Ireland has a proud history in the field of palliative care, and this provides a strong basis for co-operation and engagement with this study. The collaborators include the most senior national palliative and health reform leaders within the Irish health system as well as experienced palliative care, health systems and policy researchers.

This research project will analyse the implementation of palliative care in other countries with universal healthcare systems and apply these learnings to the Republic of Ireland. The project will explore from 2023 to 2040 what are the projected palliative care needs and what levels of service capacity and workforce requirements or would be required to meet universal palliative care in Ireland.

The project will use a multi-methods design including: 1) a comparative analyses of palliative care policy and implementation in six countries (including the Republic of Ireland) and applying the learnings to the Irish context; 2) modelling regional palliative care needs between 2023 and 2040; 3) estimate service capacity and workforce requirements required to meet these needs; and 4) determine the applicability and acceptability of expanding the role of generalist palliative care in Ireland through stakeholder engagement.

The project will include the following workstreams:

1. Reviewing palliative care policy in other countries and the learnings for Ireland

The focus of this workstream is to identify the policy options for delivering universal palliative care in Ireland.  It will draw on the learnings from other countries’ experiences, successes and failures on introducing palliative care at a policy and system level. This type of cross-country comparison will provide important evidence for policymakers. Guided content analysis will be used to describe and contrast the content of national   palliative care policy, strategic planning and/or implementation documents. The analysis will draw on the WHO’s Health System Framework ‘building blocks’: service delivery, health workforce, health information systems, medicines and technology, financing, and leadership and governance.

To assess the potential for implementing examples from other countries here in Ireland, qualitative methods will be used undertake a critical analysis of palliative care policy and implementation in Ireland since 2011. The aim is to map out potential interests and interactions of relevant stakeholders and organisations.

Questions will include: What services are provided? What do they cost? Who can access services? Who are the stakeholders in Ireland? How do they interact with each other?  What are the key developments and gaps in Irish policy?

Countries to be included in the analysis: Australia, Canada Norway, Sweden, United Kingdom and Ireland

2. Palliative care needs across the Irish population

An important development in the Sláintecare reforms is the establishment of six regional health bodies, Regional Health Areas, to deliver people-centred health and social care.  These regional health bodies will have their own budget based on local population needs and will facilitate improved accountability and transparency. The aim of this workstream is to understand regional population needs and appropriate responses to these needs.

We will identify groups of people with similar types of needs or patterns in the healthcare services they use. These analyses will allow us to estimate current and future palliative care needs across Regional Health Areas. This information will be used to design, deliver and evaluate services that meet those needs, within the resources available.

3.  Planning for future palliative care needs

The aim of this workstream is to collate and combine available data to provide a more detailed picture of palliative care capacity across the Regional Health Areas. Additionally, it will estimate future service capacity and workforce requirements to provide universal palliative care access between 2023-2040.

Components will include:

• Create a profile of palliative care supply across the Regional Health Areas and assess the adequacy of current service capacity

• Complete a rapid review to identify examples of best practice in workforce planning and modelling for palliative care provision

• Estimate workforce and system requirements to meet population need between 2022 and 2040

4. Understanding viewpoints on meeting future palliative care needs

The aim is to systematically explore and describe the range of viewpoints expressed by stakeholders about the role of generalist palliative care in supporting people with life-limiting conditions in the community and the barriers and facilitators to implementation.

This will be achieved through qualitative interviews and a Q methodology study. Q methodology is exploratory and combines qualitative and quantitative methods to provide a framework for eliciting viewpoints about a specific topic. The aim of Q methodology studies is to identify the viewpoints people hold rather than comparing proportions of the population who hold similar or different views.