Patients, taxpayers and hospital staff are core themes in the Commission's report, writes Dr Muiris Houston, Medical Correspondent.
The principles which guided the members of the Brennan Commission in drawing up their report were that patients receive appropriate treatment as indicated by clinicians following best professional practice.
"Without compromising that principle the system must work in a manner that recognises the importance of spending taxpayers money in the most tax efficient way". Prof Niamh Brennan, the Chairperson of the 12-person Commission, told the Irish Times.
The Commission members worked between June 2002 and January 2003, meeting formally 15 times.
Three broad themes emerged from their deliberations - the patient, the taxpayer and staff in the hospital service.
"We decided early on that the Irish taxpayer was entitled to the highest standards of accountability in the health service - as high as that owed to shareholders in a PLC," Prof Brennan said.
"Both take other peoples money and spend it. If you are a shareholder and you are unhappy you can sell shares. The taxpaying public cannot."
"All Commission members have been patients at some time and clearly the service available to patients was high in our minds.
"And healthcare staff deserve an environment which is most conducive to them providing a good service," she added.
The Commission identified four problem areas.
One was the absence of any organisation responsible for managing the health service as a unified national system.
"It's not the job of the Department of Health and Children to do this. They recognise this themselves and want to concentrate on formulating policy," she added.
Current systems within the health service are not designed to develop cost consciousness among those who make decisions.
"We badly need transparency and a sharing of information. If people get poor information or none at all, then sub-optimal decisions are the result."
Insufficient evaluation and analysis of existing programmes and expenditure was another problem.
"We need to introduce evidence based budgeting in which you agree to do X number of things multiplied by the unit cost of each," she said.
Another issue highlighted by the commission was inadequate investment in information systems and management development.
"There are immediate savings when you introduce higher standards of accounting and control," said Prof Brennan. "Resource allocation is the key challenge for the new system", she said.
"Its up to the CEO of the new agency, and his team, to change allocations from month to month.
"For example, in the case of a SARS outbreak, it will be necessary to take money from X and give it to Y to deal with the problem.
Unsurprisingly, given her academic credentials, Prof Brennan sees the whole issue of corporate governance as central to getting the health service out of trouble.
"We must have clarity of reporting relationships. Audit committees must be in place in both the new health service executive as well as health boards and they must operate under written terms of reference."
The Chairperson of the Commission is clearly upset at the failure of so many health boards to complete audits nine months after the year end.
"The law is systematically being broken," she said indignantly.
What should the ultimate sanction be in future?
"Under the Companies Act, the Director of Corporate Enforcement has the function of investigating and prosecuting breaches by companies of their statutory obligations.
"Consideration must be given to the establishment of similar sanctions for bodies corporate in the public sector.
She said the success of the Commission will be judged by what will have changed in the health service in 5 years time.