Thousands of health-service bureaucrats should be let go as part of ongoing reform of the Health Service Executive (HSE), according to its outgoing chief executive Prof Brendan Drumm.
But as the government prepares to implement further massive health cuts in the region of €600-€700m, Drumm warned that without the introduction of a government-funded redundancy programme, it would be necessary to essentially "wait" for people who are no longer needed to leave the system.
He said he believed potentially thousands of excess backroom office staff and managers could be let go within the HSE as new structures take hold.
In his final newspaper interview as HSE boss, Drumm said: "We have various programmes of early retirement and such, but in essence we do not have a formal redundancy programme in place. So you wait," he said. "We're constantly talking to people in government (about the need for a redundancy programme.). But I suppose the challenge for the government… is where do you come up with the upfront money to actually fund a redundancy programme?
"But I think somewhere down the line… in terms of actually reducing staff numbers in the HSE it is going to be critical."
Drumm said there was "no doubt" that it would be possible to reduce some 4,500 backroom office support staff by at least 30%, while a "couple of thousand" HSE managers could also go as new primary-care team structures take hold.
"You have to put the structure in place. And we're well along the road there to putting that structure in place. The problem for us is, is there any way for people to leave the organisation?"
Drumm also acknowledged that he would have been able to reform the health service more quickly if it had not been for a decision by Bertie Ahern's government to guarantee that no one would lose their job through the abolition of health boards when the HSE was established.
"We had agreements... that everybody was guaranteed a job, where they worked, essentially, without moving, for the rest of their lives
in the HSE," he said.
In a wide-ranging 'exit' interview as he prepares to leave his €370,000-a-year post, Drumm suggested that many doctors, nurses and therapists had resisted change in the past in part due to their egos.