Oireachtas Joint and Select Committees
Wednesday, 27 November 2019
Joint Oireachtas Committee on Health
Update on Construction of National Children's Hospital: National Paediatric Hospital Development Board
We will now receive an update on the development of the national paediatric hospital at the St. James's campus. I welcome Mr. Fred Barry, chairman; Mr. David Gunning, chief officer; Mr. Phelim Devine, project director; and Dr. Emma Curtis, medical director, National Paediatric Hospital Development Board.
I draw the attention of the witnesses to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of the evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. Any opening statements made to the committee may be published on the committee's website after this meeting.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.
I call Mr. Barry to make his opening statement.
Mr. Fred Barry:
I thank the committee for inviting us to provide an update on the construction of the new children’s hospital. I am joined by Mr. David Gunning, chief officer; Dr. Emma Curtis, medical director; and Mr. Phelim Devine, project director of the development board.
The NPHDB was appointed in 2013 to design, build and equip the new children’s hospital. A planning application was lodged in 2015 and An Bord Pleánala granted planning permission in 2016 for the new children’s hospital and the two paediatric outpatient and urgent care centres. One of those is complete and operational at Connolly Hospital in Blanchardstown and a second is under construction at Tallaght University Hospital.
Since I appeared before the committee last June, there have been a number of changes in leadership and project governance. Following a competitive process overseen by the Public Appointments Service, PAS, Mr. David Gunning was appointed chief officer in September and Mr. Phelim Devine was appointed project director in October. We have also added to the capabilities of the project team by engaging expertise in a number of areas. We have reorganised the board committee structure to focus our attention on what will be our critical challenges over the coming years. As a result of the resignation of a number of board members this year, there are vacancies on the board. These positions were advertised via the PAS and we understand a shortlist of potential candidates will be submitted to the Minister in December. We report to the children's hospital project and programme steering group on a monthly basis, providing comprehensive updates on all aspects of the project, and we also report to the project and programme board. We continue to work closely with the relevant officials in the Department of Health and our colleagues in the HSE, as well as with our colleagues in Children’s Health Ireland.
Those members who have had the opportunity to visit the site of the new children's hospital, or anybody who has passed the site recently, will have seen the progress that has been achieved in construction. Across the 12 acre site, the excavation, piling and the structural frame to the underground basement for campus-wide facilities management, energy centre and the 1,000-space underground car park are nearing completion and the first window has been installed in the hospital. Well over 1 million sq. ft of slabs have been poured. Mr. Gunning will give some further detail on the construction shortly. The outpatient and urgent care centre at Connolly Hospital in Blanchardstown was handed over to our colleagues in Children’s Health Ireland for operational commissioning earlier this year and services have commenced there since we last came before the committee.
On cost, the committee will undoubtedly recall that the Government authorised the development board to proceed with the main construction works late last year, following agreement on a guaranteed maximum price, GMP, with the main contractor. The investment decision approved at the time was exclusive of residual risks, as was communicated at the time of approval. These exceptions were also set out within the PricewaterhouseCoopers, PwC, report published in April this year. As pointed out by PwC, some of these risks are under our control and some are not, and we are actively managing those under our control while monitoring those that are not. One example relates to contractor claims. Contractor claims are a feature of most construction contracts, big and small, including this one. We are organised to ensure timely and evidenced responses to claims as they arise and are defending the public interest robustly. Contractor claims have not had a material impact on the GMP to date.
I will hand over to our recently appointed chief officer, Mr. David Gunning, who will introduce himself and provide some more detail on the construction update.
Mr. David Gunning:
I thank the Chairman and members of the committee. This is my first time to address the committee so I am thankful for the opportunity to introduce myself. I have met quite a few members before in other roles but I am delighted to be here wearing the hat of the chief officer of the NPHDB.
During my career to date, I have worked in Ireland and internationally. For approximately 20 years, I delivered large-scale and complex projects around the globe in positions of increasing responsibility with leading multinational companies. The projects were typically regional and national telecommunications networks. The scope of these projects included product design and development, network design, network build, commissioning and service delivery. I started my career as an Army officer, serving for almost ten years in the communications and information services corps in the Defence Forces. I am an electrical engineer by profession and hold a master’s degree in business administration.
In 2006, I was appointed chief executive officer of the State-owned company, Coillte Teoranta, which I led until 2013. My latest role before taking on this position was in healthcare as chief executive of the Royal Hospital in Donnybrook, where I had previously served on the board as a non-executive director. It is my intention to use the leadership, project delivery and contract management experience I have accumulated through the years over the course of my career to lead effectively the national paediatric hospital executive team and the broader team in this very significant project.
I have been in the role since mid-September and have spent more than two months familiarising myself with all the various strands of the project and getting to know the project stakeholders. This is one of those important stakeholder events. As Mr. Barry said, we have also made some operational and organisational changes to help strengthen our team and improve our governance and reporting structures. I fully subscribe to the vision for this hospital, which is to create one of the finest children's hospitals in the world. It is a challenging project but one that will have a profound impact on the children, young people and families that it will serve. Since starting, I have been very impressed by the passion and motivation of the broad team involved in delivering this significant project.
