Health service has a deficit of almost 1,000 hospital beds, ESRI estimates

An additional 300 beds a year are needed to meet demographic pressures, according to report

The health service is short of almost 1,000 hospital beds now, and needs an additional 300 new beds a year to keep up with demand, a new study estimates.

The shortage of inpatient beds is likely to be a key contributor to recent overcrowding in public hospitals, according to the study by the Economic and Social Research Institute (ESRI).

Deficits in bed capacity remain despite increases in absolute and per capita bed numbers in recent years, it notes.

Ireland has the lowest bed capacity in Europe relative to population and the highest occupancy rates, with levels often above international safety standards.


The report highlights the demographic pressures on the system, with the population projected to rise by 1 per cent a year to 2035, and the population of over-65s rising by 3.5 per cent a year.

In addition to public health beds in hospitals, step-down and rehabilitation beds are required in the community and in lower-acuity care facilities, as well as extra staff.

And while Sláintecare, which emphasises care in the community, will reduce bed capacity needs in hospitals, at least in the medium term “policymakers should be realistic about the need to invest in the hospital acute system”.

The report estimates over 900 extra beds are needed but says that in one scenario a further 330 would be required. Existing Government plans may underestimate the additional capacity needed, the authors say.

Meanwhile, a study on Ireland’s handling of the Covid-19 pandemic has concluded that much of the health service responded effectively, despite an unpromising start.

Opinion polls show the public and health service staff thought the Government “got its response largely right,” the collaboration between Trinity College Dublin’s centre for health policy and international researchers asserts.

While Covid-19 provided a “profound stress test” for the health service, with time “decision-making became much more agile and evidence-informed, with a reasonably fast response to the pandemic, appropriate stringency and general compliance with public health advice”.

Extra resources were provided, there was significant innovation, and linkage with the private sector was developed quickly. “Nevertheless, decisions made around private nursing homes, shutting transport links and occasionally ignoring public health advice had profound consequences.”

The report, which seeks to assess the resilience and sustainability of the system through its performance during the pandemic, says it is clear “imperfect” decisions were made, such as the slow expansion of testing capacity, the failure to block travel from heavily infected regions earlier and differing responses on either side of the Border.

“A key question,” the report states, “is to what extent mistakes are inevitable or even acceptable”. It quotes one unnamed “commentator” saying “once the emergency is over, the people who made an awful lot of right decisions will end up getting kicked up and down the street for the few they got wrong”.

“By and large, the Government delivered a sufficiently clear, strong and flexible response to the pandemic which was typically viewed as appropriate by the public and viewed positively by health sector staff, translating into comparatively low excess mortality rates.”

The report also describes the gap between current practice and what is required to achieve environmental sustainability in healthcare as enormous, with demand increasing and huge gaps in decarbonising activities.

While Ireland invested heavily in health during the pandemic, “questions remain concerning whether such high levels of investment can be maintained and put to good use”. About €2 billion of spending on Covid-19 related care could be available post-pandemic to meet backlogs and invest in healthcare priorities, the report says.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times