Dáil Éireann díospóireacht -
Thursday, 4 Feb 1999

Vol. 499 No. 5

Adjournment Debate. - Tallaght Hospital.

Ms McManus

I welcome the opportunity to raise this important matter in the House. The threat of industrial action in Tallaght Hospital is the latest and most alarming chapter in the short history of this new hospital. What began as a crisis is rapidly turning into a disaster. The prospect of all out strike action at the hospital beggars belief and a super-human effort is required by all the key players, particularly the Minister for Health and Children, if the hospital is to be put on a sound footing and allowed to develop as it should.

It is worth remembering that we are talking about the biggest investment in a hospital facility by the State in a rapidly growing area of Dublin city. It is a state of the art centre of excellence which promised to be a flagship for today's health services. Yet a few short months after opening, the hospital has been undermined by gross underfunding, poor communications and management and by Government and ministerial diktat. The resultant extent of demoralisation among the staff has reached the point where no one appears to have confidence in the Minister to deal fairly and competently with the current situation.

It is worth remembering how successful the opening of Tallaght Hospital has been and how the high level of patient satisfaction has been maintained in extraordinarily difficult circumstances. The move from three run-down hospitals was carried out with skill and efficiency. In reply to a parliamentary question in April 1998 the Minister stated: "enormous efforts have been and are being made by very committed people, including the staff of the transferring hospitals, construction staff and suppliers". He went on to say the move was done in a spirit of partnership and dedication in the interests of the patients. Indeed since opening, productivity in the accident and emergency department alone has increased by 30 per cent in comparison to that of the original three base hospitals. Yet it is the same dedicated staff who are now threatening to go on strike against a background of the disintegration of trust and confidence which originated long before the opening of the hospital.

Inevitably, because of departmental miscalculations from the start, cost overruns became a matter of concern to the board of Tallaght Hospital. The Department was advised of the prospect of serious funding deficiencies. Yet it is clear that in their determination to get the hospital open, the Minister and his Department did not take sufficient heed of the warnings of the board and the chief executive. It is clear from the Deloitte & Touche report that the board erroneously, as it turned out, believed that the Department was taking its submission seriously.

When he did act, the Minister sent in consultants who made a report itemising the problems relating to management and funding. The board accepted the findings of the report and undertook to work to resolve the difficulties but its commitment and co-operation has, regrettably, not been reciprocated by the Minister.

The Minister has not acknowledged that the origin of the chaos now looming at Tallaght Hospital is in a formula used by his Department in calculating a budget based on a faulty premise. The Deloitte & Touche report gets to the nub of the problem. It says the decision to base the 1998 determination on the cost structure of the three base hospitals plus certain additional moneys was inappropriate. It goes on to say that it has concluded that the determination process does not lend itself well to a situation of major change such as the opening of a new hospital. To this day, I do not believe the Minister has accommodated the conclusions.

The report outlines the profile methodology which should have been undertaken and it is damning in its conclusion that early financial planning would have brought about the benefits required to keep Tallaght Hospital from running into difficulties. The Minister's refusal to face up to this core failure in his Department is now leading the hospital into dangerous and uncharted waters. The current situation is impossible to reconcile. He simply cannot square the circle on this one.

No doubt the Minister will claim he has provided for an increase in this year's determination and while that is true, it is not enough. If the board is to keep within the limits of the 1999 service plan, there will inevitably be a loss of services and of jobs and a breakdown in industrial relations. Certainly, if nothing else, there will be a curtailment in developing services which are so essential to the future growth of the hospital. This is an untenable prospect.

Will the Minister outline in detail how he intends to deal with the current impasse? It is worth noting that when the Taoiseach visited Tallaght Hospital last Friday the Minister was noticeable by his absence. A visit which should have been a triumph was noted for the distance which the Taoiseach kept from patients and patients' families who had hoped to talk to him about their concerns. It is indicative of a breakdown between the Government and the Tallaght Hospital which is supposed to be a flagship of modern Irish acute hospital care, that we have reached this point. It has lead to plummeting morale among staff and demoralisation to an extent which I have not witnessed before in the medical profession.

Will the Minister avail of this opportunity to outline in detail how he intends to deal with the problems and undo the damage done in terms of the gross underfunding at the start and inherent to the tune of £5 million the deficiencies of the current 1999 budget? Will he outline the number of jobs at risk in this current dispute and assure the House he will not accept a service plan which provides for cutbacks in services or job losses in a hospital which is still only operating at approximately 60 per cent capacity and still requires further investment if it is to realise its full potential and prevent its downgrading at a time when demands for hospital care are escalating?

