I address myself through the Minister's representative to the Minister because, while I do not dispute the intellectual calibre of the Minister of State, I would like if this material would be made directly available to the Minister.
As in all new enterprises there are difficulties.
In September 1997 a board meeting of the Adelaide Hospital was told there would be a ten year bedding down period for the whole hospital. That indicates they realised they were to some extent moving into uncharted territory. The same happened disastrously, in some ways financially, with the Channel Tunnel which went into enormous overruns which complicated the process.
There have been overruns in the Adelaide Hospital. However, a question I would address to the Minister is whether these overruns were due to folly in budgetary procedures by the hospital or because it was underfunded from the beginning. Even at the moment when we welcomed the commitment and support of the Government to the hospital I was supplied with detailed figures which suggested there was a strong possibility that there would be underfunding. I predicted we would be back in this House looking for extra funding before the project was under way much further.
There was an allocation this year of £57 million. The requested budgetary requirement is £67 million so there is a clear shortfall here. The anticipated overrun for the year carries various estimates, from £8 million to £15 million to £20 million. The reasons for these are multiple. The three clearest are, first, the fact that the cost of moving was greater than anticipated. This is a common feature of this kind of operation; second, there were commissioning costs attaching to the hospital, and, third, there were sums for additional equipment. The first two are non recurrent items of expenditure and they have been incurred. That is an important point. It is necessary that the hospital be in a position to discharge its debt and liabilities in these areas.
The expense of running the new hospital has proved to be much greater than running the three base hospitals, and will continue to be so. Its operational costs are higher. When I discovered this it struck me at first as rather curious because the lay person would assume that if one amalgamates three separate units into one large unit one gets greater efficiency, greater concentration of resources and one does not need duplication of expensive plant and equipment. One would also assume there was an economic argument to indicate it should be less expensive to run such an institution. Apparently this is not the case and it is something which Deloitte and Touche will presumably investigate. It will be very useful to find out if they can give further specific reasons for this, although I understand that some of the reasons are increased security, the ward structures and so on.
The practical experience of this merger indicates that the attempted merger in the early 1960s between Trinity College and UCD might have also been rather problematical. It was presented as a cost cutting exercise. Now, with this sophisticated move, it is being learned that it is not always the case that merging smaller institutions into a larger one saves money.
The hospital now has a different and huge catchment area. I hope the Minister of State can assure the House that the instructions to Deloitte and Touche are not merely to whip the Adelaide Hospital into line. Reading the answer to the question tabled by Deputy Shatter in the Dáil, it appears the Minister examined the situation and told them to cut their cloth to suit their measure. They were to keep within the budget regardless and were to revise operational plans accordingly. I am not sure this is a good idea. We should keep an open mind as to the cause of the overrun. Was it underfunding, management error or a combination of the two? I assume the exercise of Deloitte and Touche will determine this. It is important its report be made available to the hospital and to the House. Will the Minister give an undertaking this will happen?
A previous report was commissioned by the Minister and Mr. Leslie Buckley and Mr. Tom McCarthy were sent to the hospital earlier this year before it opened to examine the situation. I presume the Department received the report, so can it be made available? Is it true that the suggestions, of which I have been apprised, are favourable to the hospital budgetary position? The bottom line is that the hospital must be strongly supported and must continue to function.
There is apprehension. In a letter dated Wednesday, 21 October 1998, in the newsletter of the Adelaide and Meath Hospital, Pulses, Mrs. Rosemary French, chairman of the hospital, indicated she was aware there were rumours circulating and wanted to put people's minds at rest. She said:
Figures in recent newspaper reports regarding how much money the Hospital needs are not official figures. The exact figure has yet to be determined. [This presumably is part of the exercise of Deloitte and Touche. ]
As you know, before we opened, many costs arose in preparing this Hospital for patients and for staff. Also, closing and moving the base hospitals to Tallaght was a huge task, and not least in financial terms. In addition, running costs are higher here than they were between the three base hospitals because it is a larger site with bigger cleaning, security, etc., bills.
I believe the expense to be justified and I hope to have time later to put on record the strongly positive attitudes of both medical staff and patients to the high standards of facilities, to the fact that it is wheelchair friendly and to the existence of ordinary human aspects, such as the intrusion of sunlight into a room. People do not feel they are in a corner. Every room has its view. There is a garden which can be enjoyed by people, even though they are ill. Although they are expensive, they are well worth having and will certainly make patients feel better. Mrs. French further stated:
These costs are being examined and allocated to either the Hospital or to the Tallaght Hospital Planning Board. When it has been decided who should pay each of these costs, we will then know the extent of any over-spend by the Hospital.
The Adelaide has the site in Peter Street and questions have been asked whether this should be realised to make good the shortfall. That is an understandable view of the Minister's but I understand it was already examined and undertakings given that it would not happen. It is important the Adelaide, having realised the value of the site, should have it as a contingency fund to continue to upgrade the medical services of the hospital. Otherwise, there will be an absolute dependency later on the Department. Mrs. French further stated:
Deloitte & Touche are reviewing the Hospital's financial situation with a facilitation group from our Hospital and the Department of Health & Children. We expect their report by the end of next week. Three of our Board members, Cllr Gerry Brady, Mr Salters Sterling and Prof David McConnell, are representing the Hospital.
Gerry Brady was a colleague in the Lower House; I know Salters Sterling from Trinity.
In the Irish Times of 23 October 1996, concern was already being expressed about facilities, that there may be a reduction in the number of beds and that there may be a little cheese paring. Indicating the type of problems experienced in the move, the headline in the Irish Times of 2 June 1998 read “Senior doctors may seek £700,000 for Tallaght move” because of inroads into their consultancy base, etc. Not only anaesthetists, surgeons and other high earners but also some of the other staff put in claims for disturbance money for movement, etc. There were the usual teething troubles: rooms were built to an incorrect design and operating theatres had to be demolished and rebuilt.
However, I wish to put on record the positive side I mentioned earlier. Another headline in the series of articles read: "Move from 'black hole of Calcutta' is popular":
Dr Des O'Neill was succinct in his description of the ward where he used to treat elderly patients before the move to Tallaght Hospital. "It was like the black hole of Calcutta," he said of the ward in the Meath Hospital.
Speaking of the new conditions, he said:
"It is phenomenally better. There is more space, it is brighter, the therapy rooms are wonderful and the garden is already a big hit with the patients,"
It was well worth spending the money to give citizens who are ill, unwell or feeling miserable a lift by giving them decent surroundings.
Although these are large sums of money and one cannot always assume the Celtic tiger will have a back strong enough to carry the demands placed upon it, as always with such big projects, there is a spin-off for the local community, which is a second positive aspect. Tallaght has traditionally appeared or been presented as a depressed area although it is a beautiful location.