Minister for Health welcomes publication of ESRI’s Health Service Capacity Review report on future capacity requirements for public acute hospitals
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From: Department of Health
- Published on: 28 May 2025
- Last updated on: 28 May 2025
Minister for Health Jennifer Carroll MacNeill has today welcomed publication of the first of three Health Service Capacity Review reports produced by the ESRI on behalf of the Department of Health. The report projects future demand for public acute hospitals in Ireland to 2040, indicating that a substantial increase in capacity will continue to be required to meet the demands of our growing and ageing population.
ESRI’s independent report sets out acute bed projections to 2040, with a range of 5,091 to 7,780 additional in-patient and day-patient beds required. It also projects an increase in Emergency Department attendances of between 333,000 and 444,000 by 2040 from a baseline of 1.6 million, and an increase of 950,000 to 1,298,000 out-patient department attendances from a baseline of 4.56 million.
In 2023, there were 5.3 million people in Ireland. This is expected to grow by 15% to 6.1 million by 2040. Approximately 87,000 people were aged 85 years and over, projected to more than double by 2040 to 204,000 people. Older age groups tend to use healthcare services more frequently and for longer durations. Bed day rates for males aged 90 years and over are 8,250 per 1,000 population, while females are 6,203 per 1,000 population. This compares to adults under 49, for whom the rates are less than 500 per 1,000 population.
Minister Carroll MacNeill said:
"I am grateful to the ESRI for this report, which highlights the capacity challenges we face in meeting the needs of our growing and ageing population. This evidence base is crucial for future planning, ensuring we have the facilities to provide the best care to patients. Increasing bed numbers and the necessary resources and workforce requires careful long-term planning.
"I am pleased that we are already making significant strides to increase patient capacity. Between 2020 and 2024, we opened 1,218 new acute inpatient beds, and the Programme for Government has committed to delivering thousands more through the acute bed capacity expansion plan, new surgical hubs, and elective treatment centres. With unprecedented uplift in funding and workforce increases in recent years, we are targeting future capital investment where it is needed most.
"While the required capacity increase is substantial, ESRI’s report also considers health policies that reduce potential demand. Investing in improved population health, increased productivity, and reducing avoidable hospitalisations will help us make the best use of bed capacity in the future. Continued implementation of Sláintecare will shift care away from hospital settings, better meeting future demand and delivering care to those who need it.
"We are still dealing with the aftermath of the COVID-19 pandemic. The disruption it caused to health services—and its effects—will likely be felt for a long time. This Capacity Review, a joint effort by the Department of Health and the HSE, reflects our commitment to responsive, agile, and evidence-based capacity planning, helping to deliver the best care to patients. With the Hippocrates projection model and our ongoing relationship with the ESRI, our planning process can be more responsive to new data, evidence, and policies as they emerge."
The Department of Health is committed to building a demand and capacity modelling capability, necessary for any modern health system, as part of the ongoing collaboration between ESRI and the Department of Health. The report being published today is the first of a series of Capacity Review reports on Ireland’s health service. Today’s report on acute hospitals will be followed by two further reports, on general practice services and older persons care, with regional analysis being developed for later this year.
Notes
2018 Capacity Review
The last Capacity Review was undertaken in 2018 to project future capacity requirements for the Irish health service. That review concluded that in all scenarios, there would be increased demand and also that significant reform was required.
The 2018 Review is now considered to be outdated and no longer fit for purpose. It did not include regionalisation, investment and demand shocks from COVID-19, or macroeconomic, demographic and cost shocks. We also have a changed – and changing – health and demographic landscape; with a growing, ageing and more diverse population combined with policy responses that have been developed as part of Sláintecare which need to be considered in our long-term planning (for example: urgent and emergency care, waiting lists programme, elective care)
2025 Capacity Review
The Department of Health and the HSE engaged ESRI as part of the DoH-ESRI ‘Joint Research Programme in Healthcare Reform’ to undertake a new Capacity Review to inform long-term strategic planning. The ESRI has built out their Hippocrates projection model that provides base year estimates and projections of demand, capacity and expenditure.
The Hippocrates projection modelling estimates activity rates in a 2023 baseline by age and sex. Demand is then projected by multiplying activity rates by projected population in 2040. Various assumptions and scenarios are applied to give a range of projections for services and bed capacity. The health services experienced significant disruptions to the usual trends in activity across COVID-19, and while services are recovering, the environment for future planning was more uncertain for the 2025 Capacity Review than for the 2018 Review.
The 2025 Capacity Review is projecting future demand (to 2040, at a National and Health Region level) for:
- Public Acute Hospitals
- General Practice services
- Older Persons services
The ESRI will be publishing national capacity projections over the coming weeks, with regional projections to follow later in the year. ESRI will also update the Hippocrates Query Interface (a version of the model with more limited functionality available to officials) for inclusion of latest available data.
The Capacity Review has identified the need for more detailed consideration of the capacity requirements for a number of areas of healthcare delivery. In 2025 and 2026, the Joint Research Programme will examine Occupancy Rates, capacity requirements for Short-stay, Rehab and Day Centre Care services and capacity requirements for Critical Care. These research projects will inform future capacity planning. Other areas of focus will be identified on an annual basis in line with strategic requirements of the health system.
In relation to activity rates, it is important to recognise that there was considerable disruption to healthcare delivery during the COVID pandemic. Parts of the health service have been reporting high post-COVID growth rates in activity, which have put pressure on the system and trends in activity have been less predictable than in the pre-COVID period. The 2023 base year was chosen as it reflected the most up to date post-COVID data available. Examination of the underlying data was undertaken to ensure the 2023 base year was robust. Patterns of healthcare utilisation in the 2023 base year are now broadly comparable to the pre-COVID period, providing confidence in the accuracy of the projections.
The Capacity Review will not be a one-off standalone piece of work, but rather the Hippocrates projection model will be developed over time to allow for the inclusion of future additional data (for example, Census 2026) and policy considerations as required, to produce regular capacity projections in the future. The projections can provide us with a baseline against which we can test the impact of different interventions.
Government activity
Significant growth in demand puts pressure on our health and social care services. As the ESRI report notes, Ireland did not always invest sufficiently in healthcare. However, we are now responding to this challenge in a number of ways, both in terms of investment in capital and infrastructure as well as significant health reform.
The Programme for Government has committed to increase capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country as well as increase ICU bed capacity by at least a further 100 beds. This is supported by the Acute Hospital Inpatient Bed Capacity Expansion Plan 2024-2031 which notes that Government is setting out on the largest planned expansion of public acute hospital inpatient capacity in decades.
The Capacity Review work is complemented by work being undertaken by the Department of Health to implement a Strategic Healthcare Investment Framework (SHIF) which will support the strategic assessment of health capital investment proposals to ensure health capital funding is being deployed to projects which best align with health policies, strategies and population requirements.
Sláintecare is leading efforts to move healthcare delivery away from a hospital-centric service. This reform is ongoing, as evidenced by the recent publication of the 2025+ Sláintecare action plan.