Funding problems mean services for patients look set to get worse, writes Eithne Donnellan.
The structural changes proposed in the Prospectus report are among the most far-reaching since health boards were established in the early 1970s.
Since then many things have changed.
There have been major shifts in demographics, consumer expectations have risen and the thinking on how specialist health care services should be delivered has changed.
Experts generally agree it is better for patients with certain diseases to be treated by multi-disciplinary teams at a limited number of hospitals across the State than by an individual clinician with little back-up in a smaller hospital.
However, plans to change services to mirror this thinking have been hampered by a number of factors, including so-called "parish pump" politics.
Decisions about where services should be located have more often than not been in the hands of health boards, made up of local politicians and locally-based professionals including doctors, nurses and pharmacists.
This has militated against change and the Prospectus report clearly identified this.
It said there were a number of "negative effects" of having public representatives on health boards including the likelihood of local area concerns dominating.
It has as a result controversially suggested the abolition of all health boards.
They will be replaced by a national Health Service Executive and four regional offices, the locations of which have not yet been determined, will report to it. These bodies will have greater consumer and professional representation at the expense of the local politicians.
The fact that the Government has already endorsed this recommendation is a welcome development because a previous report on value for money in the health service from Deloitte and Touche had also stressed that the political nature of the health boards constrained the delivery of value for money and could "make a nonsense of some elements of decision-making within the regions"; but nothing was done about it.
The abolition of the health boards will also mean less duplication.
Up to now each health board has had its own health promotion officers and its own suicide prevention teams, for example.
Common sense would suggest that in a country as small as Ireland these functions could be shared.
It appears this will now happen and that many other functions will also be shared under a new National Shared Services Centre.
However, how much will be saved from the radical reforms is unclear. A number of agencies will be abolished as the system is slimmed down but the Minister for Health, Mr Martin, said yesterday there were no plans for redundancies.
This means 96,000 pay cheques will continue to be issued every month and with pay accounting for 70 per cent of the health budget it will continue to be a considerable drain on resources.
Meanwhile the fact that the consultants who compiled the Prospectus report found health service structures to be seriously fragmented will surprise nobody, especially not service users and GPs who are often sent around in circles before they get to the person in the health service they were looking for in the first place.
If its recommendations result in clear lines of accountability being established to replace the "blurred" ones referred to in the report, everyone should benefit.
The setting up of a national Health Service Executive to run the service on a day-to-day basis should go some way to addressing this as should the setting up of a National Hospitals Office with which the buck will stop in relation to waiting list figures and other hospital problems.
The changes however will not happen overnight. Apart from the fact that they will meet with resistance from several quarters, the legislation required to underpin them could take up to 18 months to introduce. In the meantime the service on offer to patients, given current funding problems, looks set to get worse rather than better.