IT WILL have taken eight years but, if all goes to plan the new Tallaght hospital will open its doors to its first patients on August 1st.

Its just-appointed chief executive officer, Dr David McCutcheon, arrived from Canada last week and today addresses the hospital's consultants, who are having a day-long meeting to discuss its operation.

However, the hospital's birth has been a difficult one and the trouble is not over yet. The controversy which has dogged the Tallaght hospital project since its inception surfaced again last week with the appointment of Dr McCutcheon, an Irish doctor based in Canada for the past 20 years.

It emerged that the terms of his appointment include separate payments of £7,500 from four of the bodies represented on the Tallaght hospital board - the Adelaide, the Meath, the National Children's Hospital and Trinity College - on top of his salary of more than £50,000 as CEO.

In fact, Dr McCutcheon is taking a substantial pay cut to come back to Ireland. As CEO of the Hamilton Civic Hospital in Hamilton, Ontario, he was earning 230,000 Canadian dollars, about £115,000.

Had he been appointed to head the new Hamilton Health Sciences Corporation, a fusion of Hamilton Civic and another major hospital, it would have been 339,000 dollars. However, his application for this position was unsuccessful. His severance package from the Hamilton Civic was worth about £200,000.

"He was clearly very torn," Dr Fergus O'Ferrall, who represents the Adelaide on the Tallaght board, said of his decision to return to Ireland. "We are always talking about the brain drain. It is very nice to see someone like this coming back. Health management is a very weak and very underpaid area in Ireland. We're very, very lucky. He'll raise everybody's game.

Health management is Dr McCutcheon's speciality. After studying in Gormanston College and the College of Surgeons he emigrated to Canada, where he worked in general medicine before moving into hospital administration in 1986. As well as running the Hamilton Civic Hospital which has a catchment area of 1.8 million and a staff of 4,000, he has been teaching medical management in MacMaster University.

He will continue this part-time teaching in Tallaght, as part of the additional duties for which Trinity College will pay him £7,500. He will also carry out work for the other charitable hospital foundations, which will continue to exist as separate entities after the hospitals move to Tallaght.

"The voluntary foundations will have their own private resources and will engage in their own ongoing work as charitable foundations," Dr O'Ferrall said. "It is a matter for the Adelaide if they have a contract with him for major funding campaigns, and for "maintaining and continuing to build up our own private resources."

When, after more than a decade of wrangling, the charter of the Tallaght hospital was finally agreed, it was defined as a public, voluntary, teaching hospital. This definition meant it would be publicly funded and, therefore, part of the public health system. However, control would remain in voluntary hands.

The board would be representative of the organisations involved in the original hospitals. The Meath and the Adelaide would each nominate six members, the National Children's Hospital three, Trinity College (the medical teaching institution involved) one and the Eastern Health Board one, appointed by the Minister for Health.

To preserve the "Protestant ethos" of the hospital, the Church of Ireland Archbishop of Dublin would also nominate six people to the board, formally appointed by the Minister for Health.

The charter specified that the hospital should be "an essentially religious and Protestant institution", while providing for freedom of conscience for all staff and patients, thereby having "a multi-denominational and pluralist character".

"Essentially, this concerns the nature of the relationship between a doctor and a patient," Archdeacon Gordon Linney, a long-standing member of the Adelaide board, told The Irish Times. "For example, if in a consultation between a doctor and patient a procedure is proposed, provided it is lawful, the patient then decides on it in accordance with his or her conscience, without any outside control. That is the fundamental principle we want to establish for the future."

One of the conditions in the charter of the hospital is that staff be recruited to provide for all procedures which are lawful in the State, along with a provision that staff may exercise freedom of conscience with respect to specific procedures.

There is also provision for the recruitment of Protestant nurses. According to Dr O'Ferrall, there will be one College of Nursing, with three nursing schools, attached respectively to the three hospitals. Each nursing school will select its own student nurses from among those who cite the Adelaide, Meath or Children's as their first preference. The Adelaide will have 40 places a year and the Meath 60.

The students will study together but, according to Archdeacon Linney, they will have access to ethical training in accordance with their beliefs.

While the charter was being negotiated, concern was expressed by some Meath staff that they might suffer in promotion terms under the terms of the charter. Their concerns were met by a conscience clause and provision for an industrial relations protocol, but there are still fears that the marriage between these two hospitals will not be entirely smooth.

The Fianna Fail TD, Mr Ivor Callely, a member of the board of the Meath, said that 10 years after the amalgamation of the Richmond and Jervis Street hospitals there were still tensions between staff originating at the different hospitals. "There is a power struggle for every position

But, even if the marriage between the three hospitals moving to Tallaght does go smoothly, there are a lot of problems yet to be resolved. There will be no nurses' home in Tallaght and it is not clear where either student or staff nurses will live.

Public transport to Tallaght is inadequate, although, according to the plans, Luas will stop at the hospital. The headache of car-parking, which causes great stress around the Adelaide and the Meath, will be removed for car owners.