"The much-needed reform of our health service is not just about individual prices and numbers, it' s about the need for a more strategic vision, " Kieran Mulvey said.

Negotiations between interest groups including doctors, nurses and managers were currently "painfully slow, complex and fraught with competing interests and sometimes divergent targets and policy objectives".

Mulvey said he doubted the partnership agreement could deliver the change needed.

"Instead of negotiating with each group separately, we need an overarching process that will reach common agreement on central issues capable of delivering reform to those who need it most, the patients, " he said, adding that a change of attitude was needed "from the hospital porter to the consultant".

Though Mulvey acknowledged that health service unions were coming under immense pressure from their members to deliver better pay and conditions, he said the unions would need to show "leadership in overcoming the barriers of custom, practice, demarcation and the real and tangible concerns of their members". Management, meanwhile, would have to show "clarity of purpose" and a "sense of determination".

The LRC chief 's call comes amid mounting tension across the health service. Nurses plan industrial action early in 2007 after their claims for a substantial pay increase, a shorter working week and a Dublin weighting allowance were rejected by the Labour Court.

Talks between the HSE and consultants on the creation of a new public-service-only hospital consultant have broken down after almost two years.

And as consultants are at the apex of the health service, this in turn is preventing consequential deals with junior doctors, GPs and ancillary staff.

"It is becoming harder to get agreement in health service disputes referred to the commission and parties are adopting an increasingly adversarial stance, " said Mulvey. "We need to take an imaginative leap forward now."