Sl√°intecare and Universal Healthcare in Ireland

Research Team

Steve Thomas, Sara Burke, Sarah Barry, Bridget Johnston, Rikke Siersbaek,


House of the Oireachtas and HRB


European Observatory for Health Systems and Policies, World Health Organization


Sláintecare what is universal.

What’s the problem?

Ireland does not have a universal health system. Uniquely in a European context, people do not have universal access to free primary care. There is also two tier access to public hospital care with those who have money or private health insurance often allowed to gain speedier access to essential diagnostics and hospital treatment. As well as long waits to get necessary care, there are often high charges which prohibit access for some groups and cause financial hardship.

The current health service also provides a disproportionate amount of care in hospital settings. Interventions which could more appropriately take place in a primary care setting are instead provided at more advanced, expensive and already stressed secondary levels of care. Resources are used inappropriately driving high costs to the service as a whole.

What did we do?

In 2014, Prof Steve Thomas secured funding from the Health Research Board for the Mapping the Pathways to Universal Healthcare project. This four-year project aims to provide an excellent evidence base that will inform the strategic direction and implementation of universal healthcare in Ireland.

After the general election in 2016, an all-party Oireachtas Committee on the Future of Healthcare was established. This had a remit to devise a ten year plan for health reform including a pathway to the delivery of a universal health system through political consensus.

The Pathways team gave evidence in public and private sessions in summer/autumn 2016 and was then successful in a tendering process to provide technical support to the Committee. Between November 2016 and May 2017, the team worked closely with the Committee assisting it with its work, through providing national and international evidence and frameworks. It also assisted the Committee in drafting of their final report, Sláintecare.

What’s the impact of this work?

On 30 May 2016, Sláintecare, the report of the Oireachtas Committee on the Future of Healthcare was published. ‘Sláintecare’ is unique and historic as it is the first time there has been a cross-party political consensus on major health reform in Ireland. Sláintecare sets out a high level policy roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed using available data.

Sláintecare details reform proposals which, if delivered, will establish;

  1. a universal, single-tier health service where patients are treated solely on the basis of health need;
  2. the reorientation of the health system ‘towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible’.

Sláintecare has five interrelated components: population health; entitlements and access to healthcare; integrated care; funding; and implementation.

What's the progress to date?

The health minister has been very public in his endorsement of Sláintecare
One of the most important developments in the past 12 months − the publication of the Sláintecare Report… It has attracted unprecedented cross-party political support… For our part, the Government is committed to delivering on the Sláintecare vision… The recommendations in the Sláintecare report are grounded in eight overarching principles which I fully endorse.  (Burke et al, 2018)

In August 2018, the government responded with its official implementation plan for Sláintecare. Further, an executive director, Laura Magahy, has been appointed to a Sláintecare Programme Office in the Department of Health and she will take up her post in September 2018 to drive the reform. Prof Tom Keane has been appointed Chair of the Sláintecare Advisory Council.

If implemented, Sláintecare will radically reform access, delivery and quality of health and social care for all citizens in ireland.

Further reading

The full Sláintecare report can be accessed here:

A policy brief giving an overview of the Sláintecare reform package can be accessed here:

A health reform monitor article ‘Sláintecare - A ten-year plan to achieve universal healthcare in Ireland’ was published in Health Policy on Sláintecare by the Pathways team in May 2018.