In contrast to public perceptions of Ireland’s economic success, public dissatisfaction with its health service has been rising rapidly; long waiting lists, crowded emergency departments, and contrasting public and private care models have led to demands for change. In response, the Health Reform Programme introduced on 1 January 2005 has set the scene for significant reorganisation of acute hospital care, primary and continuing care services, and associated personal and social services.

A key thrust of the reforms is the centralisation of hospital services from the current 45 acute hospitals, each with an emergency department, to around 13 regional centres, each acting as a hub for emergency care.¹ The plan is hotly contested by political, professional, and parochial groups, and clearly …