The Taoiseach has pledged the €500 million Mater Hospital/Temple Street redevelopment will go ahead. Martin Wall unravels the background to the Republic's most expensive healthcare project
The Taoiseach's statement that there were "no difficulties" with the plans for the redevelopment of the Mater and Temple Street hospitals removed doubts over the future of the most expensive healthcare project in the history of the State.
Before making his comments at a ceremony at the Mater last week, Mr Ahern had discussed the project with the Tánaiste and Minister for Health Mary Harney and it is now expected that she will allow the development to go to tender shortly.
Earlier this year, the Department of Finance had insisted, as a condition for sanctioning the €600 million healthcare capital programme for the year, that the Mater/Temple Street development should not go to tender without its approval.
The Tánaiste had subsequently sent similar instructions to the Health Service Executive (HSE). For the Taoiseach, the doubts over the Mater/Temple Street project created significant political problems.
The development is located in his Dublin central constituency and he has long been associated with the Mater Hospital. It is understood that doctors at the hospitals had planned to publicly criticise Mr Ahern if the project had been deferred.
There was also concern among backbench deputies on the northside of Dublin. If approval for tender is granted within the next month or so, construction could get under way by the early part of next year.
However, despite the heavyweight political commitment for the project last week, there are still some outstanding issues. The Taoiseach said last week he wanted to assure the public that "a proper children's hospital" would be built on the Mater campus to replace Temple Street.
However, it is unclear where the new children's hospital at the Mater will fit in with the review of paediatric services currently under way in the Department of Health.
The Department of Health and the HSE are reviewing whether to rebuild the State's largest children's hospital, Our Lady's in Crumlin, on its existing site or move to a new location elsewhere.
Ms Harney said last month that she no longer wanted to see specialised treatment services for children spread over a number of sites. These comments were interpreted as the Tánaiste being in favour of the centralisation of specialised medical services in one hospital - a proposal which has been debated strongly, largely inconclusively, within the Irish health service for more than a decade.
Mr Ahern said that regardless of where specialties were based that he wanted to set out that the move of Temple Street to the Mater Hospital site was going ahead.
Intriguingly, it is understood that senior figures at the Children's University Hospital in Temple Street have now proposed to the HSE and the Department of Health that paediatric services could be centralised at the Mater campus - where there will still be space for expansion even after the new development is completed in 2010.
It is now expected that the HSE will seek to bring in an outside expert to reach a final agreement on the exact configuration of paediatric services in Dublin.
It is understood that the main Department of Finance concern with the Mater/Temple Street development was not the €500 million construction and equipping cost.
Rather, it was the bill for meeting the additional and ongoing running costs of operating facilities at the enlarged campus when they come on stream.
In particular, the Department of Finance was worried about the requirement for additional staff at a time when it is already concerned that the health services are employing more personnel than allowed under official policy rules.
A group comprising the two constituent hospitals and the HSE last week concluded a financial analysis of the new campus which will be sent to the National Hospitals Office and the Department of Health.
This analysis determined that the cost of running services in the new Mater/Temple Street complex will be around €10 million more per annum than the current budgets for the constituent hospitals.
The confidential assessment maintains that the operation of the new enlarged complex on the existing Mater campus will add around 4 per cent to the combined revenue requirements of the Mater and Temple Street hospitals. The increase is largely due to increased staffing levels.
The calculation set out in the financial analysis is based on the same number of patients being treated in the new development. An increase in the number of patients would add to these costs.
However, sources close to the project believe that it will present strong value for money, particularly as the new complex is designed to carry out significantly more case work during the day which is less expensive than procedures involving an overnight stay.
The new complex has been designed to cater for more patients. As well as the new accident and emergency and outpatient departments, the complex will have three additional theatres for both children and adults.
There will also be around 100 more beds and capacity to treble the number of procedures carried out during the day.
Supporters of the project maintain that the new facilities are essential to replace and enhance those in the existing Mater and Temple Street hospitals, which in many cases are inadequate for a modern health service.
Sources close to the project point out that last Friday marked the 150th anniversary of the laying of the foundation stone for the old Mater Hospital building.
The converted houses, which currently accommodate the Children's University Hospital at Temple Street, are around 200 years old. Under the plans, services for children would move to a new hospital to be developed on the campus of the Mater, which itself would be considerably expanded.
Both the Mater and the new children's hospital will retain their independence and autonomy. There will be a separate entrance to the children's hospital which will also have its own budget and staff.
Children and adults will be treated separately. However the current plans call for improved synergies on the non -clinical and administrative side between the two hospitals.