Government approves next steps in development of new Elective Hospitals

• preferred site for Cork and Galway selected
• 5 Surgical Hubs to be developed

The Minister for Health Stephen Donnelly today received government approval of the next stage of the Enhanced Provision of Elective Care Programme and progression of the development of new Elective Hospitals in Cork and Galway.

The development of elective hospitals will change the way in which day case, scheduled procedures, surgeries, scans and outpatient services can be better arranged across the country, ensuring greater capacity in the future and help to address waiting lists.

The preferred sites, recommended to be brought forward into the planning phase, are at St Stephen's Hospital, Sarsfield Court in Cork, and Merlin Park in Galway.

The Cork centre with nine planned theatres, seven endoscopy suites and nine minor operation rooms is expected to provide 180,000 extra procedures, treatments and diagnostic appointments per year.

The Galway centre with a planned eight operating theatres, seven endoscopy suites and nine minor operation rooms is forecast to provide 175,000 additional procedures, treatments and diagnostic appointments per year.

The new national Elective Hospitals (two of which are being announced today) will be located in Cork, Galway and Dublin, and will provide services for the whole population, extending well beyond their traditional ‘catchment’ area. An announcement on the Dublin project will follow once its associated Business Case has been approved by Government.

Minister for Health Stephen Donnelly said:

The Elective Hospitals will be focused on providing Day case, GI Endoscopy, minor operations, outpatient treatment and outpatient diagnostics services. These cases are relatively low acuity and high-volume in their nature (for example: operations relating to cataracts, gallstones, hernias and tonsils).

The new Hospitals will deliver greater certainty for patients who will benefit from being given an appointment date in an Elective Hospital rather than being placed on a waiting list under the current system. The separation of emergency (unscheduled) and elective (scheduled) care will lead to fewer cancellations and delays for elective care caused by seasonal surges, localised outbreaks, and surges in emergency attendances.

The new national Elective Hospitals will deliver additional capacity for our growing and aging population and reduce patient waiting times for elective care. Early access to care can help to avoid patient conditions from deteriorating further while waiting for treatment. This will lead to better health outcomes and improved quality of life for those individuals being treated and their families. The greater elective care capacity created will also release capacity in existing hospitals for non-elective and inpatient activity.

The Minister also welcomed the government’s noting of HSE plans to work with Hospital Groups to progress proposals for a shorter-term measure by developing ‘surgical hubs’ in Cork, Galway, Limerick, Waterford and Dublin. The HSE will work with hospitals/hospital groups to develop these units on site or close to existing Model 4/3 hospitals. They will be modelled on the very successful Reeves Centre at Tallaght University Hospital. It is intended that they be developed and operational in 12-18 months and have a shorter-term impact on waiting times. Once the building was identified and procured, the Tallaght model took 12-17 months to open on a phased basis and we can use the learnings from the Tallaght model and develop these quickly. The cost for five surgical hubs is expected to be 90-100 million euro. This shorter-term intervention will also support efforts to consider the necessary reforms and enablers needed to separate unscheduled and scheduled care pathways that will be required by the longer-term provision of the Elective Care programme.

In December 2021, the government approved the National Elective Ambulatory Strategy to implement a national strategy of elective ambulatory care and to progress capital investment proposals for the establishment and operation of dedicated elective hospitals in Cork, Galway, and Dublin. It was agreed that the elective care scope of service be developed in two phases commencing with day cases, diagnostics, and outpatients and then by in-patient treatment.

The strategy is informed by a number of policy documents and Government Decisions, including the 2017 Sláintecare Report, the Health Service Capacity Review 2018, the Sláintecare Implementation Strategy (2018), the National Development Plan (2018), the Programme for Government (2020), the Sláintecare Implementation Strategy & Action Plan 2021-2023, and the Ireland 2040 National Planning Framework.

The Strategy for Elective Ambulatory Care represents a step-change in the ability of the national public hospital network to deliver high-quality and timely elective care services that will provide resources to address the known demographic changes to 2035 (up to a 40% increase in day-case surgeries) and significant additional service delivery capacity.

The development of the elective hospitals, in Cork, Galway, and Dublin, will provide coverage to more than 80% of the overall population (travel distance within 120km, or approximately 90 mins).

Some patients currently travel longer distances for some elective care procedures.

The proposed service model for elective services would be, initially, high volume, low complexity procedures, and a range of related diagnostic services. The range of specialties will account for approximately:

• 63% of all Day Procedures (excluding those relating to cancer and dialysis)
• 84% of all Day Case surgery waiters
• 60% of all Outpatient waiters

It is proposed that the new Elective Hospitals will provide, at a national level and specifically in sites in Cork and Galway, the following:

Table 1 – Additional service delivery assets, resources and capacity proposed from the enhanced provision of elective care programme

Enhanced Provision of Elective Care Programme (National)

Physical assets

• operating theatres - 42
• endoscopy suites - 42
• minor operation rooms - 48
• outpatient rooms - 173
• day beds - 588
• recovery trolley/chairs - 450

Staffing resources

• medical staff - 1,533
• non-medical staff - 152
• total additional staff - 1,685

