The Health Service Executive (HSE) today insisted patient care improved last year even though it admitted failing to spend nearly a fifth of its €555 million budget.
Despite having earmarked €97m for major projects such as Dublin's Mater Hospital, the HSE said a lack of anticipated progress forced it to hold the money back.
Opposition TDs and the campaign group People with Disabilities Ireland (PwDI) rounded on the HSE accusing it of allowing bureaucracy to block reform.
There were also delays in spending for the National Rehabilitation Centre.
Michael Ringrose, PwDI chief executive, said someone had to be held to account.
"The sense of acceptance of the slow pace of delivery within the public service is simply not acceptable," he said.
HSE management agreed a deal with the Government to spend €71m of the surplus on day-to-day costs rather than hand it back to the Exchequer. They are also in talks with the Department of Finance to include the remaining €25m in this year's budget. It is understood special Government approval is needed.
The HSE offered the following explanation for the massive under spend.
"The capital under spend was partially due to the lack of anticipated progress on a number of major projects (eg the Mater Misericordiae Hospital project and the National Rehabilitation project.
"A necessary transition to new and improved capital monitoring and management structures also contributed."
Despite the spending difficulties, the HSE said there was a 60 per cent drop in the numbers of people waiting for admission from A&E units even though attendance went up 3.3 per cent.
The HSE said spending was now being managed by a new body known as the Estates Directorate which was working alongside the Primary, Community and Continuing Care and National Hospitals Office committees.
"The Estates Directorate has brought a greater focus and momentum to the planning and development of major capital projects," management said.