Dublin's major teaching hospitals are facing bed closures and possible cuts in services as a result of a projected shortfall in funding, sources have told The Irish Times.
There is growing anger among hospital consultants that the treatment-purchase fund, which will arrange for public patients to be treated abroad or privately in the Republic, has been ring-fenced while individual public hospitals in the State may be unable to operate to full capacity.
Sources at four of the five Dublin Area Teaching Hospitals (DATHS), the Mater, Beaumont, St Vincent's, St James's and Tallaght, have said they face significant budgetary deficits in 2002.
A senior figure at one of the hospitals said it had insufficient funds to support the levels of activity which it provided in 2001 and that there was no money available for extra work this year.
He also referred to the knock-on effect of the accident and emergency nurses' dispute in April which left a backlog of elective procedures which may not be completed before the end of the year.
The replacement of essential hospital equipment is also believed to be under threat at the university hospitals.
This includes outdated X-ray and operating-theatre equipment as well as the replacement of endoscopes, the flexible fibre-optic tubes used to take lung and gut biopsies. Such items are covered by capital rather than current funding.
However, a spokesman for the Eastern Regional Health Authority (ERHA), which is now responsible for purchasing services from DATHS, said: "The Eastern Regional Health Authority would like to emphasise that it has funds available to purchase acute hospital services this year to the same level as it purchased in 2001. In addition, the authority has resources to purchase service developments in the acute hospital sector."
The ERHA says that, since the beginning of the year, it has agreed to increase its spending on services from the university hospitals from €742 million to €795 million.
"This is an increase of more than €18.5 million on the total received in 2001," the spokesman added.
"It is anticipated that during the course of this year the five hospitals will receive further monies for items such as pay awards and bed capacity".
The ERHA figures refer to current expenditure, and it may be that the different projections by the authority and by hospital sources reflect the difference betwen current, capital and projected expenditure.
However, if services are affected - and one source said he felt that bed closures were likely in the autumn, then the government could face the embarrassing situation of funding patients for treatment abroad while hospital facilities lay idle in the State.