The "intense politicisation" of the hospital system is having a detrimental effect on the provision of healthcare, according to Prof Muiris FitzGerald, the UCD dean of medicine. It was often seen as a victory for local healthcare when a county hospital remained unchanged, but it was "a complete tragedy for the region", he said yesterday.
Prof FitzGerald pointed to the North Eastern Health Board with five hospitals for a population of 350,000 and the Midland Health Board with three hospitals for 220,000 people. "None of those hospitals really can be termed a regional centre," he said.
"When you are in that intensely political environment, the area to suffer most is actually that region because spreading things thin in an inadequate population base means you have to provide general services and you cannot build up expertise."
When anything complex occurred, patients were sent to Dublin, Cork or Galway, he said.
Prof FitzGerald, who is consultant physician at St Vincent's Hospital, Dublin, was speaking at a conference on value for money in the health sector organised by the Foundation for Fiscal Studies. He said politicians must be made aware of the necessity to reform the system.
Mr Michael Kelly, secretary general of the Department of Health, said it was difficult to see how the development of the health system could be sustainable without a "significantly more creative approach" to staffing and skills mix.
He questioned the continuous upgrading of professional requirements for nurses and other health professionals while they continued to do the same work. This would make staff costs "considerably higher" than that of other countries where assistant grades were a major part of the healthcare staff.
Mr Kelly said professionals must be "freed up" to concentrate on the work for which they were trained and support staff should be put in place for a more efficient delivery of services.
While accepting that problems existed in the health system, he challenged the regular criticism of the sector and pointed to a survey done by the Department of Health when the health strategy was being prepared. It showed an 87 per cent public satisfaction rate with GPs and an 84 per cent satisfaction rate with people's experiences in hospital.
The lowest satisfaction rate was given to the accident and emergency system, with 67 per cent of people saying they were satisfied with the service. Mr Kelly said the overall tenor of users' views was more positive than portrayed in public.
While hospital waiting lists were "rightly criticised", he said the numbers on public hospital waiting lists had fallen by 19 per cent between December 1997 and 2001. In February 2000, the longest waiting time for cardiac surgery in St James's Hospital was five years. By the end of that year, it had reduced to nine months,
He rejected suggestions from Prof FitzGerald that the number of health boards should be reduced and said the boards were a convenient "Aunt Sally" for targeting.
Prof FitzGerald had pointed to the greater Manchester area which had one health board for 5.5 million people compared with eight health boards for 3.5 million in this State.
The health boards' functions, not the number of boards, was the key issue, Mr Kelly said.
