Assessment of capacity review is urgently needed

The HSE’s Capital Plan 2023 was published at the end of last month.

The health capital funding available in 2023 under the plan is €967 million. There is a further €50 million provided for capital infrastructure resulting from Covid-19 actions and an additional €10 million from income generated in 2022, leading to a total €1.027 billion.

Investment for the year includes: The completion of the New Children’s Hospital; advancement of the National Maternity Hospital; progressing Sláintecare initiatives to bring about the delivery of care closer to home; maintaining investment in minor capital initiatives; the delivery of the equipment and ambulance replacement programmes; and progressing the infrastructure and decarbonisation strategy and implementation roadmap in partnership with Sustainable Energy Authority of Ireland.

A priority within the capital plan is investment to facilitate reorienting the model of care away from acute hospitals and towards primary and community settings and addressing capacity and infrastructural deficits that exist in the health and social care services.

According to the Department of Health’s statement on the publication of the plan, all capital development proposals must progress through a number of approval stages in line with the public spending code.

Before it was officially published, there was criticism that a number of the ‘new’ 261 beds under the plan were to be replacements of the existing stock. For example, all the 12 beds for Portiuncula University Hospital, Co Galway, for this year will be replacements rather than additions.

The Department has recently commenced initial planning work to assess the implementation of the Health Service Capacity Review 2018.

The 2018 review examined demand within the system for the years 2012-2016 and made projections on the potential demand and capacity requirements for a range of hospital and community-based services for the years 2017-2031. Projections were based on demographic and non-demographic factors.

The review found the need for
approximately 2,590 additional hospital beds, comprising 2,100 inpatient, 300 day case, and 190 adult critical care beds.

Earlier this year, an Economic and Social Research Institute (ESRI) report stated “optimistic projection scenarios” listed in the capacity review and National Development Plan may underestimate bed requirements. The context of Ireland’s rapidly changing demographics and long waiting lists for care mean there may be a bed capacity deficit of approximately 1,000 inpatient beds in public acute hospitals this year alone, according to the ESRI.

“This bed capacity deficit is likely a key contributor to recent overcrowding issues experienced in public acute hospitals,” it stated. “In addition to the deficit that currently exists in the system, over 300 additional inpatient beds are required per annum to keep up with demand pressures arising from an increasing and ageing population.”

The need for long-term planning of the health service’s capacity requirements is a must. But regular monitoring is also needed to ensure that any plan is reflective of the latest data and demographics, and can be changed accordingly. And, of course, it is important that the results of such assessments are acted upon in a timely manner given the urgency of the problem.