I will provide a brief construction update and we have included some images in our presentation. I am sure many members have either been to, or passed, the site.
To the south west of the site, opposite the South Circular Road, the frame to the finger blocks containing the outpatient departments, cardiology wards, therapy and play areas are completed to the south east. The structural frame containing the outpatient clinical decontamination unit, radiology, critical care and the theatres is also nearing completion. The frame supporting the fourth-floor garden to the south of the building is partially complete and sections of the ward block from levels 4 to 6 have commenced. The mechanical and electrical fit-out of the plant areas is well progressed. The fit-out of the outpatients department is due to commence shortly.
The north side of the site has come out of the ground to reach ground level, and the north fingers containing the overnight accommodation for outpatients' parents, the hospital school and the public restaurant are on level 1. The main campus access road, the U-shaped road coming into St. James's Hospital from the right-hand side of the photograph now being displayed, is now in a permanent position around the perimeter of the site. I refer to the access road from the South Circular Road into the site.
I will now show a couple of photographs. I direct members to the red writing in the centre of the first image. Basement 2, basement 1, the lower ground floor, ground level, level 1, level 2 and level 3 are all constructed in this area. For clarity, another three levels will go on top of level 4. These will contain the ward blocks in an oval-shaped building sitting on top. This view looks towards the west from the old access road.
I am now showing a view along the old South Circular Road entrance with which people will be familiar. It shows the fingers going from left to right. We can show the cardiology outpatient department, the surgical wards and the work spaces. The haematology and oncology department is on the left with more wards in the background. Members will notice that scaffolding is in place on all of this building in order to commence the construction of the cladding and the facade. Someone passing by on the South Circular Road will see quite a lot of change in the very near future.
I am now showing an image of the outpatient facilities in the north hot block. Again, multiple levels have scaffolding in place and are ready for cladding.
I am now showing the view from close to our offices in Rialto. This view is from near the Rialto Luas stop, looking north into the hospital. This will be part of the outpatients department.
While the concrete and steel frame is still under way, some of the mechanical and electrical service installation that has already happened can be seen in this photograph. The lagged pipes on the left side of the image correspond to the steam room. The fire protection, in the form of the sprinkler systems and other red-painted installations, is visible in the middle of the photograph. Members will also notice lots of places for baskets and other cable trays for further mechanical and electrical installations that have to go in. On the right of the picture one can see a large number of air handling units which have already been installed. They will condition the environment and ventilate the system.
I am now showing basement car park level B1. This is at an advanced stage of construction. There is not much more to be done in this area other than securing it completely and weather-proofing it once the whole building is enclosed.
In the centre of the photograph I am now showing members will see the cupola of the Royal Hospital, Kilmainham on the horizon. This is the view through an area which forms the main street through the hospital. There are buildings on the left and right. That will remain but it will be covered by a roof and by other buildings on top.
I have covered most of the areas. I would like to make two more points. Sustainability is a question that has come up in the past. The energy performance of the building is an extremely important factor in the design of the new hospital. We are targeting an "excellent" rating under the BRE environmental assessment method, BREEAM. This is the highest rating we can seek to achieve. That corresponds to a building energy rating, BER, of A3. Achieving this will allow a 60% or 70% reduction in the energy consumed in children's hospitals. These are large spaces that are expensive to heat.
As Mr. Barry mentioned, the outpatient and urgent care centres at Connolly Hospital Blanchardstown are now delivering services. This is making a positive impact on children's lives. Almost 2,000 children have attended the urgent care centre and 1,000 outpatient appointments have taken place at the centre in Blanchardstown. Again, the images do not adequately convey the scale and scope of what we are doing. On behalf of the board, I invite the committee members to visit the hospital at their convenience. We would be more than delighted to facilitate their visit. I thank the members for their time and for allowing me to introduce myself. I look forward to the discussion.
I thank the witnesses for their time and for the presentation. I congratulate Mr. Gunning on the tough role he has taken up. There is a lot of heat attached to it and a lot of people are watching. I genuinely wish him the very best. I ask him to excuse the directness of the question, as it is relevant to his role and to this hospital. When he outlined his experience I did not see any experience in building hospitals or major buildings. Was that an omission? Has Mr. Gunning led the construction of a major hospital in the past? Has he led the construction of other major building projects? He referenced telecoms but I am asking specifically about buildings rather than engineering or communications networks.
Mr. David Gunning:
I have not worked in the construction sector to any great extent during my career. My experience is in large and complex projects of a different type. There is a lot of similarity. I have had some experience in construction. During my time as chief executive of Coillte we built a large portfolio of wind farms. Members will be aware of that. We also built about 150 telecoms mast sites as part of the first broadband effort. My experience is in large-scale projects but my appointment here is really intended to bring leadership experience to the team.
