Professor Chris Fitzpatrick:

This model of care was endorsed by the medical director of the National Paediatric Hospital Development Board at a hearing of An Bord Pleanála in 2015. It is also of the utmost importance that these critically ill babies are cared for close to their mothers during the most vulnerable period of their lives and that mothers are not kept apart from their sick babies, stressed and worried on the post-natal wards of maternity hospitals in different parts of the city. I hope, by coming here today, that the committee will strongly recommend that the best interests of these critically ill babies, who have mortality rates between 5% and almost 20%, are addressed as a matter of priority for financial reasons, as this is the Committee of Public Accounts, but also, more importantly, for medical and compassionate reasons. If we are building the most expensive hospital in the world, these babies need to be looked after.

By way of background, in November 2012, the then Minister for Health and current Senator, Dr. James Reilly, announced that the national paediatric hospital was to be developed on the current site at St. James's Hospital. There was no reference to when a maternity hospital might be built although there was an aspiration to do so. In October 2014, the then Minister for Health and current Taoiseach, Deputy Varadkar, suggested that a planning application be submitted for a maternity hospital alongside the children's hospital. This was not done.

A document supplied by the National Paediatric Hospital Development Board to the Committee of Public Accounts in January states, in reference to St. James's, that it is not known when or if it is certain that a maternity building will be constructed. It is also of note that the National Paediatric Hospital Development Board's PowerPoint presentation to the Committee of Public Accounts on 31 January last contained not a single reference to maternity co-location. It is fair to state that there is widespread scepticism that maternity co-location will happen unless it starts soon.

Why come before the Committee on Pubic Accounts? The State is building the most expensive hospital in the world, namely, the national children's hospital. It is intended that a maternity hospital will be built beside it in the interests of critically ill babies. If a maternity hospital can never be built on this site or if, when the national children's hospital is built, there is simply no room left for such a facility, then the State will have built the most expensive hospital in the world on the wrong site. This would be both a financial and medical catastrophe.

Although PricewaterhouseCoopers, PwC, did not mention it, it should also be noted that the original cost estimates for the development of the national children's hospital, including a basement car park as cited by St. James's Hospital in April 2012 to the all important Dolphin review, was €297.75 million. In the same submission, it was also stated that, "The site proposed has very limited decanting requirements and thereby prompt access to site for development commencement (< 6 months)." Importantly, this proposal also contained a co-located maternity hospital of 42,000 sq. m.

There are certainly issues of concern as to how back-of-the-envelope financial calculations, assertions about easy site clearance and the availability of a very generous footprint for a maternity hospital, which seems to have evaporated, became the shaky foundations for the construction of the most expensive hospital in the world, the national children's hospital. Added to this remains the intrigue surrounding reports in the media of a last-minute switch of sites by the Government. Lessons also need to be learned from this. With projected costs in excess of €1.73 billion, a completion date now reset at 2023 and no sign of a co-located maternity hospital, the committee will agree that there is a need to think more carefully about what we are doing on this site, not just continuing blindly as though there are not very serious issues to deal with and not just believing everything that we are being told.

As I see it, there are two options for the current crisis relating to funding and maternity co-location. One is to stop the current development and relocate to Connolly Hospital. The advantages of Connolly Hospital are well known when it comes to construction methodology, space, nationwide access and the opportunity to co-locate the Rotunda Hospital. The analysis of this option, however, must take into consideration the money spent, or lost, on the St. James's site to date, expenditure on the satellite centre at Connolly, estimated contractual liabilities and legal costs resulting from stopping the development of St. James's Hospital and the need to significantly upgrade the adult services in Connolly to the levels of St. James's Hospital, the Mater Hospital or St. Vincent's University Hospital to support the co-location of a maternity hospital and paediatric hospital. That would be an enormous strategic and financial undertaking, which is often not factored into the equation, and also the long delay that would happen in that case.

At a pragmatic level, the project at St. James's Hospital, the site of which I visited last night, is probably past its tipping point. In addition, there appears to be limited public support to stop and start again for the third time. The political consequences of changing the site are considerable. There are certainly no votes in stopping this building.

The other option is to continue with the development on the current site. This should only continue if there is evidence that the overall projected costs can be properly estimated and are affordable; in other words, that there are no unknown unknowns, that the proper governance and cost control structures are put in place and that the recommendations of the PwC report are implemented. The overall cost must also include a maternity hospital, which should have been included from the start and the current site must be stress tested, in the same way that PwC stress tested the finances, to ensure that it can accommodate a maternity hospital, the Coombe, and that the co-location of the latter is, in accordance with Government policy, now prioritised among other planned projects on a very busy St. James's Hospital site and included in the national capital plan, with a short timeline for delivery and ring-fenced funding. It is of note now that St. James's Hospital is planning to build a cancer hospital.

This is a site that does not stand still, it is the busiest hospital in the State. It needs to be prioritised that a maternity hospital is developed on this site if it is to happen at all.

Taking all this into consideration, I propose that this co-location of the maternity service on the St. James's campus be accelerated while, at the same, time fulfilling the ambitions of the national women and infants healthcare programme run by the HSE and Department of Health in respect of women's healthcare needs. This proposal involves the transfer of maternity services only from the Coombe to St. James's Hospital. The Coombe Hospital caters for both gynaecology services and maternity services. It has the largest gynaecology service in the State. It exists on 5.5 acres or 17,500 m2. The site currently earmarked for the maternity hospital at St. James's is 3 acres, so there is an issue about fitting onto the site. The way I propose that this be done is to move the maternity service but to retain the large gynaecology service on its current site in the context of an integrated campus. This would allow the development of a benign gynaecology services as well as the national cervical screening laboratory services on the present Coombe site. Any investment in that site would be future-proofed. The reconfiguration of the services would also liberate space on the site which could be used to fund the co-location.

This would result in a faster tri-location, for less and on a smaller footprint and with considerably less campus disruption. I will not give ballpark figures or back-of-the-envelope calculations but this would cost a minimal amount in comparison with the amount that has been squandered on the St. James's Hospital site. This would develop an integrated campus across two sites.

Over the past week, "Liveline" has heard how the maternity services over the years have failed mothers and babies, how clinicians have failed at times to listen and to act with compassion and how things need to improve. I am not sure what it takes for politicians to also listen and make decisions based on medical evidence and compassion as well as economics. We do not want to be told in years to come how when we had the chance to do what was right, that we failed to respond to the critical needs of the most vulnerable children in the State and their mothers. This is not a legacy that any Government or supply party in opposition in a confidence and supply agreement would want to leave behind.

Critically ill babies should not be made to suffer because of poor decision-making at the start of this project and reckless spending since it commenced. In the end, we bailed out the banks. Babies and children are far more important than banks. We need to bail out this hospital. We need to build a maternity hospital as quickly as possible. If that means going to the European Investment Bank, EIB, for another extension on a loan, so be it. We also need to learn from our mistakes, including the mistakes that were made by the Dolphin review and that were made at the origin of this decision. We must take account of our actions. This is now a beleaguered project and we need to rediscover the vision that inspired us to bring three different types of hospitals together and to make it into a truly world-class centre. There is no option but to make it work.