Healthcare Forum Removing Private Activity from Public Hospitals - PowerPoint PPT Presentation

Healthcare Forum Removing Private Activity from Public Hospitals & its Impact on the Healthcare System Society of Actuaries Mr Martin Varley 3 rd December 2019 Secretary General 1

History of Health Reform • Track record: unimplemented reports and strategies • Fitzgerald (1960s), Hanly (2003), VFC Mental Health (2006) • Health Boards, HSE, Integrated Areas, Hospital Groups, CHOs, UHI • Removal/Reinstatement of HSE Board • Regional Integrated Care Organisations (RICOs): Health Boards revisited • Rationalisation, colocation, reconfiguration, integration … • Strategy, Planning, Management churn • Indicator of dysfunctionality 2

2017 Sláintecare Recommendations Sláintecare Year 10 Costs (%) 1% Acute Hospital Expansion 4% Primary Care Expansion 10% 27% Social Care Expansion 15% Reduce/remove charges Expand Health & Wellbeing 17% 26% Mental Health Programmes Dentistry Expansion • First decade cost: € 20bn plus € 3bn transitional • Second decade cost: € 28bn + inflation 3

Sláintecare Qualifications & Unintended Consequences “The Committee acknowledges that removing private care from public hospitals will be complex. It therefore proposes an independent impact analysis of the separation of private practice from the public system with a view to identifying any adverse and unintended consequences that may arise for the public system in the separation. Given the acknowledged need to increase capacity in the public system , it is important that any change should not have an adverse impact on the recruitment and retention of consultants and other health professionals in public hospitals .” 4

Sláintecare & Capacity Expansion?? • Expand Hospital Activity???? o Replace private insurance income year 2 – 10: Year 10 cost € 649m o Increase consultant numbers by 593 (+20%): Year 10 costs € 119m 5

Other Capacity Expansion Needs Bed Capacity Deficits o 2,600 additional public hospital beds ( € 2.6Bn) o 4,500 Community beds ( € 4Bn) Equipment & Facilities ICU Capacity o Replace obsolete o Need 330 more ICU beds ( € 412m) o Expand facilities as inadequate o € 3.64bn to replace equipment (2017-2021) 6

2019-2021 Capital Plan • HSE to provide 480 new hospital beds between 2019-2021 • This is 100 less beds over each of 3 years 7

de Buitléir Recommendations • Legislation so public hospitals exclusively public patients from conclusion of 10 year Sláintecare implementation period • New Consultant appointments Sláintecare Consultant Contracts – public only • Restore pay parity to pre-2012 levels for all Consultants • Offered “contract change payment” • All existing contracts 39 hrs • Declining Salaries A → B → B* → C ?? 8

Consultant Vacancies and the Recruitment and Retention Crisis

Outpatient Waiting List (March 2013-Oct 2019) Capacity Deficits 600,000 567,211 (Oct- 19) 550,000 500,000 450,000 400,000 375,440 384,632 350,000 300,000 300,752 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 Jan-17 Mar-17 May-17 Jul-17 Sep-17 Nov-17 Jan-18 Mar-18 May-18 Jul-18 Sep-18 Nov-18 Jan-19 Mar-19 May-19 Jul-19 Sep-19 Total Outpatients Linear (Total Outpatients) Source: NTPF (2013 - 2019) • 567,200 in October • ↑ 51,059 (9.9%) in 2019 • ↑ 189,709 (50%) in 5 years • 500 Permanent hospital Consultant posts can’t be filled 10

Consultant Vacancies and the Recruitment and Retention Crisis Specialist medical practitioners per 1,000 population in EU in 2018 (or nearest year) • 42% fewer Ireland 1.44 France medical Denmark 1.76 Belgium specialists Finland Poland than EU Netherlands 1.97 Norway average Luxembourg UK 2.09 Sweden Slovenia EU Average 2.47 • Over 500 Latvia Portugal 2.49 posts Spain Switzerland vacant or Hungary 2.62 Estonia filled on a Austria 2.75 Czechia temporary Italy 3.1 Germany 3.25 basis Lithhuania 3.51 Greece 4.95 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Source: Eurostat 11

Specialist medical practitioners in Ireland per 100,000 population as a percentage of the EU average (2016 or nearest year) % of EU Average • 1 / 4 to 1 / 2 in 100 90 many 82 82 80 specialties 66 70 61 58 60 55 53 52 51 48 46 50 • 37 UCC at 40 32 32 30 25 Connolly 30 23 20 Hospital only 10 open for 1 / 3 of 0 planned hours Source: Eurostat 12