I thank Mr. Gunning. I would like to move onto the issue of costs, which has obviously been one of the big issues with this project. Just last night I received a response to a parliamentary question from the Minister for Health, Deputy Harris. I had asked for an update on the potential future overruns. This project started at €650 million and it has now reached €1.733 billion. At least five separate categories of additional cost risk have been discussed by this committee, namely, inflation, contractor claims, changes to regulations or taxes, design changes and delays. All of those risks have potential cost implications. I did not expect the Minister to update me on the absolute costs. I fully understand that we do not know because these are moving targets. However the people running any major project, certainly a capital project like this, have provisional estimates of these potential costs. The work must be proceeding on the basis of some provisional sums, which of course encompass a range of potential figures.
The Minister said last night that there has been no change to the figure advised to Government, that is, €1.4 billion or €1.733 billion. He said the board has not advised him of any additional costs. He went on to state "As the National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital, I have referred the further parts of your question to the NPHDB for direct reply."
Here we now are. I would love a direct reply.
In terms of the five categories and, indeed, any other categories, what is the current best estimate as to what the final price will be, above the €1.4 billion that has already been advised?
Mr. Fred Barry:
Yes, I can certainly address the question. For some of the questions I will be able to give very specific answers but for others I will tell the Deputy that his view of the future is the same as that of everybody else. We do not know what inflation will be for the construction industry in two and three years' time. If he asks me to tell him what it is going to be, then I cannot but nobody else can either.
Mr. Barry has given that response before. If I were on his side of the table I would have a better understanding of what the potential inflation exposure is. My understanding would be better than the people on this side of the table because I would have a very detailed model, which would calculate, for likely and unlikely levels of inflation, what my total exposure was because I have done this. I have been on the other side of the table and I have built these models from scratch. If I worked on his team, I would be able to tell him to a very fine level of detail, given the most likely probabilities, plus or minus ten, 20 or 30 degrees, on projected inflation and we would have worked out exactly why we think inflation is going to do what it is going to do. I would be able to state, at a very granular level, the likely exposure. Either he does not have anyone telling him that information, which is deeply worrying, or he has the information but feels he cannot share it. What is going on? Mr. Barry has stated that he knows as much as anybody else on this, which is an extraordinary answer.
Mr. Fred Barry:
It is not an extraordinary answer. The range of answers are already presented to this committee and were published in the PwC report, which I believe was made available to this committee in April of this year. Within that report there is a range of exposures depending on what the levels of inflation are over the next number of years. The range is there. For the Deputy to say that I should be able to tell him what the level of construction is going to be in three year's time with precise detail is an unreasonable expectation.
Is Mr. Barry honestly telling us that since the PwC report, the Department has done no further financial analysis on the likely financial exposure of the State and taxpayers to construction inflation on this project?
Mr. Fred Barry:
A lot of claims have been submitted and significant claims have been submitted. In or about 50% of the claims that have been submitted have, at this stage, been put through the determination by the employer's representative. The total award to the contractor from those claims, to date, is well less than €1 million, and that is well within the provisions we have already been given by the Government, as an approved budget.
Mr. Fred Barry:
I am restricted in what I can say on claims that are in progress and that is why I have given a figure for claims that have been determined. Of the ones that have been determined, that is about 50% of the claims that have been submitted have already been determined. I have heard some extraordinary figures mentioned externally as to where we may end up on claims but the total to date is less than €1 million. I know that €1 million is a lot of money but in the context of what we are doing here, I will say that is within the budget provisions that we have been given by the Government.
Mr. Fred Barry:
No. In terms of part of what we are doing in managing the costs, as the construction documentation has been issued by the design team, it has been closely vetted to ensure that the design, as it is being issued for construction, is consistent with the design as was used to negotiate the guaranteed maximum price. Of course, as design develops there are bits and pieces of changes as things move around but there have been no changes that have any significant impact on the costs.
Mr. Fred Barry:
The Deputy has seen the progress that has been made. We would like if more progress had been made. We have got three years to go until the end of 2022 so there is plenty of time for the contractor to go from where he is. I am sure the Deputy will have been impressed with the level of progress already. Delays do not arise at this stage.
Mr. Fred Barry:
There are not. I would say the construction is a little behind where we would like it to be. That is certainly the case and I think I reported this at an earlier presentation. That has not changed. I am also looking forward and thinking that with three years to go, we have got some very big players working on the construction and they have the capability of recovering that time.
I have questions on the design itself but they have nothing to do with the change of design. The Coombe maternity hospital was meant to be relocated. We were told in 2015 that it would be relocated in parallel with the children's hospital but, clearly, that has not happened. The design has not even begun of the new maternity hospital.
I have spoken at some length with obstetricians and people working in the maternity services. What they have said is that the physical co-design matters greatly. For example, a corridor through which one can very quickly get mothers into the adult hospital and babies into the children's hospital is very important. Does Mr. Barry know whether the children's hospital has been designed with a view to where the maternity hospital is likely to be with a view to making sure that all of those connections can be put in place when the maternity hospital is built?
