A history of delays, disasters, rethinks and even demolitions

It is now almost 20 years since the idea of a new hospital at Tallaght was mooted. A lot has changed in medicine since.

It is now almost 20 years since the idea of a new hospital at Tallaght was mooted. A lot has changed in medicine since.

The Tallaght Regional Hospital Board, which was established in 1980, included representatives of the base voluntary hospitals - the Adelaide, the Meath and the National Children's Hospital.

It had responsibility for the planning, building, equipping and furnishing of the new hospital at Tallaght.

A planning brief was completed in March 1984.

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There was an architectural competition later that year, and the planning for the hospital was completed in 1990. Tender documentation was completed in September of that year.

However, two years later a review was concluded into the scope and scale of the proposed hospital by the Dublin Hospital Advisory Group. This recommended a scaling down of the original plan, including a reduction in bed numbers.

"That was a disastrous report," Prof David McConnell, honorary treasurer of Tallaght hospital, told The Irish Times on October 6th, when differences between the hospital and the Department of Health and Children over financing were first aired.

"It did not take into account the ageing of the population or the introduction of new types of medical care. The three base hospitals were served up this on a take-it-or-leave-it basis, though we had very grave doubts it would be adequate.

"By the time the board was set up it was obvious that the new hospital would not be adequate," he said.

"A lot of the battling over the last two years was about putting back what was taken out."

This includes an out-patient department which is still being built and a private wing - Prof McConnell said he prefers to call this extra beds - which is being built independently. The new hospital also now has its own, very substantial, laboratory. The base hospitals relied on St James's Hospital for laboratory services.

Prof McConnell also pointed out that the base hospitals were underfunded for years, operating on the basis of mend-and-makedo, in the expectation of moving to the new facility in Tallaght. They were clearly determined this would not continue in the new hospital.

There have been hiccups since the building of the hospital began in 1993, many arising from the rapid pace of change in medical technology. For example, the laboratory equipment would not fit onto the benches provided, and new ones were needed at a cost of over £250,000.

Halfway through the building of the operating theatres they had to be demolished and rebuilt because they were smaller than specified.

The hospital eventually opened in June of this year, almost a year later than planned, in a situation where certain of its functions were still not fully operational.

In the meantime things had also changed in the world of health politics.

Under the Health (Amendment) Act 1996, which became fully operational in January 1998, the accountability of health boards for public funds is spelt out.

While this does not include voluntary agencies like Tallaght Hospital, the Minister for Health and Children made it clear that he intended to apply in an administrative way any terms of the legislation that are relevant to the Department's dealings with voluntary agencies.

The most crucial aspect of this are the Letters of Determination which the Department sends to all health agencies advising them of their budgetary allocation for the forthcoming year. The agencies are then required to furnish a service plan to the Department, outlining what services they will provide.

The crux of the dispute between Tallaght Hospital and the Department of Health and Children has been the insistence of the Department that it could not depart from the Letter of Determination it sent to the hospital's board in December 1997, and the hospital's insistence that this did not meet its needs for the unprecedented task of merging three hospitals and moving them into a whole new environment.

"We could not have run the hospital on the basis of the Letter of Determination," Prof McConnell told The Irish Times last October.

"The board took the view we had to provide the kind of cover we had indicated to the Department we would provide. For example, we needed the laboratory [identified by Deloitte & Touche as costing £210,000 a month], and the IT system is very sophisticated and needed more staff. We believed we had a degree of comfort from the Department in relation to additional funding."

Clearly, Prof McConnell and the board were determined the hospital would be a centre of excellence from its inception. The Minister for Health and Children, Mr Cowen, had a more gradualist view.

He told journalists yesterday that what should have happened was the transfer of the existing services to Tallaght and then building up further services over time.

The consultants question whether the Letter of Determination procedure, based on the combined budgets of the base hospitals and an additional allocation, was an appropriate way to determine expenditure in setting up and commissioning a totally new institution.

However, at his press briefing yesterday, Mr Cowen said that no alternative proposals had been forthcoming from the hospital.

Deloitte & Touche are also critical of the hospital's management for failing to develop a financial plan prior to the issuing of the Letter of Determination, and for failing to produce a service plan earlier than March of this year.

"It is surprising that a detailed financial plan for commissioning, the move and the operations of the new hospital had not been prepared. Had the hospital been in a position to prepare its service plan in advance of the setting of the Determination for 1998, it could have been used to inform that process.

"Had this been the case, the Service Plan could have been used as a basis to seek to justify, at the very most, a need for further funding of £4 million," the report states.

The report is very specific about what should have been done: "What should have been done is that based on the design configuration of the hospital, the number of beds, the anticipated levels of activity and discharges, a detailed operating profile for the Hospital should have been created by AMINCH."

(AMINCH, the Adelaide & Meath Hospital, Dublin, Incorporating the National Children's Hospital is the formal name of Tallaght Hospital)

This would have included a detailed breakdown of staff and non-staff requirements which could have provided a framework for a financial plan.

The report is also trenchant about what now needs to be done. There should be no injection of funds, which is what the board wants. And a management team needs to be put in place which can run a tight financial ship.

At his press briefing yesterday the Minister refused to be drawn on what would happen if there was no satisfactory solution to the management problem, preferring to await the hospital's response.