If Northern Ireland is to make good progress in reducing the inherited deficiencies in delivering better living standards, improving the quality of life and offering a sustainable modern society, then creeping gradualism, a small step followed by other small steps, must be led by more forceful policy changes.
oday's adult generation have grown up in a community racked by civil tensions, seeing a sizeable emigration of their contemporaries round the world, and achieving only a modest gain relative to standards in the more prosperous parts of western Europe.
No clever insight is needed to ask what needs to happen to improve our productivity so that we, collectively and individually, make larger contributions to our well-being.
However, more is needed than gradually improving the achievements. Are there ideas that would precede significant one-off changes to break away from timid 'me to' applications copying our neighbours?
The big ideas need to come on a scale that is game changing and in discrete form to be effective and demonstrable. These big ideas also need to come with recognition that in order to invest in game changing projects, there will have to be a rigorous prioritisation to find, and reallocate, resources away from less meritorious spending plans.
As a feature of that game changing scenario, the Ulster University will shortly launch a carefully researched project to introduce at Magee, and linked to Altnagelvin and Letterkenny Hospitals, a new postgraduate medical school. The opening of the school is expected to have the support of the local health and social care trusts and the GP partnerships. This represents a major new dimension for Magee and comes against a background of inadequate provision for medical and para-medical training in the UK and Ireland.
This medical school proposal is now ready to be put to the Northern Ireland Executive if/when it is reformed in the months ahead. It would be both a policy proposal and a major public sector capital project seeking political endorsement. The key features of the proposed medical school have been outlined to interest groups including the recently established Friends of the North West which met recently for the first time in Belfast.
In anticipation, the academic plans prepared in Magee are under-pinned in terms of professional medical content through an agreement with St George's Medical School in the University of London to support the syllabus and offer teaching support. The wider impact of the proposal is being evaluated with expertise from the NI Strategic Investment Board.
In what may be a unique feature, entry to the medical school will be open to applications from any graduate (whether science related or not) who, if accepted, will commence a four-year professional training scheme.
Naturally the main interest groups in the North West are already vocal in their support of the project which hopes to admit the first medical students in September 2019.
The critical immediate question is whether the proposed new medical school at UU(M) will gain sufficient support from possible funders.
There are implications for the administration and budget of the Department of Health and Social Services and also for the Department for the Economy, which has responsibility for the provision of higher education across Northern Ireland.
The two local universities can reasonably point to the tightness of their existing funding. Yet, 100% additional funding may not be available. Since Northern Ireland attracts a very high proportion of young people into university entry, there may be merit in asking Ulster University (and possibly Queen's) to reduce the number of admissions for courses that might equally be found in further education colleges.
A successful medical school would be an exceptional game changer for our professional skills and for the well-being of the North West. Is this an opportunity for which other sacrifices can be justified?