Dr David McCutcheon's decision to tender his resignation from the post of Chief Executive Officer at Tallaght Hospital can come as no surprise but must cause great disappointment to all involved in the grand plan to move four existing hospitals into the fine new campus at Tallaght. The move of three of those hospitals - the Meath, the Adelaide and the National Children's Hospital - was accomplished with considerable success under Dr McCutcheon's expert supervision. The relocation of the fourth - St Loman's in Palmerstown - will doubtless be accomplished with similar care in due course.
Dr McCutcheon clearly made a deep impression on his colleagues and on the board members of the participating hospitals. His commitment to the quality of patient care was manifest, as was his management style of achieving consensus. The staff of the new hospital will clearly be upset by his departure, and anxious about their security of tenure in such temporary posts as have have been created in response to the perception of patients' needs but in violation of the hospital's budget as determined by the Department of Health.
It is the budget that lies at the root of the new hospital's financial problems which have doubtless caused Dr McCutcheon to throw in the towel. There have, to be sure, been faults on the part of the board and the management team in the hospital. The recent report by Deloitte and Touche has provided a comprehensive analysis of those faults, which boil down to a failure to install adequate budgetary controls in almost every area of hospital activity and yet to overspend grossly on capital developments and payroll costs, relative to the budget which the Department of Health had established.
Yet the Deloitte and Touche report also said that the method used by the Department in the determination of the budget does not lend itself to a situation of major change and that "the decision to base the 1998 determination on the cost structure of the three base hospitals plus certain additional monies was inappropriate". Small wonder, then, that there was overspending on a budget determined inappropriately. But the Minister for Health has enforced the original budget and has issued a budget for the current year which the hospital deems to be several millions short of its requirements.
The hospital now has to try to raise a bank loan to pay off a deficit in excess of £8 millions, and then find the cash to service and pay off the loan out of a budget which it believes is already too small. There has not been so much as a passing reference by the Minister to the possibility that the original budgetary determinations might have been inadequate. He and his department have simply compounded the hospital's difficulties by forcing it to draw on this year's resources to meet last year's deficit.
This newspaper has already given Mr Cowen credit for being the first Minister of Health to try to tackle the spiralling costs of hospital care. But the methods used by the Department of Health to determine budgets is cited by Deloitte and Touche as inappropriate in this instance (and is antique in many other instances) while few established hospitals in the State have accounting and budgetary control systems adequate to measure (never mind control) levels of waste in the financial resources they consume. And there has not, until recently, been any culture of detailed accountability or enforcement in hospital expenditure. Mr Cowen and his department need to shake themselves and their systems up every bit as much as Tallaght Hospital is being forced to shake itself up.