At the last count it was taking £8 million a day to run the health services. But controversies in recent months have shown this money is either not enough or it is not being spent wisely. The answer is probably a little bit of both.

As we move into 1999 there are over 35,000 people on waiting lists, a number of health boards are running out of money, and the State's flagship Tallaght Hospital is in serious budgetary difficulty. And yet the total health budget has doubled in the past five years. Day-to-day health expenditure will exceed £3 billion this year.

As Brian Cowen said in his Ardfheis speech recently, people are bemused by our health service. "The public finds it hard to understand why every year the same problems seem to reappear despite the fact that more and more money has been invested," intoned the Minister.

Mr Cowen has been keen to point out that the health service is not simply a hospital service, even though that area is responsible for 52 per cent of total expenditure. He says his brief also covers the disabled, people with psychiatric problems and, particularly given demographics, the increasingly elderly population. In the UK the over-60s will begin to outnumber the under-18s in the first decade of the new millennium, and as they are preparing for it so must we - formulating policies and services for the future.

But why, as Mr Cowen asked in his speech, do we still have problems with waiting times for public patients needing treatment; temporary bed closures as a feature of hospital management; and services in some instances not providing the level of care that we would expect or demand?

By way of explanation, he said his Department was coming from a situation "where deficits were an annual inevitability, allowing the situation to develop where the biggest overspends reaped the largest rewards. In effect, inefficiency was promoted, and an undisciplined approach was the norm. This had to be addressed."

The new accountability legislation, whereby health boards must stick to the budget allocated to them by the Department, was not, he said, "planning for planning's sake" but "planning for the recovery of the health services, putting them on a firm and solid footing". He was controlling revenue spending "on the clear understanding that we have a much enhanced capital programme".

The Minister is right. The old way has clearly failed. However, it remains to be seen if he converts his recent rhetoric into a proper plan of action, making the health services properly resourced and efficiently run.

The recent adversity appears to suit Mr Cowen, who has been applying himself with some zeal to his brief - a different situation from the start of the year when his critics questioned his level of interest in the job. However, it remains to be seen if his plans for reform are carried out with the pioneering spirit that has been evident recently.

Many of the existing inefficiencies in the health system are highlighted in the report of the group which looked into the waitinglist initiative. It called for the problem to be tackled in a "structured, co-ordinated and multi-disciplinary manner across the entire health-care system".

One of the primary issues it identified was the provision of proper step-down facilities for people who no longer need care in acute hospitals. At present in the hospital system elderly people inappropriately placed in acute hospitals make up the equivalent of 150,000 bed days a year, costing thousands of pounds a week for each bed, compared to hundreds in an appropriate facility.

The report also made other recommendations, including hostels for patients who need treatment but do not need to be hospitalised. One of its shortcomings is that the report does not cost any of these measures. The amount of money spent on health is rising each year - of every £4.50 spent by the Government, £1 is on the health system. Yet the chaos and overcrowding in parts of the system point to questions about the level of investment.

The rank occupied by Ireland in terms of European health spending has been progressively declining. The proportion of GDP devoted to health here ranked joint fifth relative to other member-states in 1985, and 11th in 1990. Since 1993, the only member-states to spend a smaller proportion of GDP on health are the UK, Luxembourg, and Greece.

When the 1980-96 period is assessed, only three EU member-states show a reduction in the allocation to health, with by far the biggest reduction of 20 per cent shown for Ireland, followed by Sweden at 9 per cent and Denmark at 8 per cent. Also Ireland is one of only four states which spends 7 per cent or less of GDP on health.