Health system reform in the context of COVID-19: a policy brief outlining lessons from Ireland's journey towards the goal of universal healthcare.

The COVID-19 pandemic has presented unique challenges and opportunities for health system reform globally. In Ireland, this period coincided with the early stages of the Sláintecare reform plan, a core goal of which is to establish universal healthcare. This policy brief synthesises key research findings from 13 studies carried out under the Foundations research programme to harness key learnings from the pandemic response for health system change. The analysis reveals how the COVID-19 crisis accelerated health system reforms in Ireland, breaking from a history of incremental change to implement rapid innovations towards universal healthcare. While a 'new normal' has emerged, the challenge remains to integrate these rapid developments into enduring health system improvements under evolving governance and leadership in the COVID-19 context. Three significant implications for health systems research and policy are identified: 1) Political consensus is essential for sustained health system reform, particularly during crises; 2) Adaptive health systems that can transform challenges into reform opportunities are crucial; and 3) Co-production in research enhances policy acceptability and implementation by aligning it with real-world complexities. Leveraging these pandemic-driven insights will be key to ensuring that the swift adaptations and lessons learned will transition into lasting elements of Ireland's health system.