Labour's manifesto before the last election promised an urgent review of ambulance services to ensure that patients had rapid access to medical services.

There is a severe shortage of ambulances across the country and taxis are increasingly being hired to fill the void. Over 68m has been spent on taxis in the past four years alone.

A large public protest will take place at Mayo general hospital next Tuesday to highlight the lack of transport for outpatients.

Throughout Ireland it is the same story, with each of the four Health Service Executive (HSE) regions spending a "significant amount of money" on taxis because they don't have enough ambulances. Local managers say they have no choice as otherwise patients have no way of getting to hospitals to receive treatment.

The biggest user of taxis is the HSE south area, formerly the South Eastern Health Board. The total bill for taxis there in 2006 amounted to over 3.34m. There are six hospitals in the area, including Waterford regional hospital and Wexford general hospital.

A stopgap measure In 2003 the taxi bill for HSE South region came to 1.7m, and has increased by over 500,000 every year since.

The HSE is broken into four regions and ten sub-regions around the country. Each sub-region has seen its spending on taxis soar over the last four years, and the figures have more than doubled in some cases.

The taxi bill for the former East Coast Area Health Board was 3.3m last year. Hospitals in this region include the National Maternity Hospital at Holles Street and the Royal Victoria eye and ear hospital.

HSE West, previously known as the Western Health Board, ran up taxi bills of 3m last year. Hospitals in its catchment area include Galway university hospital and Mayo general hospital.

Perhaps the most surprising figure is the relatively small sum spent by the former Northern Area Health Board, which operates Connolly, the Mater, Beaumont, the Rotunda and Temple Street Hospitals. A total of 1.1m was spent on taxis in the area last year and around 4.38m has been spent over the past four years.

The HSE has defended the substantial bill for taxis, saying: "HSE vehicles and their staff are prioritised for front-line, emergency work and therefore a much more effective service is provided for patients or clients who are not acutely ill through the use of taxis.

"The use of taxis for patient transport represents a more cost-effective solution when compared to investment in a fleet of HSE-owned vehicles for this purpose. Additional costs relating to this would include the provision of 24/7 staffing, maintenance, fuel, insurance and tax.

The use of taxis also allows the HSE flexibility in the face of variable demand."

Liz McManus says that the massive sums being spent on taxis show just how urgently an integrated ambulance system needs to be introduced.

"This is a significant sum of money and highlights the fact that an integrated ambulance service has not been developed properly.

In many areas there are not the ambulances to pick patients up, so the use of taxis has become widespread.

" 20m is a lot of money and the figure is surprising, but it is not that surprising because taxis have been used as a stopgap measure because of the lack of an integrated ambulance service.

"Taxis are meeting the needs of patients, especially patients who live in remote areas and have no way of getting to hospitals, but it is a very inefficient way of doing things. In order to get value for money, patient transport needs to be carried out through a reformed ambulance service."

The figures were released under the Freedom of Information Act and cover the period 2003-'06. Nine out of ten officials in the HSE subregions granted the request for the total amount spent on taxis.

Unaccountable The only region which refused to disclose the amount spent on taxi transport was the HSE Dublin North East area.

Formerly the North Eastern Health Board, hospitals in the region include Our Lady of Lourdes hospital in Drogheda, a hospital that has been consistently in the news because of the conduct of disgraced consultant obstetrician Dr Michael Neary in carrying out an abnormally high number of hysterectomies.

It is likely the taxi bill in the HSE Dublin North East area would have exceeded 3m last year and around 10.1m for the previous four years, compared to regions of a similar size.

Under the Freedom of Information Act, the Sunday Tribune requested details of the names of the companies and individuals hired by the HSE, along with how much they were paid. This request was declined and no reason was given for the refusal.

Liz McManus has criticised this decision, saying it highlights just how unaccountable the HSE has become.

HSE Area TAXI BILL 2006
Last four years HSE Dublin North East (Former Northern Area Health Board) /1.114m /4.38m HSE Dublin North East (Former North Eastern Health Board) REFUSED TO PROVIDE DETAILS /3m (est) /10.1m (est) HSE West (Former Western Health Board) /3m /10.4m HSE West (Former North Western Health Board) /482,572 /2.3m HSE West (Former Mid Western Health Board) /373,036 /1.2m HSE Area TAXI BILL 2006 Last four years HSE Dublin Mid Leinster (Former Midland Health Board) /1.35m /4.3m HSE Dublin Mid Leinster (Former East Coast Area Health Board) /3.32m /10.1m HSE Dublin Mid Leinster (Former South Western Area Health Board) /1.29m /4.7m HSE South (Former South Eastern Health Board) /3.3m /10.2m HSE South (Former Southern Health Board) /3m /10.1m