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News and Events

June 2022

Professor Steve Thomas was invited to speak at the 2nd plenary meeting of the PHSSR global partnership, led by LSE Health Policy, to update international partners on the progress to date with the Irish arm of the collaboration. Prof Thomas spoke about the metrics collected to date across the main health resilience and sustainability domains, highlighting lessons learned from the process for those in the earlier data collection phase. Of particular interest were reflections on the blue-sky discussion with an expert panel involving key national and international stakeholders, balancing feasibility of a relatively short-term project with the needs of longer-term strategic solutions. More information on the PHSSR collaboration can be found at Home > Partnership for Health System Sustainability and Resilience | World Economic Forum (

On June 7th, Prof Steve Thomas presented at a SYSTAC webinar: Health system resilience – framing, debates and latest evidence as we start to emerge from the COVID-19 pandemic. Prof Thomas reflected on the measurement of resilience and how the footprints left behind after health system shocks differ depending on the type of shock. Elements of resilience differ at different times and stages of the shock cycle, thinking about how best to deal with the legacies and avoiding the need or want to measure everything. Another nuanced view is about how resilience concepts, such as absorption, is translated within the context of different shocks – are we shock facing or system facing, perhaps leveraging the shock to capitalise political windows of opportunity. A full recording if the session with various international speakers is available from: SYSTAC European Hub News & Events - Geneva Centre of Humanitarian Studies

On June 10th, Prof Thomas presented at the North American Observatory Lecture Series – Revitalising Health Care Reform through the pandemic: Further adventures of Sláintecare in Ireland. Prof Thomas explored how shocks to the health system can facilitate reform. He reviewed the different phases in Sláintecare implementation to date and what the factors were behind them. He evaluated the prospects for Sláintecare as it faces new post-pandemic challenges in the shape of looming austerity, low morale, regional reorganisation, and limited delivery on free care and waiting lists.

On June 15th, Dr Padraic Fleming presented at the European Health Management Association’s 27th Annual Conference. During the session titled: Management, operations and practice in the context of the COVID-19 pandemic, Dr Fleming presented recently published findings on Implications for health system reform, workforce recovery and rebuilding: Lessons from the Great Recession and COVID-19. The conference abstract can be seen in the book of abstracts (page 45), available here:

The full paper is available here:

May 2022

New publication
Dr Padraic Fleming (RESTORE) led a recent collaboration between the RESTORE and Foundations’ teams in the Centre for Health Policy and Management, alongside partners in the Health Service Executive to produce a recently published paper: Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008–2021. Abstract and link to full article below.

Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland’s publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings.

Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: ‘Recession period’ December 31st 2008–December 31st 2014; ‘Recovery period’ December 31st 2014–December 31st 2019; and the ‘COVID-19 period’ December 31st 2019–August 31st 2021.

During the Recession period there was an overall decrease of 8.1% (n = 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (n = 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (n = 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (n = 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services.

This paper clearly demonstrates the prioritisation of staff recruitment within acute services—increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.

Link to full article:

May 2022

The RESTORE team issued a press release on Monday May 16th to launch a collaboration between RESTORE and the Partnership for Health System Sustainability and Resilience (PHSSR) project, which is global partnership between academic, non-governmental, life sciences, healthcare and business organisations, led by the London School of Economics, Department of Health Policy. Several tweets were posted throughout Monday 16th from the @TCDhpm Twitter account, to showcase early findings and quotes from experts feeding into the PHSSR project, highlighting the importance of the project for national and international initiatives.

Further details on the partnership can be found at the following press release:

March 2022

Dr Padraic Fleming presented findings from an ongoing realist literature review at the SPHeRE Network 8th Annual Conference: Wicked Policy Problems - Pulling Back the Curtain titled: The legacy of health system responses to the 2008 financial crisis and how this impacted health system resilience – A realist review. The presentation outlined a range of Context-Mechanism-Outcome configurations emerging from the realist analysis of 204 studies, which can be leveraged by policy -makers and health service management to develop strategies that protect and promote health system resilience. This was an online event and a recording of the ‘Health Systems’ session can be viewed online.

