Press Release

Varadkar welcomes publication of Health in Ireland Key Trends 2014

The Department of Health today (Thursday, 18 December) published Health in Ireland: Key Trends 2014 http://health.gov.ie/blog/publications/health-in-ireland-key-trends-2014/

Welcoming the publication, the Minister for Health, Leo Varadkar TD, said, “Health in Ireland Key Trends gives us an insight into trends in demographics, population health and expenditure on health services.

“Good quality data is necessary for evidenced based policy decisions, especially given our resource constraints. The enactment of an individual health identifier this year will help to facilitate effective and, most importantly, safe health care delivery. It will also provide improved information to plan and evaluate on-going health reforms.

“The 2014 edition is a mixed bag, but it’s certainly more positive than negative.  There is continuing progress, but at a reduced rate, set in a context of very significant financial constraints.

“In the last decade alone, there has been an increase of almost three years in life expectancy. These gains are driven largely by reductions in mortality rates from principal causes of deaths such as those from heart disease and cancer. ”

“Another striking feature is the growth in the number of people aged over 65. Each year this cohort increases by 20,000 people. This trend is set to continue into the future and will have implications for future planning and health service delivery.

“Rapid ageing of the population in conjunction with lifestyle-related health threats present major challenges now and for the future in sustaining and further improving health and health services in Ireland.   The health services have played and will continue to play a large part in these improvements and it points to improvements in general health and health care.

“While our fertility rates are still the highest in Europe, the birth rate has fallen to its lowest since 2005, and this should ease pressure on maternity services in coming years.

“We have fewer hospital beds overall, notwithstanding an almost 80% increase in day beds, but shorter length of stay.  This shows we’re using our capacity more efficiently.

“While health service numbers are down, the numbers of doctors are at a decade long high.  The number of administration and management staff has been falling now since 2008, in contrast to public perception.

“Our health expenditure is about average compared to other OECD countries and the modest increase we secured for Budget 2015 is very welcome.”

Ends

Notes for Editors

This is the seventh edition of this easy-to-use reference guide to significant trends in health and health care over the past decade, including population and health status, as well as trends in service provision. This year, new tables, maps and graphs have been included on some specific topics or where new data has been made available. Each section has a brief introduction summarising key statistics.

Key trends include:

  • Total hospital discharges continue to rise with 60% of this activity now carried out on a day case basis (including dialysis). When dialysis is excluded, there has been an 80% increase in the number of day cases seen in public acute hospitals since 2004. Improved and less invasive medical practice is largely responsible for the rapid growth in day patient activity.
  • Over the past decade, Ireland has achieved a rapid improvement in life expectancy. Life expectancy in Ireland has increased by almost three years since 2003 and has been consistently higher than the EU average throughout the last decade.
  • Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases. Since 2004, there has been a reduction in mortality rates for most major causes. The overall mortality rate has reduced by 18% since 2004.
  • Ireland is now beginning to catch up with other European countries in terms of population ageing.  The population of those aged 65 years and over has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to almost double in the next 20 years, with the greatest proportional increase in the 85+ age group.
  • Despite reductions in the numbers of births in recent years, the fertility rate in Ireland remains the highest in the EU.
  • In comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those with higher education attainment tend to report better health than those with lower education attainment.
  • The number of people waiting longer than 52 weeks for an outpatient appointment has increased since the beginning of 2014. The total number of people waiting has also started to increase in recent months.
  • The number of adults and children waiting greater than 8 months and 20 weeks respectively for elective procedures has been increasing since January this year.
  • 40% of the population was covered by a medical card in 2013.  Numbers covered increased by 61% over the decade but changed little between 2012 and 2013. This is in contrast to the numbers covered by private health insurance which has declined in recent years.
  • Immunisation rates have been increasing since 2004 and are now at 95% or above for most immunisations.
  • The numbers of people employed in the public health service now stands at just over 97,000 (September 2014). This is a reduction of over 12,000 since the moratorium on recruitment in the Public Service was introduced in 2009.
  • Total public health expenditure has risen from €11.7 billion in 2005 to almost €14 billion in 2013. Estimates for 2014 indicate a decline to €13 billion in expenditure.

