Geographic profile of healthcare needs and non-acute healthcare supply in Ireland
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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
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Geographic profile of healthcare needs and non-acute healthcare supply in Ireland
- 1. www.esri.ie Inter-Sectoral Analysis of Health Services in Ireland DATE 24/09/2019 VENUE ESRI PRESENTER Dr Samantha Smith
- 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) 2
- 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) 3
- 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? 4
- 5. What non-acute services are available? 5 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 6
- 7. How many are there, and where are they: DATA & METHODS 2 7 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 8 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) 9
- 10. How many are there, and where are they: FINDINGS • Supply of 10 non-acute services (unadjusted for healthcare need) 10
- 11. WTE GPs per 10,000 pop (2014) 11 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) 13 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? 19 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) 20
- 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 21
- 22. Thank you