February 2022

Professor Steve Thomas was invited to give a guest lecture on health system resilience seminar series at the Canadian Centre for Health Economics, on February 18th 2022. The lecture titled ‘The Economics of Health System Shocks and Resilience’ examined evolving thinking and evidence around health system resilience and shocks and the economic ideas implicit in how to best navigate shocks to the health system.

Earlier in the month, Professor Thomas presented at the inaugural event of SYSTAC - Systems Thinking Accelerator, a community-of-practice for applied systems thinking on February 10th 2022. The webinar: ‘Systems approaches to strengthening health system resilience: Key concepts and lessons from COVID-19’ was organised by Geneva Centre of Humanitarian Studies and reached a global audience via the online forum. A recording of the webinar along with presentation slides can be viewed at the following link: SYSTAC webinar: Systems approaches to strengthening health system resilience: Key concepts and lessons from COVID-19. - Geneva Centre of Humanitarian Studies

December 2021 – Early results from the RESTORE project presented at various fora

Professor Steve Thomas and Dr Pádraic Fleming presented early findings from the RESTORE project at the December 2021 Health Services Research webinar organised by Tampere University Sustainable Welfare Systems, Finnish Institute for Health and Welfare & Finnish Association for Social Medicine. This online presentation titled: Understanding Health System Resilience: Learning from Shocks and Building Legacy outlined findings from 1) an upcoming systematic review examining how health system resilience has been measured across different shocks over the past 20 years, 2) a realist review examining Context, Mechanism, Outcome Configurations (CMOCs) in relation to the 2008 financial crisis and the legacies for the COVID-19 response, 3) early indicators of resilience metrics within the Irish context and finally 4) highlights from the recent policy analysis of how Sláintecare has been impacted by the response to COVID-19.

This presentation was based on outputs from the 1st Annual workshop of the RESTORE project which took place in November 2021. A summary of the event, along with videos and presentations from the webinar can be found here Other Research Outputs - School of Medicine - Trinity College Dublin (

November 2021 - Full Programme (PDF 195kB) available for the upcoming RESTORE Annual Workshop - Measuring and building heath system resilience - November 16th, 9.30 to 1pm. To register, please complete the registration form here.

1st Annual Workshop of the RESTORE project - 16 November 2021

Full Programme available for the upcoming RESTORE Annual Workshop - Measuring and building heath system resilience - November 16th, 9.30 to 1pm. To register, please complete the registration form here.

Registration is now open for the 1st annual workshop of the RESTORE project (a HRB Research Leader Award) on the morning of 16th November 2021. Please click here to register. The workshop, titled: “Measuring and building heath system resilience”, will feature speakers from the European Observatory of Health Systems and Policies and the University of Tampere, Finland alongside Prof Steve Thomas and colleagues from the Centre for Health Policy and Management, TCD.

June 2021 – “Marry in haste. Repent at leisure” – The Irish Experience of VHI

On June 16th the Swedish National Board of Health and Welfare and the European Observatory held a policy dialogue entitled: “Managing a growing VHI market in Sweden: lessons from other countries”. The purpose of this policy dialogue was to understand the experiences of countries that have faced similar challenges related to VHI (Voluntary Health Insurance) and dual practice, and to consider possible options for addressing unintended consequences of VHI growth in Sweden. Prof. Steve Thomas was invited to provide an expert view on lessons learned from Ireland. Prof. Thomas outlined various policy options available to Sweden based on Ireland’s troubled history with VHI.

May 2021 – What is health system resilience? How can we assess and strengthen it

On May 19th Prof. Steve Thomas provided a keynote presentation for the 4th workshop of The Nordic network for Health Policy, Health Management, and Health Services Research. The aim of the conference was to provide a forum for researchers within the Nordic arena to share ideas, broaden knowledge, collaborate, and network. Prof. Thomas was invited to offer an international perspective on how health system resilience can be assessed and strengthened.

