The new wards that never opened

New hospital wards are being built across the country, only to stay idle because of a lack of funding to staff them, writes Paul O'Brien.

RARELY enough for an accident and emergency department, it is free of chaos: no overcrowding in the hallways, no patients sleeping on trolleys, no angry complaints from people waiting hours to be seen. But there is a good reason why this department is so peaceful: it has never been used.

Beds are wrapped in cellophane. Dust gathers in corners. The A&E is just one of several units in a €96 million, five-storey wing of the James Connolly Memorial Hospital in Blanchardstown, Dublin, which are currently lying idle.

When opposition politicians ask Health Minister Micheál Martin why the state-of-the-art building is not fully operational, they often refer to it as the "new" wing. But it is no longer new. The vast majority of units have been lying idle for over a year.

At present, only the coronary care and cardiac unit, the rheumatology service and the therapeutic psychiatry unit for the elderly have been transferred to the wing.

There is just silence and space where the following should be: the A&E department, the operating theatres, the acute psychiatric unit, the surgical block and intensive care unit, the ward block, mortuary and more.

The reason these units have not been transferred? The Northern Area Health Board (NAHB) requires €5.2 million from central government to "fully commission the new facilities". It has yet to receive it. When health officials talk about "commissioning" units that are ready to go, it can often mean that the money is not there to recruit the staff needed to run them. The empty A&E department is all the more significant when one considers that only last September, while it was gathering dust, the Irish Nurses' Organisation was appealing to the Health and Safety Authority to investigate the risks created by chronic overcrowding at the hospital's existing A&E unit.

But the wing at James Connolly is just one case. There are many others. Nationwide, at least €460 million worth of hospital facilities are lying unused because the money has not been forthcoming to open them.

GIVEN that a weekend filled with memories of war has just ended the D-Day remembrances coming as they did against the backdrop of continuing carnage in Iraq some might consider Jerry Cowley's fiery language to have been poorly chosen.

But, the Independent TD does not hold back.

"I am declaring war on the Western Health Board (WHB) and the Department of Health on behalf of the people of Mayo," he says.

Cowley, a GP before he was ever a politician, is upset that a €10.5 million, fully equipped orthopaedic unit comprising 33 beds at Mayo General Hospital has failed to come on stream. It is ready, but not open.

It is thought that €1 million would be enough to commission it.

Earlier this year, the hospital said that "the orthopaedic department plans to begin elective surgery in July with trauma surgery starting two months later".

It has now emerged, however, that the opening of the unit has been cancelled by the WHB.

Thousands turned out at a rally in Castlebar on Saturday to protest the announcement. It will not end there, says Cowley.

"I am prepared to lead the people of Mayo to the headquarters of the WHB in Galway or indeed to Dáil Eireann or wherever is required to sort out this gross inequality once and for all."

His rhetoric, coming so soon before this Friday's local and European elections, could be described as a typical political gimmick were he standing in either. But he is not.

The message is being driven by his constituents, among whom there is mounting anger. Now, a pattern of such anger is emerging across the country.

ADD To Mayo and Dublin the counties of Cork, Donegal, Dublin, Galway, Kildare, Limerick, Roscommon, Tipperary, Westmeath, Wexford all of which have facilities ready but as yet unused.

On Saturday in Clonmel, locals turned out in their thousands to protest the Government's failure to provide the necessary funding to staff the new €24 million surgical building at South Tipperary General Hospital. It, too, lies largely idle.

Patients needing acute surgical care have to travel roughly 15 miles to the nearest hospital in Cashel. "This is extremely dangerous for patients and some patients have died en route," Dr Paud O'Regan, a consultant physician at South Tipperary, said last week.

As of yet, no one in Ballymun is saying lives have been lost. But similar delays in opening a unit there have caused much suffering, according to local residents.

A €60 million civic building boasting its own health centre was completed in Ballymun more than 18 months ago.

The health centre was designed to replace the area's existing facility, which locals say is in an "appalling" condition, and which had to be closed at one stage last year on health and safety grounds.

But the NAHB does not have the funds to fit out the new centre, and the Department for Health has not yet provided them.

So the health centre sits empty while the NAHB continues to pay millions of euro in rent for the site (see case study).

Last week, the Ballymun Neighbourhood Council handed a petition with more than 5,000 signatures to Housing and Urban Renewal Minister, Noel Ahern, calling for a funding package to be put in place immediately to open the centre.

