Department of Health publishes Health in Ireland Key Trends 2017

The Department of Health has today (Thursday) published the 10th edition of Health in Ireland: Key Trends.

Health in Ireland Key Trends gives us an insight into trends for demographics, population health, hospital and primary care, health service employment and expenditure.

In this 2017 report, trends from the last decade highlight significant achievements that Ireland has made for key outcomes relating to the health and wellbeing of the population. However, it also highlights the challenges that persist in terms of the accessibility of timely healthcare.

In welcoming this report, Minister for Health Simon Harris said:

ENDS

Health in Ireland Key Trends 2017

This is the tenth 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:

• the number of live births has been falling year-on-year since 2009 and in 2016 the number of registered births was 63,897. Despite reductions in the numbers of births in recent years, the fertility rate in Ireland remains the 2nd highest in the EU, behind France
• 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 increased by 34.3% since 2008 and 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
• over the past decade, Ireland has achieved an improvement in life expectancy. Life expectancy in Ireland has increased by almost two and a half years since 2006, with male life expectancy 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 and cancer. Since 2007 there has been a reduction in mortality rates for most major causes. The overall mortality rate has reduced by 14.6% since 2007
• in comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those in higher income brackets tend to report better health than those in lower income brackets
• there have been improvements seen in survival rates from breast, cervical, colon and rectal cancer in the last 15 years. With the exception of rectal cancer, 5-year net survival rates are lower in Ireland than the average for OECD countries where data is available
• while there has been a reduction in the mortality rate from respiratory diseases (including cancer of the trachea, bronchus and lung) of almost 4% since 2010 the rate in Ireland is 38.2% higher than the EU28 average
• total hospital discharges continue to rise with 62% of this activity now carried out on a day case basis (including dialysis)
• while there are fewer public inpatient beds than a decade ago, there has been a 38.5% increase in day beds and a reduction in the average length of stay. The increase in day beds has allowed for a 47% increase in the number of day case patients over the last decade
• there are over 3,000 inpatient and day beds in private acute hospitals in Ireland
• activity in private hospitals accounts for around 19% of total hospital activity in Ireland
• from 2007 to 2016 the average length of stay in a public acute hospitals decreased by 9.2%. Between 2015 and 2016 there was a decrease of 0.7%
• the number of elective and emergency discharges in acute public hospitals per 1,000 population has increased for most age categories between 2007 and 2016
• in terms of elective procedures for adults waiting 8 months and longer there has been an increase in the numbers waiting over the period December 2016 to July 2017. For children waiting 20 weeks or longer the number waiting for elective procedures remained relatively stable throughout the year
• the total number of people on outpatient waiting lists increased between December 2016 and August 2017 and remained stable until October 2017. The number of people waiting longer than 52 weeks increased throughout the year
• the 30-day moving average of the number of admitted patients on trolleys at 2pm in emergency departments saw a decreasing trend for much of 2017, and it now stands lower than 2016 values
• between 2015 and 2016 there was a decrease (2.9%) in the number of medical cards to 1.68 million. Numbers of GP only visit cards in 2016 increased significantly to just over 470,000, though it should be noted that this is largely due to the introduction of GP visit cards to all children under six in 2015
• there were 109,095 wholetime equivalents employed in September 2017; this represents a 1.9% increase since 2016
• total public health expenditure has risen from €14.5 billion in 2008 to an estimated €15.4 billion in 2017. Estimates for 2017 indicate a 3.1% increase in expenditure from 2016

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

Section 1 – Population and Life Expectancy

Following the publication of results from Census 2016, population figures have been updated in this year’s publication with the latest demographic information. The latest population estimate for Ireland has shown that the population grew by an estimated 1.1% between 2016 and 2017. This is in addition to the 3.6% increase which occurred between census years 2011 and 2016.