Mr. Cowen

The Deloitte & Touche report on Tallaght Hospital found that staff numbers on the hospital's payroll on 11 October 1998 were 139 whole-time equivalents above approved levels. This number included 40.7 commissioning staff which the hospital anticipated would be released by April 1999. As the Deputy will be aware, the Department is currently awaiting the hospital's service plan for 1999 which should provide details on the current position and state how the hospital proposes to manage this situation.

I understand that as of the week ending 24 January 1999 the gap has reduced to 109 in the normal course of events. I have also stated that I expect the hospital to comply with relevant labour legislation and best industrial relations practice in accordance with the industrial relations protocol agreed with the unions. This protocol covers issues such as best industrial relations/personnel practice, security of tenure, agreed procedures, recruitment and promotion and has been incorporated in the hospital's charter. It was agreed in the context of the transfer of services to and the opening of Tallaght Hospital.

The security of tenure provision ensured that the issue of compulsory redundancy did not arise in the context of the transfer of services to Tallaght Hospital. Furthermore, provision was made for the concession of permanent status to long-term temporary staff subject to certain conditions. This commitment was honoured by the Department in August 1997.

In December 1997 a co-operation agreement between staff and management to cater for the transfer of staff to Tallaght Hospital was finalised. I take this opportunity to again pay tribute to the staff of the hospital at all levels who ensured the successful transfer to Tallaght Hospital on 21 June last.

The House will be aware that I agreed to an extension on the time limit for submission of the hospital's service plan until 12 February next. This extension was agreed to initially following contact with the Department by the chairman of the Tallaght Hospital group of unions. It allows the three person group which I established to oversee the implementation of the Deloitte & Touche report have an input into the service plan.

The House will be aware that approximately £69 million is available to the hospital for 1999. Given the hospital's case mix and state of the art facilities, I am satisfied this amount is sufficient to meet pay and non-pay costs, including the full year costs of 1998 developments. The determination does not include any provision for the further development of services; it has been agreed that the detail of such development will be the subject of further discussions with my Department when it is clear that the recommendations in the Deloitte & Touche report are fully implemented.

The Deloitte & Touche report made a number of recommendations on the control of pay costs at the hospital. These include the need to prepare a realistic manpower plan – the staffing requirement needs to be adequately assessed and the need to ensure the provision of accurate timely information on personnel and pay. Specifically, the hospital must consolidate the three base hospitals' payrolls into one. They also recommend that agreement must be reached between the hospital and the Department on an approved level of staff, that processes should be put in place to manage and control temporary staff, vacancies should only be filled in respect of approved and funded posts, staff recruitment should be frozen until the review of requirements is complete, that a systematic plan to reduce commissioning staff is required to ensure the hospital's objective of releasing the remainder of such staff by April 1999 is met and improved controls over authorisation and approval of overtime payments are required.

I am sure the House will agree with me that these recommendations are perfectly reasonable. The key recommendation is that the overall staffing requirement needs to be assessed. Despite the numerous requests by the Department, a realistic manpower plan was not prepared by the hospital. Now that the troika is in place, I expect this area is one to which particular attention will be paid.

There have been numerous media reports about pending job cuts at Tallaght Hospital with numbers as high as 200 mentioned. It has also been said that this is because the hospital budget was "cut" by £4.8 million – this is simply not the case. The hospital's budget has increased by 20 per cent in 1999. It is not clear to me from where the speculation is coming. However, until the ser vice plan is submitted, I am not in a position to comment further.

Senior officials of the Department together with a representative from the Health Service Employers' Agency met trade union representatives on Tuesday of this week. I understand the trade unions met hospital management the previous day.

Tuesday's meeting was very useful – there is no question of a break-down in my Department's relationship with either management or staff. The positive relationship will continue both on a formal and informal basis. Both I and my Department are fully committed to establishing the hospital on a firm footing. I am confident that with a positive attitude from all sides it will be possible to resolve the current difficulties at Tallaght Hospital. This is critical in the interests of current and future patients of the hospital.

The Dáil adjourned at 4.50 p.m. until 2.30 p.m. on Tuesday, 9 January 1999.