Mr. Phelim Devine:
Yes, is the answer. At the early stages of the design of the hospital, and before we went into planning, we had designed in all of those future links back to the future maternity hospital. The critical link is between critical care and the delivery suites of the maternity hospital back into the neonatal intensive care unit, NICU, in the children's hospital. That link is provided for, for the future.
We have also provided future links into a redeveloped St. James's Hospital at level 3. There is also an facilities management, FM, link to provide shared services linkages between the children's hospital, St. James's Hospital and the future maternity hospital because we are using specialist robots to transport materials around the site.
Yes. We are all aware of the cancellation of elective procedures in the three children's hospitals at the moment and I will outline one of my concerns. The new children's hospital is not providing many more beds. The figure given to the committee before was that there would be an extra ten beds or something but that is very few. I have a real concern that when this beautiful new facility is opened, because we do not have any more beds but a growing population the ratio of beds to children may go down. In other words, the next time there is a virus outbreak, the emergency department will fill up and, again, the new children's hospital would have to start cancelling elective procedures, which would be a disaster. One way that this is being dealt with in modern hospital design is to physically separate elective and non-elective care so that when the emergency department must deal with an emergency, a major trauma incident or the outbreak of a virus that the elective and non-elective work is separate.
At Tallaght Hospital, the elective facilities that are being built are physically separate from non-elective facilities. Was there consideration of that issue in the design of the national children's hospital?
Dr. Emma Curtis:
When the new children's hospital was being designed, several factors were taken into account. There was a significant amount of activity on capacity analysis, involving looking at the current children's hospitals activity as well as talking into account current unmet need and waiting times, which are very significant and, in some cases, breach HSE guidelines. There was also consideration of developments in care and different and more efficient and effective ways of delivering care. Although the bed numbers are not substantially different, they are based on calculated activity, which included looking at CSO projections for child populations well into the future, as well as an increase in day care beds. Account was taken of the fact that an increasing proportion of children who have a day care procedure carried out will not need an extended inpatient admission. In the past, such procedures might have required an inpatient bed. There is provision for a day of surgery admission, DOSA, unit, whereby a well child, who is anticipated will have an inpatient stay, will be admitted on the day and not beforehand. We are developing that within our current facilities and a dedicated DOSA reception unit will be built in the new children's hospital in addition to the 93 day care beds and the inpatient bed provision.
A matter in respect of which we have looked at international models, and which fits in with the Deputy's observations regarding Tallaght Hospital, is that there are two dedicated emergency theatres within our theatre provision. That means that if an emergency comes in, it will not dislodge a planned elective procedure, which is what currently happens. That is a critical part of general and trauma emergency provision.
It is welcome that there is protected operating theatre space. Are there also protected beds? In other hospitals, ward beds which are needed for post-op elective care are getting filled up due to an influx of patients into emergency departments and the increase in admissions. Many surgeries, including in children's hospitals, are being cancelled because there is no ward bed available for after the operation rather than because there is no operating theatre available. Are some of the beds protected and physically separated along the lines of the operating theatres?
Dr. Emma Curtis:
There are a couple of areas in which we have addressed that issue. On the inpatient ward population, we are separating specialist tertiary care from secondary general care. Two wards will be used for high turnover rapid admission inpatient stay. One of the major differences between paediatric and adult care is that many of the children we see are fundamentally healthy but have contracted an intercurrent illness which requires admission. They recover quite quickly from the illness. We have two wards dedicated to this high turnover patient population. They will be very consultant intensive. We have developed a general paediatric model which involves an expansion in general paediatric consultant workforce. That is already under way. This patient population would spread through other beds in the current hospitals, but it will be provided for in this dedicated intensive high-turnover acute-illness section of the new hospital. In one way, that protects tertiary national beds and elective care beds.
We are also addressing the intensive care department. One of the causes of cancelled procedures is the availability of intensive care beds. As this will be the only intensive care unit in the country for children and young people, it has significantly greater capacity than is currently available, which will offer protection in that regard. There are several initiatives within our planning that are different from the way we currently run services and will stop the cancelling of elective procedures due to emergencies. We are separating the streams and working differently in the way we designate the need for beds, as well as bringing in initiatives around general paediatrics to ensure that specialist elective care continues at all times in spite of what are predictable peaks and falls in unplanned care.
I thank the representatives for their attendance and the report which has been provided. Reference was made to personnel changes. The committee has previously discussed the convoluted nature of the children's hospital committees and how they interacted. I acknowledge that efforts were made to refine that system a little. Who are the people on the finance committee? When did they join the committee? What is their relevant experience? I am not seeking a massive amount of detail.
Mr. David Gunning:
A very clear governance framework is in place. The executive reports to the National Paediatric Hospital Development Board. We meet the children's hospital project and programme steering group on a monthly basis. We present quarterly reports to the children's hospital project and programme board which is chaired by the Secretary General of the Department of Health and of which the chief executive of the HSE is a member. Between those set-piece activities we have a significant amount of stakeholder interaction with the Department and its officials, as well as officials of the HSE. I wish to emphasise our ongoing dialogue with Children's Health Ireland which shares our building, where we have a significant amount of interaction.
