A boom time is not a time to increase spending in the health services, according to Minister for Health, Brian Cowen. Rather it is an opportunity to reduce the interest burden on our national debt.

"There is no point in talking about increasing levels of expenditure in the health services at the top of the economic cycle when in three years you have to retrench again. It causes huge disruption. I have made a decision that I am going to control expenditure in health. Any extra expenditure will go towards capital funding," says Cowen.

The Government, he explains, has given a commitment that it will increase expenditure by 4 per cent during its term. "We have a job to do, with a wide range of responsibilities including reducing the tax burden."

This year, an additional £37 million was allocated to the health services, with particular attention to mental handicap. "We need to bed down the situation and try to improve infrastructure, access, productivity and efficiency, with particular emphasis on the waiting lists."

Operating within the constraints set down, he says, the Department of Health must meet its targets for social inclusion and, most importantly, must plan ahead for an increasingly ageing population. Under new legislation, health boards must operate within the allocation given by the Department. Between now and 2006 the number of people who will require constant care will increase by 80 per cent, says the Minister.

"There are not enough beds for the elderly. We must plan now for the number of elderly people there will be in the future. People will not thank me if there are state-of-the-art facilities elsewhere and this area is not properly developed."