Roisín Shortall had been a TD for almost 25 years when she was elected chair of the Future of Healthcare Committee.

That quarter of a century of experience certainly stood to the Social Democrats co-leader when it came to securing, for the first time ever, cross-party consensus on the country's healthcare system.

Her political nous was also evident in Leinster House at the launch of the Sláintecare report on 30 May 2017.

Deputy Shortall warned that the radical reforms needed to begin immediately, and said that her committee's report should "not be allowed gather dust like 40 previous reports in the area".

The resignations of several senior people charged with implementing the plan have thrown the future of Sláintecare into question. But are they merely a stumbling block that can be overcome on the way to some form of healthcare utopia, or will the report end up being confined to the dustbin of history?

In 2017, Sláintecare was hailed as a plan that would bring about a new model of healthcare to serve the Irish people – at a cost of €5.8bn – over the next ten years.

Dr Sara Burke, from the Centre for Health Policy and Management at Trinity College Dublin, has done extensive research into the Sláintecare plan.

Read more:
What exactly is the Sláintecare programme?
What now for healthcare reform after Sláintecare exits?

"The main elements of Sláintecare are that everyone in the population would have access to care on the basis of need," Dr Burke told Prime Time.

"There would be much more care providers in the community outside of hospital, much better prevention and public health, and funding health services on the basis of health needs."

But its critics say that the rollout of the plan has been far too slow. This is believed to have been one of the reasons for the resignations of Laura Magahy, Executive Director of the Sláintecare reform programme office, and Professor Tom Keane, chairperson of the Sláintecare Implementation Advisory Council.

Dr Burke said that the ten-year plan was "slow out of the traps, because it took Government 15 months to even adopt Sláintecare as Government policy."

"When it did adopt it, it was slightly a watered-down version of the original plan," she said.

And though the Government built the foundations necessary for these massive reforms, the Covid-19 pandemic has been a complicating factor, according to Dr Burke, not least because of the surge in waiting lists.

Former Health Minister Simon Harris with Laura Magahy at the launch of Sláintecare's implementation strategy

But the pandemic has not been all bad news for Sláintecare, she noted, in that all Covid-related treatment has been universally free at the point of delivery.

"We've seen what the health system can do when it has a singular focus. But, critically, the resources that Sláintecare never got pre-Covid have been allocated in this year," Dr Burke said.

Though the pandemic has indeed led to some reforms and an increase in healthcare resources, one of the key points of contention with Sláintecare has been the reorganisation of the health service into six regions.

Minister for Health Stephen Donnelly told Prime Time that the Government and the HSE were fully committed to Sláintecare, but that the pandemic was not the time to reorganise the health service.

Though Ms Magahy and Prof Keane have not commented on their resignations, Minister Donnelly said he believed they resigned because they were frustrated at the pace of reform.

Priscilla Lynch, the Clinical Editor of the Medical Independent, told Prime Time that it was clear that the regional reorganisation was a sticking point.

"One of the key building blocks of Sláintecare is the reformation of the HSE structures – making regional healthcare structures and replacing the hospital groups and the community healthcare organisations, which don't correctly align. They are kind of messy at the moment," she said.

"So that was a key part of implementing Sláintecare and that hasn't yet happened."

Minister Donnelly said he discussed the proposed reorganisation with HSE leaders last week.

But the potential impact of the resignations cannot be underestimated, according to some experts in the health policy area.

Dr Burke said the resignations were "potentially catastrophic".

"The Government really needs to come out and show its support," she said. "Is it really 100% behind implementing Sláintecare?"

"We saw with Covid what happens when you have that combination of political support, resources allocated, and a singular focus. And if the Government is serious about Sláintecare, they need to show us that."

Ms Magahy and Prof Keane were thought to be doing their "very difficult" jobs pretty well, according to Dr Burke. She said they would not have resigned if they had the institutional and political support they needed.

The pandemic has been a complicating factor for the implementation of Sláintecare

For his part, Minister Donnelly said that developing a universal healthcare system for Ireland was "profoundly important".

"We have to have a single-tier healthcare system in our country. Sláintecare is the map to do that," he said.

Ms Lynch said waiting lists are the key metric for assessing the success of a health service and they are the key issue at the moment.

"We've up to one million people currently waiting for an inpatient procedure, an outpatient appointment - also for diagnostics scans," she said. "So, how are we going to tackle them?"

"The Government is great for announcing things that are going to happen under Sláintecare, but what has actually happened?"

The Progressive Democrats famously set out to be "radical or redundant" in the late 1980s.

Sláintecare was originally hailed as radical four years ago. How the Government deals with its current difficulties could well determine whether it actually ends up being redundant.

Additional reporting Samantha Libreri