Health boards across the State should be smaller, have fewer political representatives and include broader representation from specialists, according to a radical plan drawn up by their chief executives.
The draft plan of the Chief Executive Officers Group for the reorganisation of health boards is to be finalised today and submitted shortly to a team appointed by the Department of Health to audit structures in the health service. That audit is due to be published in February.
The CEOs' proposals, which have been seen by The Irish Times, come as pressure mounts for sweeping reform of health board structures, particularly in light of the damning findings of the report by an independent review group into the baby Bronagh Livingstone case.
That report was highly critical of the North Eastern Health Board and its management.
The CEOs' submission says: "There is a case for boards to be more strategic in terms of functions and membership.
"In this context, smaller boards with broader representation including specialities such as health economics, policy analysis and business expertise would be appropriate."
Furthermore, it notes that the number of board members ranged from 27 in the North Western Health Board area to 55 in the Eastern Regional Health Authority. "The number of members would not now be considered to be best governance practice," the document says.
In addition, it says over half of health board members are local public representatives, nominated by county councils and other such bodies. It notes this causes problems. "There is an expectation both amongst the community and their political peers that their remit is to protect existing services and develop services within their own geographical area.
"Membership of a regional body with a local mandate clearly places public representatives in difficult situations when considering the potential of regionalisation and sub-specialisation within the acute hospital system.
"Any rationalisation which could affect their own local area, but which could provide value for money when examined on a regional or conjoint basis provides particular difficulties for persons elected with a local mandate," it adds.
The document notes significant shifts in population and demography over the past 30 years since health boards were established.
However, the CEOs reject suggestions that health boards are not accountable.
They say they are now more accountable than ever to a range of persons and bodies including the Ombudsman and the Comptroller and Auditor General.
Amid calls for health boards to be scrapped and for the running of hospitals to be removed from their control, the Chief Executive Officers Group says the funding and planning of hospitals should be given over to a national agency but they should continue to be run by health boards at local level.
"The lack of a National Hospital Plan is a major impediment to the delivery of quality acute care within the country," their document states.
The Chief Executive Officers' proposals also say there is "a strong case for a reduction in the number" of statutory health agencies in the State, which currently runs to 50.
It suggests consultants should be rostered to work 24-hours and that administrative and support systems across the whole of the health sector should be unified.
Yesterday, Mr Finbarr Fitzpatrick of the Irish Hospital Consultants' Association said he had been saying since 1989 that there were too many health boards.
A root-and-branch reform would be welcome, he said. The Monaghan Hospital report findings confirmed this need.
"We had eight health boards. Now we have 11 and I have yet to meet anyone who has said the ERHA has added one bit to the efficiency or quality of the health service of the greater Dublin area," he said.