Tallaght Hospital is in financial crisis. If the hospital was a private company its creditors would probably seek the appointment of a receiver or a liquidator.
In a highly critical report released yesterday, consultants Deloitte & Touche declared that the hospital's deficit - the excess of spending over receipts - is increasing on a daily basis.
"The hospital cannot continue in this way; at present it is not in a position to meet its liabilities as they fall due and is incurring fresh liabilities which at the level of funding available to it, it cannot meet," the report said.
With the hospital in "a financial crisis of the most serious nature, immediate action is required to resolve the situation", the consultants warned. Inadequate controls on spending allowed costs to run well ahead of a budget which in itself was in excess of the funding allowed by the Department of Health and Children.
Hospital financial information and systems were not adequate to monitor and control ongoing operations.
By October 31st this year, net revenue expenditure - spending on the day-to-day running of the hospital which opened in June - was about £11 million over the "Determination" - the budget laid down by the Department. The projected net revenue expenditure for 1998 is £66.5 million. This is £7 million more than the hospital's own budget or service plan of £59.5 million, which in turn was £5.9 million higher that the "Determination" of £53.7 million laid down by the Department. Therefore, the day-to-day running costs of the new hospital in 1998 are expected to be £12.8 million over the budget provided by the Department of Health.
When the hospital adopted its own higher budget of £59.5 million (compared to the Department budget of £53.7 million) there were no definite sources of funding for the excess, according to the consultants.
Net monthly running costs at the hospital are now about £6.1 million, while the funding available under the Department's "Letter of Determination" is about £4.5 million per month. So the deficit is increasing at a rate of £1.6 million per month.
So far the deficit is being partly funded by the creditors. The hospital is extending the period taken to pay suppliers of goods and services, and to make payments to the Revenue Commissioners.
At the end of October, about £6 million was overdue in excess of 45 days to creditors, and the Revenue Commissioners were owed £3.9 million for PAYE and PRSI deductions, only £1.3 million of which related to that month.
If the hospital were operating in the private sector, creditors - including the Revenue - might not be so patient. Deloitte & Touche point out that it will be unable to fund its activities from creditors for much longer.
The other source being used to fund operations is early drawdown of allocations from the Department of Health and Children. However, only about £2 million for December remains to be drawn down against the funds provided by the Department.
In addition to serious overruns on revenue expenditure, there were overruns on capital expenditure and on spending on buildings and equipment. Committed capital spending was £140.5 million - some £5.7 million in excess of the Department of Health's provisionally approved budget of £134.8 million.
Also, the hospital considers further capital expenditure of £4.9 million to be necessary to complete the building and equip the hospital. But how could spending at the hospital get so badly out of line with its budget? The consultants list a number of problems and shortcomings to explain the situation.
The Tallaght Hospital was formed from the merger of the three city centre hospitals which moved to Tallaght in June to form one hospital.
In preparation for the move budgets were prepared earlier in the year. For the six months to June 1998, results from the three hospitals were apparently in line with budget. But after the move to Tallaght, spending started to move ahead of budgeted levels. In July, spending was £2.4 million in excess of budget while in August, spending was £1.4 million over budget. In September, management at the hospital projected that spending for the year would be £21 million over the budgeted figure of £53.7 million.
At this stage the Minister for Health commissioned the consultants' report. Among the consultants' findings were:
Pay costs for the year will be £3.5 million ahead of budget because the number employed, at 1,936, was 139 people higher than budgeted, overtime costs were £150,000 per month over budget and payments to consultants and pension payments were higher than planned.
Payroll costs are currently exceeding the hospital's service plan by about £550,000 per month, with the main part of the overspending attributed to "increased staff numbers not approved or funded and the increased level of overtime/on call payments in the hospital.
The hospital never had a realistic manpower plan, according to the consultants.
Non-pay costs will be £2.7 million over budget by the end of the year. About £400,000 to £500,000 of this was attributed to exceptional once-off costs associated with the move to Tallaght. But the costs of medicines, blood and gases was ahead of budget before the move and costs of medical and surgical supplies and the laboratory have been significantly higher than budgeted.
Non-pay costs are running at £2.1 million per month. The consultants recommended a cost review and proper processing and control over orders for goods and services, with managers made accountable for spending decisions.
The hospital board adopted a budget some £5.9 million in excess of Department allocation. But it failed to insist on the development and installation of adequate management information systems to monitor its financial performance even against its own budget.
Management reporting and control systems in the hospital were totally inadequate, the consultants found.
Budgetary control systems did not assign responsibility to managers for the budgets in their areas.
The strategic planning required to give direction and co-ordination to the new hospital was limited.
Tallaght Hospital's treasurer, Dr David McConnell, has argued that the budget allocated to the hospital was never adequate and that all the excess spending has been necessary to care for patients. It allowed no flexibility, particularly in the situation of such a major development as the merger of the three hospitals and the move to Tallaght, he maintained.
This calls into question the process of budgeting for public services. For the Tallaght Hospital the budget was formed by taking the 1997 budgets of the three hospitals and allowing for increments and developments.
The consultants question whether this system was suited to the opening of a major new hospital with development and commissioning expenditure and costing based on estimates. But consultants also said that the new hospital never produced the detailed operating profile which could have been used as a basis for formulating a more appropriate budget. While the immediate issue for Tallaght Hospital now is how can it find the cash to run the hospital, in the medium term there are some very serious financial management issues to be addressed.