There can be no dispute over the fact that it has always been necessary to ration the resources available for the provision of health care and in recent decades that necessity has become sharper with the advent of more expensive treatments and procedures. Medical inflation has been consistently higher than general inflation and, without the most careful controls, it is perfectly conceivable that unlimited hospital costs could engulf the entire national exchequer. Yet the rationing of resources has always created huge political controversy and public unease. Because those providing hospital care and those seeking it will always want more and better care than can be made available with whatever the current resources may be, the subject can easily become emotive and the controversy easily exploited.
The closure of hospital wards each summer has always provoked varying degrees of public and political outcry, yet such closures have been occurring virtually since hospitals were founded. The more recent closure of hospital beds in Galway happened because budgeted resources were running out, and caused great concern to both potential patients and the health professionals who wanted to provide services to them. And yesterday, the report prepared by Deloitte & Touche reveals the nature and the background of the current financial crisis in Tallaght Hospital which opened its doors only months ago. The bottom line of that report is written on the second page of that 211 page report and it makes chilling reading: "The hospital is in a financial crisis of the most serious nature. Immediate action is required to resolve the situation."
It is to the credit of the Minister for Health, Mr Cowen, that he has shown more determination than most of his predecessors to impose some kind of predictable ceiling on national hospital expenditure. It is not to his credit that he and his Department appear to have lost the trust of the members of the management board as a result of their handling of the crisis which had been looming (as the report demonstrates) for a long time before the Meath, Adelaide and National Children's hospitals moved from their city centre sites to the new campus in Tallaght. The methods used to measure the likely costs of the move and the new hospital's subsequent running costs, are shown to have been inadequate in various respects whether the methods were used by the Department or the hospital management.
But this can hardly come as a great surprise: the methods used to measure and monitor expenditure within Irish hospitals have been grossly inadequate for decades, and the Department of Health has been slow to impose measurement requirements specific enough to determine exact costs in respect of particular activities within the hospitals. Even the separation of inpatient and out-patient costs on such diverse facilities as the laboratories and X-ray departments have been blurred by the inadequate methods used to measure such transactions within a single institution. The contrast in financial monitoring and control between Irish and American hospitals has been striking. Small wonder that there have been discrepancies in the predictions and outcomes of a massive merger of four different hospitals on a single new greenfield campus.
It is essential that these discrepancies (both personal and financial) be resolved urgently in the case of Tallaght. It is to be hoped that better, more comprehensive and more specific methods of financial control and of medical necessity be developed for all Irish hospitals so that the best care can be provided at the most economic costs. The exchequer, the patients and the health-care professionals require nothing less.