Good morning Chair and members. Apologies for the delay. I thought the meeting was at 10 a.m. rather than 9.45 a.m. I am delighted to be here to update the committee on the progress of Sláintecare, particularly as it relates to workforce planning. I am joined by my colleagues from the Department, Ms Rachel Kenna, chief nursing officer, and Ms Breda Rafter, the principal officer for strategic workforce planning.
As Mr. Gloster has mentioned, progress on Sláintecare implementation has continued this year. The HSE health regions implementation plan was approved by Government in July. More than 558 consultants have signed the new public-only consultant contract, including 157 new entrants. I understand that figure is now higher and stands at around 620. The enhanced community care programme continues to make progress. Nearly 50,000 patient contacts were made by integrated care programme for older persons, ICPOP, teams in the year to July, with 69% of patients discharged home. In the same period 310,000 people were reviewed by the chronic disease management, CDM, programme, with 91% of those patients now exclusively managed in primary care. We have seen the largest expansion in eligibility for GP care without charges ever undertaken in the history of the State, with free GP visit cards to children aged 6 and 7 commencing on 11 August and the extension of cards to those who earn the median household income or less commencing earlier this month. As the committee will be aware, at the beginning of September the free contraception scheme was expanded to include women aged 27 to 30 years old.
We are amid the largest expansion of the healthcare workforce in the history of the Irish State. In August the total workforce stood at 142,468 WTEs, equating to more than 160,000 people employed in our health services. This is an increase of approximately 22,500 WTEs employed in the system, or 19% since the beginning of 2020. This expansion includes more than 6,500 extra nurses and midwives, 3,000 health and social care professionals and over 2,000 additional doctors and dentists. Alongside this unprecedented expansion in workforce, we are also facing unprecedented demands. We have a rapidly growing population and one which is aging as never before and we are starting to see the impact of that right across all service areas. That increased burden is felt particularly acutely in the acute system. We see, for example, that emergency department attendances by those aged over 75 are up 21% in the last four years, while admissions from emergency departments of patients over 75 are up by over 15%. In relation to scheduled care, we have seen a very significant increase in the number of additions to the waiting lists in the year to date. We are somewhere in the region of 15% to 20% above 2019 levels. There have been very significant increases in activity right across all aspects of the health system. The Minister is committed to continuing to grow and expand our workforce over the coming years, as well as ensuring that they work differently and more efficiently if we are to meet the growing and changing needs of our people.
We hear much commentary about healthcare professionals emigrating but the reality is that Ireland has both inward and outward migration of health professionals. Approximately 70% of our nursing and midwifery workforce entering the register last year were educated abroad. While Ireland has a relatively high number of nurses per capita among OECD countries, more than 45% of the overall nursing and midwifery workforce, as of December 2022, was not trained in Ireland. There remains, therefore, an urgent need to increase the domestic supply of nurses and midwives to meet expected increases in demand and to reduce Ireland’s reliance on foreign-educated nurses and midwives. Similarly, Ireland had the fourth highest proportion of foreign-educated doctors among OECD members in 2021, at over 40%. Clearly, our health service could not function without these staff from abroad. Given the enormous international competition for healthcare staff, it is worth saying that we are enormously grateful to them for choosing to work in the Irish health service. That said, it is also the case that continued reliance on healthcare staff from abroad is neither ethical nor sustainable. We simply have to educate and train far more healthcare professionals ourselves.
As I said at a previous meeting of this committee, there were 1,400 medical student places available in the Irish education system in 2021-22. We have the highest medical graduate output per capita in the OECD. However, at 46%, far too high a proportion of those graduates is made up of non-EU students. The result is that many of those who graduate from Irish medical schools return home for their further training and are lost to our service. This historic undersupply of doctors within the medical education and training system has contributed to a situation whereby there is an overreliance on foreign-educated doctors and relatively few consultants compared with the situation among our international peers.
Working in close collaboration with the Department of Further and Higher Education, Research, Innovation and Science, the Minister for Health, Deputy Donnelly, has begun to increase significantly the number of student training places across medicine, nursing and midwifery, and health and social care professionals. We have an agreement in place with the medical schools, co-funded by the Department of Health, which will see an increase of 200 in the number of Irish and EU student places in medicine by 2026. This is a good start but, I acknowledge, no more than that. Between 2014 and 2021, first-year nursing and midwifery places in higher education grew by almost 30%. An additional 662 student places are being provided by the higher education sector on health-related courses in the 2023-24 academic year. As mentioned previously, this includes approximately 200 student places the Department is directly funding in Northern Ireland. Further work is under way to increase the domestic supply of healthcare professionals. A recent Higher Education Authority, HEA, expressions of interest process found that, with investment, an additional 208 doctors, 692 nurses, 196 pharmacists and 63 dentists could potentially be trained annually. This will require significant public investment, which will have to be considered in the context of future budgetary and Estimates processes.
Additional funding of €4.6 million was provided by the Minister, Deputy Donnelly, in budget 2023 for extra intern and postgraduate medical training places. This facilitated an increase of 133 specialist training doctors in the health service. A total of 24 extra interns were provided in July this year, bringing the total number of doctor intern posts for the July 2023-24 intake to 879. The Department has been working closely with the HSE and postgraduate training bodies to increase the number of training places and consultant posts available. The total number of interns increased by 12% over the past five years. The initial specialist training intake increased by 21% and the higher specialist training intake by 27%. The number of doctors in training in Ireland now stands at 4,167, which is an increase of 4.5% since 2021-22 and, I presume. the highest number we have ever had. The number of year-one higher specialist training posts increased by 10%. The number of approved consultant posts increased by 9% to more than 4,100 in 2022, with further increases in prospect for this year.
The annual intake to the GP training scheme has increased by more than 80% since 2015. The number of GPs entering training has increased to 287 this year, with 350 places planned for next year. From 2023 to 2027, we expect that between 1.5 and 3.1 GP graduates will enter the service for each retiring GP. While this replacement rate figure is a bit crude, it is a useful measure that shows the potential increase in GP capacity that is in prospect.
I have already referred to nursing and midwifery. There is more detail in the document provided to members.
In 2021, the Department initiated a project that aims to use scenario-based projections and modelling of health and social care workforce supply and demand to inform ongoing strategic health and social care workforce planning. A key element is the development of the health and social care workforce planning model, which offers an approach for projecting our potential long-term staffing needs for the health sector. This analysis suggests that, notwithstanding the progress we have made in recent years, we will need many more healthcare professionals in the future than the Irish higher education sector is currently producing. Of course, workforce planning is not only about training more healthcare professionals. We will have to do much more. We need to find new ways of working. We must improve productivity by working and training in different ways. We will have to maximise retention of staff. Finally, we need to move to a seven-day service right across the health system if we are to meet the health needs of our people into the future.
I look forward to engaging with the committee on these issues.
