The President of the Irish Hospital Consultants Association has said that the Health Service Executive is dysfunctional and, crucially, disconnected from those involved in delivering patient care.
Speaking at the Association's annual conference in Adare, Dr Margo Wrigley said that the centralised system for managing the health service operated by the HSE was cumbersome and quite simply not fit for purpose.
She said that the HSE's hierarchical system had put extraordinary limits on what could be decided by local services and hospital managers.
"To get any decision, layers of bureaucracy have to be traversed by which time the request has become diluted, de-prioritised and lost in the morass."
Dr Wrigley said that many managers and administrators were also demoralised. She said that there was a "pervasive fear amongst managers of being seen to step out of line, then losing favour and being moved to the side".
She said that there was now "a sense of siege in the front line of medicine".
Dr Wrigley said that now, unlike during the cutbacks in the 1980s, there was not even a pretence that frontline services were unaffected.
"Today, the State and its agencies are not just cutting the cost of providing care – they are crudely cutting the amount of care itself".
Dr Wrigley criticised the impact of the Government's moratorium on recruitment and the imposition of a staff ceiling in each hospital and service around the country.
She said that this meant that nurses who retired or left were not replaced and that those remaining in place were put under increasing pressure.
"As their numbers drop and the number of patients rise, this pressure increases, making their lives increasingly difficult. So more retire early if they can. The pressure on the remainder increases. Agency nurses are brought in, each of whom costs 40 per cent more than directly-employed staff, so the budget shoots up adding to the crisis".
She said that new ceiling on staffing levels took no account of patient needs. She said that in one of the areas where she worked staff numbers will have to drop by 49 before any frontline healthcare workers can be employed.