The proposal to replace the Eastern Health Board with a new regional authority with responsibility for the voluntary hospitals has been welcomed in some quarters, but has given rise to "grave concern" in others.
The chairman of the Adelaide Hospital Society, Prof Ian Graham, who is a senior consultant in Tallaght Hospital, said the new structures gave totally inadequate representation to the voluntary health providers. He pointed out that the major voluntary hospitals, which provided acute hospital care for the eastern region, would have only three places out of 55 on the new authority.
"The proposals are a recipe for increased bureaucracy and increased administrative costs when the crying need is for resources to be directed to patient care services," he said.
Prof Graham warned that they would repeat the costly mistakes made with the National Health Service in Britain, which were now being reversed.
He added that it was unclear how the national services and specialities provided by the major Dublin hospitals were to be developed and funded. "The lack of reference to the major medical and nursing education and research responsibilities of the major Dublin teaching hospitals is very worrying indeed," he said.
Ms Roisin Shortall, the Labour Party spokeswoman on health and children, commended the Minister for introducing legislation on a subject which had been on the agenda for a number of years.
She specifically welcomed the proposal to split the Eastern Health Board area into three, and to integrate the funding of voluntary hospitals and agencies. But she warned that she would be tabling amendments to the Bill.
"The new regional authority will dominate the new structure," she said. "This will effectively stymie the devolution of health-care services to local communities and repeat the problems that have dogged the Eastern Health Board for so long."
Ms Shortall said the fact that the membership of the three area boards would be drawn from the new authority would mean they were only administrative adjuncts of it.
IMPACT, the union which represents more than 2,500 staff in the EHB, said it would press for staff and patient representation on the new authority. While acknowledging Mr Cowen's commitment to staff consultation, an IMPACT official, Mr Sean McHugh, said this had been extremely limited so far.
Sister Margherita, executive chairwoman of the Mater Hospital, welcomed the integration of acute hospital services with community care, especially for the elderly.
"There is a change in the way society operates, from the extended to the nuclear family," she said. "Support for the elderly cannot be taken for granted. Yet we're the beneficiaries of the hard work and sacrifices of that generation."
Sister Margherita said she hoped the new authority would provide the wherewithal for such social services, especially for the elderly and young chronically ill.
Mr Henry Murdoch, the chairman of the National Rehabilitation Hospital in Dun Laoghaire, said he hoped the fact that it provided a national, and not just a regional, service would be recognised when it came to funding. The same applied to a number of other hospitals with national specialities, he said.