It is “unsustainable and dangerous” for Irish hospitals to operate with 90 per cent of beds consistently occupied, an Organisation for Economic Co-operation and Development (OECD) economist has warned.
Dr Douglas Sutherland, head of the economics division at the Paris-based organisation, said that while it was “completely valid” to seek to increase the number of beds, the question had to be asked why existing beds are occupied all the time.
Some beds are being pre-emptively blocked for incoming patients and there are difficulties discharging patients because only some staff can do this, he said.
In a speech to the Health Management Institute of Ireland annual conference, Dr Sutherland benchmarked Ireland’s performance on health against those of other OECD member countries.
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Irish health spending is high as a proportion of gross national income and accounts for one of the largest shares – 20 per cent – of total public spending of any country, he said.
Minister for Health Stephen Donnelly has claimed the Irish system is underfunded compared to other countries, but Dr Sutherland pointed out that comparisons based on gross domestic product are distorted by the impact of multinationals based here.
He noted spending has been “on a rollercoaster” largely due to cuts that followed the financial crisis more than a decade ago. Other countries have enjoyed the stability in financing that is needed to plan more accurately for the future of their health service.
Pointing to “considerable” cost pressures on the health service, Dr Sutherland described doctors’ pay as “relatively high” – the third-highest in the OECD relative to average wages. Prices in healthcare are about 25 per cent above average.
The fact that competition for recruiting doctors is limited not just to Ireland but to Australia and other English-speaking countries acts as a “constraint” against lower pay, he pointed out.
Ireland performs well in some areas, according to Dr Sutherland. There have been substantial health gains in the population, people’s assessment of the state of their health is the third-highest in the OECD and people report low levels of unmet health needs.
“Irish people say their health is relatively good, their life expectancy is going up and their health needs are largely met.”
A lot of Irish health spending is based around institutions rather being more broadly used, he noted, and spending on long-term care is also high.
Ireland has a relatively low number of hospital beds, average numbers of medical staff and low numbers of specialists.
Avoidable admissions to hospitals are high in Ireland for some conditions, while the use of generic and biosimilar medicines appears underdeveloped when the cost of high-tech drugs is “going through the roof”.
Noting that Ireland has the highest number of medical graduates but the second-highest share of foreign-trained doctors in the OECD, Dr Sutherland questioned whether more could be done to make working in the health service attractive. He pointed to views expressed by Irish nurses that management systems are “old-fashioned” and that Australia offers more flexible working than the “rigid” shift system in place at home.
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Steve Thomas, professor of health policy at Trinity College Dublin, warned of a “tsunami” of pent-up demand for health services after the Covid-19 pandemic and suggested now is a bad time to be “constraining” funding.
“My worry is that that Cinderella will be going back in to the kitchen when the pent-up demand after Covid has not yet played through.”
However, Prof Thomas’s advice to “contest austerity” drew a rebuke from Department of Health secretary general Robert Watt.
Mr Watt said austerity was “a much better alternative to financial bankruptcy” during the crash.
“People should never think that politicians wanted to do things to the health system or society which were unpalatable because they just liked to do it. They did it because they had no choice and because the alternative was bankruptcy.
“We got through it because we had a plan and we were resilient.”
