Eilish O'Regan: '€2.1bn capital plan for hospitals and care has to deliver on time for patients'
Out-of-date hospital scanning machines, public nursing homes where older people must eat their dinner at their bedside, and freezing cold A&E departments remain a blight on the health service.
They are also part of the legacy of underinvestment in capital spending over many years, with priority going to funding for day-to-day services.
The Government's €2.1bn capital plan - covering three years between now and 2021 - promises to fund better facilities, newer equipment and more "bricks and mortar".
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The fact it is multi-annual funding is welcome because it allows the HSE to plan ahead and avoids officials waiting for a once-a-year allocation.
Several projects announced are already under way and it lacks a timetable or specific targets. It includes the flagship National Children's Hospital which looks destined to demand more than its current €1.4bn construction cost by the time it opens in 2023.
It also features the new Central Mental Hospital - the National Forensic Mental Health facility in Portrane, Dublin, and radiotherapy machines in Galway.
The plan is to provide money for enabling works for the new National Maternity Hospital, although it is vague on relocating other maternity hospitals.
One of the most urgent areas in need of replacement or refurbishment is the network of outdated HSE-run nursing homes.
They are housed in community hospitals across the country which inspectors have condemned for leaving residents crammed in Nightingale wards.
These homes for old people, as well as disability centres, will get a €265m injection. But only 80pc of the 90 public nursing homes, which were supposed to be replaced or upgraded between 2016 and 2022, will meet the deadline.
It is expected that by the end of this year some 31 of the centres will have been built, while many more will be at various stages of the design and planning process.
Another area which is often under the radar when talking of capital spending is the replacement of outdated hospital equipment to diagnose and treat patients.
Testimonies provided by the Irish Hospital Consultants Association from doctors yesterday spoke of serious infection outbreaks at the Rotunda maternity hospital in its neonatal intensive care unit because it is too cramped.
Sligo Hospital has an 11-year-old MRI scanner doing 9,000 scans a year and breaking down although it should have been replaced four years ago.
Yesterday it was announced a total of €39.5m is being allocated to replace equipment.
"From a risk and patient safety perspective, these increases in allocations are critical," the plan conceded.
But it still falls short of the €300m for "essential equipment replacement" outlined in briefing notes for HSE chief Paul Reid a few months ago.
The same problem has been highlighted in the plan to provide extra hospital beds which are vital to easing overcrowding and the trolley crisis.
It provides for 480 beds over three years, 300 fewer than originally pledged.
The plan states that by the end of this year the number of beds will be back to more than 11,000 for the first time since 2009.
However, this is against a background of an ageing and increasing population.
Another 30 new primary care centres are earmarked to open before the end of 2021.
Some 100 new beds will open in mental health units, increasingly under pressure to cope with demand.
Several of the proposed projects remain shrouded in uncertainty and are dependant on the vagaries of securing planning permission and escalating construction costs.
The price tag attached to several facilities yesterday is likely to be too modest before being subjected to testing in the market.
The plan for three new hospitals, treating only public waiting list patients, continues to lack detail and basics such as where they will be sited.
There are also the continuing budget overruns in the HSE, leading to a curtailment in the rate of recruitment of staff needed to operate new facilities.
They will be essential to ensure new beds which are opened this winter are properly serviced.
The long-delayed plan - launched in September rather than January because it was unclear what impact the overrun in the National Children's Hospital would have - also means it is behind schedule.
The Government must also be clear on where it stands on the removal of private practice from public hospitals which would mean some re-direction of plans.