Budget 2025 Ask #6 - Building Healthy Communities: Tackling Health Inequalities in Ireland, starting with Budget 2025

Health inequalities remain a significant challenge in Ireland, where access to healthcare and outcomes are shaped by socioeconomic disparities. Figures from the National Treatment Purchase Fund highlight the growing strain on Ireland’s healthcare system. As of April 2024, over 86,827 people were awaiting in-patient treatment, with 15% of them waiting for over a year. Additionally, 589,225 people were on outpatient waiting lists, and 18% had been waiting for more than a year. These figures reflect broader systemic issues, exacerbated by funding shortfalls, and contribute to the widening gap between the rich and poor when it comes to health outcomes.

The State of Health Inequality in Ireland

Ireland ranks lowest in accessibility according to the Euro Health Consumer Index (2018), and the situation has not improved significantly. The OECD Health at a Glance report shows Ireland's health expenditure is 6.1% of GDP, below the OECD average of 9.2%. While other nations invest heavily in public health infrastructure, Ireland’s underfunding leads to growing waiting lists, delayed treatments, and unmet healthcare needs.

Moreover, socioeconomic disparities create substantial barriers to accessing care. The OECD report highlights that 43% of people in the bottom 20% of the income distribution report having a long-term illness, compared to just 27% in the top 20%. Ireland has one of the largest income-related health gaps in the OECD, with those in the lowest income brackets twice as likely to suffer from chronic health problems.

Adding to this burden, Ireland has the highest outpatient healthcare costs, with healthcare expenses consuming about 40% of household spending for many families. For lower-income households, these costs can be prohibitive, leading to delayed or skipped treatments, which in turn worsens health outcomes.

Role of Community and Voluntary Organisations

Sector organisations, including community and voluntary groups, play a vital role in addressing health inequalities. These groups are often the first responders to local needs, especially in marginalised communities where access to healthcare is limited. They promote preventative care, advocate for more equitable services, and offer innovative solutions to unmet health and social care needs.

However, many of these organisations are hampered by the lack of multi-annual funding. This short-term approach to funding increases operational costs, limiting the ability to plan for long-term projects or secure contracts for essential services like day-service locations or residential care. Inadequate funding also reduces the capacity to innovate or take advantage of opportunities that require more extended development periods, such as the Capital Assistance Scheme.

The Importance of Resourcing Sláintecare

Sláintecare, Ireland’s national healthcare reform plan, was introduced in 2016 to shift healthcare towards a community-based model. However, the system remains strained, with acute care hospitals operating at 90% capacity, the highest across OECD countries. This overwhelming demand has hindered Sláintecare’s ambition to reduce reliance on acute hospitals and deliver more care in community settings.

To support this transition, the government needs to prioritise capital investment in community health infrastructure. The proposed allocation for Sláintecare was €3 billion over six years, averaging €500 million annually. Adjusting for inflation, this would now require closer to €672.5 million annually. Budget 2025 must deliver on this investment to build a sustainable, community-oriented healthcare system.

Addressing Mental Health and Disability Needs

Mental health services in Ireland are under-resourced and unable to meet the growing demand. The Healthy Ireland Survey 2023 found that nearly 1 in 8 people had a probable mental health problem. HSE data shows that between April and June 2023, almost 25,000 people were referred to General Adult Mental Health Services, but only 13,629 received care. Similar shortfalls were observed in Child and Adolescent Mental Health Services (CAMHS), where thousands of children are waiting over a year for support.

Budget 2025 should focus on reducing waiting lists by investing in partnerships between State agencies and community organisations to provide mental health services at the local level. Collaboration between these sectors can help alleviate the burden on public services while delivering more accessible and holistic care.

In the disability sector, nearly 1 in 5 people in Ireland live with a long-term condition or disability, according to Census 2022. Community-based disability organisations provide essential services, including home care, personal assistance, and advocacy. These groups require adequate funding to continue delivering services that uphold the dignity and rights of people with disabilities, in line with Ireland’s commitments under the UN Convention on the Rights of Persons with Disabilities.

Health Dialogue and Co-Design

The establishment of the Health Dialogue Forum has been an important step in ensuring that community voices are heard in healthcare policy decisions. This forum, along with the Partnership Principles between voluntary organisations and the State, ensures that community and patient advocacy groups are included in the design and delivery of health services.

Budget 2025 should provide additional resources to these organisations to support the co-design of services, especially in the ongoing regionalisation of health services. Engaging community organisations in the process is essential to developing integrated systems of care that meet the needs of Ireland’s diverse population.

The Need for Budgetary Action

Ireland’s healthcare system faces critical challenges, from long waiting lists to deep-rooted health inequalities driven by socioeconomic disparities. While sector organisations have stepped in to address many of these gaps, they cannot continue to operate effectively without sustained funding and government support. Budget 2025 represents an opportunity to tackle these inequalities head-on, by increasing health funding, resourcing Sláintecare, and ensuring that every community has access to the care they need.

The Wheel’s Pre-Budget 2025 submission is available HERE