Dr. Sara Burke:

It often takes a crisis to instigate major policy change. The NHS was born out of World War Two so it is not that unusual. It is a good question and I think understanding it is a key part of delivering the reform. By its nature, what does the Department of Health do? It does incremental change in the fullness of time; it very rarely does radical reform so that is the pace. That was the logic behind the idea of the original committee of having an engine room outside of the Department to motivate it to move more quickly. We saw big changes during Covid. We did pretty well. Mistakes were made but the system - the Department, the HSE and those on the front line - responded really well during Covid so there is that. The policy system changes slowly and therefore it really needs political leadership and pressure from public representatives and a watchdog over the resources.

There is also a broader societal issue around the status quo. If the majority are doing okay, then it is hard to shift that. That is a false argument because even though nearly half the population have private health insurance, it does not actually get a person many of the essential parts of care that one needs in society. Yes, one gets faster access to elective care, but it does not get one a home care package in rural Ireland or access to a public health nurse in a wealthy suburb of Dublin.

It does not get you access to a public health nurse in a wealthy suburb of Dublin, because that depends on whether you have medical card status. A body of work is to be done with citizens and communities to make the case. If people are driving a public health system and universal access, it will be much harder for politicians not to follow that.