A Government-appointed commission has called for the management of the State's health service to be transferred from the Department of Health and Children to a new executive agency.
The Brennan Commission, set up to examine value-for-money issues in the health system, says there is a management vacuum at the heart of the health service which must be "addressed urgently".
Although accountability for the delivery of health services is presently located at regional and local level, the Department of Health is "wrongly" held accountable for service delivery issues, the commission, chaired by Prof Niamh Brennan, a professor of management at UCD, states in its report, seen by The Irish Times.
"It is frequently drawn into fire-fighting and is therefore unable to create the space to carry out the necessary evaluation of care spending nationally," it adds.
The commission sets out preconditions to the establishment of its proposed national health services executive. It warns against a new executive agency becoming an additional layer of bureaucracy. A new agency must involve the consolidation of other existing bodies, including health boards.
The commission also states that accountability and authority for the management of the health service must be "explicitly devolved" to the head of the new agency.
It says it could not recommend a new executive agency unless the role of the Eastern Regional Health Authority is subsumed into the new executive and there is a reduction in the overall number of health boards.
As well as identifying a number of specific functions for the new executive, the commission outlines particular tasks which the new body will need to address as a matter of urgency.
These include providing alternatives for the long-stay patients who currently occupy 25 per cent of the 12,000 acute hospital beds in the State and the reorganisation of accident and emergency services.
This reorganisation should start in the Dublin teaching hospitals to protect elective admissions.
New budgetary and accountability systems as well as performance management programmes must also be put in place. The commission also recommends an analysis of performance, productivity, quality of care and value for money.
It says this comparative analysis should be carried out for each health board region as well as for each care programme, such as care of the elderly, childcare and disability services.
The Brennan Commission report also outlines the revised governance arrangements which the new executive and the health boards would need to put in place.
It defines corporate governance as the "way in which an organisation is directed and controlled so as to achieve its organisational goals and to deliver accountability, transparency and probity".
The commission is especially critical of a statement made by health board CEOs that an audit committee in the health service "should not have any executive decision-making powers or supervisory functions". Prof Brennan and her colleagues say the main function of an audit committee is to reassure the board, not the CEO, on a system of internal control within the organisation.
They also criticise the failure of any health board to complete an audit by January 2003. "Accordingly, all are in breach of the statutory audit completion deadline of 30th September, 2002," they conclude.