The Government will accept responsibility if the reform package announced yesterday does not improve the health service by the next general election, the Taoiseach, Mr Ahern, declared.
During lengthy questioning at the launch of the package, Mr Ahern; the Tánaiste, Ms Harney; the Minister for Health, Mr Martin; and the Minister for Finance, Mr McCreevy were bullish about the prospects for its success.
Divisions over funding that emerged last year between the Minister for Health and his Cabinet colleague, the Minister for Finance, were highlighted during a number of exchanges.
The Drugs Payment Scheme (DPS) will be reformed sharply under a package to go to the Cabinet soon, though Mr Martin said rapid spending increases "may be settling down this year".
The availability of new, more effective drugs has driven up the cost of the DPS, said Mr Martin, who pointed out that Irish people currently use far less medicine than their EU counterparts.
The Government's cardiovascular strategy had cost €40 million a year in extra tablets: "From the Minister of Finance's point of view that is bad news. From the Minister of Health's point of view that is good news."
Defending his performance, the Minister for Finance insisted that the Government's aim was to produce "a first-class health service".
In 1997, the Government spent €3.6 billion on health out of a total income tax budget of €6.605 billion, he said. This year, the Government will raise €9.307 billion in income tax "and spend every cent on health", he declared.
"In 1997, 19 per cent of total government spending went on health. In 2003, 24 per cent of total government expenditure was spent on health. In that time we have increased total government spending from €18 billion to €38 billion," he said.
Control by a single national hospitals agency would improve patient care, efficiency and control costs, the Minister for Health said.
The National Hospitals Office would be less vulnerable to local public opinion than politicians currently are, particularly in cases where changes to local hospitals are planned, he explained.
"But," he added, "you should never underestimate the dexterity of politicians in a tight corner. Neither are we responsible for the electorate. The electorate do all sort of mad things too."
The Tánaiste, Ms Harney, sidestepped questions about the Minister for Health's recent declaration that extra tax will be needed to pay the future health bills of an ageing population.
Everyone in the Government was committed to funding the health service, she said, and the best way to do that was to keep taxes low, generate economic activity and maintain job numbers.
The Government's taxation policies had helped to put 350,000 people into employment.
"We have to be mindful of what has brought us success," the Tánaiste said.
Defending the decision to publish the Brennan and Prospectus reports before the Hanly report on staffing is ready, Mr Martin said Hanly "fitted like a glove" into the reforms sought by the first two reports.
Meanwhile, he indicated that "the Health Service Reform Programme" would loosen the grip over the appointment of consultants enjoyed by the consultant-dominated Comhairle na nOspidéal.
The body that regulates the number and type of consultant appointments, and specifies qualification levels, will lose its independence and become part of the Health Services Executive.
"My view is that we need to change the consultants' contract. That is a matter for negotiation," the Minister for Health declared.
"I want to see more consultants, less reliance on junior doctors," he said, adding that 24-hour consultant cover is necessary if patients are to enjoy equal care.
However, the Minister for Finance said the Brennan Report had recommended that the Government should demand that new consultants should work only for the public, but the Government "had not gone down that particular road".
The Taoiseach, Mr Ahern, rejected charges that local democracy would be damaged by the abolition of the majority of the health boards. Politicians made up the minority of members on the health boards: "I spent 10 years on the Eastern Health Board. It isn't driven by politicians," he said.
The existing health board members, political or otherwise, would not be compensated for the loss of their offices, he said.
Oireachtas members would have the opportunity twice a year to probe into service standards during meetings with regional Health Service Executive officials.
The Minister for Health said job losses would not be caused by the reform plan.
