Press Release

Capacity Review shows investment and reform must go hand in hand if we are to break the cycle of hospital overcrowding – Minister Harris

The Minister for Health, Simon Harris, TD, today (Tuesday) said that investment and reform must go hand in hand if we are to break the cycle of hospital overcrowding.

The Minister was speaking as he published the report of the Health Service Capacity Review, which outlines projections of demand and capacity requirements for a range of health services to 2031.
The key findings of the report are as follows:

  • The system is operating at or above capacity across most services, and demand will grow significantly over the period to 2031.
  • If key reforms and productivity measures are implemented, the following additional capacity will be required by 2031:
    • nearly 2,600 extra acute hospital beds
    • 48% increase in Primary Care workforce
    • 13,000  extra residential care beds (older persons services) and;
    • 120% increase in homecare

The Minister welcomed the publication of the report, stating that “Increasing capacity in the health service is vital but this must be done based on evidence. That is why commissioning this Bed Capacity Review was a priority for me. It looks at capacity needs of the health service not just now, but up to 2031. This kind of analysis is integral to future planning. The completion of this review is timely as we enter a new period of investment in our public services and it clearly outlines the need for investment and reform in the Irish healthcare system and provides quantitative evidence for this.”

In relation to future demand for health services, the Minister said, “We know we have entered a relatively new phase of demographic ageing in Ireland. Our population also continues to grow. These changes will have particular impacts on the demand for health services, as older age cohorts tend to be the highest users of most health services. The findings of this review are broadly consistent with a separate analysis of future demand for healthcare undertaken by the ESRI last year and give us a clear indication of the extent of demand increases to expect.”

The Minister concluded, “This report, which was internationally peer reviewed, provides us with a very important evidence base, which will inform future investment and policy decisions. It is clear that investment and reform must now happen in tandem and must be mutually supportive of each other.  That is why as Minister for Health I am committed to delivering both. The findings of this review are being considered in the context of the upcoming National Development Plan, while the implementation plan for Sláintecare, which will be considered by Government shortly, will set out a clear roadmap for reforming our health service.”


Notes for Editors

Health Service Capacity Review 2018

The capacity review was a key commitment in the Programme for a Partnership Government, and was commissioned in response to the growing demand for health services.  

It is the culmination of a year-long project within the Department of Health. A Steering Group comprising senior officials from the Department of Health, Department of the Taoiseach, and the HSE, and clinical and academic experts including representatives from the ESRI and NUI Galway oversaw the Capacity Review.  An independent international peer review group was established to review and validate the methodology and approach.  PA Consulting was commissioned to provide technical, analytical and engagement expertise.  

The Capacity Review examined capacity requirements in key elements of acute care, primary care and services for older people. Mental Health and Disabilities were not within the scope of the project. The Terms of Reference of the Review were:

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

b)        To determine drivers of future demand and estimate impact on capacity requirements to 2031.

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

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 report of the Health Service Capacity Review was produced by PA Consulting on behalf of the Department of Health.

Key findings:

  •  Two sets of forecasts are provided, the first is on the basis of no major change to our current system, and the second is on the basis of significant reform and productivity improvements happening over the next decade.
  • The population is forecast to increase by 12% over the projection period, with an increase of nearly 60% in the 65 years+ age cohort. The number of people aged over 85 years is projected to double.
  • The report projects that, over the next 15 years, demand for healthcare services will increase by [full details in Executive Report, Table 5]:
    • 46% in primary care
    • 39% for long-term residential care
    • 70% for homecare
    • 24% for non-elective in-patient episodes in public hospital
  •  The report provides capacity forecasts on the basis of two alternative scenarios:
    • A baseline “status quo” scenario which assumes no major change in the way health services are delivered and a continuing over-reliance on the acute hospital system.
    •  A reform scenario which considers the impact of a range of potential reforms including health and wellbeing initiatives, a fundamental change in the model of care, and productivity improvements.
  •  Without reform, the following capacity increases are projected to meet this increase in demand [full details in Executive Report, Tables 6,7]:
    • over 7,000 extra acute hospital beds
    •  37% increase in  Primary Care workforce
    •  12,000  extra residential care beds
    •  70% increase in homecare
  •  If reforms are implemented, the following capacity increases are projected to meet this increase in demand [full details in Executive Report, Tables 12,13]:
    • nearly 2,600 extra acute hospital beds
    • 50% increase in Primary Care workforce (including approximately  1,000 extra GPs, 1,200 extra practice nurses and 1,100 extra Public Health Nurses)
    • 13,000  extra residential care beds and;
    •  A 120% increase in homecare (homecare packages and home help hours)
  • Finally, the report highlights that Ireland’s acute hospital occupancy levels are around 95%, far in excess of the international norm of 85%.These occupancy levels mean that at times of peak demand, such as being experienced at the moment, hospitals have extremely limited available “surge” capacity. The report calls for this to be addressed in the short term.