The health service will not be better governed by further centralising responsibility for the delivery of services, or by reducing the role of elected representatives, the chief executive of the Health Research Board, Dr Ruth Barrington, has warned.
And despite plans to drop local councillors from the new regional structures which will replace health boards, politics can never be taken out of health, she said.
Dr Barrington's comments are contained in a book of essays published this week by the Institute of Public Administration.
Dr Barrington, who is also a member of the Irish Times Trust, expressed disappointment that health boards have not been given credit for "the important contribution they have made to the operation of the health services".
She stressed that when health boards were established in 1970 they took over the health functions of local authorities, which at the time were funding half the cost of health services through local taxation. This was a major reason why elected local authority representatives constituted the majority of members on a health board.
When, in 1994, the government decided to replace local authority funding with central taxation, the job of local politicians changed to one of securing as much central funds for the development of health services in their region as they possibly could, she wrote.
Dr Barrington said it was extraordinary that all the criticism of health boards and their political nature had included no analysis of the financial incentives that give rise to the behaviour that is seen as hostile to the implementation of national strategies.
The problem, she wrote, will not be solved by even tighter financial controls on local bodies or by removing elected representatives from decision-making, but "may be ameliorated by more closely linking the raising of taxation to the spending of it".
"What is required is an alignment of responsibility for funding and delivery of health services. The highly personal and political nature of health services requires that this alignment take place at regional and local level," she added.
Her essay is published is Governance and Policy in Ireland: Essays in honour of Miriam Hederman O'Brien.