The chief executive of the State's flagship hospital is said to be unhappy with its 1999 budget allocation.
Dr David McCutcheon is reportedly concerned that he will not be able to run the hospital properly because of the financial restrictions being insisted upon by the Department of Health.
Tallaght Hospital has been allocated a budget of £64.69 million, more than £4 million less than hospital management requested. Sources close to Dr McCutcheon say he is "very disappointed at the way the funding difficulties have been resolved", especially at a time when the economy is booming.
Compounding Dr McCutcheon's upset are the constraints prohibiting the development of further clinical services at the hospital until the Minister for Health, Mr Cowen, is satisfied with the hospital's financial performance. Dr McCutcheon has spent recent weeks in meetings with his management team discussing how the hospital might live within its allocation and how many staff layoffs this may entail. The allocation was received two days before Christmas, and it is now up to the hospital to produce a plan for the Department of Health by the end of the month, outlining the services it will provide in 1999.
Hospital sources say morale is very low, and a number of staff fear for their jobs. A report carried out by Deloitte & Touche on the running of the hospital, commissioned by Mr Cowen, identified 120 posts in the hospital which were unapproved.
A spokeswoman for the hospital said yesterday that management was preparing a project plan, which will be presented to the board and then the Department of Health.
Many of the expenses which applied last year were incurred because of the cost of moving and would not be relevant this year, she said.
The hospital newsletter Pulse, which was distributed yesterday, said "adequacy of this year's funding allocation to run existing service levels is being investigated by the management team". So far, it continued, no decisions had been made as to how the hospital would live within the 1999 budget. "However, clinical developments will only proceed after June 1999 when the Minister is satisfied with the financial performance of the hospital as outlined in the Deloitte & Touche report".
Included in the clinical development plan, which will not now go ahead, is a clinic where patients with suspected heart problems would be "fast-tracked". A hospital source said that several patients had come to casualty yesterday, complaining of chest pains, but because of the absence of such a clinic and the over-stretching of resources, they were still there last night.
The source said that Dr McCutcheon was also unhappy and frustrated that "certain realities" were not faced before the opening of the hospital, including a 30 per cent rise in casualty attendances.
The hydrotherapy pool, for physiotherapy, is being used to store medical records, and plans for a children's high-dependency unit in the National Children's Hospital section of Tallaght Hospital have also been put on hold. The children's hospital has neither an intensive-care unit nor a high-dependency unit, which is a lower category of care, for sick children. Extra dialysis units have also been delayed, as has a day hospital for the elderly.
Hospital management is in the process of securing a long-term bank loan of £8.5 million to cover its revenue deficit for 1998.
The Deloitte & Touche study showed that the hospital would run out of funds if serious cost overruns, including £550,000 a month on the payroll, were not tackled.