But residents are not hugely confident as they await to see what becomes of their protest.

MICHEÁL MARTIN does not need protestors in Cashel, Castlebar or Ballymun to tell him what he already knows.

He has been getting unpleasant reminders about these unopened hospital facilities since he was handed the health portfolio.

Arguably the most inspired at least in a sheer politicking sense came two years ago, appropriately enough from a former Health Minister, Michael Noonan.

At the end of April 2002, just days away from a crucial general election, the then Fine Gael leader paid a visit to Longford-Westmeath General Hospital in Mullingar, and posed for pictures in its by-then five-year-old "new" wing.

The wing was as exactly as it had been when completed in 1997: an empty shell.

There was no spin necessary. Noonan's party bombed in the subsequent election, but the photo his team conjured up became one of the campaign's most enduring images.

Now, there is another election looming and opposition candidates the length and breadth of the country are spouting the "Government's broken promises" mantra.

Combating that soundbite will be difficult for the coalition parties. Pointing to what Mr Martin has achieved during his time in the ministry will not work.

What they need is something showy, such as a pre-election splurge to commission all those unused facilities, hire the staff that they require, and open up hundreds of new beds in the process.

A month ago, it seemed that was exactly what was on the cards.

THE Health Minister had drawn up an aide memoire for the Cabinet, subsequently obtained by the Sunday Tribune newspaper, which illustrated the problem.

By his reckoning, there were about €400 million of facilities (not including Ballymun) lying idle that could be commissioned reasonably quickly if funding was provided.

Up to 20 units were involved and these were just the ones that Mr Martin was suggesting be prioritised.

In some cases, they required equipment or fitting-out. In others, staffing was the key problem. Either way, there was a "pressing and urgent need" to get them up and running.

Doing so would "have an immediate impact on relieving pressure on services such as acute hospitals, services for older people, mental health services, services for persons with an intellectual disability or autism, and adult homelessness," the minister's aide memoire stated.

"Many of the present facilities being replaced by these new units date from the 19th century."

It was one thing, however, to find the cash to get them off the ground, another entirely to keep them running year after year.

Mr Martin made it clear his department had €35 million it could reprioritise to open the units this year. He was seeking a commitment from Cabinet that money would be provided for their continued operation in subsequent years.

In effect, the aide memoire was putting the problem at the door of the Department of Finance to solve. After all, it was Finance, the document pointed out, which introduced the "existing level of service" budgetary policy following the 2002 General Election.

This policy meant that only existing services would be funded, and new developments would have to wait thus delaying the opening of most of the units in question.

The Government cap on recruiting public-sector staff was also a major problem for the hospitals.

If the leaking of the aide memoire was an attempt by someone loyal to Mr Martin to shift the blame by illustrating that the problem really lay with Finance Minister Charlie McCreevy, a good job was made of it.

On Friday, Labour leader Pat Rabbitte had a go at Mr McCreevy, saying it was "safe to assume" that he had blocked the proposals contained within the aide memoire.

Equally, if the leak was an even more cynical attempt by someone within the Government to suggest good news was around the corner, it was just as successful.

That is according to Fine Gael's health spokesperson, Olivia Mitchell. "Half the public are now going to feel that all these things are going to happen," she said.

"In fact I don't think we'll ever hear any more about it."

At least, not in the short-term. The Department of Finance has confirmed to this newspaper that no proposals for extra funding have been received from Health.

While a spokeswoman for the latter said yesterday that negotiations between the two ministers were "ongoing", it is believed these discussions are mostly to do with lifting the Government cap on recruitment.

There will be no pre-election spending spree.

Communities waiting for vital units and services will just have to wait longer.

IT'S a case of horses and machines, according to Labour's health spokesperson, Liz McManus.

"The Cabinet spent €50 million on e-voting machines," she says.

"And they spent €15 million on an equestrian centre. They refused to spend the money on opening healthcare facilities as they came on stream."

In the midst of all this come fears about the Hanly Report on health service reform and the effects it might have on some hospitals if and when fully implemented.

Will some of the mothballed units actually have any future role in the health service at all?

Yes they will, according to Defence Minister Michael Smith, who took questions on Hanly on the Government's behalf in the Dáil recently.

Moving on to the subject of the unused hospital facilities, he gave a firm commitment to deputies.

He told the Dáil: "Every project will be opened."

He just never said when.