With the issue of healthcare front and centre over the last 18 months, you could be forgiven for being unaware of the multi-billion euro plans to radically reform our health system which have been ongoing throughout the pandemic.

But when Sláintecare hit the headlines again this week for the first time in a long time, it did so for all the wrong reasons as two of its top officials stepped down.

In the wake of the resignations, the Government has repeated its commitment, and one that was made in the Programme for Government - to implement Sláintecare during its term.

But what exactly is Sláintecare? And how far are we away of the "unprecedented change" it purports to offer?

What is Sláintecare?

Ahead of the 2016 General Election, almost all political parties made some sort of commitment to universal healthcare.

Put simply, and as per the definition from the World Health Organization, universal healthcare is a system where "all individuals and communities receive the health services they need without suffering financial hardship".

This includes "the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course".

In the wake of that General Election, and with talk of "New Politics" in the air, all the parties agreed to work together and establish a committee on the future of healthcare in this country over the next 10 years.

The Programme for Government that year pledged to develop an agreed framework for "an efficient and effective health service" on foot of the cross-party recommendations.

Almost exactly a year on from the formation of the committee, its chair Róisín Shortall led the publication of the Sláintecare report.

It had lofty ambitions.

On RTÉ's Morning Ireland on 31 May 2017, Ms Shortall said that the plan was about offering a "public health service available to everyone" that's "not dependent on what you have in your pocket".

It had a number of key aims, including phasing out private beds in public hospitals, reducing and removing charges for the likes of inpatient care and prescription charges for medical card holders, and expanding primary care in a bid to switch healthcare from hospitals into the community.

It placed a big emphasis on joined-up thinking, both to drive efficiency and cut waste in the health service.

The plan aimed to achieve these goals over the course of ten years. It would require significant and ongoing investment, including €2.8 billion to build the necessary capacity and a further €3 billion transitional fund to support investment in infrastructure, e-health and training.

Putting the plan into practice

The then minister for health, Simon Harris, described the plan as the "last chance of this generation to get this right and take the politics out of health".

To help bring the plans into reality, a Sláintecare Programme Office was set up and some big-hitters were employed to oversee its implementation.

One of them was Laura Magahy, who previously headed up projects such as the €1 billion urban renewal of Temple Bar in the 90s, and the development of the Mater Hospital in the 2000s at a cost of €280 million. Having taken the role in 2018, she resigned this week.

In one of the initial tranches of funding, Budget 2019 allocated €20 million for the establishment of a Sláintecare Integration Fund to "test and scale how services can best be delivered". It provided the funds for delivery of services which focus on prevention, community care and integration of care.

The first full year of work from the implementation team came in 2019. In that year, it said that it progressed 138 projects with 112 of them on track, 24 facing minor challenges and two facing significant challenges.

For the first six months of this year, of 112 targets, 84 are on track, 25 face minor challenges and three face significant challenges.

In its plan to further implement Sláintecare, in the wake of the pandemic for 2021-2023, Ms Magahy said that "steady progress" had been made since late-2018 in bringing through "key reforms". She said the programme could build on the progress to date and the lessons learned from Covid-19 to have a major impact on our health system.

Next steps

The programme has not been without its detractors. The Opposition frequently criticised the pace at which it got to work after the cross-party report was published in May 2017 and how it has progressed since.

Doctors have also been critical as they remain in negotiations over the public hospital contract, a key element of Sláintecare reforms.

And, despite its grand aims of reducing waiting lists and transforming healthcare in this country, it has also faced criticism that these benefits are not taking hold across the country yet.

Of course, the pandemic has played a huge role too. As pointed out in Sláintecare's 2021-2023 plans, the ever-rising waiting lists have not been helped as many services were paused or curtailed in response to Covid-19.

And while the Department of Health responded to the resignations this week by pointing to achievements under the Sláintecare umbrella, such as the new GP contract and over €1 billion in additional funding from Budget 2021 which is increasing acute hospital bed capacity and providing enhanced community care, it is clear that there was a sense among some that the desire for reform was lacking.

Speaking in the wake of the resignations, Ms Shortall - who chaired the group that first proposed Sláintecare - said the reality was that "progress has been very slow".

"This has to be more about more than merely every branding exercise.

"We need to see actual real reform and fundamental changes in how we provide services and how there is accountability for the provision of those services. And to date we haven't seen any progress in that area at all," she said.

She and other opposition TDs have raised concerns that the Government is not committed to the kind of radical reforms first proposed in the Sláintecare report in 2017.

For his part, the Taoiseach has said the Government does remain committed to Sláintecare.

Micheál Martin said it is "very much committed" to its principles and in continuing the investment in health which arose due to the Covid-19 pandemic. Minister for Health Stephen Donnelly also said that the mission to achieve universal health care must continue.

Whether this mission will be achieved in the coming years post-pandemic remains to be seen.