Dr Samantha Smith delivered this presentation at an ESRI conference tilted ‘Health and social care supply and resource allocation planning in Ireland' on 24 September 2019.
There were two reports launched at the event. They can be read here:
‘An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital’
https://www.esri.ie/publications/an-analysis-of-the-effects-on-irish-hospital-care-of-the-supply-of-care-inside-and
‘Geographic profile of healthcare needs and non-acute healthcare supply in Ireland’
https://www.esri.ie/publications/geographic-profile-of-healthcare-needs-and-non-acute-healthcare-supply-in-ireland
Photos from the conference are available to view on the ESRI website here: https://www.esri.ie/events/health-and-social-care-supply-and-resource-allocation-planning-in-ireland
2. Introduction
“An inter-sectoral analysis by geographic area of the
need for, and the supply and utilisation of, health
services in Ireland” - HRB Project 2015-2019
• Project team
• Samantha Smith, Brendan Walsh, Maev-Ann Wren, Seán Lyons,
James Eighan, Steve Barron, Edgar Morgenroth
• Steering Group
• Michael Fitzgerald (Social Care Division HSE), Julien Forder (LSE
& University of Kent), Anne Nolan (TCD/ESRI), Richard Layte
(TCD), Charles Normand (TCD), Sean Murphy (Mater Hospital),
Davida De La Harpe (former HSE)
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3. Aim, Context & Motivation 1
• Aim
• Inform Irish health policy about the transfer of care from acute
hospitals to non-acute settings
• Clarify terms:
• Acute: outpatient, inpatient, day patient, emergency care in acute
hospitals
• Non-acute: services provided outside of acute hospital setting (e.g.,
GP clinic, long-term residential care facility, health centre, home, etc.)
• Policy context
• Core policy priorities: Transfer care from acute to non-acute
settings & achieve greater integration
• Motivation & Approach
• Insufficient evidence of adequacy of non-acute care supply
(Report 1)
• Insufficient evidence on interaction between acute & non-
acute care (Report 2)
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4. Report 1:
Geographic Profile of Healthcare Needs and Non-
Acute Healthcare Supply in Ireland
• Report 1 provides first building block for contributing
to the evidence base on transferring care:
• What non-acute services are available?
• How many are there and where are they?
• And where are they in relation to
healthcare needs?
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5. What non-acute services are available?
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Primary and
community care
services
GPs Included
Community nurses (PHNs & other registered
nurses working in community)
Included
Physiotherapists Included
Occupational Therapists Included
Speech & Language Therapists Included
Podiatrists & Chiropodists Included
Counsellors & Psychologists Included
Social Workers Included
Care for older
people
Long-term residential care Included
Home care Included
Others (for
example):
Disability services Not included
Mental healthcare services Not included
Palliative care nurses Not included
6. How many are there, and where are
they: DATA & METHODS 1
• BASIC DATA REQUIRED:
• Number of public and private professionals/beds/hours
• Geographic location
• Additional data required to compare supply across
areas & across services:
• Whole time equivalents – available or estimated WTE
• Supply per capita – population data (denominator)
• Common geography – supply per capita by county
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7. How many are there, and where are
they: DATA & METHODS 2
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Non-acute service Data source
(Year 2014)
Geographic
aggregation
WTE? Public &
Private?
GPs Irish Medical Directory &
Irish College of General
Practitioners
Street address Estimated Private
Community nurses HSE Personnel Census LHO/Regional Available Public
Allied health
professionals
HSE Personnel Census LHO/Regional Available Public
only*
*Private
physiotherapists
Irish Society of
Chartered
Physiotherapists
Street address Estimated Private
Long-term residential
care beds (2015)
HIQA, DOH, NHI Street address Not applicable Public &
private
Home care hours Social Care Division, HSE LHO Not applicable Publicly
financed
Population data 2014 ESRI population estimates
8. And where are they in relation to
healthcare needs: METHODS 1
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Behavioural Model of Health Services Use (Andersen et al., 1995)
9. And where are they in relation to
healthcare needs: METHODS 2
• Adjusting area supply for differences in area need
(Gravelle & Sutton, 2001; Hann & Gravelle, 2004;
Goddard et al., 2010)
• Older population aged 65+ years
• Older population aged 85+ years
• Mortality rates
• Disability rates
• Medical card (or GP visit card)
• Chronic illness (Medical Card holders with one/more
