1. Adapting International Best Practice to Transform Irish Health Care Ed Walsh NAGP AGM Dublin 23 November 2013

2. Barringtons Limerick

4. ConsultantsBarringtons Hospital

5. ProceduresBarringtons

6. Health Expenditure

7. Irish Health Expenditure HSE m Private

8. Public Expenditure as % GDPOECD 2012

9. Public Expenditure as % GDP Age adjusted Source: Paul Redmon, Public Policy.ie based on OECD health data 2012. GNP used for Ireland

10. Private Health Expenditure as %GDPAge Adjusted

11. Total Health Expenditure as % GDPAge Adjusted Paul Redmond, Expenditure and outputs in the Irish health system: a cross country comparison. Public Policy.ie c 2013 Age demographic adjustments are author’s own calculations. The denominator for Ireland is GNP.

12. Hospital Price LevelsOECD 2009 OECD 2009

13. Potential Savings % GDP 2009from greater efficiencies in Public Healthcare Spending

14. Potential Savings % GDP 2009from greater efficiencies in Public Healthcare Spending

15. Potential Savings % GDP 2009from greater efficiencies in Public Healthcare Spending

16. Potential Savings % GDP 2009from greater efficiencies in Public Healthcare Spending €9.7b (2003)

17. Keys to Sorting Irish Healtcare • Not more Funding but • Smarter Spending

18. HSE Staff 2013

19. Practising Doctors per 1 000 Population

20. Hospital Beds per 1 000 population,

21. GPs, Specialists and other Doctors 2009

22. GPs, Specialists and other Doctors 2009

23. Doctors Consultations per Capita 2009

24. Gynaecologists and Obstetricians per 100 000 Females 2009

25. Key Issue • Misallocation of Resources • Too few medics at the front line • Too many others in offices • Failure • to rationalise HSE when created • Integrated computer system

26. Medics Key Action • Increase number of GPs by factor of 2 • Increase number of Consultants by factor of 2.5 • Redeploy resources

27. Redeployment of Resources Where the savings?

28. Introduce State of the Art InformationTechnology&reduce size of Administration

29. HSE Staff 2013

30. Management Administration & Support Staff • If numbers reduced by 25% • Potential savings ≥ €500 m *Number November 2012, NSP 3013

31. Drugs

32. Treasure Island • Pharma sector dub Ireland: ‘Treasure Island’ • Atorvastastin • UK €2 • Ireland (new reference price) €9.14

33. Pharmaceutical expenditure growth Annual per capita 2000-09

34. Expenditure on pharmaceuticals per capita % GDP, 2009 Irish expenditure 36% above OECD average

35. Cost of Month’s Supply 2012 Source; Sligo Today 10 Aug 2012

36. Savings: Drugs • Current expenditure €1.9 b • Cut expenditure by 36% to OECD average • Savings €690 m • Or cut by 73% to UK level (based on Donegal/Derry report) • Saving €1,380 m

37. Absenteeism

38. Absenteeism Rates 2012 • Varies between 2.9% and 7.06% • Mean value ~ 5% • Private sector norm ~ 2.5%

39. Absenteeism • Medical/Dental 1.2% • Nursing 5.3%

40. Savings: cut absenteeism • HSE pay bill 2013: • €7,147 million/y • cut in absenteeism from 5% to 2.5% • saving €180 million/y

42. Nursing

43. Practising Nurses per 1 000 population 2011 Note: Data includes all nurses in healthcare , including those who work as managers, researchers, etc http://dx.doi.org/10.1787/888932524279

44. Hospital Nurses' Remuneration 2011

45. Nursing • HSE had 37,540 nurses in 2009 • Number reduced by c. 4,000 • OECD numbers list all practicing nurses including those in management, education, etc.

46. Primary Care

47. Irish Healtcare StaffingHSE NSP 2013

48. Public Health Expenditure 2013 million

49. HSE spend on General Practice million

50. Number Medical or GP Visit Cards million