The health service only increased its most demanding and costly form of hospital care by only 2 per cent over the last six years, despite a 52 per cent rise in real spending and its workforce growing by a third.
The small increase relates specifically to inpatient activity including people treated in emergency departments and those with acute illnesses.
It means there was little improvement in the pace at which the Health Service Executive (HSE) was delivering acute hospital care, including in emergency departments where demand has continued to rise sharply.
Productivity analysis of the HSE, compiled for Minister for Health Jennifer Carroll MacNeill, has now questioned if hospitals were converting increased resources and staffing into more inpatient activity, the most resource-intensive form of hospital care.
RM Block
Separately, Carroll MacNeill has criticised a number of hospitals unable to explain “consistently” poor trolley figures.
The HSE has pointed to Ireland’s growing and ageing population as the reason for increased demand in hospital services, and said the volume of attendances at emergency departments has reached record levels.
According to an analysis by the Department of Health, seen by The Irish Times, the HSE hospital workforce has increased by 33 per cent since 2019 with real spending up by more than 50 per cent in the same period. That has resulted in hospitals delivering more care, with overall activity up 14 per cent in the last six years.
However, the same report noted inpatient activity increased by only 2.2 per cent. The Department of Health has questioned whether HSE hospitals were turning increased staff and investment into increases in the most expensive and high-demand forms of hospital care.
Demand has increased sharply in Ireland in the last year, especially in emergency departments. The number of presentations increased by 7.2 per cent between August 2025 and August 2026, to about one million by the end of this summer. The number of emergency department patients aged over 75 also increased by 10 per cent in the same period.
Carroll MacNeill told The Irish Times the HSE’s “challenging budgetary situation” this year was “a credibility challenge for everybody.”
“And I think going into the winter, when I see the very significant increases in emergency departments around the country of well over 7 per cent everywhere, I don’t see inpatient hospital activity increasing,” she said.
The Minister said while there were some increases in outpatient and day-case appointments it was “nothing like the level of investments that’s gone into the hospitals.” She said the HSE had improved its trolley numbers from 2024, “but it’s not as good as where we were in 2025, we’ve lost some of the grip on that”.
She said part of the reason was a rise in emergency department presentations but also that “while some regions and some hospitals have very much gotten on top of it, a cohort have not”.
“There are a cohort of hospitals that do not have consistently good performance and do not have good explanations for those. And those are very simply St Vincent’s in Dublin, CUH – which is up and down; Mayo, Letterkenny, Sligo and Limerick – but there are different reasons in Limerick. It’s partly capacity and partly the sheer scale of presentation.”
Looking to an ageing population, the HSE said a “significant number” of people attending emergency departments “are being admitted for ongoing care, with increasingly complex needs”.
In a statement, it said that “actions are ongoing at site, regional and national level to minimise the number of older and more vulnerable patients who are cared for on trolleys, particularly those who are on trolleys in excess of 24 hours”.
“A number of individual sites have delivered significant reductions in the numbers of patients over 75 years on trolleys for over 24 hours, these include Our Lady of Lourdes, Wexford, University Hospital Limerick and Galway University Hospital.”
