A survival package for Tallaght Hospital is expected to be developed urgently, following publication of a damning consultants' report revealing a financial crisis and ineffective management systems.
The Minister for Health and Children, Mr Cowen, is to meet the hospital board tomorrow to hear its proposals for tackling the predicament facing the State's largest acute hospital.
The Deloitte & Touche report on the hospital's financial position, commissioned by the Minister, was published by Mr Cowen at a press conference in Dublin yesterday. The hospital board received the report last week and is to discuss it tonight. Its conclusions are expected to be formally conveyed to the Minister by its chairwoman, Ms Rosemary French.
The hospital authorities declined to comment on the consultants' report until they have deliberated on it, but the treasurer of Tallaght Hospital, Prof David McConnell, said the hospital was "locked into a blunt instrument" of funding arrangements. This precluded the board from having the necessary flexibility to procure the extra funding required, he said.
"We were locked into a system that was totally inappropriate for the job we had to do," Prof McConnell said.
The 211-page document chronicles a developing crisis at Tallaght Hospital which, in the absence of a cash injection in the short term, will lead to the hospital running out of funds. After just six months in operation on the greenfield site, the consultants say, the hospital is "already significantly in arrears in paying its creditors, the principal funding source for the deficit".
In spite of the major difficulties facing the hospital, the Minister insisted yesterday that confidence in the hospital was not being affected and that patient care was efficient.
"The report speaks for itself. There are very serious issues involved . . . We want to see the recommendations quickly implemented. I gave an outline to the board of how they might move on from here," Mr Cowen said.
However, he refused to give any indication that he was willing to soften his implacable opposition to funding hospitals which exceed their budgetary limits. Tallaght Hospital's overrun amounted to £13.2 million over the £54 million provided for running costs in the last year.
Mr Cowen is expected shortly to install his own team of experts to oversee the implementation of the report's recommendations.
According to the Deloitte & Touche report, there was "an absolute requirement" for the board to devolve all management responsibility to a "properly structured hospital management team".
The relationship between the hospital and the Department "is strained, considerably worsened by the current financial difficulties", the report acknowledges. This relationship needed to be "rebased" and the agreement of a longer-term strategy between the parties, as well as funding for an approved level of service in the new facility in Tallaght, was essential.
The report's authors bluntly stated that they found it difficult to understand why the board adopted a service plan which was going to cost £5.9 million in excess of its letter of determination from the Department. The letter of determination is the mechanism the Department uses to inform hospitals and other bodies of their budgets for the following year.
However, the consultants also questioned the suitability of the funding procedures applied in the case of a new hospital. This budgetary system was "a blunt instrument".
The determination process "does not lend itself well to a situation of major change, such as the opening of a major new hospital, unless supported by a fundamental review of the likely cost profile of the hospital".
The report was severely critical of payroll management systems, speaking of "a complete absence of regular and reliable personnel information", which made it impossible to control staff increases. The hospital had continued to operate three separate payrolls, with "different coding systems for like staff", according to the consultants. They concluded that it was "an understatement to say that the consolidation of one personnel payroll system is urgent".