The management of Tallaght hospital was surprised when the media reported Department of Health concern about the new hospital's budget overrun for 1998. While conceding the overrun could turn out to be around £15 million, the hospital maintains the need for additional funds had been signalled to the Minister for Health many months ago, and it was confident he understood the position.
"We could not have run the hospital on the basis of the letter of determination [which allocated this year's budget]," says Dr David McConnell, treasurer of the hospital and chairman of its resources committee. This was for £53.6 million.
"We told the Department that last February, and it gave us every reason to believe it did understand. We believed we had a degree of comfort from the Department in relation to the additional funding."
The need for additional funding arises from two sources, he says - problems associated with the move, which will require once-off payments, and extra funding for the day-to-day running of the hospital if it is to provide the kind of service promised. He and the rest of the board have welcomed the appointment of consultants Deloitte and Touche to examine the budget and arrangements for service planning. Such a review was envisaged when the hospital had had a few months of operation, they say. The report will be with the Minister in two weeks.
"It is quite simple," according to Dr McConnell. "They will have to disentangle the following: the costs of a capital nature which occurred; the costs of extra staff etc. resulting from the move; the costs of industrial relations agreements and claims arising out of the move, like disturbance money and sectoral agreements.
"In addition, a larger number than expected retired or took early retirement from the Adelaide and Meath, and their pensions are a cost on the annual budget. There are costs which arise out of the geography of the building. There is not the same income from private patients as there was in the base hospitals because there are fewer private beds. Then we had to stock the hospital from scratch.
"We will need a complete list of all expenditures, confirm they were proper expenditures, see what is the shortfall and see what additional expenditures are going to arise. Then confirm to the Government they were all properly vouched for. It will then be up to the Department to seek the additional finance."
Ideally, the hospital should have been fully built and in place for a year before the base hospitals moved, Dr McConnell says, so people could go out and assess it in the light of their needs. But this could have cost even more. He points out that Beaumont lay empty for years before its base hospitals moved in, because of squabbling between them. "We have had a successful merger, thanks to David McCutcheon (the chief executive of the hospital)."
The Department of Health has pointed out that since 1996 the hospital has received £8.7 million to facilitate opening on June 21st this year.
DR McCONNELL says some confusion about funding arises from the existence of two boards - the Tallaght Hospital Planning Board, set up by the Department of Health under the chairmanship of Mr Richard Conroy to bring the hospital into being, and the Tallaght hospital board - the full name of the hospital is the Adelaide and Meath, incorporating the National Children's Hospital. According to Dr McConnell, the planning board was meant to be amalgamated with the hospital board on April 10th last. However, it is still in existence.
"It was very difficult to know where people's responsibilities and liabilities lay before the opening," says Dr McConnell. "Early in June, if we saw something that needed to be done, the operations group, headed by Dr McCutcheon, did it. Things needed to be bought.
"For example, there were no word-processors. If we had to purchase word-processors, where was the liability? With the Tallaght Hospital Planning Board or the Adelaide and Meath board?"
The Adelaide and Meath board is concerned it will have to meet the cost of the move out of its allocation for running the hospital, which, at £54 million for 1998, it already considers too little. The existing allocation was initially based on what it had cost to run the three base hospitals, which had a history of being very severely underfunded, according to Dr McConnell.
"Everyone expected there would be a substantial professional improvement in the way services were being delivered. The geography of the hospital requires that," he says.
He says the appropriate figure for comparison was what it took to run Dublin's other acute teaching hospitals, like St James's, the Mater and Beaumont, whose budgets are about £67 million annually.
However, the Department of Health has pointed out that the allocation to St Vincent's Hospital in Elm Park is only £56 million for the whole year, and that St James and Beaumont have 780 and 629 beds respectively, compared with the 534 Tallaght had before the move. When fully operational, Tallaght will have 589, including 56 psychiatric beds. St James's and Beaumont also have a greater number of specialities, the Department said, including a number of national and regional specialities.
No one has raised the matter, but officials in the Department of Health cannot but be aware that the Adelaide is about to raise several million pounds from the sale of the old hospital building, and this money will go to the Adelaide Society. The sale is expected to go through in November.
"The Adelaide Society supports Tallaght hospital in perpetuity," says Dr McConnell. "But it was solemnly agreed that its assets and those of the Meath and the National Children's Hospital would not meet any short-term financial needs the new hospital might face. That was agreed with the Government and the courts. I don't expect this to be raised."
He points out that each of the foundations had pledged £500,000 to the new Trinity teaching centre, and, between them, £3.5 million to the hospital over the next five years.