HEALTH SERVICE CAPACITY REVIEW 2018 REVIEW OF HEALTH DEMAND AND CAPACITY REQUIREMENTS IN IRELAND TO 2031 MAIN REPORT II HEALTH SERVICE CAPACITY REVIEW © PA KNOWLEDGE LIMITED HEALTH SERVICE CAPACITY REVIEW III Glossary ABF Activity Based Funding KPI Key Performance Indicator ACC Adult Critical Care LOS Length of Stay AHPs Allied Health Professionals MAU Medical Assessment Unit AL Annual Leave MIUs Minor Injury Units AMAU Acute Medical Assessment Unit MDTs Multidisciplinary Teams AMD Age-related Macular Degeneration NQAIS National Quality Assurance Improvement System AMU Acute Medical Unit NEL Non-Elective ANP Advanced Nurse Practitioner NHQRS National Healthcare Quality Reporting System CHC Children’s Hospital Group NHS National Health Service CHO Community Healthcare Organisation NHSS Nursing Homes Support Scheme CIT Community Intervention Team NTPF National Treatment Purchase Fund COPD Chronic Obstructive Pulmonary Disease OECD Organisation for Economic Co-operation and CQC Care Quality Commission Development CSO Central Statistics Office OOH Out of Hours DAY Day Case OPD Outpatient Department DM Dublin Midlands (Hospital Group) OT Occupational Therapist DOH Department of Health PN Practice Nurse DOSA Day of Surgery Admission PHN Public Health Nurse DRG Diagnosis Related Group PET Patient Experience Times ED Emergency Department POD Point of Delivery EL Elective PHY Physiotherapist ENT Ear Nose and Throat RC-STB Residential Care Short Term Beds FA First Appointment RC-LTB Residential Care Long Term Beds FU Follow-Up (Appointment) RCSI Royal College of Surgeons Ireland (refers to the Hospital Group) GP General Practitioner SAU Surgical Assessment Unit GDP Gross Domestic Product SG Steering Group GPC General Practice Co-operatives SL Sick Leave HCP Home Care Packages SUHC Saolta University Health Care (Hospital Group) HDU High Dependency Unit UL University of Limerick (Hospital Group) HG Hospital Group WHO World Health Organization HHH Home Help Hours WTE Whole Time Equivalent HIPE Hospital Inpatient Enquiry database SG Steering Group HIQA Health Information and Quality Authority SIVUH South Infirmary Victoria University Hospital HPO Healthcare Pricing Office SL Sick Leave HSE Health Service Executive S&LT Speech & Language Therapist ICGP Irish College of General Practitioners SUHC Saolta University Health Care (Hosp Grp) ICU Intensive Care Unit UL University of Limerick (Hospital Group) IE Ireland East (Hospital Group) WHO World Health Organization IHCP Intensive Home Care Packages WTE Whole Time Equivalent IP Inpatient © PA KNOWLEDGE LIMITED IV HEALTH SERVICE CAPACITY REVIEW CONTENTS 1 Introduction 1 3 International Benchmarking 1. Introduction 2 of Health Services 14 1.1 Terms of Reference 2 3.1 International Benchmarking Exercise 15 1.2 Background 2 3.1.1 Resourcing 17 1.3 Scope 3 3.1.2 Activity 21 1.4 Exclusions 3 3.1.3 Health Indicators and Drivers 27 1.5 Guiding the Review 4 3.2 Summary 32 1.6 Structure of the Report 4 4 Baseline Scenario: Demand 2 Health Service and Capacity Projections 33 Review Methodology 5 4.1 Demographic Changes 34 2.1 Definitions of Metrics 6 4.2 Non-Demographic Changes 36 2.2 Framework for Modelling Demand 8 4.3 Profile of Current and Forecast 37 and Capacity Demand by Sector Type 2.3 Model Outputs 11 4.3.1 Profile of Current and Forecast 37 2.4 Approach to International 11 Demand within the Acute Sector Benchmarking 4.3.2 Profile of Current and Forecast 51 2.5 Policy Assessment 12 Demand within the Primary Care Sector 2.6 Stakeholder Consultation 12 4.3.3 Profile of Current and Forecast 54 2.7 Limitations 13 Demand within the Services for Older Persons Care Sector (Residential and 2.8 Summary 13 Home Care) 4.4 Profile of Current and Forecast 59 Capacity for Resources by Sector Type 4.4.1 Profile of Current and Forecast 59 Capacity against Required Capacity in the Acute Sector 4.4.2 Profile of Current and Forecast 62 Capacity against Required Capacity in the Primary Care Sector 4.4.3 Profile of Current and Forecast 64 Capacity against Required Capacity in the Services for Older Persons Care Sector 4.5 Private Hospital Acute Activity 66 4.6 Summary 71 © PA KNOWLEDGE LIMITED HEALTH SERVICE CAPACITY REVIEW V 5 Policy Analysis 73 8 Conclusions and 5.1 Analysis and Refinement of 74 Recommendations 119 Applicable Policies 8.1 Conclusions 120 5.2 Key Policy Themes 74 8.1.1 Baseline Conclusions 120 and Considerations 8.1.2 Scenario Conclusions 122 5.3 Summary 75 8.1.3 General Conclusion 123 8.2 Recommendations 124 8.2.1 Baseline Recommendations 124 8.2.2 Scenario Recommendations 125 6 Stakeholder Engagement 76 8.2.3 General Recommendations 127 6.1 Summary of Wave 1 Workshop 77 8.3 Summary 128 Findings 6.2 Summary of Bi-Lateral Engagements 81 6.3 Summary of International Peer 84 Review