Some jobs will no longer be needed in the reformed health service, the Minister for Finance told the Dáil. However, Mr McCreevy said that did not have to mean redundancies.
"I expect that changes will largely be absorbed by natural wastage and redeployment," said Mr McCreevy. "The bottom line is to free up the maximum level of resources in order that these can be put into the improved delivery of front-line services. In this, we have the support of the social partners. This will be one of the benchmarks for delivering better value for the money being invested in health and improved services for patients."
Speaking during a debate on the health strategy, Mr McCreevy said that the role and work practices of hospital consultants had also been the subject of much discussion, reflecting the central role which they occupied within the hospital system. Senior clinicians must be willing to accept responsibility for the resources they consumed or cause to be consumed, he said.
"The consultants' common contract must support these needs," he said. "We have already signalled that we intend to begin negotiations with consultants on their contract without delay. We will bring the various recommendations from the Brennan report as well as the emerging issues from the Hanly report to the table for those negotiations."
Mr Dan Boyle (Green Party, Cork South Central) said he was glad that Mr McCreevy had joined the debate.
"Very often the problems which have arisen in the health service have been the result of an accountant's approach which does not recognise changing demographics or acknowledge that health conditions can vary at any particular time," Mr Boyle added.
"The approach has been to measure by cheque book. That is not to say we should not seek a better result from the money which is being spent, but it must be noted that in European terms we spend less per capita than many other states."
The Fine Gael spokeswoman on health, Ms Olivia Mitchell, said the Government's greatest failing was that it waited until its seventh year in office before deciding to reform the health service.
She said that if the structural changes were to achieve any efficiencies, and if the Hanly proposals for regional centres for excellence, were to be pursued, massive investment would be required.
"Unlike factory production, a health service cannot be turned off while processes are changed," she added. "Costly parallel systems will need to be kept in place, probably over many years."
The Labour spokeswoman on health, Ms Liz McManus, said that flawed and all as it was, the 1970 Health Act was about changing the health service - in part at least - to meet the needs of patients. On the evidence, so far, she said, the new Act being proposed would not deliver limited or even incremental reform.
"Essentially, it will be about changing one bureaucracy for another bureaucracy, a more streamlined one possibly, a less accountable one definitely," she added.
"The central issues in our health service of capacity and access are completely and shamefully ignored. That said, I am not even convinced, on its record so far, that this Government has the stomach to deliver all the administrative changes it proposes."
Mr Caoimhghín Ó Caoláin (SF, Cavan-Monaghan) said the Government was embarking on administrative change rather than real reform. The two-tier health system was inherently inefficient and no amount of better financial management or administrative restructuring could change that reality.
"There is now a vicious cycle in the system," he said. "Waiting lists and bed closures in the public system have meant that more and more people who can afford it - and some who cannot - have opted for private health insurance and private care. The public system suffers as a result."
The Minister for Health, Mr Martin, who opened and closed the debate, said he was determined to move forward as quickly as possible with implementation of the proposals.
"I also believe that the decisions made will reinforce and build on the efforts to date in creating a more innovative and participative working culture in the health services," he added.
The Minister of State for Health, Mr Tim O'Malley, said that the largest ever reform of the health services would put patients before politicians, boards, structures and bureaucracy.
