Minister for Health Stephen Donnelly welcomes the publication of the fourth and fifth research papers in the ‘Healthcare Capital Investment in Ireland’ series

• research will inform capital investment prioritisation through the new Strategic Healthcare Investment Framework in Ireland to ensure a strategic, effective and efficient approach is applied to public investment in health going forward
• an analysis of built healthcare infrastructure and healthcare service capacity is provided, with insights into the regional distribution of facilities and services

The Minister for Health Stephen Donnelly and the Minister for Public Expenditure and Reform, Michael McGrath, today published the fourth and fifth papers in the ‘Healthcare Capital Investment in Ireland’ series as part of the 2022 Spending Review process to improve the evidence base for policy decision making.

The aim of this work is to inform capital investment prioritisation through the new Strategic Healthcare Investment Framework in Ireland. This Framework, due to be published next month, will better align investment with the needs of the health system, the Climate Action Plan, the National Planning Framework, and National Development Plan.

• the research papers to be published provide an overview of acute and community beds, radiological equipment, and community-based healthcare practitioners by region, as well as an overview of the age, condition, quality, functional suitability and potential maintenance requirements of the healthcare portfolio
• the papers identify differences in the use of healthcare infrastructure capacity by Regional Health Area (RHA) in a range of areas, informing considerations around the spread of planned investment in service capacity across a number of settings to ensure even access to care and its use
• the analysis provided in the papers provides the groundwork for evidence informed prioritisation of infrastructure projects through the upcoming Strategic Healthcare Investment Framework (SHIF)
• further analysis will be required in each case to determine the appropriate level of healthcare infrastructure by Regional Health Area taking account of factors including future demand, different population structures and the presence of national centres of excellence in some regions

Minister for Health Stephen Donnelly welcomed the publication saying:

These papers build on the initial papers in the Healthcare Capital Investment in Ireland series, and the subsequent Strategic Investment Framework will seek to ensure a strategic, effective and efficient approach is applied to public investment in Health going forward.

The full research papers are attached:

1. An Analysis of Healthcare Infrastructure Capacity

2. An Analysis of Built Healthcare Infrastructure

The 6 Regional Health Area (RHAs) will cover the following areas:

Area A - North Dublin, Meath, Louth, Cavan, and Monaghan.

Area B - Longford, Westmeath, Offaly, Laois, Kildare, and parts of Dublin and Wicklow.

Area C - Tipperary South, Waterford, Kilkenny, Carlow, Wexford, Wicklow, part of South Dublin.

Area D - Kerry and Cork.

Area E - Limerick, Tipperary and Clare.

Area F - Donegal, Sligo, Leitrim, Roscommon, Mayo, and Galway.

Paper 4: Analysis of Healthcare Infrastructure Capacity

Summary

This paper provides an analysis of healthcare infrastructure as it relates to service capacity and provides insights into access to care such as beds and radiological equipment by region.

The authors find that healthcare infrastructure capacity varies by Regional Health Area (RHA), thereby motivating considerations around the spread of planned investment in the coming years to ensure even access to care and its use.

The analysis provided in this paper provides the groundwork for evidence-based prioritisation of infrastructure projects facilitated by the upcoming Strategic Healthcare Investment Framework (SHIF). This will inform future healthcare infrastructure investment decisions across a range of care settings.

Findings

The paper finds variation in the distribution of infrastructure capacity in many service areas and the factors that account for this, including:

• CCU Capacity: There is variation in CCU bed access by Regional Health Area adjusting for population, with RHA A, B and E having significantly more CCU beds relative to population than RHA C, D and F. This variation is likely to be partially reflective of the presence of National Centres of Excellence in some Regional Health Areas and the associated higher acuity care provided in these hospitals. HSE is nearing completion of delivery of Phase 1 of the strategic multi-year plan to expand adult critical care capacity with attention now focused on delivering Phase 2 which looks to deliver a total of 446 CCU beds in the long-run
• trolleys: The number of patients on trolleys is consistent across five out of seven Regional Health Areas. RHA A appears to have significantly lower numbers of patients on trolleys than all other RHAs, indicating the relative effectiveness of their emergency departments
• access to Day Procedures: The number of patients on waiting lists per ambulatory beds available is highly skewed, with 36 patients waiting per bed in RHA F, compared to just 12 patients per bed in RHA E
• access to radiological equipment: The levels of access to radiological equipment varies across Regional Health Areas with RHA F having 8.4 X-rays per 100,000 population compared to 5.5 in RHA E. This may influence the levels of unmet need and delayed discharge in each region. 47% of X-ray machines are over ten years old, implying the need for investment and replacement strategy for these assets

These findings will serve as an important input for further investment considerations, however further analysis will be required to determine the appropriate level of healthcare infrastructure by Regional Health Area (RHA) by taking account of factors including future demand, different population structures, and the presence of national centres of excellence and clinical care networks. This will be facilitated by the publication of the forthcoming Strategic Healthcare Investment Framework (SHIF).

Paper 5: Analysis of Built Healthcare Infrastructure

Summary

This paper provides an analysis of the physical infrastructure within the HSE Acute and Community care settings.

The analysis presents an overview of the condition, quality, energy efficiency, maintenance requirements and functional suitability of the HSE Estate for both the Community and Acute Care settings.

The analysis presented can be used to inform future healthcare infrastructure investment on the basis of all the areas considered. While specific analysis will be needed in a given region and service area to identify and prioritise planned investment, the paper outlines an evidence base for reference that can be used in addition to findings from the previous paper “An Analysis of Healthcare Infrastructure Capacity”.

Findings

This paper has a number of findings in relation to the appropriateness of public healthcare infrastructure in Ireland, including:

• Ageing Capital Stock - The age of both Community and Acute Facilities, varies significantly with a large proportion of both portfolios being built over 40 years ago. This likely has negative associated impacts on maintenance costs, patient safety and efficiency in healthcare service delivery
• Quality of Stock - The overall quality of the Community Care portfolio is good with over 90% of all sites receiving B or above scores across all four categories measured. The quality of the stock within the Acute setting is much more varied, with 43% of sites having a quality score below the recommended B rating
• Energy Efficiency - Just 28% of the top 120 energy users in the HSE portfolio exceed a B3 Display Energy Certificate rating. While the full monetary cost of achieving retrofitting and net-zero energy needs continues to be developed it is likely that significant investment will be required to achieve carbon abatement targets in the health sector in line with government objectives
• while more detailed analysis will be required to inform need and priorities in a given service area region, the evidence presented in this paper provides a baseline for any future healthcare investment planning supported by the publication of the Strategic Healthcare Investment Framework (SHIF)

Reports