Engagement Appendices 129 6.4 Identification of Potential Scenarios 86 Appendix A Longlist of Reviewed Policies 130 6.5 Summary of Wave 2 Workshop 86 Appendix B Shortlist of Reviewed Policies 132 Findings Appendix C Final List of Reviewed Policies 133 6.6 Summary of Public Consultation 87 Appendix D List of Data Sources 158 Process Appendix E Model Technical Overview 162 6.7 Summary 88 Appendix F Scenario Approaches 187 Appendix G Stakeholder Engagement 201 Appendix H Membership of 204 Steering Group 7 Impact Of Alternative Appendix I Members of the International 205 Care Models 89 Peer Review Group 7.1 Scenario 1: Improved Health and 91 Appendix J List of Submissions to 206 Wellbeing Public Consultation Process 7.2 Scenario 2: Improved Model of Care 98 Centred around Comprehensive Community- Based Services 7.3 Scenario 3: Hospital Productivity 107 Improvements 7.3.1 Scenario 3A: Hospital Group / 107 National Care Pathway Improvements 7.3.2 Scenario 3B: Improvements to Patient 113 Flow through Hospitals 7.4 Summary 117 © PA KNOWLEDGE LIMITED | JANUARY VI HEALTH SERVICE CAPACITY REVIEW Index of Tables Table 1: 6 Table 15: 80 Definitions of Metrics Prevention Initiatives Table 2: 8 Table 16: 81–82 Model Approach: Generation Summary of Public Provider Feedback of Demand Forecast Table 17: 83 Table 3: 10 Summary of Private Provider Feedback Model Approach: Generation of Capacity Forecast Table 18: 84–85 Summary of International Peer Table 4: 11 Review Group Meeting Modelled Policy Scenarios Table 19: 86 Table 5: 15 Overview of scenarios considered International Benchmarking Countries for further analysis Table 6: 35 Table 20: 86 Current and forecasted age structure Summary of Wave 2 Comments of the Irish population on Baseline Results Table 7: 36 Table 21: 87–88 Age Profile of Service Users in 2016 Summary of Department of Health Public Consultation Table 8: 66 Key Assumptions Made in Private Table 22: 93–94 Demand and Capacity Assessment Overview of POD Capacity for Baseline and Scenario 1 Table 9: 72 Summary of Forecast Capacity by Table 23: 97 Sector Point of Delivery (POD) with Summary of Evidence for Scenario 1 percentage changes from baseline Table 24: 101–102 Table 10: 77 Overview of POD Capacity for Data Quality and Accessibility Baseline and Scenario 2 Table 11: 78 Table 25: 105–106 Improvements Within and Across the System Summary of Evidence for Scenario 2 Table 12: 79 Table 26: 109 Unmet Demand and Unmet Need Overview of POD Capacity for Baseline and Scenario 3A Table 13: 79 Ireland’s Ageing Population Table 27: 111–112 Summary of Evidence for Scenario 3A Table 14: 80 Non-Demographic and Epidemiological Trends Table 28: 115–116 Overview of POD Capacity for Baseline and Scenario 3B © PA KNOWLEDGE LIMITED HEALTH SERVICE CAPACITY REVIEW VII Table 29: 118 Table 46: 173 Summary forecast of capacity Services for Older Persons Care for all Points of Delivery Non-Demographic Forecasts Table 30: 124 Table 47: 174 Summary of Capacity Requirements Waiting Lists Incorporated for with no Service Reconfiguration all Three Care Sectors Table 31: 127 Table 48: 175–179 Impact of Scenarios on Capacity Requirements Historic Activity and Waiting Lists Methodology – All 3 Sectors Table 32: 130–132 Long list of Policy Documents Reviewed Table 49: 179–182 Historic Resources Methodology – All 3 Sectors Table 33: 132–133 Short list of Reviewed Policies Table 50: 183 Acute Care: Levels of Resource Efficiency Table 34: 133–150 Final Reviewed Policies Table 51: 184 Acute Care: Levels of Resource Table 35: 151–152 Efficiency by Site, Specialty, and Analysis of International Best Practice Age Band (source: HIPE data) Table 36: 158 Table 52: 185 Demographics and Regions Data Sources Primary Care: Levels of Resource Efficiency Table 37: 158–159 Table 53: 185–186 Primary Care Data Sources Services for Older Persons Care: Levels of Resource Efficiency Table 38: 159–160 Acute Hospital Data Sources Table 54: 187 List of Modelling Approaches for each Scenario Table 39: 161 Social Care Data Sources Table 55: 200 List of Scenario-related Modelling Assumptions Table 40: 162 Universal Dimensions used within the Model Table 56: 203 List of Workshop Participants Table 41: 163 Model Dimensions by Care Sector Table 57: 203 List of organisations engaged Table 42: 164 through bi-lateral meetings Model Calculations Table 58: 204 Table 43: 165 Steering Group Members Acute Care Sector Specialty Mapping Table 59: 205 Table 44: 167 International Peer Review Group Members Activity Data Incorporated into the Model for all Three Care Sectors Table 60: 206 List of Submissions Received Table 45: 171 Acute Care Non-Demographic Forecasts © PA KNOWLEDGE LIMITED VIII HEALTH SERVICE CAPACITY REVIEW Index of Figures Figure 1: 16 Figure 15: 30 Elderly Population (aged 65