The Government's healthcare strategy - by far the most important domestic policy initiative of recent years - will take time to assimilate and evaluate. The subtitle "Quality and Fairness" reflects widespread concerns about the present system, but the issue itself - healthcare - and the depth of the analysis in the strategy demand, and deserve a period of reflection. Besides, there are sub-strategies to follow. What can be done, however, is to put this strategy into some kind of context. Specifically, the criteria by which the new strategy should be evaluated - and where appropriate further developed - are clear.
Equality of access is fundamental. There are clear and unequivocal indications that the present system is skewed and highly discriminatory. There is an enormous burden of expectation - based on people's experience, on the views of healthcare providers and on new insights into the healthcare systems that operate in comparable countries - that equality of access has to be the cornerstone of any credible strategy.
In the past, the emphasis has tended to be on expenditures and inputs, rather than on what really counts, namely outcomes for the individual. There is enough research evidence regarding Ireland's position in league tables in, for example, oncology, to demonstrate just how much needs to be done: not alone in terms of improved performance metrics but also in empowering physicians and other healthcare providers with the necessary flexibility to focus on healthcare outcomes.
One of the key headlines in the new strategy is proposals to increase the number of beds within the public system. A proposal of central importance is, where necessary, to buy in capacity either from the private sector or from abroad. It is simply not acceptable to hold public patients hostage to a system that is ostensibly divided between public and private components. We have to look - and manage capacity - from the perspective of the whole system.
There must be no return to the old ad-hoc "cuts" that did such real damage to the system and are highly regressive. In the less benign economic environment that now confronts us, expenditures on the scale of recent years are simply not sustainable. That is why it is vital that the private component of the public-private mix is incentivised and encouraged to increase capacity.
The business of government should be to fund continually rising levels of acute healthcare, but not necessarily to deliver it. There are two implications here. First, the need to free up and make more flexible the public hospital systems. The second issue is to incentivise a significant increase within the private sector.
Quite simply the regulatory system which operates within the private system is top heavy with constraints and "running on empty" as far as competition and incentives are involved. That is not, it should be said, the intention of policy. But it is, demonstrably, the effect.
Increased co-operation across the different components of the healthcare system - especially between the primary and the acute sectors, is essential. The proposals to invest significantly in community based multi-disciplinary primary healthcare sectors is far-sighted. The thing is to keep people healthy and out of the acute system. This will require a much more empowered and system intensive role for the primary sector.
Waiting lists were always going to be a key element of the strategy. In fairness, it should be said that a great deal is being done at the level of health boards and Government in recent years. Money isn't the real issue here: smart ideas are. The investment in A&E makes sense. But there are a whole raft of other things that could be done to bring down waiting lists.
For example, a focus on waiting lists by procedures. Equally a reduction in referral rates using, of course, rigorous protocols. Putting limits on how long people should have to wait is a step forward.
Addressing, at the secondary care level, the quiet and silent crises, in terms of the adequacy of care within the community of individuals - and families - with emotional and physical difficulties.
Medical manpower plans that will create a significantly larger pool of consultant posts deployed, more flexibly, through the system, including A&E; proposals to attract and retain skilled nursing personnel and to put in place administrative procedures to prevent "burn-out", which is at the heart of the nursing and midwife shortage crisis.
There is an enormous challenge for the medical profession in relation to the new strategy. The reality is that the different components of the profession have, quite simply, failed to develop, and articulate and push forward a clear vision of what they know could be delivered, in terms of improved levels of outcomes and more cost-effective ways of treatment. There are sector-specialist plans and strategies and submissions. But it is long past the time that consultant groups, the Royal Colleges and others took co-ordination by the scruff of the neck and developed a strategic version - as well as objectives and instruments - and performance measures, which they believe appropriate for Irish patients. If they fail to do so, their role will be eroded and "crowded out" by those inevitably less informed of what is happening at the cutting edge. That's what "physician-led" should mean.
A new, more flexible and sensitive healthcare strategy needs to be driven by physicians and to be patient-centred. What does the latter mean? It means, for example, that women do not wait for months to get the results of smear tests, and the necessary treatment.
What we are talking about here, quite simply, is good process-management; at the heart of which are the needs and worries and concerns and rights of patients. In this particular example, some of the delays that currently exist are unacceptable.
The reality is that most of the structural and management and organisational flaws in our healthcare system - with which the strategy will mainly be concerned - simply should not be there. They are yesterday's problems. They wouldn't exist in a world-class company.
The new healthcare strategy will have to deliver, and manage, an acute system that is based on objective ethical principles.
Ten years from now - indeed it is already happening - the really difficult issues that we will be addressing in the acute healthcare sector will have to do with the objective ethical principles upon which cloning and other new therapeutic and clinical inventions should be based.
Philosophy and morality will replace economics and accountancy as the language in which healthcare strategy, and rights, and litigation will be spoken.
Philosophy provides us with the only viable template within which to address these ethical issues, which are already preoccupying many hospital CEOs.
Ray Kinsella is director of the centre for insurance studies at the Smurfit School of Business in Dublin.