Issues

ESRI: Up to 15,000 healthcare staff needed by 2035

A report by the Economic and Social Research Institute (ESRI) has projected that the HSE may need to recruit a further 15,000 staff by 2035 in acute hospitals in order to cope with population growth, an increasing elderly population, and the implementation of the Government’s Sláintecare programme.

The report, entitled Projections of Workforce Requirements for Public Acute Hospitals in Ireland, 2019–2035, further explains that the HSE will require the recruitment of minimum 12,418 extra staff, 3,236 extra medical staff, 8,868 nursing and midwifery staff and 3,277 healthcare assistants.

The population of the State is expected to increase to around 5.4 million by 2035, with the over-85 population expected to almost double in that timeframe.

The study has taken into account factors such as the Government’s Sláintecare programme, as well as changing age demographics and an ever-increasing population as the main factors which mean that more jobs and increased and sustained investments will be necessary in order to provide an adequate healthcare system in Ireland.

It has further outlined the challenges based on demographics, and has outlined different workforce models that could be utilised by the HSE, who funded the report.

Keeping healthcare staff in Ireland

The report emphasises the challenges of ensuring a properly resourced health service, citing an OECD report from 2019 which stated that Ireland’s number of doctors per head of the population was the sixth lowest in the European Union.

Additionally, the number of nurses per head of population, whilst above the EU average, has been decreasing consistently over the last 10 years.

Despite having the highest number of medical graduates per capita in the EU, Ireland’s healthcare system remains increasingly reliant on foreign staff to adequately staff the HSE. Incentivising qualified medical professionals to stay and work in Ireland is outlined at one of the key challenges to be overcome in order to meet the sharp increase in demand of healthcare staff.

Furthermore, almost half, 44 per cent, of foreign healthcare staff are based in Dublin, thus furthering the squeeze on healthcare staff throughout the State.

“Internationally, workforce demand modelling can vary significantly in terms of its sophistication, ranging from models that consider how population growth alone may affect workforce demand to models that explicitly account for changing workforce delivery and care utilisation patterns.”

The report continues: “Internationally, workforce demand modelling can vary significantly in terms of its sophistication, ranging from models that consider how population growth alone may affect workforce demand to models that explicitly account for changing workforce delivery and care utilisation patterns.”

Changing demographics

The Republic’s population is expected to increase by around 500,000 people by
2035. The report makes upper and lower scale estimates that the State’s population by 2035 could be anywhere between 5.3 million and 5.8 million people.

The report further states: “The projections show the importance of international migration in determining the future path of the population figures.”

The population is becoming increasingly concentrated around Dublin and, as a consequence, the surrounding counties of Kildare, Meath, and Wicklow. In accommodating these demands, the report recommends a higher level of sustained investment and for a large bulk of the necessary job creation to happen in this part of the country.

The report projects that the population density of the western rural counties, such as Roscommon, Donegal, and Leitrim, are expected to remain relatively low compared with the eastern counties. It does not state how this will be accommodated.

Changing workforce model

The report outlines that the ‘silo’ workforce model relies on a traditional and potentially outdated model that relies on the consistency of differing healthcare needs based on age- and gender-specific requirements which cannot be relied upon as consistently going forward.

As one of the options, the report outlines the adoption of a multi-professional integrated approach which has been pursued in most of the world throughout the last decade.

“The National Strategic Framework for Health and Social Care Workforce Planning identifies the need for workforce planning to be aligned to current and future population health needs, but there is also clear recognition that workforce planning needs to also capture advances in strategy and policy.”

Immediate challenges

The report concludes by reiterating that population growth and a growing elderly demographic will be the key drivers in how health policy is formulated in the short to medium term, and that the implementation of Sláintecare will require these factors to be taken into account.

“The whole time equivalent requirements for all workforce categories considered are projected to increase substantially by 2035. These increases are largely driven by increases in the underlying population and, in particular, changes in the age structure. Percentage increases are projected to be relatively higher for HSCPs [health and social care professions], given the concentration of activity in the older age categories.”

Regional variation in projected requirements is also observed, with relatively higher increases in Eastern regions again largely driven by population change. Projected workforce requirements can be sensitive to assumptions in relation to grade- and skill-mix.

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