prescription for a chronic health condition)
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10. How many are there, and where are
they: FINDINGS
• Supply of 10 non-acute services (unadjusted
for healthcare need)
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11. WTE GPs per 10,000 pop (2014)
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Higher than national value Lower than national value
0 2 4 6 8
Meath
Kildare
Monaghan
Kilkenny
Laois
Leitrim
Clare
Dublin North
Wexford
Roscommon
Cavan
Offaly
Longford
Tipperary North
Wicklow
Tipperary South
Donegal
Louth
Dublin South
Limerick
Westmeath
Carlow
Mayo
Kerry
Waterford
Galway
Cork
Sligo
12. WTE community nurses per 10,000
pop (2014)
120 2 4 6 8 10
Meath
Wexford
Kildare
Wicklow
Waterford
Limerick
Cork
Dublin North
Dublin South
Clare
Kilkenny
Louth
Carlow
Laois
Offaly
Galway
Mayo
Cavan
Monaghan
Tipperary South
Tipperary North
Roscommon
Sligo
Leitrim
Kerry
Donegal
Westmeath
Longford
Higher than national value Lower than national value
13. WTE public & private physiotherapists per
10,000 pop (2014)
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0 1 2 3 4 5
Meath
Wicklow
Monaghan
Wexford
Waterford
Offaly
Cavan
Clare
Laois
Kilkenny
Donegal
Kildare
Carlow
Tipperary South
Dublin North
Tipperary North
Cork
Mayo
Roscommon
Galway
Sligo
Louth
Limerick
Westmeath
Kerry
Longford
Dublin South
Leitrim
Higher than national value Lower than national value
14. WTE occupational therapists per 10,000 pop
(2014)
140 1 2 3 4 5
Wicklow
Tipperary North
Meath
Kildare
Wexford
Waterford
Clare
Offaly
Tipperary South
Galway
Limerick
Kerry
Kilkenny
Cork
Donegal
Roscommon
Mayo
Longford
Cavan
Dublin North
Carlow
Dublin South
Louth
Laois
Monaghan
Westmeath
Sligo
Leitrim
Higher than national value Lower than national value
15. WTE social workers per 10,000 pop (2014)
150.0 0.5 1.0 1.5 2.0 2.5
Carlow
Longford
Meath
Offaly
Wicklow
Wexford
Tipperary North
Kilkenny
Kildare
Mayo
Clare
Cork
Cavan
Waterford
Kerry
Limerick
Westmeath
Monaghan
Dublin North
Tipperary South
Roscommon
Galway
Dublin South
Donegal
Laois
Leitrim
Louth
Sligo
Higher than national value Lower than national value
16. Long-term residential care beds per 1,000 pop
aged 65+ (2014)
160 20 40 60 80
Laois
Donegal
Sligo
Dublin North
Kerry
Wexford
Waterford
Monaghan
Tipperary South
Dublin South
Mayo
Louth
Meath
Leitrim
Cork
Clare
Limerick
Offaly
Carlow
Longford
Cavan
Kilkenny
Westmeath
Wicklow
Galway
Tipperary North
Roscommon
Kildare
Higher than national value Lower than national value
17. Average annual no. of publicly financed home
care hours per pop aged 65+ (2014)
170 10 20 30 40
Dublin South
Clare
Waterford
Kildare
Longford
Offaly
Westmeath
Wicklow
Kilkenny
Mayo
Wexford
Laois
Carlow
Limerick
Tipperary South
Galway
Tipperary North
Monaghan
Cavan
Roscommon
Cork
Donegal
Meath
Louth
Dublin North
Kerry
Leitrim
Sligo
Higher than national value Lower than national value
18. GP1
PHN/CN2
PT3
OT2
SLT2
P&C2
CO&PSY2
SW2
LTRC4
HCH5
Kildare 9
Meath 8
Wexford 8
Wicklow 8
Clare 7
Kilkenny 7
Waterford 7
Offaly 5
Carlow 5
Laois 4
Limerick 3
Mayo 3
Tipperary North 3
Dublin North 3
Kerry 3
Monaghan 3
Longford 3
Roscommon 3
Dublin South 2
Cavan 2
Louth 2
Donegal 2
Tipperary South 1
Westmeath 1
Leitrim 1
Sligo 1
Cork 0
Galway 0
Number of services
>10 per cent below
national average
Long-Term CareNon-Acute Primary and Community Care
19. And where are they in relation to
healthcare needs?
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GP1
PHN/CN2
PT3
OT2
SLT2
P&C2
CO&PSY2
SW2
LTRC4
HCH5
Kildare 9
Meath 8
Wexford 8
Wicklow 8
Clare 7
Kilkenny 7
Waterford 7
Offaly 5
Carlow 5
Laois 4
Limerick 3
Mayo 3
Tipperary North 3
Dublin North 3
Kerry 3
Monaghan 3
Longford 3
Roscommon 3
Dublin South 2
Cavan 2
Louth 2
Donegal 2
Tipperary South 1
Westmeath 1
Leitrim 1
Sligo 1
Cork 0
Galway 0
Number of services
>10 per cent below
national average
Long-Term CareNon-Acute Primary and Community Care
20. Conclusions 1
• Key findings
• Considerable regional inequality in supply of non-acute services,
unrelated to need
• Some areas consistently under-supplied relative to national average;
some notable regional patterns
• Limitations/Questions:
• Reasons behind the inequalities?
• Changes since 2014?
• National average not an indicator of adequate supply
• Supply is one element of access
• Ease of access incorporates a range of other factors not addressed in this
study (e.g., distance, travel costs, uneven entitlements)
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21. Conclusions 2
• Policy implications
• Sláintecare implementation strategy
• Challenges for resource allocation planning:
• DATA!!
• Disparate data sources
• Incomplete data on private supply
• Incomplete information on local practices
• Catchment populations
• Limited data on accessibility (e.g, distance, travel time)
• Appropriate need adjustments
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