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Dáil Éireann díospóireacht -
Thursday, 10 Dec 1998

Vol. 498 No. 3

Adjournment Debate. - Tallaght (Dublin) Hospital Report.

It is in the public interest that the Deloitte & Touche report into the finances of Tallaght Hospital be published, as many media reports in the past 24 hours have grossly overestimated the extent of the hospital's expenditure overrun and have misrepresented the likely contents of the report. It is absolutely appalling that the Minister for Health and Children engaged in an unprecedented breach of faith with the board and management of Tallaght Hospital. He met the board yesterday and handed the report to them. I understand that both sides agreed that no public comment would be made on the substance of the report pending a further meeting that would address working out the various issues related to the hospital.

In an unprecedented and extraordinary breach of faith, the Minister issued a statement yesterday which stated that the "Deloitte & Touche report indicates serious governance and general management problems at the hospital." The Minister's strategy with this statement was to point the finger at the hospital board as being solely responsible and to target them as being to blame. Because of the Minister's behaviour it is now essential that the report be put in a public forum and be made generally available. The Minister has behaved in this manner to cover up what may be anticipated as criticisms of him and his Department in the report. I challenge him to either confirm or deny that the report describes the allocation of funding by his Department to Tallaght Hospital as inappropriate, that it describes the methodology used to assess what funds were required as inappropriate and that it makes quite clear that when funding a new acute hospital, different principles should apply from those which apply on a year on year basis to existing hospitals in existing population areas.

It is likely this report not merely voices some criticism of the management structures of Tallaght Hospital, but that it makes quite clear that in so far as there are financial shortfalls, the original financial allocation made by the Minister for the hospital was based on principles that were not appropriate and that, as a consequence, the hospital has run up a substantial overdraft.

In the context of the breach of faith shown by the Minister and the critical comment in the statement he made, which was designed to pillory the management board of the hospital, he undermined public confidence so much that he should consider his position as Minister. He has created extraordinary problems for this and other boards having confidential discussions with him. His statement is not only damaging to the board of Tallaght Hospital; it is likely to undermine public confidence in the hospital itself. I feel the Minister accepts it has operated well, as is acknowledged in the report according to other statements that have been issued.

Tallaght Hospital is the only major acute hospital in the State with a Protestant ethos. The Minister has been addressing issues related to the hospital with the sensitivity of a herd of stampeding rhinoceroses. The manner in which he deals with the hospital will be seen as a litmus test of the Government's commitment to a new Ireland by many groups on all parts of the island. The Minister seems fixated by media control. Too many reports dealing with health issues, including this one, are caught in the public relations stranglehold of the Department. The Minister needs to be reminded that this is a parliamentary democracy, and Members of the House are entitled to see reports such as this, which have been prepared at public expense. The media are entitled to access to such reports. By issuing a selective statement which misleads and does not set out the position clearly, the Minister is undermining the freedom of the press to report in an informed way on important health issues. If he has nothing to hide he should publish the report, and if he intends to remain Minister for Health and Children he should publish a public apology to the board of Tallaght Hospital for his breach of faith in making critical public comments in circumstances in which it was agreed that no substantive public comment would be made on the contents of the report. The Minister should publish the report and let the public judge how the difficulties in Tallaght should be addressed and how the difficulties created by his Department should be addressed to ensure that a new hospital does not experience similar difficulties in future.

I refute the allegations made by Deputy Shatter. There is no question of a breach of faith. That is certainly not the case. I am surprised that on one hand he criticises me for seeking to maintain confidentiality while on the other he says I should be criticised for not making this report available to every person in the media all over the country. His position is totally contradictory.

The Minister released bits of the report selectively to control the way it was reported. That is how he has behaved with every health issue for the past 18 months.

Deputy Shatter should allow the Minister to speak. He was given six minutes to speak instead of five.

I appreciate that.

The Deputy always has a problem with the fact that parliamentary democracy means that Ministers have the freedom to refute allegations.

Just publish the report.

I will come to that. I am grateful to the Deputy for giving me this opportunity to clarify this matter. I acknowledge, as the Deloitte & Touche report does, that the move of three long established hospitals from the inner city to Tallaght was a significant logistical and operational task which was carried out well by those responsible. It is only fair in the context of current problems that I make that point.