Further key trends, by section of the booklet, are presented below:

Section 1 – Population and Life Expectancy

  • The population in 2014 was 4,609,600 persons. This is a slight increase of 0.8% on the 2011 Census of Population. There has been an almost 12% increase in population since 2005, with the largest % change in the over 65 age groups. (Tables 1.1 and 1.2)
  • Counties in the west and north-west of Ireland have a greater proportion of people aged 65 and over. (Figure 1.1)
  • The total population in Ireland has increased more rapidly than the EU average in the last decade. The population aged 65 and over has increased at a greater rate than the population as a whole. (Figure 1.2)
  • The numbers of registered births in 2013 have shown a 4% decrease on the previous year, 68,930 births being registered in the year.  This still represents 7,000 more births annually than a decade ago. (Table 1.3)
  • The Total Fertility Rate has decreased slightly in recent years and now stands at 1.96. However, Ireland continues to have the highest rate of fertility amongst EU countries, the EU average being 1.58. (Figure 1.4)
  • In 2013, counties Dublin, Donegal, Clare and Kerry had the lowest fertility rates. (Figure 1.3)
  • The numbers of people in older age groups is beginning to increase significantly.  The numbers of people over the age of 65 years is projected to almost double to around 1 million by 2031.  The greatest proportional increase will be in the 85+ age group. (Tables 1.4, 1.5 and Figure 1.5)
  • Although women have a higher life expectancy than men, when life expectancy is expressed as years lived in good health (i.e. healthy life years) at age 65, the difference between women and men is less significant, indicating that women live longer but with more health problems. (Figure 1.9)

Chapter 2 – Health of the Population

Please note that any references below to 2012 and 2013 mortality data should be considered provisional, as 2012 and 2013 data in this report are based on year of registration, and not year of occurrence.

  • In 2012, 83% of males and females rated their health as being good or very good. This is the highest in the EU and compares with an average of 71% and 66% for males and females respectively across the EU. Those with higher educational attainment report being in better health. (Table 2.1, Figures 2.1, 2.2)
  • 55% of males and females aged 65 and over reported suffering from a chronic illness or health problem. In the 75+ age category, 47% and 48% of males and females respectively reported some or severe limitation in usual activities due to health problems. (Tables 2.2, 2.3)
  • Over the 10 year period 2004-2013, age-standardised death rates for all causes fell by 18%. Most recently, death rates have shown a slight increase of 1.5% between 2012 and 2013 (data for 2012 and 2013 are provisional). (Table 2.4)
  • Among those aged 65 years and over diseases of the circulatory system accounted for 35% of all deaths registered in 2013. This compares with 20% of deaths to those aged less than 65 years. A decline in the age-standardised death rate of 30% occurred between 2004 and 2013. (Table 2.4 and Figures 2.3a, 2.3b)
  • Deaths from respiratory diseases (including cancer of the trachea, bronchus and lung) accounted for 20% of all deaths to those aged 65 and over and 12% of all deaths to those aged under 65.
  • 18% of deaths in 2013 to those aged less than 65 years were due to external causes of death such as transport accidents and suicide. This compares with less than 2% of deaths to those aged 65 years and over. (Figures 2.3a, 2.3b)
  • There has been a 10% decline in the age-standardised death rate for cancer in the last decade, however more recently there has been a slight increase of 0.8% between 2012 and 2013. The female breast cancer death rate declined 15% since 2004. (Table 2.4)
  • Death rates from suicide are down 13% since 2004 and have decreased by 5% between 2012 and 2013 (data for 2012 and 2013 are provisional). (Table 2.4)
  • While Ireland’s age-standardised death rate in 2011 was 3.7% below the EU average, the death rate from respiratory diseases (including cancer of the trachea, bronchus and lung) was 31% above the EU average. (Table 2.5)
  • Ireland has had a lower infant mortality rate than the EU average over the last decade; however the gap has narrowed in recent years. (Figure 2.7)
  • 5-year relative survival rates from breast and cervical cancers are lower in Ireland than the average for EU countries where data is available. However, the survival rate in Ireland for colorectal cancer is the same as the EU average. (Figure 2.8)
  • The percentage of mothers breastfeeding on discharge from hospital has increased steadily in the last decade. In 2013, 56% of women breastfed at least partially. (Figure 2.9)
  • Both alcohol and cigarette consumption have declined over the past decade. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the decline. Both alcohol and cigarette consumption in 2013 have declined compared with 2012. (Figure 2.10)

Chapter 3 – Hospital Care

  • Inpatient discharges from publicly funded acute hospitals have increased by 11% since 2004. Excluding dialysis, day cases have increased by 80% since 2004. (Table 3.1)
  • There has been a 79% increase in the number of day beds available between 2004 and 2013. (Table 3.1)
  • Hospital discharge rates increase with older age groups. There has been an increase in the discharge rate of adults since 2004, with a small decline in rates for children over the same period. In particular, older age groups saw the largest increases. (Figure 3.1)
  • In the last year, there has been an increase in the numbers of adults waiting longer than 8 months and children waiting longer than 20 weeks for elective procedures. (Figure 3.2)
  • The number of people waiting longer than 52 weeks for an outpatient appointment has increased since the beginning of 2014. The total number of people waiting has also started to increase in recent months (Figure 3.3).
  • The numbers of admitted patients waiting on trolleys in Emergency Departments of public acute hospitals since July 2014 has started to rise in comparison with the same period in 2013. (Figure 3.4)
  • 294 transplants were carried out in Ireland in 2013, the highest rate of transplants in the decade. (Figures 3.5, 3.6)
  • The number of admissions to psychiatric hospitals and units has slightly increased between 2012 and 2013. There are now more than 17% fewer admissions than in 2004. (Table 3.2, Figure 3.7)

