Budget 2025: Healthcare system facing ‘escalating crises’ says Irish Medical Organisation

The ever-lengthening waiting lists in our hospital emergency departments, as well as increasing wait times to see doctors, have become hallmarks of a health service that every year eats what is the largest allocation of any government department in the budget, and then comes back, Oliver Twist-like, looking for more, months before the next budget rolls around.

This oft-lamented state of affairs is despite the best efforts of an overstretched workforce of nurses, doctors, and other medical professionals.

Last year, they had to cope with a recruitment freeze by the HSE after it outspent its budget early in the year.

This year, the freeze had been replaced with a recruitment embargo, according to the Irish Medical Organisation’s (IMO) pre-budget submission.

In the introduction to the submission, the IMO sets out the context for its budget demands for the coming year in stark terms: “Our healthcare system is at a critical juncture, facing persistent and escalating crises in emergency-department overcrowding, ongoing and significant deficits in bed capacity, and serious shortfalls in medical staffing and long waiting lists.

“A decade of under-investment through the years of austerity, matched with increases in population and, in particular, the ageing population, has led to a situation where our health services are not in a position to meet the challenges of dealing with the healthcare needs of the population in a timely manner.”

The population has grown significantly in the past decade and, at the current rate, the Central Statistics Office estimates it will grow to somewhere between 5.65m and 5.9m by 2032.

What is more concerning again is that the CSO estimates that there will be more than 1m people over the age of 65 by 2030 and that over half of hospital-bed days are used by people aged 65 and over.

Extra allocations of more than €1.5bn in 2023 and an estimated €1.2bn for this year help the health service stand still, rather than expand its provision.

Another threat that the IMO pointed out in its submission is the loss by public hospitals of income from private health insurance providers and this is going to have knock-on impacts unless this loss is made good from the Exchequer.

While the main focus of the concern is the overcrowding of emergency departments, the other issue that is contributing to this crisis is the perceived lack of GPs in towns and villages around the country.

A leading member of the Irish College of General Practitioners, Dr Diarmuid Quinlan, a Glanmire-based GP, told The Echo of his hope that Ireland would not become plagued with ‘medical deserts’, like other parts of Europe.

A medical desert is where a person who is ill has to travel for more than an hour to see a doctor.

Work is ongoing to address this, through the expansion of training programmes to ensure that more GPs, be it those with foreign qualifications or Irish qualifications, are brought into the Irish system.

“Currently, we have approximately 4,200 GPs in the country,” Dr Quinlan said.

“Of those, 14% are aged 65 and over — that’s about 500 aged 65 or over —and most of those will retire within three years, thus creating a huge gap in our workforce.”

The intake in medical students this year has expanded and this will have to keep increasing if Ireland is to have sufficient doctors to treat its population as it grows and ages.

In tandem with an increase in the supply of doctors, the IMO has also called for an investment to increase the number of hospital beds by around 40%, from 3,438 to 5,000. This will have a knock-on effect, requiring an increase in the recruitment of nurses and other ancillary medical staff.

As well as the difficulty of maintaining a cohort of GPs, there is also work to be done to get the 5,600 consultants required by our current population level.

This figure looks unlikely to be reached, given that of the 4,500 approved consultant posts, just 3,700 have been filled on a permanent basis.

The IMO has called for the implementation of a report issued earlier this year by the National Taskforce on the Non-Consultant Hospital Doctor Workforce, in which there were recommendations, which the IMO welcomed at the time, about work-life balance as well as the working week, against a backdrop of exhausted doctors working extremely long hours in hospital emergency departments.

As is well reported, there are increasing numbers of vacancies for therapists and other professionals to treat children with special needs across CAMHS, as well as in schools.

Another ask of the IMO is for “significant investment in electronic health records and IT infrastructure”.

Bearing in mind the harsh lessons learned when the HSE computer system was hacked in 2021, the IMO has called for investment that would deliver a fully digitalised health service over the next five years.