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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
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
Funder: Health Service Executive Research Award
Principal Investigator: Dr Bridget Johnston
Co-applicant: Dr Katharine Schulmann
Project duration: 2023-2024
Funded through a Health Service Executive Research Award, the NPCAVI study explores stakeholders’ needs for an atlas of variation, a data visualisation tool, dedicated to mapping aspects of palliative care in Ireland, with the ultimate aim of reducing inequalities in access to services. The project’s main objectives are to identify and learn from excellent examples of Atlases of Variation in use in other countries, to map current data availability and priorities for data infrastructure in the area of palliative and end of life care in Ireland moving forward, and to formulate recommendations to support development and implementation of the Atlas of Variation for Palliative and End of Life Care in Ireland.
The research project takes a multi-method qualitative approach and unfolds over three core strands of work:
1) A cross-country comparative review of excellent examples of Atlas of Palliative and End of Life Care development and implementation from across a select range of countries.
2) Building on learnings from the review of the international literature, a mapping exercise to establish data availability in Ireland relevant to a future Atlas.
3) Semi-structured stakeholder interviews to identify priorities and issues of feasibility for development of an Atlas of Variation for Ireland. Stakeholders recruited for interviews include individuals with expertise in the planning and provision of palliative care services, and with expertise in health and social care data infrastructure more generally.
The Lead Knowledge User for this Research Award is Dr Paul Kavanagh, Specialist in Public Health Medicine with the HSE’s National Health Intelligence Unit.