Empowering Ireland’s healthcare future

Driven by a rapidly-ageing and growing population, demand for Irish healthcare services is set to rise steeply in the coming decade, exacerbated by staff supply shortages, capacity constraints and inflation.

These trends are likely to fuel growth in the sizable private healthcare sector as consumers seek access to care in the face of rising levels of chronic disease and growing waiting lists. These changes demand a proactive response by sector stakeholders in order to maintain access and drive care quality.

In particular, we see significant opportunities to further enhance efficiency through technology adoption and innovation, optimised staff utilisation, and accelerating the shift towards preventive care.

A previous report from the Economic and Social Research Institute forecasts demand for public hospital services could rise by 37% by 2030 from a 2015 baseline, with private hospitals and GPs likely to experience similar demand pressures driven by population growth, ageing, and long-term increases in chronic diseases.¹²

This demand picture collides with staff shortages at all levels of the system to produce lengthy and growing waiting lists across all specialisms, with over 560k people on outpatient active waiting lists for care in hospitals as of the end of December 2023.¹³

Supply has not matched demand growth, for a number of reasons. Compared to other EU countries, RoI is not cost-effective, having the 10th highest health expenditure per capita in the EU. RoI is also not self-sufficient in nurses or GPs and suffers from chronic staff shortages, constraining provision growth.

According to a recent Irish Times report, almost 1,000 permanent consultant posts were unfilled in July, and RoI has the fourth-highest proportion of doctors educated abroad amongst OECD countries for which data is available, implying RoI does not have the workforce to meet domestic demand.^14,15,16

While there has been demonstrable uptake of Sláintecare public-only consultant contracts, with over 1,000 consultants having signed such contracts between March and mid- November of 2023, it remains unclear when this additional capacity will begin to alleviate the backlog of demand.¹⁷

These trends have driven an expansion of private provision models, with insurers broadening the scope of their coverage, and offering ‘fee-for-service’ care models, and other integrated care and insurance packages.

RoI’s healthcare services are not utilised evenly, creating ‘quick win’ opportunities for optimisation. Physiotherapists and pharmacists, for instance, could both have capacity to handle additional patient demand, and could be used to alleviate a burden currently falling on GPs.

In the UK, the First Contact Practitioner (FCP) model has seen physiotherapists placed directly into GP practices to treat patients with musculoskeletal problems, with the The Chartered Society of Physiotherapy (CSP) estimating that FCPs could see up to 5% of GP patients.¹⁸

Similarly, the Irish Pharmacists Union has suggested that ~5% of GP consultations could be redirected to pharmacists, under approaches like the NHS’s Minor Ailment Scheme, under which patients with minor ailments are evaluated and – if necessary – prescribed medication directly by pharmacists.¹⁹

This elevation of pharmacists’ role in the UK’s primary care landscape will also be promoted by the imminent Pharmacy First scheme, which will see health care advice, treatments, and medicines for common illnesses dispensed from a patient’s local pharmacy without the need for an appointment, as well as access to patient health records digitally extended to those same pharmacists.

The use of Advanced Nurse Practitioners (ANPs) is another proven means to expand primary care capacity by redirecting patient demand away from GPs, as was starkly illustrated during the pandemic, when extraordinary patient demand saw ANPs play a critical role in keeping patients out of hospitals and unblocking access bottlenecks to primary care services, often via virtual clinics.²⁰

Despite their proven value, RoI has relatively few ANPs, creating a significant opportunity to raise system efficiency by training more.

Raising capacity and staffing levels meaningfully will require significant investment in both the private and public sectors. The private sector’s ability to make such investments would benefit from longer contracts that provide the necessary stability and cash flow visibility to do so.

As in all sectors, adoption of new and emerging technologies offers significant potential for efficiency, quality and access gains. 21st-century healthcare will come to be defined by the ‘digital front door’ paradigm, in which patient interactions with providers will match their experiences elsewhere in the economy of frictionless and value-adding digital assistance. Private providers such as Allview Healthcare and Webdoctor are already embracing telehealth, where the pandemic has greatly accelerated patient engagement. This growing consumer comfort with platform-based services has also opened space for other service providers and innovations, such as harmonised EHR implementation across the primary and secondary care systems.

A range of other technologies look set to have starring roles in the near future of healthcare, e.g.:

• Artificial intelligence (AI) is widely anticipated to deliver some of its most profound benefits in this sector and holds huge potential to unlock efficiency gains through vastly improved patient results analysis, diagnostics, and automation of routine tasks.
• Advances in robotics promise to revolutionise surgical treatment by greatly enhancing the capabilities of human consultants.
• Virtual wards and telehealth, in which patients can receive continuous monitoring and care from the comfort of their home environment, can minimise the inpatient burden on hospitals whilst allowing patients a greater degree of comfort and security.
• Digital therapeutics, which see medical treatment administered via clinically-evaluated software, often in the form of an app, allow patients to receive care through their own smartphone, and provide opportunities to expand care capacity across a range of ailments.
• Wearable technology can vastly increase the amount and accuracy of health data collected by all its wearers, empowering them to take greater responsibility for their health while empowering physicians to make more informed diagnoses, more quickly.

With all of these technologies already being adopted in the world’s leading healthcare systems, we expect to see them play a larger role in RoI in the near future.