• the population estimate for 2017 is 4,792,490, an increase of 1.1% on Census 2016 (Table 1.1).t
• the Census 2016 estimate of the population showed an increase of 3.6% on the previous Census in 2011. The largest change was seen in the over 65 age group which increased by 34.3% between 2008 and 2017 (Table 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, and at a greater rate than the EU average for those aged 65 and over (Figure 1.2)
• the numbers of births in 2016 have shown a 2.5 % decrease on the previous year, with 63,897 births being registered in the year. The number of live births has fallen year on year since 2009 (Table 1.3)
• the Total Fertility Rate has decreased slightly in recent years and now stands at 1.82. However, Ireland has the 2nd highest rate of fertility amongst EU countries behind France. The EU average fertility rate in 2015 was 1.58 (Table 1.3 and Figure 1.4)
• in 2015, counties Waterford, Carlow, Kilkenny, Wexford and Dublin had the lowest fertility rates (Figure 1.3)
• the number 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 1.1 million by 2037. The greatest proportional increase will be in the 85+ age group (Table 1.4, Table 1.5 and Figure 1.5)
• life expectancy at birth for women in Ireland was 3.8 years longer than for men in 2015; this has improved from a 5.5 year difference in 1995 (Table 1.6)
• life expectancy at birth in Ireland is slightly above the EU average and, although the life expectancy at birth for women in Ireland has matched the EU average for women over the past decade, the life expectancy at birth for men in Ireland has been consistently greater than that of the EU average (Figure 1.6 and Figure 1.7)
• in addition to longer life expectancy, women at age 65 are likely to experience a higher proportion of healthy life years than men, indicating that men live shorter lives with more health problems (Figure 1.8)

Chapter 2 – Health of the Population

Please note that any references below to 2016 mortality data should be considered provisional as 2016 data in this report are based on year of registration, and not year of occurrence.

• in 2015, 83.0% of males and 81.7% of females rated their health as being good or very good. This is the highest in the EU and compares with an average of 69.6% and 64.4% for males and females respectively across the EU. With those in higher income brackets tending to report better health than those in lower income brackets (Table 2.1, Figure 2.1 and 2.2)
• 50.8% of males and 52.8% of females aged 65 and over reported suffering from a chronic illness or health problem in 2015. In people over the age of 75, 42.9% and 49.3% of males and females respectively reported some or severe limitation in usual activities due to health problems (Table 2.2 and Table 2.3)
• over the 10 year period 2007-2016, age-standardised death rates for all causes fell by 14.6% (Table 2.4)
• among those aged 65 years and over diseases of the circulatory system accounted for 30.8% of all deaths registered in 2016. This compares with 19.2% of deaths of those aged less than 65 years (Figure 2.4a and Figure 2.4b)
• deaths from respiratory diseases (including cancer of the trachea, bronchus and lung) accounted for 20.1% of all deaths to those aged 65 and over and 12.6% of all deaths of those aged under 65 (Figure 2.4a and Figure 2.4b)
• there has been a 9.9% decline in the age-standardised death rate for cancer in the last decade. Cancer of the female breast death rate has decreased by 3.4% since 2007 (Table 2.4)
• death rates from suicide are down 15.4% since 2007 and have decreased by 7.4% between 2015 and 2016 (data for 2016 are provisional). Since 2006, males have consistently had a higher suicide rate than females, in both Ireland and the EU (Table 2.4, Figure 2.7)
• the 5-year age-standardised death rates from respiratory system diseases (including cancer of the trachea, bronchus & lung) (2012-2016) are highest in counties Longford, Westmeath, Offaly, Laois and Limerick (Figure 2.5a)

Ireland’s age-standardised death rate in 2014 was below the EU average. The death rate from respiratory diseases (including cancer of the trachea, bronchus and lung) was 38.2% above the EU average (Table 2.5)

