More managers and administrators have been employed by the health service in recent years than nurses, according to ESRI professor Ms Miriam Wiley.

In a presentation today on Budget perspectives, Prof Wiley will say that the recruitment of large numbers of administrators explains lengthening waiting lists and increasing public dissatisfaction. In the four years from 1996 to 2000 when spending on health almost doubled, over 4,000 mangers and administrators were recruited compared with less than 2,000 nurses.

At the end of December 2000 there were 12,366 mangers and administrators employed and 29,177 nurses.

According to Prof Wiley the Government or medical manpower forum have no proposals to increase recruitment of nurses, despite hospital directors recruiting large numbers of foreign nurses on short-term contracts.

"The waiting lists are not a surprise if the numbers delivering the service are not being recruited in the same numbers as those administering it." This has implications for any proposed expansion as a lot of beds are closed because of nursing shortages. "It is simply that waiting lists for elective surgery are not being given adequate priority.

She added that the problems had been exacerbated since the pay dispute and by the lack of cost-of-living payments for the Dublin area. These issues are not being tabled because of the possible implications for public service pay.

Prof Wiley will insist that questions need to be asked about service delivery and accountability. "What needs to be put on the table is whether or not the Department has to justify increases in spending and explain what improvements can be expected. Perhaps that is done but there is no evidence of it."

She pointed to the example of health promotion where there has been a 600 per cent increase in expenditure but no clear idea of what the return is. Smoking, for example, has increased while this money has been spent.

It is not clear if the Department of Health has to set out what it expects to achieve before obtaining Exchequer funds for projects. According to Prof Wiley: "We have to see some accountability for levels of expenditure."

New data collected by the ESRI has also found that in 1999 and 2000, admissions of private patients in public hospitals grew twice as fast as admission of public patients. This was irrespective of whether patients were admitted on a planned, emergency or day basis.

According to Prof Wiley real equity in health may need a cap on the numbers of private patients treated in public hospitals and the introduction of a common waiting list for all patients in these hospitals.