UCC SONM 25 Year Book

UCC / School of Nursing and Midwifery

Introduction During the period 1994 to 2019 demographic, environmental, social, epidemiological and technological advancements occurred as well as emerging trends in globalisation, free trade, individualism and inequity being evident. These have challenged the health services to respond. The changing profile, of the population most notably in the last two decades of the 20 th Century and the first decade of the 21 st saw immigration from Europe, Africa and Asia doubling the number of ethnic and racial minorities to 12% of the population of Ireland with Polish people constituting the greatest growth in numbers (Central Statistics Office 2018). In relation to health issues a significant reduction in the major causes of death such as circulatory system diseases, and cancer means that people are living longer healthier lives, life expectancy for women is 83.6 years and for men 79.9 years (Department of Health, 2018). However, Irish people are living longer with chronic diseases such as diabetes, Chronic Obstructive Pulmonary Disease (COPD), asthma and cardiovascular disease and with multiple co morbidities. The effects of unhealthy lifestyle practices, especially inadequate diet, sedentary habits, obesity and stress will most likely continue to challenge hospital and community services. In response to these trends the health services have undergone considerable change. Health policy has endeavoured to address the issues identified and set a vision for reform of the health services. The Health Strategy ‘Quality and Fairness’ (DoHC, 2001) and the Primary Care Strategy (2001) focused on a people-centred service, quality of care, accountability and principles of equity and fairness. The local Regional Health Boards were replaced by a centralised Health Service Executive (HSE) in 2005. A number of service pillars were established nationally such as population health, primary, community and continuing care and a national hospital office. Yet despite policies and a range of other documents setting out a future health service (Harvey, 2007) proposals have not been implemented and have received opposition from various bodies including the medical profession, the unions and the Department of Finance. Successive governments also seem to have taken the view that Ireland could not afford a welfare state as extensive as Great Britain or Northern Ireland. Thus a two tier health system is embedded with one third of the population covered with private health insurance and a growth in private hospitals and other facilities is apparent. A major factor influencing health policy implementation in the period 2009-2014 was the prolonged austerity resulting in decreases in financial funding despite increase in demand for health and social services. The programme for Government 2011 promised a single tier health

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