The board of management of the hospital confirmed to my Department at the end of September that there were difficulties facing it with regards to its budget. These difficulties are of a much greater degree than it had envisaged when it submitted its service plan in April this year.

The results of the first six months of this year were in line with the hospital's budget. The Department received outturn figures at the end of August for July which report a major deficit — £2.4 million — in its revenue costs for that month alone and which projected that a significant element of this would recur for the remainder of the year.

The board was asked to confirm the situation and it confirmed a projected deficit for the year of approximately £21 million on 24 September. I initiated an independent review of this data to be carried out by Deloitte & Touche, and this work began immediately. The review also examined the arrangements within the organisation for service planning and associated staffing and financial budgets as well as the processes, systems and practices for reporting and control. The report was delivered to the Department of Health and Children on Thursday evening last, 3 December. I met the chairman and representatives of the board of management of the Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, yesterday, 9 December, and gave them copies of the Deloitte & Touche report on the hospital.

As the Deputy will be aware, the board of management has responsibility for overseeing the effective management of this autonomous voluntary hospital. I informed the board that I accepted the report and I am extremely concerned at its contents. I told the board that I want the report to be implemented. A £13.2 million revenue overspend and a potential £4.3 million overrun of capital expenditure is involved.

Following adjustment in the normal way in regard to the hospital's claims for additional funding, such as increased pension costs, special pay awards, PRSI and superannuation, the projected net revenue deficit for 1998 is approximately £8.5 million. I informed the board that I will not find this remaining deficit, the funding of which is a matter for it. I am adopting the same policy with this hospital as I have taken throughout the year with all other hospitals.

What does the report say about departmental mechanisms?

Deputy Shatter, I ask you to allow the Minister to conclude his remarks.

I have clearly enunciated this policy in the House on a number of previous occasions. Each element of capital expenditure is currently under review to establish if it was of a critical nature and absolutely essential to the opening of the hospital. I will consider whether any further capital funding is appropriate when I receive this assessment before Christmas.

The report also refers to issues of governance and general management at the hospital. It is comprehensive and runs to 211 pages. I agreed with representatives of the board of management yesterday that we would work to resolve the issues raised in it as speedily as possible. This starts with the board assessing the implications of this comprehensive review, recognising that it must deal with the financial problem and must agree a modus operandi with me for effecting change. The board members have much to consider and I asked them to be speedy. I must, however, give them the opportunity to consider all these matters. I was obliged to issue a short statement last night setting out the main thrust of the report and the necessary approach to resolve the problem speedily.

It said nothing about the Minister or his Department.

Deputy Shatter, the Minister's five minutes have concluded. I propose to allow him to continue with his contribution, but if you do not allow him to continue I intend to adjourn the House until Tuesday.

I issued a challenge to the Minister to reveal what the report said about the methodology of funding. He is reading from a set script.

Deputy Shatter, if you do not cease to interrupt I will adjourn the House and you will not hear the remainder of the Minister's contribution.

Does the Deputy want a reply?

He is not answering the question.

I understand the hospital board is working hard to fulfil all its responsibilities in that matter. The question of considering the publication of the report does not arise. To do so would not be helpful to resolving the problem which I am charged to do and intent on achieving and with which the board agrees.

It would not help the Minister or his Department.

I am satisfied following my meeting with the board yesterday that the co-operation necessary to help resolve these problems quickly is already forthcoming. At the meeting, I made additional outline proposals to the board which, along with the recommendations in the report, are aimed at putting the hospital on a firm footing.

I assure the Deputy that my Department and I will work closely with the hospital so that we can resolve matters and ensure that this fine facility can be established on a secure basis. My primary concerns are for the patients and staff of the hospital. An enormous number of people have worked very hard to get the new hospital up and running in Tallaght. I am particularly grateful for the enormous effort made by the staff of the hospital at all levels to ensure the smooth and safe transfer of patients and services to the new hospital at Tallaght. The work to be done over the coming week is designed to guarantee the future of Tallaght hospital. The letter of determination is the same as is available to every other hospital. If the Deputy is suggesting that any other process was available, he is mistaken.

Does the report indicate whether the letter of determination was appropriate? The Minister has deliberately not answered my question.

The Dáil adjourned at 5.35 p.m. until 2.30 p.m. on Tuesday, 15 December 1998.

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