Health Service Capacity Review in Ireland 2018

Background to the Health Service Capacity Review in Ireland

The Department of Health in Ireland commenced in 2017 a national “bed” capacity review to inform future capital investment in the health service, now referred to as a Health Service Capacity Review in 2018. Early in the review process, it was decided that this review would take a more comprehensive view of capacity than previous exercises undertaken here which predominately focused on acute bed capacity only. It examined capacity requirements within the acute hospital system but also those areas that directly impact on demand for hospital services i.e. capacity and services provided in primary care and availability of non-acute beds and services in the community, for example residential care, home care etc.

We were also aware that thinking internationally had developed in relation to capacity planning and there had been efforts to better capture the dynamic nature of health systems. This was considered both in the policy analysis element of the Review and the creation of the reform scenario projections.

Review Structures

The Department led and oversaw the Review.  The Review oversight structures included a Steering Group (see membership in Table 1 below), and an International Peer Review Group (an independent peer group of international health experts – see membership in Table 2 below) with which the Department consulted, as necessary, to review and validate the methodology and findings of the Review, and the final report.  A project team in the Department supported the Steering Group and as part of the project, additional technical expertise on capacity modelling was commissioned to assist on the Review. PA Consulting provided the technical expertise for this project.

Terms of Reference for Capacity Review

The Programme for a Partnership Government committed to the undertaking of a “bed capacity review”.  It had been agreed that the review would have a wider scope than previous reviews and would examine key elements of primary and community care capacity in addition to hospital capacity.  The review was advanced sufficiently to inform the progression of the National Development Plan and was completed by the end of January 2018.

The terms of reference for the review are as follows:

a. To determine and review current capacity, both public and private, in the health system and benchmark with international comparators.

This included:

  • Mapping of current capacity and analysis of existing activity at national and regional level
  • Examination of relevant efficiency and effectiveness trends achieved by the sector
  • Identification and estimation of unmet demand
  • Mapping of patient pathways to identify connections of care and bottlenecks and to provide an analysis of implications for capacity
  • Benchmark against international comparators

b. To determine drivers of future demand and estimate impact on capacity requirements to 2030.

This included current unmet demand, demographics, health status, health innovations and health behaviours and rising expectations.

c. To consider and analyse how key reforms to the model of care will impact on future capacity requirements across the system.

This included:

  1. Expansion of services in primary care, including management of chronic disease
  2. Provision of suitable post-hospital care, including long-term and short stay beds and home care supports
  3. Optimising use of acute care to maximise patient flow and health outcomes for patients
  4. Operational efficiencies

d. To provide an overall assessment, including prioritisation and sequencing, of future capacity requirements on a phased basis for the period 2017 – 2031 at a national and regional level, cognisant of resource availability.

The Health Service Capacity Review was published in January 2018. For the Executive and Main reports please see here.

The conclusions from this Review are quite clear. Significant investment across all health services over the coming 15-year period is required in tandem with a fundamental programme of reform. Based on the findings of the Capacity Review, the Government committed to 2,600 acute beds, 4,500 community care beds and three new elective hospitals in Cork, Dublin and Galway. These commitments are part of a broader €10.9bn programme of investment for the health service to 2027.

The Capacity Review set out in broad terms what the potential impact of possible reforms might be – it was not tasked with detailing a comprehensive reform programme or how those reforms might be implemented.  However, the Sláintecare report has provided a clear direction of travel for reform, and the Sláintecare Implementation Strategy provides the framework through which reforms can be realised. The Sláintecare Implementation Strategy is now being carried out by the Sláintecare Programme Office, led by the Executive Director Laura Magahy.


Table 1 – Capacity Review Steering Group Membership
Organisation/Speciality Representative(s)



Colm O’Reardon, Policy and Strategy Division, Department of Health

Department of Health Tracey Conroy, Acute Care Division

Fergal Goodman, Primary Care Division

Frances Spillane, Social Care Division

Muiris O’Connor, Research and Analytics Division

Health Service Executive (HSE) Angela Fitzgerald, Deputy National Director, Acute Hospital Division, HSE

Michael Fitzgerald, Head of Operations & Service improvement, Services for Older People, HSE

Department of Public Expenditure and Reform No nominee confirmed.
Department of the Taoiseach Eileen Keogh, Social Policy Division
Public Health Specialist Paul Kavanagh, Specialist Public Health Medicine, HSE.
Public Policy Research Maev-Ann Wren, Senior Research Officer, Economic & Social Research Institute (ESRI).
Academic Eamon O’Shea, health economist, Irish Centre for Social Gerontology, NUIG (National University of Ireland, Galway)
Clinical (Acutes) Colm Henry, Consultant Geriatrician and National Clinical Advisor and Group Lead for Acute Hospitals
Clinical (Non-Acutes) David Hanlon, GP and National Clinical Advisor and Group Lead for primary Care.
Clinical (Nursing) Margaret Gleeson, Chief Director of Nursing and Midwifery, UL Hospitals Group (Limerick)


Table 2 – Members of International Peer Review Group
  • Carolyn Gullery, General Manager Planning, Funding and Decision Support, Canterbury District Health Board, New Zealand
  • Niek Klazinga, Professor of Social Medicine, University of Amsterdam; Coordinator Health Care Quality Indicator Program (OECD)
  • Steve Wright, international consultant in health policy and finance (British, based in Luxembourg)

Submissions to public consultation process in relation to the Health Service Capacity Review can be found here.