• the age-standardised death rates for cancer (excl. trachea, bronchus and lung), circulatory system diseases, ischaemic heart disease and respiratory system diseases (incl. cancer of the trachea, bronchus and lung) have all decreased over the previous 15 years (2000-2016) (Figure 2.6)
• 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 2.9)
• there has been improvements in survival rates from breast, cervical and colon and rectal cancer in the last 15 years. However, with the exception of rectal cancer, 5-year net survival rates are lower in Ireland than the average for OECD countries where data is available (Figure 2.10)
• the percentage of mothers breastfeeding on discharge from hospital has gradually increased over the last decade. In 2016, 59.9% of women breastfed at least partially (Figure 2.13)
• cigarette consumption has declined over the past decade, while alcohol consumption increased slightly in 2016. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the recent years’ decline. Cigarette consumption excludes ‘roll-your-own’ cigarettes (Figure 2.14)
• in 2017, 22% of adults said they were current smokers, with an apparent relationship between social class and smoking rates (Figure 2.15)
• the proportion of adults who binge drink on a typical day of drinking is higher in the younger age groups, with a higher proportion of men binge drinking across all age categories (Figure 2.16)
• the percentage of children aged 11-17 engaged in risky health behaviours such as smoking, alcohol and cannabis consumption reduced between 2010 and 2014, with the exception of illicit drug use (Figure 2.11)
• over 30% of adults in 2017 were eating takeaway, ready meals or chips between one to three times per week. Over 20% consumed cakes, muffins, chocolate, sweets or ice-cream once or more per day (Figure 2.18)
• daily consumption of sugar-sweetened beverages is higher amongst younger age groups, with nearly a quarter of people aged 15-24 drinking sugar-sweetened beverages daily. Men consumed more than women across most age categories (Figure 2.17)

Chapter 3 – Hospital Care

• inpatient discharges from publicly funded acute hospitals have increased by 7.1% since 2007 (Table 3.1a)
• from 2007 to 2014 the average length of stay decreased by 10.6%. It has since increased by 1.6%, with the average length of stay currently at 5.5 days (Table 3.1a)
• the number of beds for day cases has risen to 2,140 in 2016, an increase of 38.5% since 2007 (Table 3.1a)
• the number of day cases has risen to 1,056,656 in 2016, an increase of 47.1% compared to 2007. There has been an increase of 13.9% in the number of day cases as a percentage of total discharges (in-patient and day cases) in the period 2007-2016 (Table 3.1a)
• the elective and emergency discharge rate per 1,000 population has increased for most age categories from 2007 to 2016 (Figure 3.1a)
• there has been an increase in adults waiting 8 months or longer for an elective procedure during the period November 2016 to August 2017. Children waiting 8 months or longer has remained stable throughout the year (Note: refers to those classified as active) (Figure 3.2)
• the total number of people on outpatient waiting lists increased in the period November 2016 to August 2017. (Note: refers to those classified as active) (Figure 3.3)
• the 30-day moving average of the number of admitted patients on trolleys at 2pm in emergency departments saw a decreasing trend until August 2017, and it now stands lower than 2016 values (Figure 3.4)
• the national average emergency ambulance response time in 18 minutes and 59 seconds or less, for life threatening cardiac or respiratory arrest was 80%. For life threatening other than cardiac or respiratory arrest the national average was 60.6% (Figure 3.5)
• 280 transplants were carried out in Ireland in 2016, with kidney transplants being the most common (Figure 3.6)
• the number of admissions to psychiatric hospitals and units has decreased over the period 2007 to 2016, with 16.8% fewer admissions in 2016 than in 2007. The admission rate per 100,000 population has fallen by 24.1% over the same period (Table 3.2, Figure 3.8)

Chapter 4 – Primary Care and Community Services

• the percentage of the population with a medical card is higher in 2017 compared to 2008 across all age groups except for those under 4 and aged 65 and over (Figure 4.1)
• in 2017, counties in the North, North-West and South-East had the highest percentage of population with medical cards (Figure 4.2). NOTE: data in the map are presented by Local Health Office areas
• 35.5% of the population had a medical card at the end of 2016. This compares with 29.2% in 2007 (Table 4.1)
• between 2015 and 2016 there was a decrease (2.9%) in the number of medical cards to 1.68 million. Numbers of GP only visit cards in 2016 increased significantly to just over 470,000, though it should be noted that this is largely due to the introduction of GP visit cards to all children under 6 in 2015 (Table 4.1)
• the number of people registered for the Drugs Payments Scheme has decreased by 2.2% between 2015 and 2016 (Table 4.1)
• the numbers of people on the Long-Term Illness Scheme has increased by 118.5%, or over 100,000 people, since 2007 (Table 4.1)
• the number of people treated under the dental and ophthalmic schemes has risen by 61.4% and 51.4% respectively between 2007 and 2016 (Table 4.1)
• the number of prescription items dispensed has decreased by 0.9%. The average cost per item has decreased by 4.3% between 2015 and 2016 (Figure 4.3)
• there have been a similar percentage of people covered by private health insurance in 2016 compared to 2012; 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 beds available in long-term care units covered by the nursing homes support scheme has increased by 9.2% over the period 2013 to 2016. The proportion of patients aged 75+ in long term care has decreased slightly over the period 2013 to 2016, with nearly half of all patients in long term stay units in 2016 aged 85+ (Table 4.2, Figure 4.5)
• the immunisation uptake rates of children aged 24 months in 2016 was 95% for most immunisations, with the exception of the MMR, Meningococcal and Pneumococcal Conjugate vaccines (Table 4.3)
• the number of people registered with the National Physical and Sensory Disability Database was 21,763 in 2016, with 50.8% of these having a physical disability only (Table 4.4)
• the number of persons under 18 with an intellectual disability availing of day services has increased by 16.4% over the period 2007-2016. There has been an increase of 21.8% of those of all ages availing of these services as day attendees only, compared to a fall of 6.7% in full time residents availing of the services (Table 4.5)
• the number of cases in treatment for problem drug use (including alcohol) has increased by 34.9% during the period 2007-2016. The number of cases in treatment for problem drug use (excluding alcohol) has increased by 72.9% for the same period. There has been a slight decrease of 1.2% of new entries (including alcohol) and a 5.6% decrease in entries (excluding alcohol) between 2015 and 2016 (Table 4.6)

