Positive sentiment towards the largest healthcare investment in the history of the State has already turned sour. Martin Wall explains why.
It is at times like this that the Department of Health justifies its reputation as one of the most troublesome political portfolios. A week ago the Minister for Health, Mr Martin, announced that he had secured agreement with the Department of Finance for the largest State investment in healthcare facilities involving the expenditure of €2.5 billion over the next five years.
Yet just days later, the Minister is facing condemnation from the opposition and accusations that government health strategies are in disarray. He has also been met with anger and concern from those working in the area of general practice and mental health, who believe that they are to be treated as lesser priorities in the health service pecking order. So how can such a good news announcement go so wrong?
In truth, there has been a broad welcome for the investment. The disagreement is due to the fact that the general hospital sector is likely to see the benefits of the money before other areas, such as community care services or mental health.
Because of the way the investment has been structured by the Department of Finance, the health services will receive five tranches of capital funding from the exchequer, each of roughly €500 million annually, up to 2008.
However the Department of Health has already embarked on a massive hospital building programme and the bills for these will have to be met first. The consequence of this, as the Department acknowledged in internal letters obtained by The Irish Times, is that difficult decisions had to be made and some planned spending had to be deferred.
The coming years will see massive hospital developments around the State. These include a new children's hospital on the campus of Dublin's Mater to replace Temple Street. This alone will probably end up as the most expensive healthcare development in the State's history, with a final bill of around €400 million. There will also be major new facilities at St Vincent's University Hospital in south Dublin and at Tullamore General in Co Offaly, as well as at a number of other locations.
However - as the Department of Health pointed out to the Department of Finance in recent months - these facilities will need to be equipped once construction is complete.
While the tone of some of the language in their correspondence prior to agreement on the capital programme can be attributed to the traditional posturing that forms part of all such negotiations, it is clear that senior figures in the health service were unhappy at the way the payment of the funds was to be structured.
For if the bulk of the money in the early years of the programme was going to be eaten up by commitments already planned and entered into in the acute hospital sector, then funding promised to other areas of the health service would have to be postponed.
"A fundamental policy underlying the proposals is that equal investment should take place on the non-acute and acute sectors of the health service in the life of the programme. Because of the general level of major projects currently in progress in the acute sector, the major component of investment in the non-acute sector will have to be deferred until 2007 or 2008," the Department of Health told Finance in May.
Among the areas of the non-acute sector now facing a deferral of funding is the high- profile plan to develop a network of multi-disciplinary primary care centres where GPs, nurses, midwives and social workers would all work under the same roof.
The development of this network of primary care teams formed the centrepiece of the Government's ambitious Primary Care Strategy launched in 2001. However, only a small number of pilot projects have been funded in this area to date. And in July Mr Martin became embroiled in a public row in Government Buildings with the leaders of the Irish Medical Organisation who claimed that "realistically no progress" had been made on implementing the strategy.
Then, the Minister had insisted that the Primary Care strategy was a blueprint to be implemented over a 10-year period.
However, internal Department of Health documents show that while relatively low levels of funding will continue in this area in the immediate future, the large-scale State investment promised has been put back for three years.
Mr Martin indicated yesterday that private sector funding for these primary care centres, encouraged by tax breaks, could come on stream sooner.
The Department also maintained that further talks with the Department of Finance on "flexibility" within the capital plan could allow for money to be invested in the non-acute sector earlier than planned. However, this was not enough for either the IMO or the opposition.
It is understood also that the Mental Health Commission expressed its concerns to Mr Martin yesterday on the implications of deferring funding in its area.
If next week's Cabinet reshuffle results in the appointment of a new Minister for Health, the latest controversy will come as a salutary lesson to the newcomer. In the health service, most of the players see their particular area of interest as the most important. And State investment - no matter how large - will lead to criticism if one sector believes that it is losing out to another.