The President of the Irish Hospital Consultants' Association, Dr Colm Costigan, has called for radical health service reform to reduce bureaucracy. He called for changes "that will move us from an increasingly expensive system to a more effective service".
The association's a.g.m. in Sligo heard of a huge staff increase in administration within the health system.
Dr Costigan said: "From 1980 to 1999, the number of medical, dental and nursing staff in the health services fell slightly from 33,700 to 32,500. In the same period, the number of clerical and administrative staff in the health service almost doubled, from 5,400 to 10,500.
"We have so many layers of bureaucracy that power and responsibility do not sit at the same desk."
Speaking on a motion calling for the rationalisation of health boards, Dr Gerard Burke, a consultant physician at Limerick Regional Hospital, asked if there was a need for such bureaucracy.
Pointing to the low numbers of people served by the Midland and North Western Health Boards, he questioned the need for 11 health boards, three more since the formation last year of the Eastern Regional Health Authority.
A motion calling for mutualisation of the Voluntary Health Insurance Board was also approved.
Mr Stephen McMahon of the Irish Patients' Association told The Irish Times his organisation welcomed the association's move: "We would add a further caveat to mutualisation, asking that the VHI be subjected to current general insurance industry legislation."
Dr Tim Lynch, consultant neurologist at the Mater Hospital told of his frustration at not being able to work as hard as he wished within the public health service.
"When I came back to Ireland from the United States, I had no office and no secretary." He said he routinely finishes a weekly outpatient clinic after 8 p.m. because of waiting list pressures.
Dr Costigan called for the introduction of comprehensive primary health care. "Because the State fails to provide adequate primary care, people understandably are forced to come to the accident and emergency departments of hospitals. This is wasteful and it clogs up the hospital service."
In his address, the Minister for Health, Mr Martin, said there will have to be a reorganisation of the delivery of care away from a "Monday to Friday, 9 a.m. to 5 p.m. provision of care".
He signalled that a National Task Force on Medical Manpower will shortly implement the recommendations of reports which call for a reduction in the hospitals' dependence on non-consultant doctors.
The meeting welcomed the appointment of advanced nurse practitioners in hospitals and called for the setting up of clear practice guidelines for the post. Mr Kevin Barry, consultant surgeon at Castlebar General Hospital, said that from his experience in the US, nurse practitioners added stability to hospital services.