‘Substantial expansion’ of acute hospital capacity required

Ireland’s public acute hospitals will require a net increase of between 4,400 and 6,800 inpatient beds by 2040, according to projections from the Economic and Social Research Institute (ESRI).

This expansion will be required to address demand growth driven by demographic trends, ongoing system pressures, and changing patterns of hospital utilisation.

The projections are set out in the ESRI’s Projections of National Demand and Bed Capacity Requirements for Public Acute Hospitals in Ireland, 2023-2040, prepared on behalf of the Department of Health under the ESRI/Department of Health Research Programme in Healthcare Reform.

The report, published in late-May 2025, applies the ESRI’s ‘Hippocrates model’ to produce demand and capacity scenarios based on 2023 hospital activity profiles and updated population projections incorporating Census 2022 data.

The central finding is that Ireland will require a sustained programme of capacity expansion over the next 15 years to meet projected increases in demand for emergency and elective care. The requirement for additional beds will arise even under optimistic progress scenarios which assume successful delivery of key reforms, including expanded chronic disease management and increased community-based care.

Demographic drivers of demand

The projected population of the State is set to increase from 5.3 million in 2023 to between 5.9 and 6.3 million by 2040. The proportion of the population aged 65 and over is expected to rise from 15 per cent to approximately 21 per cent. These shifts will have significant implications for demand for acute hospital services, given the higher rates of hospital use among older cohorts.

The modelling also takes account of trends in activity rates, healthy ageing assumptions, and a range of policy-related factors, including the impact of potentially avoidable hospitalisations and waiting list management initiatives.

Projected activity growth

Across all services modelled, demand is projected to increase substantially by 2040:

• Emergency department attendances are projected to increase by between 333,000 and 444,000, with an average annual growth rate of 1.1 per cent to 1.4 per cent.
• Outpatient attendances are projected to increase by between 950,000 and 1.3 million, with an annual growth of 1.1 per cent to 1.5 per cent.
• Day patient discharges are projected to rise by between 302,000 and 442,000, an annual growth of 1.3 per cent to 1.9 per cent.
• Inpatient bed days are projected to rise by between 1.2 million and 2.1 million, reflecting an annual growth of 1.6 per cent to 2.6 per cent.

Capacity requirements

The core capacity finding is that inpatient bed capacity will need to increase by between 4,400 and 6,800 beds by 2040, requiring an annual growth rate in bed numbers of between 1.9 per cent and 2.8 per cent.

The report also projects a requirement for between 650 and 950 additional day beds.

These requirements are based on achieving target occupancy rates of 85 per cent to 90 per cent. If occupancy were to remain at current elevated levels, the additional capacity required could be even higher.

Scenarios and sensitivity analysis

The report presents multiple scenarios:

• a status quo scenario, assuming existing activity patterns continue;
• low-pressure and high-pressure scenarios, varying key assumptions including population growth and rates of healthy ageing; and
• a progress scenario, incorporating potential impacts of successful policy implementation, including:
  • greater delivery of care in community settings;
  • improved chronic disease management;
  • reduced avoidable hospitalisations; and
  • enhanced management of waiting lists.

Even under the progress scenario, which assumes effective delivery of Sláintecare reforms and optimal reduction of unnecessary hospital admissions, the model projects a requirement for significant additional inpatient capacity.
Policy implications

The report concludes that sustained investment in hospital infrastructure and workforce will be required over the coming 15-year period to meet the projected demand. The findings have implications for:

• implementation of the Acute Hospital Inpatient Bed Capacity Expansion Plan;
• capital planning and alignment with the National Development Plan and Project Ireland 2040;
• workforce planning, given the recruitment and retention challenges associated with operating an expanded hospital system; and
• design and delivery of integrated care models, particularly in respect of primary and community-based alternatives to hospital admission.

The report also highlights the importance of improving the health system data landscape, particularly in relation to outpatient services, where current data quality and consistency remain limited. The full implementation of the individual health identifier is deemed a key enabler for improved modelling and planning.

Next steps

The ESRI recommends that projections of this nature be updated regularly to reflect changes in demographic trends, service delivery models, and policy implementation. The authors further note that while system reforms will contribute to managing demand growth, they will not eliminate the need for significant capacity expansion.

Speaking upon publication of the report, Aoife Brick, senior research officer at the ESRI and lead author of the report, said: “Our findings highlight significant future growth in demand for public acute hospital services, driven primarily by population growth and ageing. The report offers policymakers evidence on the scale of service expansion needed to meet future demand.”

Reacting to the report, Minister for Health Jennifer Carroll MacNeill TD, said: “This resource from the ESRI allows us to better anticipate future healthcare demand and capacity, ensuring our health system evolves to meet the needs of our changing population. I look forward to ongoing engagement with the ESRI and our colleagues in the HSE as we continue to develop and strengthen our future capacity plans.”