Tuesday 25 June 2019

Martina Devlin: 'When it comes to healthcare in Ireland, money can be found for bricks and mortar but not for hard-working, dedicated people'

'The bill for the Children’s Hospital almost doubled in 18 months, from €938m to €1.7bn. How many nurses’ salaries would such an overspend provide?' Stock image
'The bill for the Children’s Hospital almost doubled in 18 months, from €938m to €1.7bn. How many nurses’ salaries would such an overspend provide?' Stock image
Martina Devlin

Martina Devlin

A massive dent has been knocked in the Government's halo - pushed out of shape by revelations about ballooning costs at the new National Children's Hospital. As loudly as ministers sing from the same hymn sheet about public pay prudence, their words are drowned out by stupendous overruns on a key capital project.

Broadly speaking, the nurses have chosen an unpromising time to strike because our immediate future is uncertain - Brexit presents an unquantifiable challenge to the economy. We simply know it will be either bad or dreadful.

However, their claims for across-the-board pay rises seem modest compared with the price tag for a major infrastructure project being allowed to triple. The Government failed to manage or do much by way of damage limitation on stupendous overruns there.

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So much for its cost containment mantra - when Paschal Donohoe talks about fiscal prudence it smacks of do as we say and not as we do. And of an administration that's penny wise and pound foolish.

Odd, that bricks and mortar count more than people. Bricks and mortar don't bite back, of course. Bricks and mortar don't require holiday time and sick leave, nor overtime payments. But neither do bricks and mortar stroke your hand when you're in hospital and feeling vulnerable, bring you tea and toast in the middle of the night when you can't sleep, fetch an extra pillow or administer pain relief.

So, money can be found for bricks and mortar but not for hard-working, dedicated people.

Whether we like it or not, healthcare is a business and all businesses seek to keep salary costs under control. Starting salaries are €31,000 for nurses, but allowances raise them to €37,000 (the average industrial wage) according to the Health Service Executive. The HSE also says average salaries for staff nurses are €53,000, again with all the add-ons factored in. This would include unsocial hours payments.

The Government is concerned that giving the nurses what they want - parity with other graduate-entry groups such as physiotherapists, who earn up to €7,000 more annually - will cost the State between €600m and €900m of borrowed money every year because of knock-on claims from other public service unions.

It's a compelling argument. Except for the Government's Achilles' heel when it lectures us on cost containment while signing off on the world's most expensive hospital. The bill for the infrastructure almost doubled inside 18 months, ratcheting up from €983m to €1.7bn by last December, and that's not necessarily the final figure.

No wonder frontline health workers are demoralised. How many nurses' salaries would such an overspend provide?

Three strikes so far, three more back-to-back next week - and no sign of mediation. Nor of imaginative problem-solving. What about the costly use of agency staff to cover staff shortages? The Government would do better to divert the funds poured into that stopgap to address staff retention shortfalls.

Is a cost-neutral option to deal with some of the nurses' concerns possible? For example, in other countries nurses do some of the procedures currently carried out by junior doctors in Ireland - inserting catheters and so on. If nurses took them on, it would free up medical staff for other work.

Far from being resolved, this disruption is escalating, with backlogs accumulating from deferred surgeries and patients being put at risk. The Government needs to reach a settlement speedily and move on. It's been awarded special status because of Brexit, but that state of grace has begun to sour over its gross incompetence in relation to the children's hospital.

The Coalition continues to adopt the moral high ground over the nurses' strike, although the shakiness of such a position should be self-evident. Key ministers who ought to have been in the loop are claiming the gross overspend at the children's hospital is all Greek to them. They simply don't know how it happened, which stretches our credulity.

As for civil service membership of the hospital project building board, it seems fanciful that any Government appointment would fail to flag runaway costs to either the health or finance minister. The largest capital project on the State's books overruns to astounding levels, yet he stays quiet about it? A senior official's purpose on the board is to protect the public interest, as he would be well aware.

I have served pro-bono on a board for the past five and a half years and the financial report is always a vital element of business. Any board which takes its duties seriously scrutinises the figures, compares them with the previous set of sums, chews over current projections and queries the adjustments. This is standard procedure on the boards of organisations large and small. Those with slack financial controls do not survive.

And another thing. Bids for the hospital construction contract ranged between €637m and just under €815m, with the cheapest chosen. Plumping for a competitive tender is understandable, indeed commendable, if it's a sound bid. BAM, the winning bidder, was €131m below the next highest tender, a significant price difference which should have sounded alarm bells. The other three bidders were relatively close in their estimates.

Clearly, the project has been woefully mishandled. It appears the extent of the assault on the public purse only became apparent in August, with the full horror confirmed in November, when the Government's choices were to hit the pause button, go for re-tendering or proceed. It opted to continue on the basis that there was no silver bullet solution and the hospital is urgently needed.

Consultants have been employed to get to the bottom of the substandard stewardship. At a cost of up to half a million euro, incidentally; they don't come cheap, these mystery-solvers.

Taoiseach Leo Varadkar has said the terms of reference for the review into the cost overrun will be revised to allow for individuals to be held to account - I for one won't be holding my breath - and we're promised it'll be a learning experience and nothing comparable will ever happen again. Reassured? Me neither.

Meantime, nurses are picketing, ambulance staff belonging to the Psychiatric Nurses Association are taking industrial action, and GPs were demonstrating outside Leinster House earlier this week. And the Government's case for holding the line on public pay is fiscal prudence, an admirable virtue which it preaches but doesn't practice.

March 29 is the day set for PwC consultants to deliver their report into how and why building a hospital can bust budgets by hundreds of millions of euro. If that's a familiar-sounding date, it's because the UK exits the European Union then.

Could the halo-wearers have a cynical deflection ploy in mind?


Irish Independent

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