977,700 procedures annually

• 223,500 Day Case surgery and Minor Operations
• 128,100 Endoscopy procedures
• 426,900 Outpatient diagnostics and treatments
• 199,200 Outpatient consultations

Patients

• 3,259 patients per day (operating 8 hours/day)
• 19,554 patients per week (operating 6 days/wk)
• 977,700 patients per annum (operating 50 weeks per year)

Table 2 – Additional service delivery assets, resources and capacity for the proposed Elective Hospital in Cork

Elective Hospital (Cork)

Physical assets

• operating theatres - 9
• endoscopy suites - 7
• minor operation rooms - 9
• outpatient diagnostic suites - 6
• outpatient rooms - 10
• outpatient consultation rooms - 16
• pre-op rooms - 4

Staffing resources

• medical staff - 300
• non-medical staff - 33
• total additional staff - 333

180,000 procedures annually

• 44,100 Day Case surgery and Minor Operations
• 21,300 Endoscopy procedures
• 76,200 Outpatient diagnostics and treatments
• 38,400 Outpatient consultations

Patients

• 600 patients per day (operating 8 hours per day)
• 3,600 patients per week (operating 6 days/wk)
• 180,000 patients per annum (operating 50 weeks per year)

Table 3 – Additional service delivery assets, resources and capacity for the proposed Elective Hospital in Galway

Elective Hospital (Galway)

Physical assets

• operating theatres - 8
• endoscopy suites - 7
• minor operation rooms - 9
• outpatient diagnostic suites - 6
• outpatient rooms - 10
• outpatient consultation rooms - 15
• pre-op rooms - 3

Staffing resources

• medical staff - 284
• non-medical staff - 33
• total additional staff - 317

175,500 procedures annually

• 42,000 Day Case surgery and Minor Operations
• 21,300 Endoscopy procedures
• 76,200 Outpatient diagnostics and treatments
• 36,000 Outpatient consultations

Patients

• 585 patients per day (operating 8 hours per day)
• 3,510 patients per week (operating 6 days/ wk)
• 175,500 patients per annum (operating 50 weeks per year)

In relation to Dublin, the development of the Preliminary Business Case is ongoing. Once completed, it will be submitted to internal and external review and then to Government for consideration. It is hoped to do this as early as possible in the new year.

Budget and process

The development of the additional elective capacity requires significant infrastructural investment and therefore their development is following the process outlined in the updated Public Spending Code (PSC), setting out the value for money requirements for the evaluation, planning, and management of large public investment projects.

It is too early to give precise project costs as they have yet to go through the planning and procurement stages. However, the preliminary business cases did set out indicative estimates:

• the indicative range for the capital budget for the build, technology and programme team for Cork is estimated to be between €614 million - €828 million
• the indicative range for the capital budget for the build, technology and programme team for Galway is estimated to be between €516 million - €695 million

More exact costs will be known following planning permission and procurement processes.

The government today gave “approval-in-principle” to pass Gate 1 of the PSC for a Programme-level Preliminary Business Cases as well as project-specific Preliminary Business Cases for Cork and Galway. Approval allows for the progression to the Decision Gate 2 stage which involves the development of the detailed project brief. Key elements include the appropriate procurement strategy that will also consider how best the national services will be commissioned, development of governance structures, developing and refining the budgets, developing the project designs (including for the statutory planning processes), and reviewing and confirming assumptions made within the PBCs. The Final Business Case will be brought back to Government for approval to deploy the tender strategy and procurement strategy. At Decision Gate 3 Government can give approval to award contracts for the project(s).

The expected timelines for Cork and Galway, based on current expectations and subject to the necessary approvals and affordability within the NDP capital envelope, is to reach Decision Gate 2 of the PSC by the end of 2023 and Decision Gate 3 by the end of 2025.

The Preliminary Business Cases have been subject to extensive and rigorous review, including by the internally by Irish Government Economic Evaluation Service (IGEES) and externally under the External Assurance Process and Major Projects Advisory Group.

Surgical Hubs

This initiative to address waiting lists in the shorter term, complementary to the electives programme but with a much narrower scope of procedures, will be modelled on the existing surgical unit at Tallaght University Hospital- the Reeves Centre. It has ensured waiting times for certain day-care procedures have fallen dramatically for patients awaiting care at that hospital.

These initiatives are estimated at a cost of €90 - 100 million between capital and revenue, which will be funded from within existing resources. Any further additional investment will be subject to the estimates process in the usual way.

This shorter-term intervention will also support efforts to consider the necessary reforms and enablers needed to separate unscheduled and scheduled care pathways that will be required by the longer-term Enhanced Provision of Elective Care programme.

The Reeves Centre Model

• this facility was developed as a dedicated centre for day cases only and it cannot be adversely impacted by the pressures of unscheduled care
• now open 24 months (December 2020) the total number of patients waiting on day case surgery has reduced by 58%, with those waiting over 3 months down by 91%
• very effective in certain specialties – it deals with Orthopaedics, General Surgery, Urology, ENT, Vascular, Gynaecology & Anaesthesia / Pain Medicine
• the centre is served by 50 full time staff including 35 nurses and 8 anaesthetists
• 4 fully operational day surgery theatres, with an 11-bed primary recovery unit and a further 14 beds in a second stage recovery unit