Capital spending in health
Capital spending on health accounted for 10.4 per cent, or €1.084 billion, of the €75 billion allocated under the National Development Plan in 2021. Capital spending on health will amount to €5.7 billion in the first five years of the renewed NDP.
Of the 10 national strategic outcomes included in the renewed NDP, released in October 2021, number 10 pledges the Government’s commitment to “access to quality childcare, education and health services”. Under this heading, the expansion of primary and community care in line with Sláintecare reform goals is the key health goal mentioned, a goal that will require sustained capital spending on health around the State in order to localise health infrastructure.
In its sectoral strategy section for health, the NDP states that the Sláintecare Implementation Strategy “identifies capital investment as a critical enabler of the reform proposed” and that “capital investment has a key role to play in enhancing service provision, ensuring the delivery of high quality and safe health and social care” such as the delivery of the recommendations of the Health Capacity Review, the eHealth Strategy for Ireland, the National Maternity Strategy 2016-2026 and a host of other government plans.
Over the full course of the NDP, 2021-2030, the plan says health capital investment will be “based on needs to enhance service provision, enable reform in the sector and the ongoing need to address patient safety and regulatory requirements”; from 2021-2025, the investment will be focused on “patient safety, regulatory requirements” and will “provide the foundations for reform in the sector”.
Projects outlined as priorities in health spending from 2021 to 2025 include: eHealth and ICT investment programmes (estimated between €50 million and €100 million); the new Children’s Hospital campus at St James’s and the second outpatient department and urgent care centre at Tallaght Hospital (over €1 billion); radiation oncology units in Galway, phase two of Dublin Beaumont construction and St James’s redevelopment (all €50 million-€100 million); acute bed capacity projects (estimated €500 million-€1 billion); and the construction of primary care centres (estimated €100 million-€500 million).
Health service capacity will, given the context of the Covid-19 pandemic, be the most high profile of the reforms funded through the NDP, but it is an area of the plan where details are light. The plan states that the building of dedicated elective centres in Dublin, Cork and Galway is currently being progressed for consideration through the Public Spending Code and that “these facilities will provide high volume, low complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services”.
The plan also states that additional capacity has been delivered since the publication of the Health Service Capacity Review in 2018, but that “further beds in line with overall requirements and informed by regional requirements will be required to be provided in the period to 2030”. In 2018, before the pressures of the pandemic, the Health Service Capacity Review stated that an additional 2,590 hospital beds would be required between 2018 and 2031; the plans within the NDP do not seem to address this need.
Indeed, amongst the most costly and common of the health priorities for the period 2021-2025, many appear to be refurbishment and replacement schemes that while providing necessary updates to Irish health and its technologies, will not increase capacity. It has been well documented that the National Children’s Hospital will not add significant capacity to the health system, but other projects such as the replacement and refurbishment of 88 community nursing units to regulatory compliance are estimated to cost €500 million-€1 billion. Continued maintenance of the current ambulance fleet is set to cost €50 million-€100 million with no added capacity. Both the Equipment Replacement Programme, which will update diagnostic equipment, and the Infrastructural Risk Programme, which focuses on fire and electrical safety as well as emergency supply, carry estimated costs of €100 million to €250 million.
The National Maternity Hospital project, which will add capacity to the health system, is estimated under the plan as costing €20 million-€50 million, which indicates that its construction will likely not commence until after 2030, with the majority of the capital spending related to the project happening then.
While the capital spending on modernisation efforts within the health system are no doubt worthwhile and necessary, aside from the Children’s Hospital, the plan shows a bias towards replacement buildings, equipment, ambulances and investments in eHealth, which raises the question of the amount being spent. The €5.7 billion of capital spending allocated to health from 2021-2025 account for approximately 5 per cent of the total health spend in that period. When the capacity issues facing the health system are taken into account, the lack of projects similar to the Children’s Hospital in scale, but with the key provision of enhancing capacity, seems a glaring omission.
