Mr. Derek Tierney:

I wish the members of the committee a good morning. We are delighted to be here today. I hold responsibility for health infrastructure. I am joined by my colleagues Mr. Muiris O’Connor, assistant secretary for research, development and health analytics; Mr. Chris Ryan, principal officer in our strategic research and evaluation unit; Ms Rachel Kenna, assistant secretary and chief nursing officer with responsibility for strategic workforce planning; and Ms Siobhán McArdle, assistant secretary for social care, mental health and unscheduled care. We thank members for the opportunity to address the Joint Committee on Health and to outline how the Department of Health considers matters relating to long-term planning in our health services within the context of population changes, capital and other investment needs, and the ongoing development of health services.

On the issue of responding to demographic change, Ireland, like many developed nations, faces ongoing demographic challenges: rising life expectancy, population growth and an increasingly older population, alongside fluctuating birth rates and migration patterns. These demographic changes and trends are fundamental in shaping health service planning that serves almost 5.5 million people today. The significant improvements in health outcomes and increased life expectancy seen in recent decades are achievements worth celebrating but they are the result of both external factors, such as social, environmental and economic conditions, and internal factors within the service, including enhanced access to healthcare, improved diagnostics, advanced medicines and greater personalisation of care.

The Department continuously analyses population projections and epidemiological trends to ensure that service planning not only addresses immediate care needs but is robust for future population structures. Older people, as research confirms, require both a higher volume and a different mix of services. At the same time, inward migration and natural population increase drive demand across all age groups. Therefore, demographic intelligence informs investment in paediatric care, maternity services and specialised areas such as chronic disease management, reflecting Ireland's relatively youthful population alongside our growing ageing population. This means that demographic change requires a whole-of-society response to ensure people are enabled by their communities to age in place throughout their lives. In 2019, the WHO recognised Ireland as the world’s first age-friendly country, acknowledging its leadership in the global age-friendly communities movement.

Turning to long-term strategic planning, the Department’s long-term planning is framed by national reform programmes such as the Path to Universal Healthcare: Sláintecare and Programme for Government 2025+, published earlier this year. This acknowledges Ireland’s rapidly ageing population and declining birth rates as central challenges shaping the future of healthcare delivery.

In response, the plan recognises the need to build a health and social service that is sustainable for the future. The plan prioritises long-term strategic investment in health infrastructure, workforce and workforce reform to meet the growing demand for age-appropriate services. It also promotes the establishment of the new health regions and a shift toward widened community-based care, enabling more people to receive treatment in their communities and maintain independence in their own homes, and expands programmes like the enhanced community care, ECC, programme and healthy communities. The ECC programme is also delivering end-to-end care pathways that care for people at home and, over time, prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so, enabling a “home first” approach to healthcare delivery. The plan also emphasises preventive health, digital transformation and integrated care pathways to manage chronic conditions more efficiently.

Initiatives are ongoing to strengthen specialist and community-based care for older people, enhance palliative and end of life supports and improve access to mental health services. For example, with the number of people living with dementia expected to double over the next 20 years, a national dementia registry is being developed to guide the planning and delivery of dementia diagnostic and post-diagnostic services in line with the dementia model of care.

To address the challenges and opportunities of an ageing population, the Government established an independent Commission on Care for Older People in 2024. The commission’s work is structured into three consecutive modules, with the first focusing on evaluating the effectiveness, adequacy and efficiency of current health and social care services for older people. The report for module 1 is expected by the end of the year.

The Department of Health has worked to build our capacity for long-term planning in partnership with the HSE and with independent agencies such as the Economic and Social Research Institute, ESRI, and the Central Statistics Office, CSO. As part of a joint research programme with the Department, the ESRI has developed a forecasting model, which we call the Hippocrates model. This combines demographic forecasts with detailed service utilisation patterns to forecast future demand scenarios for health and social care in Ireland. The projections, which extend to 2040 and align with the national planning framework, cover hospital bed needs and primary and community care requirements. This work enriches the evidence base used for health system planning and informs our understanding of future demand. It is the foundation of our workforce planning and our capital investment planning. Importantly, service planning and development strategies are routinely reviewed in light of demographic modelling, including geographic variations and urban-rural differences.

Our national health policy aims to ensure that the health system remains sustainable, equitable, and responsive to demographic realities, with population-based planning frameworks guiding service design and resource allocation.

Service development remains central to our long-term vision for healthcare. The Department fosters innovation and capacity building at all levels, ensuring service models evolve in response to both population needs and best clinical practice. Investment is directed at expanding bed capacity, developing new models for out-of-hospital care and enhancing clinical pathways for chronic illness, paediatrics, maternity and older persons’ services. The Department is committed to delivering care closer to home, improving patient experience and reducing unnecessary acute hospital admissions.

