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Research Leader Award – November 2020- October 2025
The RESTORE research programme examines the key challenges facing the Sláintecare reform programme and evaluates strategies to facilitate its effective and thorough implementation in a complex adaptive system. It reviews the causality of how shocks to the system (such as COVID and the 2008 financial crisis) challenge or even facilitate reform. In particular, it evaluates public sector staff engagement over time as both a sign of resilience and a precondition for the implementation of effective change. The proposed research combines both qualitative data from stakeholder and key informant interviews, with quantitative data from surveys of health sector staff, alongside a review of key system metrics and the progress of reform. It will develop evidence-based strategies for policy makers in government to manage the competing tensions between system performance and reform to achieve universal care through enhanced resilience.
RESTORE project Components:
- Evaluating Health System Resilience
- Evaluating the challenges to large-scale reform and proposing strategic direction
- Assessing Staff Engagement Trends
- Building Resilience Theory
PI: Professor Steve Thomas
Centre Researchers: Dr Liz Farsaci, Catherine O’Donoghue and Dr Arianna Almirall-Sanchez
The Medical Workforce Planning team is working on a project in partnership with National Doctors Training and Planning (NDTP) to determine the future demand for consultants and NCHDs in Ireland. We are using demand estimates to inform the future HST intake requirements for each specialty, both medical and surgical by 2038.
Medical workforce planning integrates current unmet demand, projected supply and demand, models of care and upcoming changes to service delivery, as well as government policy. We utilise a collaborative approach that includes consultations with training bodies such as RCSI, RCPI and the Clinical Programmes to determine and refine intake recommendations.
2023 included nine dual trained (general internal medicine plus specialty) medical specialties and seven surgical specialties. Early 2024 we expect to publish jointly with NDTP two summary reports, one for each group of specialties. These reports will detail agreed projections and describe the methodological approach used to model these projections. The specialty of Ophthalmology will be presented as a separate individual specialty specific report.
2024 will include seven medical specialties. The current plan is that each specialty will be modelled separately and published in individual specialty specific review reports towards the end of 2024. The specialty of palliative care will have an update of existing workforce plan published in 2017.
Research Team: Dr Bridget Johnston (PI), Dr Andrew Malone, Veronica Segerstrom, Ali McDonnell
Challenge
In Ireland we don’t know how many children have life-limiting conditions and need palliative care. We have UK-based estimates which are out-of-date and not detailed enough to help plan palliative services. We don’t know how many children miss out on palliative care referral because some clinicians view it as end-of-life care, or because the definition of life-limiting changes over time with improvements in life-expectancy for some conditions. There are concerns that children with life-limiting conditions have lengthy hospital stays and have difficulty accessing palliative care across the country. This project will gather and examine information to address these knowledge gaps and to improve how children’s palliative care is planned and delivered in Ireland.
Research Project aims and methods
Our team includes parents of children with life-limiting conditions, children’s palliative care policymakers, planners, providers, and researchers. We will discuss different definitions of life-limiting conditions and palliative care need. We will examine national datasets on hospital stays, deaths, children’s palliative care activity and others to learn about children who are at different stages (dying, unstable and receiving emergency care, deteriorating and receiving intensive care) of their illness. We will look at how complex these children’s needs are, and how they use hospitals. We will compare the geographic location of children’s palliative care services with where children with life-limiting conditions live. We will use all this information to guide and improve children’s palliative care policy, planning, and service delivery, supporting our goal of universal access to palliative care in Ireland.
Public, patient and personal involvement (PPI)
The Family Engagement Committee at LauraLynn, Ireland’s Children’s Hospice, is our PPI co-applicant for this project.
This group of parents have children who have, or have had, direct experience of children’s palliative care in Ireland. Our PPI co-applicant was involved during the project proposal stage and will take part in the project advice team. This is the team that includes all our co-applicants and collaborators and will meet at key points in the project, provide general oversight for project progress and assess what are the key messages from the analysis. In this sense, our PPI co-applicant will have involvement at all stages in the project.
Timeline
March 2023 – March 2025
Research Team
We are a collaboration of researchers, knowledge users, PPI, and data controllers. The project is managed by Drs Samantha Smith (Lead Researcher) and Joanne Balfe (Lead Knowledge User) and supported by the project advice team which includes representatives from the Children’s Palliative Care Strategic Advisory Group, our PPI representative, the Department of Health, national and international palliative care researchers, and data controllers.
