Reform of the health service will not see all specialist procedures provided near every home in the State, the Minister for Health, Mr Martin, said yesterday.
International evidence demonstrates that clinical outcomes for patients are improved when they are treated by multi-disciplinary specialist teams operating in units where there are high volumes of activity and access to diagnostic and treatment facilities, he said.
The Minister said it was time Irish people faced up to these issues.
"As a society, we need to achieve a consensus about the reality of achieving high quality safe care in a country of this size and population."
The Taoiseach, Tánaiste and Minister for Finance joined Mr Martin in promising to begin work immediately on a programme of radical reform.
After months of criticism over cutbacks and the confused response to the SARS crisis, they presented the plan as a determined effort to improve the system and achieve better value for money for the State.
In his speech yesterday at the health reform launch, the Taoiseach, Mr Ahern, said the Government was obliged to act when shortcomings were pointed out.
While he dismissed claims that the health service was on a par with third-world states, he said "there are many who are not receiving anything like the level of service which they should".
"In pointing to cases of real and urgent need there is no justification for denigrating the real facts of what is being achieved," said Mr Ahern.
"Change is often uncomfortable but is also essential if you are to make sure that you are meeting the needs of today rather than a former time."
The Tánaiste, Ms Harney, said that no-one she knew believed that reform was not necessary.
Stating that the management structures in the service "aren't right", she presented the initiative as an effort to improve accountability, performance and management.
She said: "There will be clear political accountability for our health services. But to ensure that, as well as making national policy work, we do not need 263 health board members in addition to 166 Dáil deputies and 60 senators."
The Minister for Finance, Mr McCreevy, said there were too many agencies delivering services, adding that it was often not entirely clear who was responsible for what.
He said the plan would deliver a more rational system, "one where everyone is clearer about their powers and responsibilities".
Mr Martin said the Government agreed with the analysis of the current problems in reviews by Professor Niamh Brennan of UCD and by Prospectus management consultants.
The current system was designed in different times to meet different demands. It was unsustainable to have 58 agencies operating a public health system.
"This multiplicity has resulted in a complex and fragmented system which has itself become an obstacle to achieving improvements," he said.
"Rationalisation, standardisation and much-improved co-ordination are all required to overcome this fragmentation and to give me, as Minister, a realistic span of control over the agencies for which I am responsible."
Mr Martin said the two reviews highlighted a lack of clarity about roles between the Department of Health and the system; and tension between local representation on health boards and national policy.
He said the central importance of adequate planning had been repeatedly highlighted.
"Part solutions to these problems in the past have brought us some way forward but part-solutions, by their nature, are limited. It is high time to devise a comprehensive and integrated solution to the whole system."
