Health and care services

Investing in healthcare infrastructure

Head of Estates at the Health Service Executive (HSE), Jim Curran, outlines plans for greater investment in healthcare services and the current deficit in capital funding.

“When people talk about infrastructure they largely focus on issues such as broadband, roads, water and education,” states Jim Curran. “It’s not too often that health gets an airing but if you look at the requirements of a proper functioning economy or of the communities within an economy, you can see how much of a critical element health is.”

Pointing to the Estate’s mission statement, “to create and sustain a first class physical environment that enhances wellness in our patients and clients and enables and encourages our staff”, Curran highlights the need for high class facilities to ensure high class care to the community.

As one of the largest, and most diverse, property owners in Ireland, HSE Estates manages approximately 2,500 properties with an estimated value of €10 billion. These include:

  • 49 acute hospitals;
  • 119 community nursing units;
  • 628 community health centres;
  • 92 Primary care centres;
  • 795 mental health units;
  • 372 disability service units;
  • 96 ambulance bases; and
  • various offices and warehouses.

Explaining the current requirements for health infrastructure, Curran says: “Looking at the 49 acute hospitals there are modern elements but there are also a lot of elements that need to be updated. As well as replacing existing outdated facilities, we also need to increase capacity to accommodate better management and changes in procedure. We need to update our facilities to deliver on clinical strategies around areas such as maternity services or cancer care. Some examples of how we are currently trying to deal with those requirements include the National Paediatric Hospital project, the National Maternity Hospital to St Vincent’s University Hospital and the delivery of a national network of radiation oncology centres.

“These are the headline projects in terms of acute hospitals, but I think every hospital manager in the country wants their hospital to also be a building site because of the need for development on their campuses. In Letterkenny where we are currently handling major works following a flooding incident there a couple of years ago, Sligo needs a new ward block and the emergency department in Galway needs to be replaced. This scenario is similar all around the country where hospitals need to have a sizeable capital project or capital investment on their campuses.”

A major focus of the HSE and subsequently Estates in recent years has been the decentralisation of health services to primary care centres. It is estimated that Ireland needs around 350 primary care centres in order for the system to be fully effective, a figure which is likely to decrease upon review of potential combinations. A core aspiration of successive governments has been to deliver a model whereby the primary care needs of a patients such as GP, public health nursing, therapies, dental, mental health and progressive disabilities could be met under one roof and closer to the community, essentially removing people from an acute hospital setting where possible.

Curran explains that the delivery of primary care units are being achieved through three key methods: exchequer funded; public private partnerships (PPP); and operational lease. To date around 180 locations have been advertised since 2008, 92 care centres are in operation, 15 are in the construction/equipping stage and 11 were due to open in 2016. Of these 14 locations have been delivered via PPP. Of the 13 locations on the HSE’s Central Plan, four including Grangegorman, Corduff, Borrisokane and City Cork North West are due to become operational in 2016/2017. A total of 47 Primary Care Centres have been delivered via operational lease model funded from the HSE’s revenue allocation, 20 locations are at an advanced stage where agreements for lease have been entered into and a further 38 locations have had letters of intent issued.

 

Community nursing

A further challenge for HSE Estates is an upgrade and replacement of community nursing facilities to meet HIQA accommodation standards, which is estimated to require a €800 million investment. While large investment is needed to meet the national policy in relation to mental health ‘A Vision For Change’. Curran explains: “The national policy is about moving away from the large institutions to a more community-based model, reducing the need for people to be in a hospital setting for the long-term and treating people closer to home.

“It’s a similar scenario for mental health care. One of the major changes in Ireland has been the shift from the 1950s and 1960s when Ireland had one of the largest inpatient totals for mental health, as a portion of their population, in the world. We have largely taken patients out of those big institutions located around the country and are building facilities closer to the community.”

The flagship project for mental health provision lies in the replacement of the Central Mental Hospital in Dundrum with a new National Forensic Mental Health Service (NFMHS) on the site of St Ita’s Hospital in Portrane, a €120 million allocation from the HSE Capital Programme. It will be supported by four new intensive care rehabilitation units (ICRUs) proposed at Portrane, Cork, Mullingar and HSE West, as well as new regional, residential Child and Adolescent Mental Health (CAMHS) in Galway, Cork and Dublin.

Capital Funding

Curran is currently undertaking a review of the HSE’s current infrastructure. This year capital funding allocated through the 10 year Capital Investment Plan is in the region of €350 million but Curran estimates that Ireland needs to rapidly get to €1 billion a year to meet its need. Some of the major requirements Curran lists include €5 billion for acute hospitals, €800 million for social and older persons care, €600 million in primary care and €500 million each in mental health and infrastructural risk.

He concludes: “In relation to capital funding in health we are the poor relations mother of the government agencies in terms of what we get. A few metrics to think about are related to revenue spend. Health has 36 per cent of the Exchequer revenue, yet we only have 10 per cent of the capital. Is there a disconnect there?

“In relation to capital as a percentage of the health service revenue, this year our capital funding is 2.6 per cent of our revenue funding. We need to be investing more in our infrastructure in order to maintain our services. Investments help improve not only clinical outcomes but they provide a comfort for the people who use our facilities and acts as a key contributor to improve the efficiencies of our health service.”

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