David Labanyiasks those at the coalface of the health sector what issues they would like to see addressed this year
While best-laid plans can be overtaken by unexpected events, there are a number of significant items on the health agenda for 2008.
Industrial relations issues will be to the fore with talks on the new consultant contracts likely to dominate the start of the year. Negotiations are also due to start on new GP contracts.
Another tricky industrial relations issue is the proposed reduction of the nurses' working week to 37.5 hours in June, a target that the chief executive of the Health Service Executive, Dr Brendan Drumm, has admitted will be challenging.
Below, a range of medical professionals, politicians and senior healthcare officials identify what they see as the most significant healthcare issues for 2008.
Dr Tracey Cooper, chief executive, Health Information and Quality Authority:
"The transition to the eight cancer centres will begin this year and is an important and essential step in the ongoing improvements in the provision of the initial treatment and diagnosis of patients with breast cancer.
"This is a crucial development - not just in the treatment of breast cancer but also in rebuilding confidence in the quality of our health services.
"Related to this is the work that the Hiqa is undertaking in the national review of symptomatic breast disease services that will be rolled out during the beginning of the year.
"Also, the various investigation reports, two of which will be published by Hiqa early in the new year, are widely anticipated, particularly by the patients and their families affected by misdiagnosis and errors. A lot of hard lessons must be learned from these reports and it will be essential that the recommendations are speedily and effectively implemented.
"Hiqa hopes to be in a position later this year to take over the inspection of nursing homes. This will be an important step in ensuring that residents in nursing homes are receiving the highest possible standards of care wherever they are in Ireland."
Prof Brendan Drumm, HSE chief executive:
"Delivering our 2008 Service Plan and meeting the growing demand for care, in a tightening financial environment, will be a significant challenge.
"Greater financial accountability for budget holders will be a major feature of 2008. Every budget holder will be identified and funding matched to service levels.
"All funding will be allocated at the start of the year, which removes any expectation that more funding will be available later in the year.
"This will involve a greater emphasis on reducing average length of acute hospital stays where they are unnecessarily long, more and better discharge planning, more day case procedures, more days of surgery admissions and more active management of out- patients' appointments."
Dr James Reilly, Fine Gael health spokesman:
"I think the HSE and the manner in which it is run is going to be the big issue in 2008. It is at the centre of much of what is wrong with the service.
"Will we get cervical screening this year? We haven't got the laboratory facilities and we haven't made any arrangements for people to take them. I think the plan, as proposed, is pie in the sky.
"BreastCheck will be another major issue. The HSE says they are extending the service and it will cover the entire country. It will be interesting to see if this happens."
Jan O'Sullivan, Labour Party health spokeswoman:
"The biggest impact, and unfortunately a negative one, will be the construction of private, for-profit hospitals on the grounds of public hospitals. This will consolidate the growing division between patients who can afford health insurance and those who cannot.
"Co-located private hospitals will occupy valuable, publicly owned land.
"There are a variety of good uses to which that land could be put: accommodation for patients who are having tests; accommodation for parents of children in hospital; step-down beds for patients who no longer need a costly acute bed; re-location of maternity services which should be close to a general hospital, etc."
Stephen McMahon, chairman, Irish Patients Association:
"The real fear for 2008 is that despite the huge investment in healthcare that there will be continued cutbacks or "budget readjustments" or whatever the language is.
"If the implementation of a planned service is delayed because of employment ceilings, this is a cutback. This has an impact on patients' lives.
"Late last year the pharmacists flexed their industrial relations muscles threatening action on a vulnerable group of methadone patients. A mutually acceptable agreement must be struck to safeguard patients."
Dr Paula Gilvarry, president Irish Medical Organisation:
"We hope that, in 2008, the Department of Health and Children would begin to learn from its mistakes of 2007 and plan in a more measured and consultative fashion.
"We welcome the appointment of former secretary general of the Department of Finance Tom Considine to study the way the HSE uses the taxpayers' money.
"Under the new financial regulations, each budget holder, right down to the small teams like mine (four doctors), will be responsible for keeping within budget. I welcome this but only if a realistic budget has been agreed with the team and if consultation takes place at the beginning of the financial year and at regular intervals throughout.
"The Medical Practitioners Act is delayed and I hope that any problems with it are ironed out and that we have a new Medical Council appointed without further delay."
Liam Doran, general secretary Irish Nurses Organisation (INO):
"The INO believes 2008 should see significant changes in work practices which will enhance patient care, both in the community and the hospital setting.
"The major changes that the INO expects this year is a roll-out of the expanded role of the nurse/midwife. The INO also wants wider application of nurse/midwife prescribing. These changes, which have been spoken about for many years, can be brought forward in the next 12 months.
"The new year will also bring the introduction of the 37.5-hour week for all nurses/midwives leading to greater efficiency in rosters, less use of agency nurses and no diminution in the quality of care to patients.
"Also this year we will see the publication of the second benchmarking report and every nurse/midwife in the country expects that it will, finally, recognise and acknowledge the equal contribution of nurses and midwives to our health service as all other degree level health professionals."
Finbarr Fitzpatrick, IHCA general secretary:
"The greatest single challenge facing our health service in 2008 is one of capacity. It is generally accepted that the one million patients and day-case patients who attended our acute hospitals in 2007 received high-quality medical treatment once they were admitted.
"Similarly, the 2.2 million people who attended outpatient departments received good quality care, again, once they got an appointment.
"There has been virtual unanimous agreement on the part of all health commentators and politicians within this jurisdiction, in addition to numerous OECD reports, that the bed capacity of Irish hospitals is insufficient.
"Recent Central Statistics Office statistics prove our population is growing at an exponential rate. It is an established fact that our population will increase to levels equivalent to that of 150 years ago by the year 2021. Yet, there seems to be a lack of preparation."
Prof John Crown, consultant oncologist at St Vincent's Hospital:
"I think in 2008 the health service is going to progress from meltdown to freefall. It is going to be a very bad year in cancer because we are getting the perfect storm of negative forces.
"We are getting increasing regulation of what doctors are allowed to do for their patients, coupled with the general decline in the economy, coupled with centralisation without expansion of existing resources, coupled with the unbelievable conflict of interest that will be built into the new co-located hospital management plan.
"I think the result is going to be that public patients are going to find themselves squeezed and we are going to see a contraction of access due to budgetary constraints."