By any standards it is an astonishing and ultimately unsustainable rate of increase in spending. The old argument that Ireland is way behind other EU countries in terms of health spending is now becoming harder and harder to sustain. Ask a group of people to name a country with a health system they admire and France is likely to be high on their list . . .

quite rightly too, as the UN ranks its health care at number one in the world. But the latest increase of 7.5% in our health budget means that Ireland's health spending, as a percentage of GNP, is now almost equal to that of France, even though we have a younger population. Nobody in their right mind would argue that our health service is as good as that of the French, but it seems clear that a lack of resources is not the reason for that.

And the undeniable fact is that we simply cannot afford to keep annually increasing our health budget by 1bn-plus a year. In nominal terms, the amount spent on health has increased fourfold over the last decade since the government came to power. Of course, to be accurate, the high rate of annual medical inflation and the growth in the population since then have to be taken into account.

Economist Moore McDowell estimates that when they are factored in, the real level of increase in health spending is . . . at a conservative estimate . . . in the region of 75%.

The obvious, if slightly simplistic, question, is whether the health service is 75% better than it was a decade ago? There is no doubt that the public perception is that, at best, there has been no improvement in that time. It would be churlish to deny that many areas of the health service are a good deal better now than 10 years ago. The minister for health outlines a whole series of service improvements below, but serious problems still remain. The problem with A&E has not gone away nor has the issue of hygiene.

There has been some reform of the system . . . for example, the creation of the Health Services Executive to replace the health boards. However, the kind of tough action recommended in the Brennan and Hanly reports has not been undertaken . . . political considerations have simply got in the way. Lack of beds remains an issue, as does GP coverage after hours; while the consultants' contracts remained untackled . . . will they ever be? Vested interests still seem to hold sway and the suspicion lingers that at least some of the increased budget has gone into a swelled health bureaucracy. The most worrying point of all is that if 14.5bn isn't enough money to buy us a world class health system where rich and poor are treated equally, how much will it cost and will we be able to afford it?

Are we getting value for money from the increased spending in the health service?

Mary Harney Minister for Health

THINK it is appropriate to focus on service improvements that are being achieved since 1997. For example, total patient admissions to hospitals are up by more than 300,000 to over one million. Waiting times for operations have been dramatically reduced from years to months. No longer do 75% of children and adults wait for more than a year for heart operations. There are nearly 40,000 more cancer patient hospital admissions; more people are being treated and surviving cancer. Infant mortality has fallen by a third. Breastcheck is in place and will start for all women in the country in spring next year, when there was no breast cancer screening programme in 1997. There are more than 3,000 Home Care packages now for older people, when there was none in 1997. There are approximately 1,500 additional acute beds in use. We are providing 1,700 more residential places and nearly 3,000 more day places for care, as one part of the first ever multi-annual programme for services for people with disabilities.

Janette Byrne Patients Together

THE spending on health may have gone up, but we're still keeping patients on trolleys, keeping patients in chairs, seeing massive delays in treatment and long waiting lists for surgery, so there has certainly been no signi"cant change in our system. Hygiene may have improved, but there are not enough beds and that is what it still comes down to. As the minister said when she was quoting us, even one person left without a bed is one person too many and we have up to 200 patients like this every week. We are still getting calls and the verdict is that there is still a lot of anger and a lot of suffering faced by patients in our hospitals. An increase in the budget hasn't stopped that.

Maev-Ann Wren Health Services expert

WHEN it comes to these spending increases, it is necessary to look at where we were coming from in 1997 and it's important to note that when people look at health spending, they tend to think it all goes into hospitals. In fact, half or less than half of the money goes into hospitals. A lot of it goes on social spending, care of the homeless, disability and elderly services. In 1997, Irish health spending was 78% of the EU average. In 2004, it was around 90%, so we still have a long way to go when it comes to spending.

People relate the spending directly to A&E, they don't see how much improvement has taken place in disability and elderly services.

Moore McDowell Economist WHAT percentage of that increase has gone into delivery of healthcare? It's a planned health economy that we have and somebody has to allocate resources. Extricating those [from the "gures] is dif"cult. Anything that has gone up in real terms by 75% in 10 years [which takes into account medical in"ation and a 20% growth in population in that period], you would have to ask big questions about. Where is the increased cost coming from? Some of it is down to more costly procedures, but you come back to the huge rate of growth in the pay bill. There have been huge increases in the numbers in the old health boards and in the hospitals. Is that value for money? Have we got value for money for a 75% real increase in spending? I will leave it to the punters to decide.