Increased Acute Hospital Capacity Requirements Public Hospital Inpatient and Day Case Beds, and Population Growth 2008 to 2019 Total Inpatient and Day Case beds Total Population 2008-2019 (April) 2008-2019 YTD 4921.5 13,584 4,857.00 4,792.50 13,231 13,141 13,096 4,739.60 4,687.80 12,847 12,835 4,645.40 12,732 4,614.70 12,630 4,593.70 4,574.90 12,499 12,486 4,554.80 12,432 4,533.40 12,386 4,485.10 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 YTD 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Source: Department of Health Open Beds Report Sept 2019; Health in Ireland: Key Trends 2017, DOH; CSO • Population ↑ 9.7% • 22 % ↑ (273,433) in inpatient and day cases performed • Bed capacity ↓ 2.6% • 12.3% increased deficit 13

Total Inpatient and Day Case Waiting List (March 2013-Oct 2019) 90,000 86,111 85,000 80,000 75,000 68,086 67,511 (Oct- 70,000 19) 65,000 60,000 55,000 47,413 50,000 45,000 44,870 40,000 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 Jan-17 Mar-17 May-17 Jul-17 Sep-17 Nov-17 Jan-18 Mar-18 May-18 Jul-18 Sep-18 Nov-18 Jan-19 Mar-19 May-19 Jul-19 Sep-19 Total Inpatients/day cases Linear (Total Inpatients/day cases) Source: NTPF (2013 - 2019) • ↑ 24,089 (55%) in 7 years 14

Hospital beds per 1,000 of population in EU, 2018 (or nearest year) Sweden 2.04 UK 2.11 Denmark 2.44 Spain 2.43 Our hospital Italy 2.62 Ireland 2.77 bed capacity: Finland 2.8 Netherlands 2.92 France 3.09 • 31% below Portugal 3.25 Latvia 3.3 EU average Cyprus 3.43 Estonia 3.45 Greece 3.6 • Regular bed Luxembourg 3.7 EU28 4.02 shortages Czech Republic 4.11 Slovenia 4.2 • Hungary 4.27 Rationing Malta 4.69 Poland 4.85 care Slovak Republic 4.91 Belgium 4.98 • Delays Austria 5.45 Lithuania 5.47 Croatia 5.49 Germany 6.02 Romania 6.84 Bulgaria 7.27 0 1 2 3 4 5 6 7 8 16 Source: OECD.Stat; Eurostat

Consultant Vacancies and the Recruitment and Retention Crisis • Over 500 Vacancies + 108 non-specialists in Consultant posts since 2008 • “Jeopardising patient safety” – Justice Peter Kelly • Medical agency spend 2012- 2018 ↑€ 57m p.a. • Agency Consultant costs up to three times New Entrant Permanent Consultant Cost • New Entrant salary is up to 51% below colleagues • Failed to fill 38% of posts advertised 2015-2017 • Not competitive – salaries in Australia, Canada and US up to 48% above non-new entrant salary • Annual Medical Indemnity costs quadrupled between 2013-2018. Increase of € 184 million 19

Number of patients treated on trolleys annually (2008 – 2018) 108,227 98,981 100,000 93,621 92,998 86,481 77,091 75,859 80,000 Number of Patients 67,863 66,308 63,713 59,435 60,000 40,000 20,000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Source: INMO Trolley Ward/Watch • 108,000 admitted patients treated on trolleys in 2018 • Nearly double ‘national emergency’ level of a decade earlier 21

Trolley Analysis January/July 2008-January/July 2019 Source: INMO Trolley Ward/Watch • Year round problem • July 2019 (9,439) a record for the month – ↑ 33% on July ’18 • August 2019 (9,562) highest ever for the month – ↑ 10% Aug ’18 • September 2019 (10,641) – worst Sept on record – ↑ 36% Sept ’18 Oct 2019 (11,452) – worst Oct and 2 nd worst month ever – ↑ 26% Oct ’18 • 22

Delays in Accessing Treatment resulting in missed Cancer KPI targets • Symptomatic Breast Disease Clinics 44% < target • Rapid Access Clinics for Prostate Cancer patients 21% < target Source Health Service Performance Profile January to March 2019 23

Media Coverage

de Buitléir Report Terms of Reference “The Review Group will examine and enquire into the effects of the removal of private activity from public hospitals and will specifically examine potential benefits and potential adverse consequences, including any unintended consequences that may arise, in the removal. In particular the group will examine and consider… • possible impacts, both direct and indirect, immediate and over time, of removing private practice from public hospitals, including but not limited to impacts on: access; hospital activity (including specialist services); funding; recruitment and retention of personnel; and any legal or legislative issues that might arise. ” 25