20,000 each year and is projected to increase by over 110,000 in the next five years. Life expectancy is now greater than the EU average. These very positive developments also present the health service with significant challenges that need to be addressed, in part through better planning and evidence-based resource allocation models. This report marks a further step to utilising current demographic projections, disease prevalence, and service utilisation data and knowledge to support decision-making and inform service design so that we can improve health outcomes in the longer term. An over-arching element of this year’s paper is the population age-specific cohort approach to analysis across all service lines in all the HSE divisions profiled. This year’s paper includes an analysis of Health Inequalities specific to service areas. The report also contains a chapter on Pre-Hospital Care (National Ambulance Service). There is additional data within service chapters, facilitating stronger analysis and forecasting, for example, the Primary Care chapter has a more comprehensive analysis of age-specific utilisation of Primary Care Therapy and Nursing Services and waiting lists (unmet need). I would like to thank Dr. Breda Smyth and the Planning for Health Team for all their work in producing this paper and to acknowledge the contributions of the many staff across service divisions who participated in consultation sessions, provided data, expert advice and suggested content. I am also very grateful to the Information Unit in the Department of Health, the Central Statistics Office and the Health Research Board for their continued collaboration and support. Knowledge and intelligence gained from analysis of robust health information is the cornerstone of evidence-led Health Service planning and this paper, building on its predecessors, provides further progress in this regard. I very much look forward to working with colleagues and continuing to build capacity for this important work within the health service. Dr. Stephanie O’Keeffe National Director Health and Wellbeing PLANNING FOR HEALTH 2017 1 INTRODUCTION Translation of health data, evidence and intelligence into a utility of knowledge is essential to enrich the planning process and ensure the direction of travel at this time of reform in our health system is population focused. The aim of this paper is to set out a clear and comprehensive overview of the imminent demographic pressures which our Health Service will encounter in 2017 and continue to do so over the next five years to 2022. In addition we have examined areas of service that are growing and highlighted elements of unmet demand and need where appropriate and possible. All current and relevant population and Health Service datasets are examined, interrogated and translated. This is achieved by applying a standardised approach using consistent methodologies and population projections across all areas of service at a national level. This is essential for equity based Health Service planning. We have developed this paper in partnership with our colleagues across HSE Divisions and I would like to thank them for their valuable input into this process. This year we are presenting this information in two separate formats. The comprehensive document which includes all chapters and appendices is available online at the following link (www.hse.ie/eng/services/publications/planningforhealth.pdf) Our print version incorporates the key messages only from each of the chapters. It is important when reading ‘Key Messages’ to be cognisant of the assumptions and contextual basis of these analyses. I would like to take this opportunity to thank the Planning for Health co-authors for their engaging and informative discussions, and tireless work in bringing this document to completion. These include: Mr. Paul Marsden Dr. Fionnuala Donohue Dr. Paul Kavanagh Dr. Aileen Kitching Dr. Emer Feely Ms. Lorna Collins Ms. Louise Cullen Ms. Aishling Sheridan Dr. David Evans Dr. Peter Wright Dr. Sarah O’Brien Dr. Chantal Migone Dr. Breda Smyth MD. MPH. FPHMI. Consultant in Public Health Medicine Lead Author and Editor To be cited as: Smyth B., Marsden P., Donohue F., Kavanagh P., Kitching A., Feely E., Collins L., Cullen L., Sheridan A., Evans D., Wright P., O'Brien S., Migone C. (2017) Planning for Health: Trends and Priorities to Inform Health Service Planning 2017. Report from the Health Service Executive. ISBN 978-1-78602-037-6 2 PLANNING FOR HEALTH 2017 CONTENTS 1. Key Messages ............................................................................................5 2. Overview .................................................................................................18 3. Demography, Health Status and Lifestyle ........................................ 26 4. Acute Hospitals .....................................................................................42 5. Primary Care ..........................................................................................72 6. Social Care .............................................................................................112 7. Mental Health ..................................................................................... 134 8. National Ambulance Service ............................................................. 146 Acknowledgements ................................................................................... 160 Appendix A: Consultation Process ...........................................................162 Appendix B: Demography .........................................................................164 Appendix C: Primary Care ........................................................................168 Appendix D: Social Care ............................................................................170 Appendix E: Mental Health ....................................................................... 172 Appendix F: National Ambulance Service ...............................................174 References .................................................................................................. 180 PLANNING FOR HEALTH 2017 3 01 KEY MESSAGES 1: KEY MESSAGES ASSUMPTIONS • The aim of this paper is to project the impact of demographic change on the short term (2017) and medium term (2022) demand for health services funded by the HSE. • No new service improvement initiatives are included in projections of activity or costs. Projections only reflect the effect of demographic pressure on current service provision. • Population projections are based on the CSO M2F2 scenario. • Acute hospital in-patient and day case utilisation rates are based on Hospital In-patient Enquiry (HIPE) activity for 2015, the HIPE dataset used at the time of analysis was approximately 98% complete and figures may be subject to slight change. The HIPE file used for all analyses was “HIPE_2015_AsOf_0216_V15”. • In producing estimates of activity and associated costs, it is assumed that hospital discharge rates, unit costs and the ratios between in-patients and day cases will remain stable between 2016 and 2017. • Projections do not take into account changes in activity due to models of care, disease patterns, medical inflation, changes in policy on eligibility, the health of the population, the expectations of the public or the state of the national economy. • Population projections by Community Healthcare Organisation (CHO) are based on CSO regional population projections and use the ‘recent’ internal migration scenario. • Analysis by CHO Area involving rates are crude - per 1,000 or 100,000 where applicable - and are not standardised to a national population. Standardisation requires further analysis. • Future demand for community services was derived from key performance indicator data collated by the Business Intelligence Unit. Various indictors of utilisation were provided and “referrals accepted” was chosen as the basis for projection since it best reflects overall service capacity and was common across these service lines. • Data on claims made under the various Primary Care Reimbursement Schemes was obtained from PCRS via The Department of Health and analysed using PHIS; it has been cross validated with PCRS. Monthly trends were analysed to determine the basis for projections. Note that, in keeping with