Projections from the ESRI show thousands more hospital beds are needed over the next 15 years. David Lynch reports
New research has reaffirmed what many doctors, and healthcare experts, have long known: We require many more hospital beds.
A recent report by the Economic and Social Research Institute (ESRI) projected that public acute hospitals will need at least 40 per cent more inpatient beds by 2040, in response to a growing and ageing population.
The report predicted that emergency department (ED) attendances will rise from 1.6 million in 2023 to between two and 2.1 million by 2040 – an increase of 20 to 27 per cent.
By 2040, the health service will require an additional 650 to 950 beds for day cases – a rise of 25 to 37 per cent. Inpatient bed demand is projected to grow even more sharply, with a need for 4,400 to 6,800 extra beds, representing a 40 to 60 per cent increase.
Responding to the ESRI report, Minister for Health Jennifer Carroll MacNeill said it would allow the Government to better anticipate future healthcare demand and capacity.
“While the required capacity increase is substantial, ESRI’s report also considers health policies that reduce potential demand,” said the Minister.
“Investing in improved population health, increased productivity, and reducing avoidable hospitalisations, will help us make the best use of bed capacity in the future.”
Demand
The Minister added that the continued implementation of Sláintecare “will shift care away from hospital settings”, better positioning the health service to meet future demand.
Dr Aoife Brick (PhD), ESRI Senior Research Officer and lead author, told the Medical Independent (MI) the report projected significant increases in capacity requirements for all services.
“This is mostly due to population change, growth, and ageing,” she said.
By 2040, Ireland’s population is expected to grow by between 600,000 and one million people (ie, by 12 to 20 per cent). “But more importantly – we also have an ageing population,” added Dr Brick.
Currently, about one in seven people are over 65. By 2040, that will be closer to one in five.
“That shift has big implications for healthcare in general, and hospital services in particular, as older people are very high users. This means that even at the lower end of our projections, which take a more optimistic view on, for example, healthy ageing and community care expansion, Ireland will need significant additional hospital capacity to meet future demand,” said Dr Brick.
In regard to the most effective strategies to reduce future inpatient requirements, Dr Brick said the ERSI analysis indicated the need for a focus on clinically appropriate reductions in length-of-stay and improvements in population health.
“This involves identifying opportunities to shorten hospital stays safely and to prevent emergency admissions altogether,” she told MI.
“Emergency inpatients currently account for five times more discharges and six times more bed days than elective inpatients. Therefore, targeted interventions in this area can have a significant impact.”
Possible interventions included enhancing vaccination coverage for conditions such as influenza and pneumonia to reduce potentially avoidable admissions and decrease length-of-stay. Dr Brick also pointed to a further expansion of community-based care, “particularly for the management of chronic conditions” to decrease avoidable ED visits and hospitalisations.
There is a need to increase access to step-down care, including short-term beds, rehabilitation services, and home support, to reduce delays in discharging patients to a more clinically appropriate setting.
The capacity review was conducted under the Department of Health/ESRI joint research programme in healthcare reform. The work uses 2023 as a base year, with demand and capacity projections out to 2040.
This report on acute hospitals is the first of a series of capacity review reports on Ireland’s health service. It will be followed by reports on general practice services and older persons care, with regional analysis being developed for later this year.
The acute care report found that outpatient department attendances are projected to grow from 4.6 million in 2023 to between 5.5 and 5.9 million by 2040 – a growth of between 21 and 28 per cent. Day-case discharges are projected to increase from 1.2 million in 2023 to between 1.5 and 1.6 million by 2040, a rise of 25 to 37 per cent.
Inpatient discharges and inpatient bed days are also projected to increase.
Inpatient bed days may increase from 3.9 million in 2023 to between 5.1 and six million in 2040, a growth of between 32 and 55 per cent.
IMO and IHCA reaction
For many years, the IHCA and IMO have raised concerns over the lack of bed capacity in the health system. Both organisations have broadly welcomed the publication of the new data.
In a statement to MI on the ESRI publication, the IMO warned it was “critically important” that any projections on future bed capacity “must not use the minimum end of the scale as a benchmark”. The statement added that analyses must consider the significant shortfall the system is currently experiencing.
The IMO stated that the ESRI’s bed projection estimates “are particularly low” given that in 2018 the Institute said that up to 5,600 additional public hospital beds were needed by 2030. The Organisation said just 1,500 additional beds have been delivered since 2018.
The IMO argued that the ESRI report “appeared to under-estimate the bed numbers required given at least 5,000 additional beds are needed immediately” to address chronic under-resourcing in the health system.
“Our shortfall in bed numbers has led to increasing trolley numbers, ever-lengthening waiting lists, increased doctor burnout, doctor recruitment and retention challenges and, worst of all, poorer patient outcomes,” said Dr Anne Dee, IMO President and a Consultant in Public Health Medicine in the Mid-West.
“It is unconscionable in 2025 that we do not have the bed numbers we need to cater for current patient demand, which would give us the foundation we need on which to improve service delivery.”
Despite continual warnings from the IMO, she said successive governments have failed to address inadequate bed numbers in the system.
The IHCA stated that the Government should “expedite the implementation” of its acute hospital inpatient bed capacity expansion plan. This plan, published in May 2024, aims to open 3,378 new beds by 2031.
The IHCA has also urged the six HSE health regions to publish in-depth regional projections of their acute hospital bed capacity requirements up to 2040. This is required to identify where to locate up to 6,800 additional inpatient beds needed to meet future demand for care.
“Consultants have also suggested that this regional analysis should identify where this additional hospital capacity can be accommodated on existing hospital campuses and where new hospital builds may be needed,” said the IHCA.
While noting both the Government plan and ESRI report “are positive steps in the right direction”, the Association emphasised that its members believe “timely delivery is crucial”. Any delays in expanding bed capacity have direct consequences on patient care, leading to longer waiting times and increased pressure on the health service.
The ESRI report is available at: www.esri.ie/publications/projections-of-national-demand-and-bed-capacity-requirements-for-public-acute
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