The secretary general of the Department of Health, Michael Scanlan, has said that "unfortunately" the health service had a poor record of spending the capital allocation provided to it by the Government in recent years.
Speaking at a debate on the health service at the Irish Congress of Trade Unions' biennial conference, Mr Scanlan said this was a pity because with the right sort of capital investment, the service could be revitalised.
"If we could gear up to spend our capital in different ways and to spend it efficiently, personally I would have no difficulty going to make a strong case for even more capital investment," he said. The exchequer provides the Health Service Executive with more than €500 million annually in capital funding. However, last week it emerged that around €100 million had had to be handed back last year as the health service was unable to spend the money.
Mr Scanlan also told the Bundoran conference he did not envisage the introduction of a free GP service for all in Ireland.
"Frankly at this point in time, as a pragmatist, I do not see that happening and I am not sure that I see it as essential. What I would continue to argue for forcefully is some very fair and transparent way of helping those who need a medical card or a GP-visit card, to have it [ made] very clear how you qualify and [ have it made] very simple to understand, so you know what you are entitled to."
Mr Scanlan said this same issue was facing health services across the world: the need to move the emphasis from hospitals to primary care to prevention. Without this, "we are going nowhere".
He said he did not believe there was a simple yes or no answer to the question of the need for additional hospital beds.
He also said the Government's 2001 health strategy and primary care strategy were guiding policy, but that these were not "static" strategies.
Mr Scanlan said that as a career public servant, he was not hung up on the issue of the involvement of "for-profit" organisations. "It seems to me that my duty as a public servant in the Department of Health is to see that people get the best possible service. And if for some reason, some way, that can be provided by the private sector, I see nothing wrong with that.
"At the same time I am proud to be a public servant and it seems to me that if the public service is able to provide services efficiently, effectively and - yes, I use [ the term] value for money - we can easily win this race against the private sector. We don't have to make a profit."
The director of the Adelaide Hospital Society, Fergus O'Ferrall, told the conference it was a myth that the for-profit private sector was more efficient.
VHI chief executive Vincent Sheridan said the rate of growth in public spending on health was viewed around the world as unsustainable, and some private income was necessary to complement public funding.