On the governance framework, there is a significant degree of governance across all aspects of the project, of which finance is a component. Mr. Barry referred to the rearrangement of the board committees. As the Deputy is aware, we are recruiting board members. The skill set required in order to fill some of these vacancies includes in the finance area, administration, project management and other skills to which reference has been made. Our board members are very accomplished, but we currently have a reduced number of members. The finance committee meets monthly. We present to it from an executive perspective. We are in the process of merging it with the audit committee. In my experience, there is a significant degree of interaction between the executive and the finance committee on all matters relating to the project.
Okay. Mr. Barry meets the Minister as and when required. Is it at the Minister's request or at Mr. Barry's? How does it happen? Mr. Barry has said there are no scheduled meetings. I do not know how it is arranged or who requests it. If no formal arrangements are in place-----
With the greatest of respect, I would not expect Mr. Barry to be sitting there with his shorthand notebook. However, are the meetings minuted? I would have thought it would have been important that meetings on a project of this size would be minuted because the Minister and the Secretary General are in attendance and these are important meetings.
Mr. Fred Barry:
I am not saying a word otherwise. I have been attending meetings with Ministers for 15 years. I have never taken a minute, myself. I know many of the meetings have been minuted but I do not get a set of minutes afterwards. All I am saying is that many of the meetings are probably minuted, but I am not keeping the minutes and I do not track what his Civil Service support is doing. I presume they are doing whatever they are supposed to do for him.
I have a number of questions on this. We know that with major infrastructural projects the claims will continue for up to four or five years afterwards. They do not all get settled as they go along as Mr. Barry would know. In his experience are the bulk of the claims settled at the early stages of construction, or are they more likely to be settled towards the end or afterwards?
Mr. Fred Barry:
What we are aiming for and how the contract is framed is that we have a continual process of dealing with claims as they arise. My experience is that claims are made throughout the construction project and I have no expectation that this will be any different. I expect that we will be dealing with claims right up to the very end.
Mr. Fred Barry:
Five years would be unusual. Typically, at the end of substantial completion, the buildings get handed over to the children's hospital. At that point the contractor is not finished working. He is far enough advanced to allow handover, but a lot of work continues after that. That work continues on and there is a defects liability period. The contractual period with the contractor will run and will probably be-----
While I am no engineer, my information is that at this point in the proceedings we would be talking about a very small level of claims settled and the bulk of them will not happen until closer to the end or after the final handover date. The figure of €1 million would not be much by way of a guide. It is not possible to say that just because it was €1 million for the first year, it will be €1 million for the second or third.
Mr. Fred Barry:
We do not know what it will be, in fairness. We certainly could not say that because it that much this year, it will be the same next year. The procedures under the contract require that claims be submitted in a fairly tight timeframe and that the employer's representative addresses them within a tight timeframe.
Mr. Phelim Devine:
The contract mechanism is such that the contractor must notify of a claim within 20 working days of recognising that he feels that there is a justification. Within that 20 days they must submit substantiation for that claim. The first 20 days is notification. Within 20 days they must issue substantiation. The employer's representative has the opportunity to seek further information. The ER then has another ten days to receive that and ten days to determine. The whole cycle comes to around 40 days and then the determination is made.
Mr. Fred Barry:
I am not suggesting for a minute that even though we have gone through this process the contractor may not come with additional claims at the end. The contractor will be hard-pressed to come up with justifiable new claims at a later stage. That is not to say they would not be made. I would not suggest that for a minute, but I think-----
I ask Mr. Barry to let me finish this one. At what point in the project do the majority of the claims arise? Is it towards the end of the project? At the time of the handover would he expect a spike in claims? Is it immediately post handover or would he expect it to continue at a steady pace during the course of the project?
Mr. Fred Barry:
Some of the claims are very big. If we were to lose out on a very big claim, it could be considerably more than that. I am not in any way saying that because we have had this success so far, we can extrapolate from that and be sure we will have continuing success at that level. The Deputy has reasonably many questions about what is happening with claims and I am just reflecting back to her the experience to date.
What percentage by value of the claims are settled? The question is not necessarily specific to this project but based on Mr. Barry's experience with large-scale infrastructural projects. Would it be 70% of the claims? I am talking about the value of claims and not the number of claims because 70% could relate to all the tiny claims or all the enormous ones.
Mr. Fred Barry:
Without wishing to praise or disparage any individual contracting company, it depends very much on whom one is dealing with. Some contracting companies put forward well-considered and justified claims. They might get a high percentage of their claim values. Other companies might put forward highly inflated claims and they might end up with quite a low percentage. There is no one percentage.
I welcome the witnesses and I wish Mr. Gunning the best of luck in his new role. He has achieved one thing today. He has justified the use of these two big screens for the first time in my career.
Listening to the witnesses over the past half an hour, one would wonder what we have all been worrying about since all this blew up. Based on what they have said it seems that everything is rosy in the garden, but it is not.
