The Government's proposed hospitals agency could easily ignore public opinion following the decision to exclude local politicians from having a supervisory role, Fine Gael warned last night.
"The health boards are a handy whipping boy. The problems in the health service did not begin or end with the health boards," said Fine Gael's health spokeswoman, Deputy Olivia Mitchell.
However, she offered a heavily qualified welcome to the Government's plans: "I am not looking at it entirely negatively. I hope it works. I definitely accept the need for a streamlined management system, and a clear line of command," she said.
She said, however, that the line of accountability from the Health Services Executive to the Minister and on to the Oireachtas was far from clear. "I would have grave reservations about this. The line in the diagram between the Minister and the HSE had to be filled in with biro in the presentation pack that most of the people at the press conference received." she said.
She sought guarantees that the Minister would be obliged to answer all questions posed by TDs in the Dáil about the executive. "I want to be sure that I can put down a Dáil question and get an answer," Ms Mitchell said.
The Labour spokeswoman on health, Ms Liz McManus, said the reports had highlighted "administrative bureaucracy and accountancy", but had not dealt with the system's "central deficiencies", inequality, quality of care, funding and value for money.
"The measures announced today will do nothing to deal with the crisis facing the Mater Hospital, which has forced it to make contingency plans to treat accident and emergency patients in the car-park.
"Nor will it do anything for the problems facing Our Lady's Hospital for Sick Children in Crumlin which has resulted in the hospital now having fewer beds than it did 50 years ago," she said.
"It is less than two years since the Government's health strategy was launched with great ceremony. That strategy, we were told, would provide the basis for a solution to our health problems.
"It has been quietly shelved and the public has been let down. Today's reports have been launched with almost as much pomp, but unless the Government is prepared to take other measures the underlying problems of the health service will remain."
The Brennan and Prospectus reports were largely accountant driven. "They deal with the issue of administrative reform, rather than the needs of the patient," Ms McManus said.
Sinn Féin TD Mr Caoimhghín Ó Caoláin said the Government's plan could not deliver real improvements for patients unless "the virtual apartheid" between public and private patients was ended.
"While new bureaucratic structures are being set up, public patients will continue to suffer and die on waiting lists, hospital beds will remain closed and 200,000 people will be left without the medical card cover promised them," he said.
The Cavan/Monaghan TD, who has been a member of the North Eastern Health Board since 1999, said the removal of all elected representatives would mean "less accountability and more centralisation".
He said there was no sign the Government wanted to challenge the power without accountability wielded by the consultants' representative bodies. "On the contrary, it appears that their power will be enhanced."
The Green Party said while structural reform was required, it must be combined with a sustained level of investment and should not be used to hide behind the severe cutbacks.
The party's spokesman, Deputy John Gormley, said it was incredible the Government's spin regarding the health services was being so uncritically accepted. Ireland attained an EU health expenditure average only in 2000. "This level would need to be sustained over a decade to allow for catch up."