Chapter 4 – Primary Care and Community Services

  • 39% of the population had a medical card in 2014. This compares with almost 28% in 2005. (Figure 4.1)
  • Louth, Mayo and Donegal had the highest percentage of population with medical cards. (Figure 4.2) (NOTE: data in the map are presented by Local Health Office areas)
  • Between 2012 and 2013 there was a very slight decrease (0.2%) in medical cards to 1.85 million representing 40% of the population. Numbers of GP Visit cards decreased by 4% to over 125,000. (Table 4.1)
  • The number of people registered for the Drugs Payments Scheme has declined 4% between 2012 and 2013. (Table 4.1)
  • The numbers of people on the Long-Term Illness Scheme has increased by 70% or over 65,000 people since 2004. (Table 4.1)
  • The number of people treated under the dental and ophthalmic schemes has risen by 83% between 2004 and 2013. (Table 4.1)
  • The number of prescription items dispensed under the General Medical Services has increased by 0.3% between 2012 and 2013, yet the average cost per item has reduced by over 5%. (Figure 4.3)
  • There has been a reduction in the percentage of people covered by private health insurance between 2007 and 2013. This is the case for all age groups, with the exception of those aged 70 and over where there has been an increase in the percentage of people covered. (Figure 4.4)
  • The number of children in care increased by 2% between 2012 and 2013. The percentage of these children in foster care also increased to almost 93% in 2013. (Table 4.2)
  • The proportion of those aged 85 and over in long stay care as a % of all those in long stay care has increased by 18% during the period 2004 to 2013. All other age groups over 70 have shown declines over the same period. (Table 4.3, Figure 4.5)
  • The immunisation uptake rates of children aged 24 months in 2013 was 95% or higher for most immunisations, with the exception of the MMR, Meningococcal and Pneumococcal Conjugate. Hepatitis B and Pneumococcal Conjugate vaccines were introduced in 2008 and show immunisation rates of 95% and 91% respectively. (Table 4.4)
  • The number of people registered with the National Physical and Sensory Disability Database was 24,391 in 2013. Over 54% of these had a physical disability only. (Table 4.5)
  • The number of persons with intellectual disability availing of day services has increased by 23% for day attendees over the period 2004-2013. (Table 4.6)
  • The number of cases in treatment for problem drug use has increased by 55% during the period 2004-2013. (Table 4.7)

 

Chapter 5 – Health Service Employment

  • Since 2007, total numbers employed in the public health services have shown a gradual decline.  There were 97,088 wholetime equivalents employed in September 2014. This represents a decline of 2.9% since December 2013. It should be noted that figures for 2014 refer to September, and do not therefore represent the end of year position. (Table 5.1, Figure 5.1)
  • Medical/Dental and Nursing were the only grade categories to show an increase between December 2013 and September 2014. (Table 5.1)
  • Nurses make up the largest grade category in the public health service, with 35% of total staff employed. (Figure 5.2)
  • The number of consultants employed by the public health service increased by almost 33% in the period 2005-2014. They also increased by 3% between December 2013 and September 2014. (Table 5.2, Figure 5.3)
  • The number of non-consultant hospital doctors increased by almost 20% in the period 2005-2014. They also increased between December 2013 and September 2014. (Table 5.2, Figure 5.3)
  • There were 2.7 practising doctors per 1,000 population in Ireland in 2012. This is below the OECD26 average of 3.2. (Figure 5.4)

Chapter 6 – Health Service Expenditure

  • Total public non-capital expenditure on health has increased by 13.4% since 2005, however it has decreased by 7.1% between 2013 and 2014 (data for 2014 are estimates). (Table 6.1)
  • Public capital expenditure on health decreased by 0.8% between 2012 and 2013 and decreased by almost 32% since 2004. (Table 6.3)
  • In 2012, Ireland’s total health expenditure on health was 8.9% of GDP and 10.9% of GNI. This compares with the OECD averages of 9.3% and 9.8% respectively. (Table 6.4, Figure 6.4)
  • Ireland’s per capita total health expenditure has increased steadily in real terms between 2003 and 2008, but has decreased since 2009. There is a slight increase, however, between 2011 and 2012. (Figure 6.3)