The board of Tallaght hospital has submitted a service plan for the year to the Department of Health and Children, as required under the deadline in the Letter of Determination. This set its budget for 1999 at £64 million.
In a statement after the meeting the board issued a terse statement saying it had adopted the plan. It added: "The service plan seeks to provide for the existing level of services within the letter of determination."
It is clear from the statement that the board is not certain that this effort will be successful. The plan was approved only reluctantly, with some board members voting against and others abstaining, while still others voted for it only because they felt obliged to under the letter of determination.
The board also voted unanimously to place on the record its reservations about the service plan, which reduces some services below what was carried out by the base hospitals before the move.
The plan was submitted as a debate began in the Dail on a motion of confidence in the Minister for Health, Mr Cowen. The Labour Party spokeswoman on health, Ms Liz McManus, devoted much of her attack to the Minister's record on Tallaght hospital.
It was unclear last night whether the service plan would avert the threatened industrial action planned by unions representing non-medical staff to oppose job cuts at the hospital. "The concern of the board is that it may well be forced to cut staff and services," said a source.
While the meeting was going on a letter arrived from Mr Kevin Bonnar, the chairman of the Troika - the team Mr Cowen put in to assist the management team - with news that another £1 million would be available to fund 35 of the 179 non-permanent staff whose jobs are threatened, and who are in critical areas. This money is only for this year, is conditional, and will not come on stream until April.
There is hope that a further £1 million can be found when the budget for the Federated Dublin Voluntary Hospitals, which includes Tallaght, is finalised.
"The fact that the Minister had to come up with an extra £1 million is an admission that the initial allocation was wrong," said one source. But members of the board were still unhappy about the level of services contained in the service plan.
Among the services reduced or not operational is the cardiac catherisation unit, which has been staffed and equipped, but for which there is no development budget, so that it will not be able to operate. Cardiac patients requiring certain procedures will have to be taken to St James's.
"Senior medical opinion will say that transferring patients to St James's for this procedure puts patients' lives at risk," said one source.
Another area which faces cutbacks is orthopaedics. The plan foresees a 20 per cent reduction in this service, relative to what was carried out by the base hospitals.
Board sources point out that among the unapproved staff are 16 people working in the hospital sterile supplies department, which was completely revamped to meet EU regulations. While these jobs were unapproved by the department, the hospital cannot run without this service.
It is clear from the terms in which the service plan has been presented, the lack of unanimity on the board in voting for it and the misgivings of certain board members about the medical implications of aspects of it that the battle between the hospital and the Department is not over.
Board members remain convinced that an understanding they had with the Department last spring was broken. They point to a note within the Department dated last March which said: " thought that we had put enough funds aside, while it does not look like that now, the amount is set;" and a letter the following May which said that "we have agreed in formulating an agreed solution to the issues which influenced your board of management decision [relating to not taking in St Loman's patients at that stage]".
As far as the board is concerned, these amounted to a commitment to fund the hospital along the lines of the needs they had outlined. The Department insists the board lost control of funding, and the service plan is necessary to bring it back on track. For the board, the plan only serves to illustrate the gap between the two perceptions.