Ireland has a growing, yet ageing population and over the next 20 years, the number of people aged 85 and over is projected to increase by around 6,000 each year which will present challenges in terms of access to and capacity of the health system. In acknowledgment of the requirements to transform the health system to respond better to the needs of the population and to put a stronger focus on prevention and primary care, the Sláintecare 10-year reform programme was launched in 2017. Sláintecare sets out to improve effectiveness, accessibility, resilience and fiscal sustainability of the health system. An important component of the programme was the setup of a health system performance assessment (HSPA) process to measure, monitor and report on achievements against the objectives of Sláintecare and broader policy and decision-making cycles. This is in recognition that the current system, which is based on activity- based indicators, needs to move towards a measurable and quantifiable outcome-based model strongly embedded in the policy making cycle which will monitor effective working of the health sector including policies and reform measures. This will allow for better evidence informed health policy decisions.

The project was supported by the European Commission Structural Reform Support Service who provided funding for the Phase 1 development that was launched on 10 September. The University of Amsterdam were chosen as the project providers. Governance structures were put in place to progress the project, including: 

• a small core project team led by the Department of Health and the University of Amsterdam
• a Project Working Group chaired by the DoH including key intra-departmental officials, HSE personnel and external stakeholders including the Health Research Board
• a Steering Board consisting of Senior Managers from the DoH and HSE
• an International Advisory Board involving HSPA experts from different European countries

Additionally, the department was in close contact with the EU Expert Group on HSPA to align activities with international experiences.

Three main purposes were defined for the development of the Framework:

• measure performance of the delivery system (health and social services)
• provide information (accountability) to the public regarding the effectiveness of policies and strategies of the DoH and HSE on overall population health
• monitor the progress of the Sláintecare reform to enable evaluation of the priority areas of the reform and to ensure that the healthcare system is more responsive to the needs of the population

The framework being presented is organised into five clusters and 16 domains:

• outcomes (health status)
• outputs (access, person-centredness, quality, costs)
• processes (coordination of care, integration of services, continuity of care)
• structures (finances, health workforce, health services structures, health technologies, health information
  cross-cutting cluster (resilience, equity, efficiency)

Each domain is further specified by subdomains and related features, which were populated with a total 260 indicators for all three purposes of the framework. All indicators were accompanied by an indicator passport which includes the original indicator source, the primary and alternative uses of the indicator, and expected source of data (e.g, surveys, administrative data, clinical data, civil registries, disease-specific registries, incident reporting system). In some instances, a specific indicator or suitable data source will require further development in the future.