Ireland’s healthcare system is in crisis. From overwhelmed emergency departments and spiralling waiting lists to chronic underinvestment in rural services and long delays for specialist care, the system is failing those who need it most. Especially at risk are people living with long-term illness, heart conditions, disabilities, and our children—those who cannot afford to wait, and should never be asked to.
What we need is more than reform—we need a transformation.
We propose the establishment of NHS Ireland, a unified, public, all-island National Health and Care Service, inspired by the founding principles of the UK’s NHS and guided by both the Sláintecare report in the South and the Bengoa report in the North.
This is about fairness, about equity, and about national ambition: free, universal healthcare at the point of delivery, available to all, based on need—not on ability to pay.
Core Principles: One Ireland, One Health System
We propose a truly unified, single-tier health service—north and south, urban and rural, child and adult, that prioritises:
Universal access, regardless of geography or income
Free care at the point of use
Equity for people with chronic illness, disabilities, heart conditions, and children
Fully integrated services across primary, secondary, mental health, disability, and social care
An all-island, interoperable digital and clinical system
Cross-border collaboration, making the best use of capacity wherever it exists
Focus: People with Heart Conditions, Chronic Illness, Disabilities, and Children
Long-Term Conditions and Heart Disease
Heart disease remains one of the leading causes of death in Ireland. Those living with conditions like heart failure, angina, or those recovering from heart attacks must often battle poor access to cardiologists, lack of rehabilitation services, and long gaps between follow-up care.
Under NHS Ireland:
Cardiac rehab programmes would be offered in every region, with home-based options and telehealth support.
Remote monitoring and virtual clinics would be standard for those with stable heart conditions.
Fast-track cardiac diagnostics would ensure early detection and intervention.
Ongoing medication and lifestyle support would be free and community-based.
Chronic Illness and Disability
People with long-term conditions—such as diabetes, COPD, autoimmune diseases, multiple sclerosis, and others—would benefit from:
Guaranteed treatment timelines, integrated care plans, and named coordinators.
Access to free medication, physiotherapy, mental health, and occupational supports.
Reimbursement or removal of medical card thresholds for lifelong conditions.
Disability rights integration, with universal access to therapies and supports regardless of postcode.
Children and Early Intervention
Every child in Ireland deserves a fair start. Under this system:
Universal free GP, dental, and mental health services for all under 18s.
School-based health and counselling supports, especially in DEIS schools.
Expanded early intervention teams: speech therapy, OT, psychological services.
A National Children’s Health Authority, focused on planning and innovation for young people.
Funding: Paying for It Fairly and Sustainably
- A Ring-Fenced Health Solidarity Levy
A progressive tax, starting at 1% on earnings over €50,000 and 3% above €150,000, to provide stable, transparent funding.
All revenues go directly into the health system—visible, protected, and ring-fenced.
- Ending Wasteful Two-Tier Subsidies
End tax relief on private health insurance and redirect those funds (over €1.3bn per year) to public capacity.
- Drug Pricing Reform
Establish a joint Ireland-Northern Ireland Pharmaceutical Agency to negotiate better prices.
Use cross-border volume and leverage to drive down costs.
- Prevention as Investment
Invest in preventive health, lifestyle support, and chronic condition management to reduce long-term costs in A&E and inpatient admissions.
The All-Island Roadmap for Integration
We must not only transform services in the South—we must integrate care across the island, harnessing the strengths of both systems and ending duplication. To do this:
- Sláintecare + Bengoa = Blueprint for All-Island Health
The Shared Island Unit should develop detailed costings for implementing both reports in tandem, and publish options for integrating health systems north and south. These must be fully resourced and action-oriented—not left on shelves.
- Political and Professional Leadership
Ministers for Health in both jurisdictions, along with Assistant Secretary Generals (or equivalents), must lead on design and delivery. HSC Trusts in the North and HSE Regional Health Areas in the South must be equal partners, not competitors.
- A National Forum of Experts
Bring together a high-level All-Island Health Council of:
Health professionals and hospital administrators
Unions and professional bodies
Health economists and data experts
Universities, training bodies, and regulators to coordinate workforce planning, research, and service delivery.
- A Unified Hospital Waiting List System
Patients should not be penalised by borders. A shared hospital waiting list system will:
Enable patients to be seen in either jurisdiction, with consent
Balance demand and supply of specialists across the island
Ensure consistency in waiting times through shared targets
- One Digital Record, One Patient Identity
A shared electronic health record from GP to hospital to home care, with consent-based data sharing across borders, will improve safety and save time.
- Emergency Services That Work Across Borders
In the border region, patients should have access to the nearest available ambulance, emergency department, or air medical support, regardless of which side of the border it lies on.
- All-Island Clinical Programmes
Establish shared national strategies for key disease areas—cancer, heart disease, diabetes, mental health—with aligned clinical guidelines and targets.
- Common Professional Standards and Mobility
Develop cross-border regulation and professional standards to allow health workers to practice freely across the island, with mutual recognition of qualifications and CPD.
- All-Island Workforce Planning
Use data and projections to train the right number of nurses, doctors, therapists and care workers, with shared training pipelines and guaranteed placements across the island.
- A Rural Health Commission
Rural Ireland and rural Northern Ireland face identical challenges. A dedicated Rural Health Commission must:
Design an all-island rural health strategy
Focus on mobile care units, rural diagnostics, telemedicine, and home-based supports
Ensure that distance from a hospital doesn’t mean distance from care
Conclusion: Care Without Borders, Health Without Profit
We know what works. We know the public supports it. What’s missing is the political will to act boldly.
Let’s create a health system where a child in Leitrim gets the same care as one in Louth. Where a person with heart failure in Derry is treated with the same urgency as one in Donegal. Where living with disability or chronic illness does not mean battling bureaucracy or financial hardship.
This is about equity. This is about unity. This is about justice.
Let us build NHS Ireland, an All-Island National Health and Care Service—for all of us, and each of us, no matter where we live, or how much we earn.
Because healthcare is not a luxury. It is a right.
