Many reports over the past decades have been acted on only partially or minimally. We now have major funding for health and it time for major reforms. The system is not working well. Not only will it be unable to respond to increased funding in future, it is not using well enough its existing €9 billion funding. When evaluating these reports the Minister and the Government should think big and look beyond the pressures from interest groups and individuals which inevitably arise when change is proposed. Change is difficult but it must be embraced. It brings uncertainty and people's fear of change is often greater than their dislike of present problems. Organisations and systems do not welcome change, even when people within them know that something is wrong with the status quo. I have no doubt there will be objections from well-meaning people and organisations, from clinicians, managers, administrators, representative groups and public representatives.