The Irish Congress of Trade Unions (Ictu) has said that the Government's main health service reform, the establishment of the centralised Health Service Executive (HSE) had taken the last remnant of democracy out of the health service.
At the launch of a new briefing paper on health yesterday, Ictu general secretary David Begg expressed concern that there was a "democratic deficit" in the new HSE structure.
He said the HSE was responsible for about €12 billion annually, or one-third of all exchequer expenditure, but that the funding was vested in a body which had no direct political accountability.
Mr Begg also said there was no monitoring of the quality of healthcare delivered. He was not sure that the new HSE structures "had delivered as expected".
Mr Begg said Ictu would never be reconciled to the Government's plans for the development of co-located private hospitals on the grounds of public hospitals. However, he acknowledged that the plan was now likely to go ahead.
Mr Begg said he could not understand why, if the HSE was arguing that bed capacity in hospitals was not an issue, the Government was pressing ahead with the development of 11 new private co-located facilities.
He suggested that it could be part of a move to deliberately generate spare capacity in the system to allow for the creation of an internal market in which the HSE would invite tenders for services.
He said that the Irish hospital system could become "some kind of ideological laboratory".
Mr Begg said Ictu believed that the co-location project was "fundamentally wrong" and that those involved, while operating with best intentions, were "profoundly mistaken".
The Irish Congress of Trade Unions briefing paper, produced in association with Siptu, the Services, Industrial, Professional and Technical Union, says there is no longer a role for county councillors in the HSE structure, unlike on the former health boards.
It says it is unclear to whom the HSE is accountable. It maintains that two-thirds of parliamentary questions are referred by the Department of Health to the HSE but that 95 per cent of these are not answered.
It also suggests that there is significant discontent among staff about the manner in which the HSE is running the service "with complaints of excessive bureaucracy and poor management".
The paper calls for the provision of 400 additional beds every year up to 2013. It recommends a single waiting list for all patients, a doubling of investment in healthcare facilities over the next decade and a 10 per cent increase in day- to-day spending.
The HSE had said it was fully accountable and was totally committed to transparency in how it delivered its services.
It said the Health Service Executive was directly accoun-table to the Minister for Health, the Government and the Oireachtas, its chief executive had appeared regularly before the Public Accounts Committee and officials had regularly given evidence to the health committee.