March 2021 - Strengthening health systems resilience.

Prof Steve Thomas joined, as guest speaker on health systems resilience, a seminar series at the School of Cities, University of Toronto, which seeks to develop a multi-disciplinary understanding of resilient supply chains by examining two which are of critical importance to everyday life: food and health supply chains. The talks in this series look at these supply chains, both independently and together, through the inclusion of diverse speakers representing at least the following perspectives:

  • Supply Chain Optimization
  • Northern and Remote Food and Health Security
  • Urban Food Systems
  • Systems of Food Production
  • Healthcare Systems

Prof Thomas covered the key findings from the WHO Policy Brief, including defining resilience and its distinct stages and outlining the shock strategies that countries and health systems around the world should consider.

Overview and recording of talk can available here.

February 2021 – Future-proofing our health system

At the 17th National Health Summit Steve Prof Thomas suggested that we may have to get used to shocks to our health system. Future pandemics, increasingly severe climate events and economic shocks like Brexit will test the resilience of our healthcare system. What can we learn from international experience of building health system resilience, what strategies can we use and where do we go from here in Ireland?

February 2021 - Covid-19 and the sustainability of health financing: anticipated effects and policy options

Prof Thomas presented at The European Observatory on Health Systems and Policies COVID-19 HSRM webinar series, which draw on the lessons from country experiences, analysing how health systems can respond to the pandemic and what makes them more resilient to external shocks and crises. More information about the seminar series available here: WHO/Europe | Events - Observatory webinar series on the COVID-19 response

Recording of full webinar available here

January 2021 - Strengthening health system resilience – what role for migrants and migration policies?

The RESTORE team kicked off 2021 to a good start, publishing a ‘Think Piece’ on the role of migrants and migration policies in strengthening health system resilience in the Migration Policy Hub. This followed a presentation by Professor Steve Thomas at an online conference on November 9th 2020 that launched the “Migrants and Systemic Resilience Hub” (MigResHub), a joint initiative of the Migration Policy Centre (MPC) at the European University Institute (EUI) in Florence and Migration Mobilities Bristol at the University of Bristol.

View the online conference session on Migrants and systemic resilience in health services here.

Paper abstract

The resilience of health systems has never been so important with the increasing frequency of extreme climate events, mass migration, economic crises and pandemics. This paper examines what strategies can build resilience; the central role of workforce in resilience before, during and after shocks; and whether migrant labour makes health systems more resilient or more vulnerable. The importance of sufficiency, flexibility and motivation / engagement, in relation to resilience building, are discussed within the context of a global shortage of health care workers and a profound demand and supply imbalance between high and low-middle income countries. The question of whether health system resilience can be bolstered by migration is nuanced. Governments who rely on health worker migration need to set robust policies, manage migration in a constructive way and adopt formal agreements for which they are accountable.

Full article available here.

June 2020 - Strengthening Health Systems Resilience Policy Brief

Prof Steve Thomas and colleagues published (on 18 June 2020) a policy brief for the WHO European Observatory on Health Systems and Policies exploring health systems resilience during shocks like COVID-19 and economic downturns. It is important reading for anyone interested in how health systems can prepare for, recover from and learn from crises.

Key findings include the following strategies for enhancing health system resilience:

  • Governance: effective and participatory leadership with strong vision and communication; coordination of activities across government and key stakeholders; an organizational learning culture that is responsive to crises; effective information systems and flows; and surveillance enabling timely detection of shocks and their impact.
  • Financing: ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds; ensuring stability of health system funding through countercyclical health financing mechanisms and reserves; purchasing flexibility and reallocation of funding to meet changing needs; and comprehensive health coverage.
  • Resources: appropriate level and distribution of human and physical resources; ability to increase capacity to cope with a sudden surge in demand; and motivated and well-supported workforce.
  • Service delivery: alternative and flexible approaches to deliver care.

Full Policy brief available here.