A further priority is tackling health inequalities, including regional disparities and social determinants of health, and supporting vulnerable populations. The Department’s long-term planning integrates actions to improve access, ensure equity and promote positive health outcomes in every community. We also need to ensure equality of access to drug and other social inclusion health services across all regions as we seek to address the changing needs of our growing, ageing and increasingly diverse population and changing patterns of drug use.

On resources, the 2026 health Vote, excluding disability, now stands at €25.22 billion and there is an additional capital allowance of €1.54 billion. With a continued focus on improving controls, the Department’s focus in 2026 will also be on improved access, value for money and performance consistency in service delivery across the regions. This approach focuses on optimising the use of both existing and new resources to drive even greater efficiency and advance progress toward achieving national equity in healthcare for the people of Ireland.

On strategic workforce planning and reform, the Department recognises the health and social care workforce as its greatest asset. Effective workforce planning goes beyond numbers, focusing on aligning workforce skills with patient needs. With regard to workforce growth, as of July 2025, there were 149,099 whole-time equivalents employed in health and social care services by the HSE and section 38 agencies, which represents a 24.4% increase since December 2019.

On education and training expansion, since 2022, up to 1,000 additional student places have been created in health and social care programmes across Irish universities. A separate agreement with Ulster University and Queen’s University Belfast, spanning the years 2023 to 2025 and co-funded by the Department of Health and Department of higher education, has added over 400 places in medicine, nursing, midwifery and allied health professions.

With regard to strategic workforce planning, the Department’s future health workforce strategy outlines a sustainable and evidence-based approach to workforce development. It emphasises increasing domestic supply, reducing reliance on internationally trained professionals and implementing innovative service delivery models. Our planning framework and workforce planning are guided by five pillars: plan, build, optimise, retain and recruit, and invest. It considers short, medium, and long-term actions. A new planning tool, developed in conjunction with the EU, supports and aids in projecting workforce needs over the next ten to 15 years.

Together with an increase in the workforce, we turn our attention to workforce reform and optimisation. Recognising that future services require new approaches, with the HSE, the Department is reforming care pathways and team structures to be a more person-centred service. Initiatives include developing advanced practice roles, expanding skill mixes and introducing new roles such as physician assistants and theatre assistants. We have also reached out to an international network of collaboration and have ongoing engagement with global organisations like the WHO, the OECD and the European Commission, which informs Ireland’s strategic workforce planning.

On capital investment, capital planning is rigorously governed by national frameworks to ensure value for money, compliance with regulatory standards and alignment to the strategic priorities of the Government, the Department and the HSE. The Department maintains a steadfast commitment to strategic capital investment, recognising the importance that infrastructure and digital technology serve in enabling the delivery of health services. The HSE's capital and digital ICT plans for 2025 exemplify this, with a record €1.44 billion allocated for construction and equipping healthcare facilities and progressing digital health nationwide, and investment to rise to €1.54 billion in 2026. This will allow investment in upgrading and adding more acute and community beds and facilities, more primary care centres, the new children’s hospital, progressing the national maternity hospital, new surgical hubs and planning for elective care centres for ambulatory care capacity. These are all essential to meeting forecasted needs driven by demographic trends.

Digital health is recognised as a critical enabler in planning and delivering healthcare and integrated health to meet the evolving needs of Ireland’s population. The Digital for Care strategy, published last year, outlines key investment priorities, including foundational infrastructure ranging from the HSE patient app to the shared care record, all of which pave the way for a future national electronic health record. Priorities also include a number of digital innovations. I will just mention the national e-prescribing system, the medical laboratory information system and other clinical systems alongside back-office and enterprise solutions like the integrated financial management system. With regard to modern care models, we are expanding virtual beds, virtual care and remote monitoring and telehealth to bring services closer to home. We are also using technology integration to leverage data, automation and AI to enhance clinical decision-making and drive system-wide efficiencies. All of these together aim to modernise healthcare delivery, improve patient outcomes and support a more responsive and efficient health system.

I will conclude by mentioning our integrated approach and continuous review. The Department adopts an integrated whole-system approach that combines health service planning, increasing capacity, enabling reforms, a focus on productivity and demographic adaptability. Regular engagement with this joint committee, the HSE, service providers, patient groups and the wider public is crucial to informing strategy, understanding needs, reviewing progress and ensuring accountability. Through the combination of strategic vision, robust demographic planning, dynamic service development and evidence-driven investment in capacity, our workforce, reform and efficiency, the Department of Health and the HSE work to build a resilient, responsive and future-proofed health system for the public. The Department values the opportunity to discuss its approach to long-term planning with the committee and looks forward to continuing our dialogue on delivering world-class health services now and for the future.