A challenging winter ahead for healthcare sector

From Covid-19 and the energy crisis to helping displaced people from Ukraine, Ireland’s healthcare sector is feeling the pressure warns Bank of Ireland’s head of Healthcare Sector Grainne Henson.

“The energy crisis threatens the health service, with those most vulnerable to fuel poverty at increased risk of adverse health consequences”

Health Service – Acute Hospitals

The HSE faces its third consecutive challenging winter with COVID-19 and the seasonal influenza. Furthermore, preliminary CSO Census 2022 data shows population growth exceeding projections not including approximately 55,000 displaced persons from Ukraine, with further arrivals expected.  

Additionally, the energy crisis threatens the health service, with those most vulnerable to fuel poverty at increased risk of adverse health consequences.

The HSE Winter Plan documents many initiatives aimed to mitigate emerging risks and seeks to deflect unnecessary presentation to acute hospitals. The private sector has potential to ease pressure on acute hospitals by providing services such as transitional and specialist dementia care through agreements with the HSE.

Nursing homes

Whilst Covid-19 is no longer a main concern for many businesses, their focus is instead on the turbulent external environment. It remains one of several challenges facing nursing home operators. Whilst case fatality and disease severity have decreased significantly thanks to the vaccination program, disruptive outbreaks continue to impact service delivery, staffing and occupancy levels, putting huge cost demands on the sector.

Government financial supports include the repurposed Temporary Assistive Payment Scheme and the Temporary Business Energy Support Scheme (TBESS). Despite these, in 2022, an unprecedented number of small nursing homes (< 40 beds, avg. 29 beds) closed or pivoted their business to accommodate displaced persons from Ukraine. This, alongside the proliferation of larger nursing homes (> 100 beds), is changing the Irish nursing home landscape.  

In continuing consolidation, German investor IMMAC Healthcare Group increased their nursing home portfolio to eight by buying Bethany House (90 beds) in Meath. Bartra sold four care establishments to Belgian real estate investment company Aedifica on a sale and lease back agreement in an €161 million deal that included Loughshinny (125 beds) in Skerries and Northwood (121 beds) in Santry. Bartra has also secured planning permission in Blackrock, south Dublin, for an age friendly designed 38 unit ‘later living’ facility and restricted to occupancy by those aged over sixty.

Nursing Home Support Scheme (NHSS)

The NHSS or ‘Fair Deal’ provides financial support for those in long-term nursing home care whereby, following financial assessment of income and assets, the resident pays a portion, and the balance is paid by the state.

In a bid to remove a disincentive for residents in nursing homes to rent out their vacant property, an update to the NHSS has now reduced the rate at which the rental income is assessed from 80% to 40%. 

This will allow residents to keep more of their income and will alleviate pressure in the rental market.

Home care

Sláintecare reform proposed expansion of social care to include universal access to Home Care with the ESRI projecting an increase of between 26%-30% in demand. 

As there is currently no Irish legislation or statutory regulations for the sector there is work now underway with the Department of Health and HIQA to introduce measures to provide a legal entitlement to home care as well as regulation, licensing, and minimum standards for providers, plus a new funding mechanism for service users.  

Plans will include a Statutory Home Support Scheme, akin to Fair Deal for Nursing Homes, enabling people to live in their homes with necessary supports if they choose to do.

Community pharmacists

Community Pharmacists are well positioned to promote and deliver flu and COVID-19 vaccinations, with 87% of patients stating they would be happy to access this service from their local pharmacist.

 Whilst the combination of reduced medicine reimbursements and cuts to pharmacy fees have put strain on the sector, Community Pharmacists continue to show resilience and provide an ever-expanding range of basic primary healthcare service including direct access to contraception.

Of concern to the sector is the shortage of pharmacists, with reports that it can take up to five months on average to fill a vacant position. This necessitates a reliance on expensive locum cover.

The Irish Pharmaceutical Union (IPU) workforce planning group, amongst other solutions, proposes fast tracking registration tor non-EU pharmacists. Some pharmacists are now offering innovative solutions such as profit share or equity share options to upcoming pharmacists.

Sector Developments & Insights November 2022

Main image: Photo by Luis Melendez on Unsplash

Grainne Henson
Gráinne Henson is head of health sector with Bank of Ireland’s business banking sectors team. She brings over 30 years’ experience of health service management in Ireland and the UK.