Time to address hospital capacity deficit

The scale of the capacity deficit within Irish acute healthcare has been laid bare in yet another report.

The previous official capacity review was undertaken in 2018. That review concluded increased demand for health services meant additional capacity was required across the system.

However, it is now considered to be outdated and no longer fit for purpose.

The Department of Health notes that the 2018 review did not account for regionalisation, the impact of investment and demand shocks resulting from the Covid-19 pandemic, or wider macroeconomic, demographic, and cost-related shifts. Since the pandemic, the healthcare and demographic landscape has continued to evolve, marked by a growing, ageing, and increasingly diverse population.

In recent years, the Department of Health and the HSE engaged the Economic and Social Research Institute (ESRI) as part of “a joint research programme in healthcare reform” to undertake a new capacity review to inform long-term strategic planning.

The first of the three planned reviews was published last month. The report, which focused on the acute service, projected a steep rise in demand for hospital care in Ireland over the next 15 years. By 2040, the number of inpatient beds in public acute hospitals will need to increase by at least 40 per cent to meet growing demand, driven largely by population growth and ageing.

Ireland’s population is expected to rise from 5.3 million in 2023 to between 5.9 and 6.3 million by 2040, depending on migration trends. The number of people aged 65 and over will grow substantially – from one in seven in 2023 to one in five by 2040. This demographic accounted for 60 per cent of inpatient bed days in 2023.

The report projects that emergency department attendances could rise to over two million annually, outpatient visits to nearly six million, and inpatient bed days to as many as six million. In terms of capacity, between 4,400 and 6,800 additional inpatient beds and up to 950 more day-case beds will be required.

While policy changes – such as reducing inpatient length of stay – could help manage the pressures, the ESRI finds that most of the increase in demand is unavoidable due to demographic trends.

The review underscores the urgent need for long-term planning and sustained investment to expand hospital capacity and ensure timely access to care. It will be followed by two further reports on general practice services and older persons’ care, with regional analysis being developed for later this year.

In her response to the report, the Minister for Health Jennifer Carroll MacNeill pointed out 1,218 new acute inpatient beds were opened between 2020 and 2024. While the Minister acknowledged the required capacity increase is “substantial”, she said the new review process with the ESRI will allow the planning process to be more responsive to new data and evidence as they emerge.

It could be argued, however, that the review is largely telling us what we already know. And at the end of the day, governments will be judged by the concrete policies they implement, not the number of reviews they commission. The challenge is clear. The time has come for those in power to address it.