Analysis: The Tánaiste and Minister for Health, Ms Harney, has put her stamp on health policy with the announcement of the health Estimates for 2005.
With substantial initiatives in the areas of medical cards, accident and emergency and disability, she has outlined what she sees as priority areas for the health service.
By detailing 10 specific actions for dealing with the A&E crisis and providing €70 million, the Minister hopes to defuse, at least partly, growing public disquiet over hospital access.
Three Dublin hospitals will get acute medical units, the development of which were advocated in a report published by Comhairle na nOspidéal this week. These will assess and treat patients with strokes, pneumonia and heart failure and avoid them joining the queues in A&E.
If they work, it should mean older people in particular getting a bed rather than a trolley and being treated with some of the dignity clearly absent from frontline hospital care. However, such units require the referral of patients by GPs who know them and not by deputising services who traditionally provide night cover for doctors in Dublin. Ms Harney rather vaguely referred to the "provision of more out of hours GP services" without specifying how this might be done.
The Minister also needs to clarify what she referred to as "measures to enhance direct access for GPs to diagnostic services".
Access to full X-ray and other services has been reduced in urban areas in particular, and has contributed to higher A&E attendances. And although not billed as such, the higher charge for attending A&E without visiting a GP, at €55, should reduce unnecessary attendance.
Without doubt the most unexpected initiative was creating a new category of medical card. The "doctor visit" medical card will allow free access to a GP but will not cover the cost of any drugs prescribed.
It is a clever way to add an additional 200,000 cards which would otherwise have required far greater funding. Only 70,000 "traditional" cards could have been provided for the same money because of the €800 million GMS drug bill. It means the Government is now partly "off the hook" over its election commitment to provide an additional 200,000 medical cards.
The Irish Medical Organisation has reacted positively to the move; it has been arguing that poorer people were unable to access medical care because of the cost.
However, the issue of drug costs will still be a problem for those eligible for the new medical cards. It may force them to "skimp" on or even avoid treatment.
They may also find it difficult to find GPs to look after them because of the growing manpower crisis in primary care. But the provision of 30,000 extra "traditional" medical cards must also be acknowledged and welcomed.
An additional 1,000 frontline staff promises a substantial increase in the number of speech and occupational therapists for the disabled, many of whom have had great difficulty accessing rehabilitation services.
For too long the Cinderella of the health system, the disabled look like finally getting the funding and personnel they deserve.
Another former Cinderella is mental health. It gets an additional €15 million. Of particular note is the commitment to provide and staff an additional 14 beds at the Central Mental Hospital, a move that will help end the degrading practice of patients there having to "slop-out".
The Minister has produced quite a focused package of initiatives. The challenge now will be to make it happen despite the dysfunctional nature of the health service.