Opposition parties have welcomed proposals to reduce the number of health boards but warned that the plans in a leaked report could make the health services less accountable.
Fine Gael's health spokeswoman, Ms Olivia Mitchell, said yesterday she was entirely in favour of changing the health board system which was "an out-of-date structure built for another time. They are groaning under the weight of extra responsibilities, and there are far too many of them", she said.
However, she warned against the possible loss of accountability arising from the reduction of political representation on the boards, saying: "I know it has become terribly popular to get politicians off everything. We could certainly have fewer on health boards, but there must be some mechanism to ensure accountability, a health ombudsman, for example."
She said her own experience on the Eastern Health Board was that it was the political representatives who tended to take a broader view, while the professional representatives "tended to be far more sectoral and territorial". Despite criticisms, local politicians were accountable to the people, she said, "and less self-interested than some professionals would be. People availing of the health services are vulnerable people by definition and need to have their interests represented".
She also said that the proposed new hospitals agency should not be completely separated from those who were running GP and community care services. "We need an integrated, seamless service, and it is not clear that that will exist under the proposals that have been leaked," she said.
The Labour Party said it also wanted a smaller health board system but warned that "democratic accountability" must be maintained. The proposed reduction of political representation should not lead to health boards being less representative of the community.
The party's health spokeswoman, Ms Liz McManus, said her party wanted direct elections by the public to health boards. "If this area is given sufficient priority by the Government, there is no reason why new structures could not be in place to allow these elections to be held with the European and local elections in June 2004," she said.
She questioned the proposed "consumer" representation on the smaller number of new boards, saying such people must be genuine representatives of the community.
"The principle of developing a smaller, more focused health-board system to concentrate on community care and efficient service delivery, while establishing a separate new structure for the hospital service, is a good one.
"But the Minister must spell out in more detail how this is to be done, and particularly how the element of democratic accountability is to be retained and strengthened," she said.
Any changes should come out of a desire to improve efficiency and accountability, not simply to facilitate cost-cutting by the Department of Finance.
Ms McManus called for the immediate publication of the Prospectus Management Consultants' report.