Sometimes I wonder whether many people have read the PwC report. I have read it in depth, as have most of my colleagues, and I re-read it before I came to the meeting. A great deal of information in the report needs to be followed up on, which is what I want to do now. Our guests will appear before the Committee of Public Accounts, of which Deputy O'Connell and I are members, in a couple of weeks. I have always believed that the layers of how the project is being managed are insane, as was noted in a recommendation of the Committee of Public Accounts. There are three layers, and there are the Department, the HSE and the Minister. It is insane. This is part of the original problem the board inherited. It should not continue. The layers need to contract.
Of the residual risks, Mr. Barry stated some are under control, while others are not, but that the latter are being monitored.
The report contains two categories, one of which is divided into two further subcategories. There are risks that can be controlled, and there are risks over which the board has some influence and risks over which the board has no control. Since Mr. Barry joined the board, have risks in either of the latter two subcategories been elevated beyond what was outlined in the report?
I appreciate that. I am not asking about the individual. I will restate my question in case Mr. Barry needs more time to answer it. Was the loss of the chief procurement officer of Ireland, who is based in the Department of Public Expenditure and Reform and is no longer on the board, a loss to the project?
Mr. Fred Barry:
All the board members who retired or resigned from the board gave tremendous commitment to the project. I certainly did not ask any of them to leave, and had they stayed, I would have welcomed that. I say that as a general comment about all the board members and I will not comment on any individual board member.
I will ask the question a third time. I have not named the individual. Was the loss of the chief procurement officer, a significant position in the country, to the project, which is the largest in the country's history? I refer to the person's expertise, whoever he or she is, given that he or she was ultimately the person in charge of the project.
I am not asking Mr. Barry to address the qualities of any individual. Mr. Barry turned the question. I do not want him to address the quality of the individual, whom I do not know. Rather, I want him to address the loss of the role and all it brings. It has a role in the State and was put on the board for a specific purpose, but it is no longer on the board. It will be strange if Mr. Barry fails to answer the question and states it was not a loss that the role is no longer on the board.
I have now made four attempts. I note to the committee that Mr. Barry effectively refused to answer a question on the loss of the expertise of the role - not the individual - to the board. He effectively refused to state it was a loss. That is now public.
Let us get this right. It was not a confrontational question. Trust me, I will have some such questions later and we are only starting. Mr. Barry has been around the block before Oireachtas committees for years and I have dealt with him on many occasions. I must acknowledge that he is good when he appears before committees and is clear and concise in his answers. I accept that the role he took on was a poisoned chalice and I admire him for taking it on. Nevertheless, there was a reason the chief procurement officer of Ireland was put on the board, for expertise. The expertise of that role - I do not refer to the individual - is no longer there. How Mr. Barry could appear before the committee and not state it was a loss is beyond me and does not give me any confidence. It shakes my confidence, which had been improving.
I accept that, but the public are watching.
I turn to the guaranteed maximum price, GMP. I know what it is, Mr. Barry knows what it is, and the public are now becoming familiar with the term. I listened to his responses to my colleagues earlier. According to pages 26 to 28, inclusive, of the PwC report, the GMP will be based on the design team's assertions with 95% cost certainty. Is that correct?
It is interesting that footnote 30 on page 28 states:
Stage 2C Design commenced in July 2016. We note that as of the date of this report, the Stage 2C report has yet to be approved by NPHDB.
Has it been approved since?
We have design A and design B for the two stages. It is agreed that 95% would have to be agreed for the GMP to be signed off on. Is that correct? It is in the document. We might get the specific date in April - I am sorry, as I do not have it - on which this report was done. It was the month of April in any event.
I understand that. What is bugging me is that, when it came to the actual design, we still had not got to a percentage. Let me make this more Bauhaus and simple. In terms of the actual design process, what percentage of certainty had we as regards the design of the children's hospital when Mr. Barry took over a good few months back compared with now?
Mr. Fred Barry:
They follow the completion of the design. The thrust of the Deputy's questioning is that the design might have been incomplete when the GMP was agreed. It was not incomplete, but the issued for construction, IFC, documentation has to follow, as it always must in these projects. That is the normal design and construction process.
There are two parts to what Mr. Barry just said. First, while I accept what he says in respect of the first part, I want to be 100% clear that the design for stage 1 or stage A, as we will call it for the sake of clarity, has not changed at all since Mr. Barry took up his position. The second part is the second phase of the design that Mr. Barry has outlined so eloquently. Between his taking up office - I should say "role", as "office" is not the best term - and today, what percentage of the design has been put in place? I am hearing stories from people who are still experiencing serious issues on site as regards implementing the current construction design.
Mr. Fred Barry:
Certainly. Mr. Devine might correct me if necessary, but as far as I understand it, the design to be provided by the design team is fully complete. Some of the design is in the hands of the contractor. The IFC drawings, which are being done by the design team during the course of this year and into early next year, are well advanced. They are at least six months in front of the construction effort, and maybe more.
Yes. It is €27 million. Has that percentage changed since Mr. Barry took on his role? Is there an additional amount over the €27 million? Regarding the design stages, Mr. Barry stated that the design was 100% complete and six months ahead. I understand the design's phases and how they fall into one another, having read all of the reports. In fairness, they are graphed out well in the report. Has there been any change of significance that has concerned Mr. Barry since he took this role?
