Can We Deliver?

Denis Doherty
Denis Doherty

The best answer to a radio interview question I have heard in a long time was given by Dr. Frances Ruane, Chair of the national Competiveness and Productivity Council (NCPC). Asked for her view of the greatest potential obstacle to the realisation of the goals set out in Ireland’s Competitive Challenge 2023, she nailed it in a single word – DELIVERY, writes Denis Doherty.

Healthcare workers don’t need any further explanation of her concern. From the Fitzgerald Report of 1968 to the National Children’s Hospital, still a work in progress, and countless examples in between, we are inured to experiencing delays. Fitzgerald recommended a network of Regional and General hospitals. If implemented, the number of acute care hospitals would have been fewer in number but all of them would have been fit for purpose.

The political response was to invent a new category of acute hospital named minimum scale hospitals and thereby avoid the closure or downgrading of existing hospitals. The negative impact of that purely political decision is still being felt. We have too many, questionably viable acute hospitals and too few acute care and emergency care beds. A modern acute hospital needs to have the volume of beds, equipment and specialist staff required to deliver the range of high quality care expected in a modern, high performing economy like ours. The hospital services in Northern Ireland are experiencing very similar problems with, it seems, just as little success in finding a workable alternative network of hospitals.

In my most recent column for Health Manager, I drew attention to the increase in population and of our economy since 1971, the year the health boards came into being. I asked if our health service is fit for purpose?

‘Ireland’s Competiveness Scorecard 2022’ deals with population and economic growth in Ireland and in Ireland in a European context. Dealing with delays, that scorecard states, “When considering the incidence of delays and blockages which can impede Ireland’s competitiveness and productivity, it is worth considering the carrying capacity of the economy, including the public and private sectors, and the wider public service (including regulators) which supports the economy.”

It goes on to state that “The pace of expansion of the past two decades has generated challenges for the public and private sectors to meet the rapidly rising demand. In the case of the public sector, it is evident the expansion of its capacity to respond adequately to the needs of the economy and society has not kept pace with the growth of the economy and broader demographic changes”.

Just recently, Eamon Ryan, the leader of the Green Party and Minister for the Environment and Transport expressed the view that “thousands of additional public servants are required because of the growth in the size of the economy by an increase in the size of the State. Thousands of new public servants are needed to match the success of our country”.

In recent years, Ireland has experienced corporate tax windfalls, which the Minister for Finance and his predecessor are keen not to see whittled away. It shouldn’t be an option either to squirrel it away just because we cannot think of anything better to do with it. Would it not make sense to invest portion of the windfall revenue to develop the carrying capacity of the health services and other areas of our public services.

 In the area of healthcare, the need for strategic capital investment in buildings, information technology and assistive technologies is apparent but does the capacity to deliver and achieve value for money exist? We don’t have a coherent view of the increased carrying capacity our health services require to deliver the ubiquitous Sláintecare.

“Ireland’s Competitive Challenge Report 2022” contains a section devoted to Strategic Investment in Healthcare. Having reported on work carried out by the Department of Health it goes on to say that “The analysis supports the development of a Strategic Investment Framework to ensure that proposed health expenditures align with both the National Development  Plan and Sláintecare objectives. The proposed framework would take the form of an overarching hierarchy and a multi-criteria analysis where projects are scored against criterion(sic) such as: Patient Safety and Quality, Value for Money, Resilience, Accessibility, Regional Diversity, Future Healthcare Demand, Alignment with Sláintecare and adaptability. A considerable body of evidence and analysis has been collected and undertaken to inform the Strategic Investment Framework; however, it is recognized that further an(sic) on-going work will be required in the implementation and development of investment in the sector”.

“This Framework is essential to ensuring that the ongoing rise in construction costs is fully imbedded in investment priority decisions. Inflationary pressures alongside the uncertainty around final costs of infrastructure delivery mean that the projects that best align with national objectives should receive priority, and through this achieve better outcomes in healthcare in Ireland. The Council is of the view that the Strategic Investment Framework should be published by Government as soon as is practicable, and that it should be fully implemented across all investment decisions in health”.

Sound advice; it remains to be seen if it will be adopted.


Reading ‘Ireland’s Competitive Challenge Report 2022’, I was shocked to discover how badly persons with disabilities in Ireland fare in relation to employment. The OECD published a paper titled ‘Disability, Work and inclusion in Ireland’ in September 2021 which highlighted that the employment rate of persons with disabilities in Ireland in 2016 was about half the rate for persons without disabilities (35.5% v 72.8%). This employment gap is much larger than in most other EU-OECD countries and slightly larger than the gap in Ireland ten years earlier. Ireland’s target of an employment rate for persons with disabilities of 38% by 2024 would, if realised be a note able achievement. The results of the 2022 census will be a good indication of progress being made.