Elective Hospitals

As part of the Sláintecare vision for the future of healthcare in Ireland, in December 2021 the Government committed to establishing new standalone national Elective Hospitals in Cork, Dublin and Galway. These will enable the delivery of high-quality and timely elective care services to address the known demographic changes to 2035 (up to a 40% increase in day-case surgeries) with significant additional service delivery capacity. The additional capacity to be provided by the overall Elective Hospitals Programme (in terms of procedures, treatments, and diagnostics) is estimated to be 977,700 annually. Separating elective and non-elective care will further help to free up capacity in existing healthcare facilities to better address unscheduled care needs.

In December 2022, the Government approved the next stage of the Enhanced Provision of Elective Care Programme and progression of the development of new Elective Hospitals at proposed sites in Cork (St Stephen's Hospital, Sarsfield Court) and Galway (Merlin Park University Hospital). A memorandum to Government in May 2024 noted that there are two emerging preferred sites for the development of new elective hospitals in Dublin, at Connolly Hospital in Blanchardstown and at the current Children’s Hospital site in Crumlin.

The HSE is now progressing the planning phase of the programme. This includes the procurement of an Architect-led Design Team which will be appointed in 2024 to progress the detailed design and pre-tender business cases.

Further information on the Elective Hospitals Programme is available in the Programme Overview and FAQ Documents.

Significant international evidence (including from Canada, the United Kingdom and many other European countries) supports the separation of emergency (unscheduled) and elective (scheduled) care for improving services for all patients. The separation of care can lead to fewer cancellations and fewer delays for elective care caused by seasonal surges, localised outbreaks, and surges in emergency attendances. Reducing waiting times for elective cases 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 for their families.

The greater elective care capacity created will also release capacity in existing hospitals for non-elective and inpatient activity. Allowing the new Elective Hospitals to focus on elective-only treatment will mean better care for all patients.

Besides providing a learning and continuous improvement environment, the additional healthcare delivery capability provided by the Elective Hospitals will be focused on providing the following services:

1. Day cases

2. GI Endoscopies

3. Minor operations

4. Outpatient treatments

5. Outpatient diagnostics services

The Elective Hospitals will be processing cases that are relatively low acuity and high-volume in their nature. Some examples of such cases include cataracts, gallstones, hernias and tonsillectomies.

The locations chosen for the new Elective Hospitals will allow for new facilities of an appropriate size and scale to ensure the implementation of a national elective care programme which will improve overall access to healthcare by reducing waiting times on a national basis. The new facilities will be designed to maximise their capacity and in doing so will operate to cover as wide an area as possible, extending beyond existing and future health regions. This new delivery capability in the public healthcare service will benefit the whole population, including those who do not fall within the immediate traditional geographical catchment.

In December 2022 the Government gave approval-in-principle to the Preliminary Business Case for the programme and the project-level business cases for Cork and Galway. The preferred sites identified for the development of the new Elective Hospitals are:

• Cork: St Stephen’s Hospital, Sarsfield Court.
• Galway: Merlin Park University Hospital.
• Dublin: A memorandum to Government in May 2024 noted that the two emerging preferred sites for the development of new elective hospitals in Dublin are at Connolly Hospital in Blanchardstown and at the current Children’s Hospital site in Crumlin.

The Oireachtas Committee on the Future of Healthcare Sláintecare Report (2017) articulated a new vision for healthcare in Ireland, including the provision of elective only hospitals, providing protected capacity for elective care. This approach has since been confirmed by various policy documents and Government decisions including 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.

In December 2021, the Government approved the National Elective Ambulatory Strategy to progress capital investment proposals for the establishment and operation of dedicated elective hospitals in Cork, Galway, and Dublin. In December 2022, the Government approved Preliminary Business Cases for this programme as a whole and for preferred sites in Cork and Galway. The business case for Dublin is currently under development and will be brought to Government in due course.

To ensure that the right procedures, locations, and sites are selected, and that they ultimately represent the best value for taxpayers’ money, careful planning and deliberation is required. The programme is therefore being developed in line with the Infrastructure Guidelines, which ensures that capital investment decisions are underpinned by a clear policy rationale and that costs, risks, and mitigating actions are well developed and understood.

Preliminary business cases (PBCs) have been produced for the Elective Hospitals programme and the individual projects in Cork and Galway. The Programme PBC provides the overall rationale for the programme and sets out high-level expectations for what will be delivered. The individual project-level business cases provide detailed considerations of available sites and the process to determine the recommended sites to be taken forward to the planning stage at each location.

The PBCs have undergone extensive internal and external assurance, as required by the Infrastructure Guidelines. This included detailed consideration by the Major Projects Advisory Group (MPAG). In December 2022, the Programme PBC as well as the project-level PBCs for Cork and Galway were approved by Government at Decision Gate 1. The Dublin PBC is in development and will be considered at Gate 1 in due course. Subsequently all Business Cases will be considered at Gate 2 (approval to proceed to tender) and Gate 3 (approval to award the main construction contract) of the Infrastructure Guidelines.

Further information on the Elective Hospitals Programme is available in the Programme Overview and FAQ Documents.

The PBCs can be downloaded below. A Cover Note to the Cork and Galway PBCs is also available which outlines how they were updated following their review by the MPAG.

In addition to the strategic development of Elective Hospitals, the Minister for Health announced in 2022 that the HSE would progress proposals for a shorter-term measure to deliver Surgical Hubs at locations across Ireland. These will provide additional elective capacity and will have a shorter-term impact on waiting times. The Hubs are based on the Reeves Day Surgery Unit at Tallaght University Hospital, which has successfully led to a 17% reduction in the total Day Case Waiting List at the hospital and a 34% improvement in the achievement of the 12-week Sláintecare access target for day case procedures.

The sites for the new Surgical Hubs are as follows:

• South Dublin: Mt Carmel
• North Dublin: Swords
• Galway: Merlin Park
• Cork: Cork University Hospital
• Limerick: Scoil Carmel site
• Waterford: Former Glanbia site

The Surgical Hubs are expected to commence seeing patients in 2024 and 2025. Once fully operational each Hub will be able to deliver over 25,000 day cases, minor operations and outpatient consultations annually.