A chronic lack of ambulances throughout the country is forcing the HSE to splash out massive amounts of cash on the services of local cab firms.

Taxi bills have come to over 68m in the last four years as a result.

Labour's health spokesperson Liz McManus described the 20m figure as a "significant amount of money" that highlighted just how badly an integrated ambulance system needed to be introduced.

The biggest user of taxis is the HSE Southhern area (previously the South Eastern Health Board). Its total bill for taxis in 2006 amounted to over 3.34m. Hospitals in the region include Waterford Regional, Wexford General and St Luke's in Kilkenny. In 2003 the taxi bill for the HSE Southern area came to 1.7m and has increased by over 500,000 each year since.

The HSE has defended the substantial bill saying it was more cost effective to use taxis to transport patients rather than invest in a dedicated ambulance fleet. This avoids the need to pay maintenance, staff and fuel costs.

A HSE statement said taxis were more flexible in the face of variable demand but added that the executive was working in conjunction with the National Ambulance Service to develop a national protocol on the hiring of patient transport.

The HSE has declined to reveal the companies or individuals who have contracts to transport patients, or how much they were paid.

McManus criticised this decision, saying it highlighted how unaccountable the HSE had become. No reason was given for the decision not to release the figures under the Freedom of Information Act.

"Twenty million euro is a lot of money and the figure is surprising but it is not that surprising. Taxis have been used as a stopgap measure because of the lack of an integrated ambulance service, " said McManus. "Taxis are meeting the needs of patients, especially patients who live in remote areas. . . 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."