Chapter 5 – Health Service Employment

• over the period 2008 to 2014 total numbers employed in the public health services have shown a gradual decline, however in recent years this number has started to increase. There were 109,095 whole time equivalents employed in September 2017; this represents a 1.9% increase from since 2016 (Table 5.1, Figure 5.1)
• all grade categories have shown an increase since 2016. Nurses make up the largest grade category in the public health service, with 33.3% of total staff employed (Table 5.1, Figure 5.2)
• the number of consultants employed by the public health service increased by 30.5% in the period 2008-2017. They also increased by 3.1% between December 2016 and September 2017 (Table 5.2, Figure 5.3)
• the number of non-consultant hospital doctors increased by 25.1% in the period 2008-2017. They also increased by 2.5% between December 2016 and September 2017 (Table 5.2, Figure 5.3)
• there were 2.9 practicing doctors per 1,000 population in Ireland in 2015. This is below the OECD28 average of 3.3 (Figure 5.4)
• staff nurses represent the largest proportion of the nursing grades at 67%, followed by 20% for nurse managers and just over 4% for specialised nurses; this may include nurse prescribers, midwives, children’s nurses or advanced nurse practitioners (Figure 5.5)

Chapter 6 – Health Service Expenditure

• total public expenditure on health has increased by 6.4% since 2008, with an increase of 3.1% between 2016 and 2017 (data for 2017 are estimates) (Table 6.1, Figure 6.1)
• HSE non-capital total allocation has increased by 35.4% in the period 2010-2016, with an increase of 5.5% in the period 2015-2016. Acute hospitals accounted for 33.8% of HSE gross non-capital expenditure in 2016 (Table 6.2, Figure 6.2)
• public capital expenditure on health increased 6.3% between 2015 and 2016 and decreased by 27.7% since 2007 (Table 6.3)
• according to the System of Health accounts (SHA) methodology, Ireland’s current total (public and private) health expenditure was estimated to be €19.9 billion in 2015. The largest financing scheme in Ireland is the Government financing schemes and compulsory contributory health care financing schemes, accounting for 70% of all finance in health care expenditure. Curative and rehabilitative care accounted for 54% of total current health care expenditure, and hospitals accounted for 35% of total current health care expenditure (Table 6.4, Table 6.5 and Table 6.6)
• total health expenditure in Ireland per capita in real terms (adjusted for inflation) has shown an overall increase over the period 2006-2016 (Figure 6.3)
• in terms of health expenditure per capita, Ireland ranks as the 6th highest spend amongst selected OECD countries. Using modified gross national income or (GNI*) for Ireland as a comparator with GDP from other countries (as recommended by the Economic Statistics Review Group), Ireland’s total current health expenditure as a percentage of GDP/GNI* ranks joint 4th alongside France and Sweden. This position changes to 12th when looking at public expenditure only (Table 6.7, Figure 6.4)
• the percentage breakdown of health expenditure by type of care according to the System of Health accounts methodology for Ireland is shown in Figure 6.5