While the Department of Health has rubbished the Euro Health Consumer Index as "out of date and not factually accurate", the report's authors continue to insist that the Irish authorities refused to respond to several written requests for information.

However, a spokesman for health minister Mary Harney this weekend again dismissed these claims as "wholly inaccurate", with a spokesman saying there was "no record in the department of any request for information or any follow-up attempt by this organisation to request information."

The war of words has trundled on all week between the Irish government and Health Consumer Powerhouse, the Brussels-based company which published the Euro Health Consumer Index, a survey of European health systems that placed Ireland second-from-bottom of a table ranking the performance of the health sector in 26 European countries. Only Lithuania finished with a lower points tally than Ireland after the authors awarded points based on 28 criteria.

But while the report's authors and the Irish authorities quibble over who is in the right, the eminent retired cardiac surgeon Maurice Neligan has backed the report, saying that the Irish health service is easily among the worst in Europe.

"They [the Department of Health] may question some of the statistics but the report tells the truth . . . that we have an appalling health service", Neligan told the Sunday Tribune. "It is ironic that we are told that the authors of the report don't know what they are talking about by the very people who demonstrably don't know what they are talking about."

Beds According to Neligan, the Health Service Executive (HSE) and the Department of Health have not accepted that the "root cause" of the problems in the health service is the lack of beds in the system.

The section of the report in which Ireland scored lowest was in relation to waiting times, stemming from the lack of available beds in hospital.

Neligan claims that attempts to reform the health sector have failed. "The health service in Ireland is seriously bad and it is something we should be seriously ashamed of, " he said.

Health Consumer Powerhouse (HCP) stands by its findings and has criticised the Irish government for failure to improve the health service. According to HCP's Kajsa Wilhelmsson, the health service here is so dismal that even major changes to statistics would not have impacted upon the final table standings.

"We would not have expected Ireland to finish so low down the table because the country has gone through a long period of economic growth, " she said. "However, if you look at the health system, it is clear that the benefits of this growth have not been transferred into the health system. Even if some statistics used in the report had been updated, even an enormous improvement would still leave Ireland a long way behind the majority of European countries."

Ireland achieved the lowest points possible in 16 of the 28 categories measured in the report. The country received its highest ratings in categories dealing with pharmaceuticals and outcomes, but performed very poorly in sections dealing with patient rights and waiting times.

According to Wilhelmsson, there are simple steps that could be taken to improve the health service from a consumer perspective. These include opening a 24-hour information phone line (as happens in Belgium, Portugal and Malta); increasing infant polio vaccinations (as in Cyprus, France and Hungary); establishing a separate patient ombudsman (as in Austria, Greece and Poland); and facilitating patients in seeking a second opinion (as in Denmark, Germany and even Lithuania. ) "The report looks at healthcare from a consumer point of view, " she said. "We didn't rank lifestyle factors because we were not interested in how likely citizens of different countries were to get heart attacks; we wanted to know what their chances of survival were if they did get a heart attack."

Wilhelmsson insists the company sent emails and letters to every department of health in Europe late last year seeking information to be used in the report, but that Ireland was the only country not to respond.

While some countries wrote back to say that they would not be aiding the survey, Ireland was the only country that did not respond in any way, she says.

That claim is disputed by the authorities in Ireland, who deny receiving any communication from the report's authors, except for an email dated 20 June last in which HCP sought to meet with the department in order to discuss the findings of the survey.

"This report is out of date and inaccurate and wrongly portrays the health service in Ireland, " said a spokesman for the Tanaiste. "The findings of the survey are fundamentally wrong and were written by people who have no understanding of the health service in Ireland."

Ireland achieved maximum points under just one heading, that of subsidy levels for pharmaceuticals. In terms of patient rights and outcomes, Ireland was strongly criticised. The report found that waiting lists for treatment in Ireland were longer than in most other European countries, and also identified high levels of MRSA infection and infant death as among the biggest problems facing the health service here.

Ireland scored 350 points out of a potential 750.

France was found to have the best health system, scoring a total of 576 points.

"Waiting lists are far too long in Ireland, " said Wilhelmsson. "One move Ireland could make to counter this would be to remove the 'gatekeeper' position of GPs. As it stands, patients have to go to their GP to get a referral to see a specialist. Our research has shown that one way to counter waiting lists is to allow people to go directly to see specialists."

Direct access to specialist care was one of the major factors behind France's good performance in the survey. According to the Euro Health Consumer Index, direct access to specialists has helped to cut France's waiting lists.

France, Belgium, Germany, Luxembourg and Switzerland were all found to have the lowest waiting times for patients seeking cancer treatment, heart by-passes or hip operations.

However, the Department of Health defended its position on direct access to specialist care, saying "it is not accepted internationally that this is the most appropriate way to organise services."

Ireland was one of just seven countries to record more than six infant deaths per 1,000 births. While France has reduced its figure to less than six, five countries now record less than four infant deaths per 1,000 births.

One of the issues disputed by the department relates to the presence of a patients' ombudsman.

Ireland recorded the minimum score in that category for failure to employ a designated patients' ombudsman, but the department maintains that the ombudsman for children has a mandate in the field of healthcare, making the low score unfair. Health Consumer Powerhouse countered this by saying that a specific ombudsman was needed in order to raise public awareness.

"There is no point in having an ombudsman if the patients are not aware that they can turn to them, " said Wilhelmsson. "Other countries were also marked down for this. For example, Sweden does have a law that enables patients to seek a second opinion but in practice that law has no effect, so we still gave Sweden the minimum score for that section."