Researchers
Dr Samantha Smith, Centre for Health Policy and Management, Trinity College Dublin
Dr Peter May, Centre for Health Policy and Management, Trinity College Dublin
Dr Tara Delamere, Centre for Health Policy and Management, Trinity College Dublin
Prof Lorna Fraser, King’s College London
Prof Suzanne Guerin, University College Dublin & Research at LauraLynn
Dr Helen Coughlan, St Vincent’s University Hospital
Knowledge Users & PPI
Dr Joanne Balfe, LauraLynn & Tallaght Hospital
Ms Orla Murphy, PPI Representative
Ms Avril Easton, Irish Hospice Foundation
Mr Maurice Dillon, Health Service Executive
Mr Tyrone Horne, HSE Cork University Hospital
Dr Mary Rabbitte & Dr Emer Brangan, All Ireland Institute of Hospice and Palliative Care
Dr Fiona McElligott, Temple Street Hospital
Dr Mary Devins, Crumlin Hospital
Mr Paul Rowe, Department of Health
Data Controllers
Ms Sinead O’Hara, Healthcare Pricing Office, HSE
Dr Cliona McGarvey, National Office of Clinical Audit
Funding & Support
This project is funded by the Health Research Board with additional co-funding from the Irish Hospice Foundation and LauraLynn Ireland’s Children’s Hospice
For Further Information Contact:
Email: ssmith1@tcd.ie
Smoking is harmful to human health and programmes to help people stop smoking are key public health efforts that improve individual and population health outcomes. Research shows that financial incentives improve the success of stop smoking programmes. However, a better understanding of how they work is needed to better inform policy and to support building capability for implementation.
The research is a realist review investigating how, why, for whom and to what extent financial incentives impact on the success of individuals' efforts to stop smoking. The project is undertaken using realist review in the school of Pawson and Tilley and guided by the RAMESE project quality standards.
Data from international literature sources will be searched, screened, selected and synthesised into a set of explanatory findings. These findings will explain:
- Individual, community and programme level causal mechanisms that impact positively and negatively on the success of financial incentives in aiding efforts to stop smoking among a) general populations and b) pregnant women
- Which individual, community and programme level contexts are likely to enable both the success and failure of financial incentives in aiding in efforts to stop smoking among a) general populations and b) pregnant women
- How a health system can facilitate the provision of financial incentives in a manner that best supports the success of efforts to stop smoking among a. general populations and b. pregnant women.
The review is registered with Prospero and can be accessed here. A study protocol published in the BMJ-Open is forthcoming.
Dr Rikke Siersbaek, Research Fellow, is the lead methodologist and researcher on the project, supported by Research Fellow Dr Sarah Parker and Researcher Luisne Mac Conghail. Dr Sara Burke, Research Assistant Professor, is the Principal Investigator on this one-year research project with Dr Paul Kavanagh from the HSE's Health Intelligence Unit and the Tobacco Free Ireland programme as the lead knowledge user. Dr John Ford from the University of Cambridge is the senior methodologist providing oversight and support. This work is funded under the HSE’s Financial Incentives and Stop Smoking Services Research Award 2021 (FISSS2021)
PI: Associate Professor Sara Burke
Centre Researchers: Dr Rikke Siersbaek, Dr Sarah Parker, Luisne Mac Conghail
Health system foundations for Sláintecare implementation in 2020 and beyond - co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system’s response to COVID-19 is a Health Research Board Applied Partnership Award funded from 2019 to 2021.
A study protocol published on HRB Open is available here https://hrbopenresearch.org/articles/3-70/v1
Learn much more about the project and its outputs on the project’s stand-alone website.
PI: Dr Sara Burke
Centre Researchers: Dr Sarah Parker, Luisne Mac Conghail, Dr Rikke Siersbaek
This HRB funded study led by Dr Lorna Roe, will explore the care of older adults living with frailty and cognitive impairment for the first time. It's widely acknowledged that services and supports are inadequate, and the needs of older adults are poorly understood. The study "The Frail Brain and the Frail Body: Impact of FRAILty and COGnitive impairment on trajectories, patterns and costs in care in old age (FRAIL-COG)" will use data from The Irish Longitudinal Study on Ageing (TILDA) to examine the health trajectories of older adults living with concurrent frailty and cognitive impairment, and model how these trajectories determine the use and cost of health and social care; hours of informal care provided and the degree of functional decline. FRAIL-COG will provide valuable insights into the complex needs of older adults and identify gaps in service provision. The Health Service Executive (HSE) are knowledge partners in this project, ensuring a clear route for dissemination which will inform future service planning.
To find out more about this project, please email Dr Roe: loroe@tcd.ie
PI: Dr Lorna Roe
This is a six-country trial led by Vrije Universiteit Brussel (PI: Professor Joachim Cohen). The PaCE team led by Professor Normand is responsible for the economic evaluation work package.
For more details, click here.
Trinity PI: Professor Charles Normand
Funding: European Commission
This is a five-country trial led by King’s College London (PI: Professor Irene Higginson). The PaCE team led by Prof Charles Normand is responsible for the economic evaluation work package.
For more details, please email ssmith1@tcd.ie.
Trinity PI: Dr Peter May
Funding: European Commission
The Palliative Care Economics (PaCE) research group at Trinity College Dublin is among the most active in the field worldwide.
In the context of rising costs and poor outcomes associated with serious illness, we work with clinicians, policymakers and other social scientists to generate high-quality evidence on what care and interventions should be provided to and prioritised for which groups of patients.
Our current research programme covers studies in Ireland, England, the United States, Jordan, and elsewhere. We welcome collaboration with other investigators and centres interested in questions that relate to the quality, cost-effectiveness and appropriateness of care for people with serious and life-limiting illness.