My first question was on the 68%, or €27 million, uplift in design costs according to the April report. Mr. Devine will revert to us with the sign-off times. My second question was on whether there had been changes in the construction design that concerned Mr. Barry in any way, shape or form.
-----I have been entertained by the meeting so far and previous meetings.
As a prelude, I will mention something that I have said previously. I am glad to see the Committee of Public Accounts monitoring the programme, but it has no function whatsoever in determining what money should be spent on any project until after it has been spent. Its job is to review value for money in almost every area. To do otherwise would be to interfere in Government policy, which no committee has the right to do. In particular, the Committee of Public Accounts is statutorily excluded from doing so. I say this as a reminder. I do not wish to go into some of the things that have happened at the Committee of Public Accounts down the years, nor would it be appropriate to do so, but I did not approve of them. Nor would anyone.
The purpose of the exercise is to build a modern hospital quickly in a way that gives good value for money, sticks to its contracts insofar as that is possible and, in the event of something inexplicable happening, having it explained. It may just appear to be inexplicable, but there is usually a reason for everything.
Someone approached me before the project even started about a potential reduction in the cost. This is a new topic, Chairman, given that everyone has been concentrating on increases. This committee is taken up with them, as are others. There was a suggestion that, if a road was closed or opened, contractors could use an internal road more effectively. I brought that to the attention of those involved at the very beginning. I am sure that the witnesses are aware of it. I cannot recall the details off-hand, but it would have entailed the closing of a road for some time until a part of the project had been concluded, thereby eliminating the need to criss-cross public traffic. I will leave that matter with the witnesses.
I am impressed with the work to date. It is great to see a major engineering project of this nature. It is long sought after and is very necessary for the provision of health services in the country. We hope that it works well and that there is not an ongoing inquiry.
Lengthy tribunals do not serve us well in terms of service provision and they also do not encourage tenders for State projects. This is a State project in respect of which there are strict rules which must be observed. It should be borne in mind that continually dragging down the project is not conducive to good value for money or the delivery of the project.
It was mentioned that some elements of the project are not progressing as fast as people would have liked. Have the witnesses been able to identify the areas that are causing the delay and worked out the extent to which they could contribute to a reduction or increase in the cost of the project?
Mr. Fred Barry:
Yes and some are prefabricated. I have some sympathy for our main contractor because as there is a huge amount of building work going on around the country resources are tight. While we are pressing the contractor to try to recover schedule resources in that area are very tight. I would expect, and I am not speaking for the contractor, that he is somewhat constrained by the resources available. This is the area where as per the contractual programme the works should be even more advanced than they are at the moment.
Mr. Fred Barry:
If the frameworks and slab works are continually delayed the work of the mechanical, electrical and fit-out subcontractors will be delayed. As I stated, in terms of timeline there are three years remaining. Large, capable, competent contractors can do so much in three years. I am not concerned.
Unlike my colleagues who are very conscious about costs, I am not paranoid about them because I believe we have to deliver. To deliver, we presume a level of expenditure. I previously asked for the original costing and I was told that no actual costing had been undertaken and no engineering or quantity surveyors reports had been secured, which are requirements in terms of estimating a cost. Is Mr. Barry satisfied that sufficient work has been done in terms of forensically examining all elements of the project with a view to it remaining in line with cost?
Mr. Fred Barry:
The Deputy is probably tired of hearing it but there are a number of costs risks that are outside of our guarantee maximum price and outside of our control. I appreciate that some people are of the view that we should have a better feel for the level of inflation into the future in regard to the costs that outside of our control. If the inflation is higher in a few years' time, then the cost will be higher. This will be dealt with by the Government by way of separate budget or additional budget. I am not sure what the mechanics of that will be.
The Deputy spoke about reducing costs. We have taken the measures we can to reduce costs and balance other pressures on increasing costs. In my view, there is no chance of the project being done for less than is currently budgeted. The pressures on this project are all upwards. There is no doubt about that. We have done well during this year in addressing the claims that have come in. The team has done well in managing the project but we will remain under pressure for the next few years. It is a tough, difficult project and I am not suggesting that there will not be continuing problems and challenges.
My colleague, Deputy Donnelly, suggested that if he was on Mr. Barry's side of the room things would be different. I am not so sure. Maybe he would close down the project such that the hospital would not be built. I am not putting words into his mouth. One should be always careful not to do that.
The degree to which Deputy Donnelly is preoccupied with the project would indicate to me that if he were on the other side of the table there would be an exclusion of certain elements of the facility. Obviously, the foundation would have to be put in place but some elements of the facility would be excluded. With that in mind, I issue the following warning. In a different political era I was involved in the development of a hospital which doubled in cost over a two year timeframe. There was a different Administration in office at the time and matters were handled differently then. Suffice to say, I believe that the project which the board has been tasked with delivering is major in terms of addressing the deficiencies in the fabric of our health services. I wish the board well and I hope it goes well. I hope that the project team do not get disheartened by the amount of negativity surrounding the project and the level of ridicule poked at it.
