In the plush surroundings of a five-star hotel overlooking the lakes of Killarney last April, Minister for Health Simon Harris told doctors that the €10.9 billion capital investments earmarked under the Government's National Development Plan would transform the health service.
In a speech to the Irish Medical Organisation conference, he argued the new funding would drive down waiting lists, increase bed capacity, reform pathways of care and modernise how we deliver health services.
Capital investments in the health services, over the coming decade, he said, would “support existing Government priority projects and commitments and will enable the roll-out of new additional capacity guided by the Sláintecare report and the health service capacity review”.
It has now emerged that a month or so later the Minister wrote privately to his colleague Paschal Donohoe, the Minister for Public Expenditure, to argue that the 10-year capital plan was "not balanced" and that the HSE was facing "a funding gap" of €109 million this year.
Harris sought Donohoe to agree to bring forward €913 million in funding earmarked for the later end of the 10-year strategy to the early years.
Later years
The problem was that, as the development plan was structured, the bulk of the money would come in later years. The capital funding budget would not top the €1 billion mark until 2023, for example, and not reach €2 billion until 2027.
Harris argued that the financial demands of large-scale contracted projects such as the new National Children's Hospital, the new National Forensic Mental Health Campus at Portrane in North Dublin and the relocation of the National Maternity Hospital to St Vincent's campus would consume the bulk of capital funding available over the next three years.
He said there would be little scope “to undertake the essential investment in diagnostic and medical equipment, to commence planning and design of future projects including bed capacity and other projects identified in the National Development Plan and in the Sláintecare implementation plan”.
Spending on a number of planned projects may have to proceed more slowly or be deferred into 2019
Two months later, in July, Department of Health officials warned its secretary-general Jim Breslin in advance of an appearance before the Public Accounts Committee that while there was provision for €493 million in capital funding to be made available to the health service this year, the HSE's current capital plan showed "a cash flow projection over the agreed allocation of approximately €110 million".
‘Impact’
“The steps which would be required to remain within allocation will have an impact on some very important capital investment proposals including stated priority commitments, infrastructural and clinical risks including equipment replacement and ambulance replacement programmes.
“Spending on a number of planned projects may have to proceed more slowly or be deferred into 2019.”
The Department of Health refused on a number of occasions in recent weeks to say what projects could be affected by the current capital funding pressures.
However, highly placed sources have told The Irish Times that about half of the equipment and ambulance replacement programmes originally scheduled will not go ahead this year. This will largely impact on the replacement of diagnostic equipment such as MRI, CT scanners as well as X-ray and ultrasound facilities.
A number of high-profile building projects are also expected to be slowed down by six months or so, bringing them into next year's budget. These include new radiation oncology facilities for cancer patients in Galway, a new acute psychiatric unit in Sligo and a new renal unit for kidney patients in Tallaght.
Sources said the transfer of the National Maternity Hospital to St Vincent’s campus in south Dublin may also be slowed down.