I congratulate Mr. Gunning on his appointment and I wish him the best of luck. I thank the project team for delivering to date. The hospital cannot come quick enough. I attended the accident and emergency department at Crumlin hospital last Sunday with a child. The lack of facilities is shocking. Deputy Donnelly spoke about the rotavirus and RSV in young children. To my mind, it is wholly unacceptable that vomiting babies, breast-feeding mothers and children with head injuries, broken arms and so on have to wait together in one room for treatment. Following on from Deputy Donnelly's question regarding the pull between elective and non-elective surgery, in terms of air conditioning what facilities are there in the admissions department of the new hospital that will mitigate the transmission of airborne viruses at the point of entry?
Dr. Emma Curtis:
In terms of design of the emergency department, there is a common waiting area and a triage office located directly off it. There are many more triage rooms that are currently in place. Patients are triaged through the waiting area and directed to various clinic rooms. There are 56 clinic examination rooms, which is a huge increase in terms of what we have now in the emergency department at Crumlin hospital.
Dr. Emma Curtis:
That Deputy is correct. A patient will come into the waiting area, be triaged and placed in the appropriate clinic. A patient suffering trauma would be sent directly to x-ray. There is a separate flow for major trauma and major illness and resuscitation rooms that are not used for general activity. This would be an operational division rather than a physical division.
As the Deputy is aware, the CHI at Connolly Hospital and at Tallaght Hospital are urgent care centres. The likelihood is that there would be an operational differentiation in what is the large department in the new children's hospital whereby there will be a streaming of children who are of an urgent care triage-type category and then children who have more significant illnesses or injuries. Operationally, one will get a separation of children. There is the provision of both standard isolation rooms where there is a concern that somebody has something significant but also then a more sophisticated isolation room if there is a concern that somebody has a very serious infectious disease. The design has been set up so that there is rapid flow through so that people are dealt with quickly, the waiting times are short and people are directed to the appropriate clinical assessment room. There is a separate stream for resuscitation and there is also provision for highly infectious diseases.
In terms of the roles of Connolly Hospital and Tallaght Hospital, I was struck when I was picking up the leaflet when I was trying to get out of Crumlin that the unit in Connolly Hospital closes at the weekends so there was no alternative option. For the cohort of people who arrive in and they are not sure how sick their child is, which Dr. Curtis will be aware is commonly the case, is she saying there will be an equivalent to the service provided by Connolly Hospital and Tallaght Hospital there for a child with a small cut, for example?
I do not want to stray too much into the maternity hospital, but in terms of the plant and the capacity of the parent site, is there existing capacity in the infrastructure to run the maternity hospital? Perhaps this is Mr. Gunning's area. For want of a better way of putting it, is there capacity to plug the maternity hospital into the existing plant or will we have to upgrade the plant and the capacity of the system to keep the maternity hospital going? I do not wish to simplify Mr. Gunning's job or perhaps it is Mr. Devine's job.
Mr. Phelim Devine:
I might pick that up. There are some shared services allowed for in the children's hospital to allow the maternity hospital to be plugged in. That is to do with electrical generation and also boiler plant. Fundamentally, the maternity hospital is a separate building which will be linked by a corridor. It will have its own mechanical and electrical, M&E, plant associated with it, but there are some shared services that we have catered for.
I think Mr. Barry referred to the building energy rating, BER. Was it always the case that we were looking for this rating or did the application happen during the design or post the design stage? My concern is about the cost. While I am in favour of it, and think it is positive to get a 60% to 70% reduction in current output, which is to be welcomed in terms of climate and costs, but is this a new thing or was it always built into the project?
Following on from Deputy Durkan's questions about the slowing of the project in terms of construction costs and concrete costs, prefabricated pieces are coming in and there is also pouring on site into shuttering in the normal way. Is it as simple as supply and demand or have there been any other identifiable or quantifiable overruns on concrete?
Mr. Fred Barry:
The contractor is the one who has the detailed information on where it stands vis-à-visits subcontractors. What I see on our site is what is what I see on various other sites around town as well, that there are resource constraints in the industry at the moment and this is one area and there will be others.
Surely the children's hospital is buying more concrete than anyone else right now and more prefabricated units, so it must have the upper hand in terms of buying power. I am not suggesting that someone who wants just a load of concrete should not get it, but surely the company constructing a building such as the children's hospital that requires so much concrete is in a stronger position than someone digging a hole out the back of the house and looking to fill it?
I think Deputy O'Reilly referred to claims when I was momentarily absent, additional claims on top of the guaranteed maximum price, GMP, have been submitted by the contractor, which is fairly normal. Did Mr. Barry say that more than 50% of those claims to date have been paid?
Going back to the concrete again, if one cannot build a concrete frame and bring in the beams and shuttering, one cannot put in the windows or heating system. My question is on the sequencing of works on site. Let us say if the contractor does not get the beams and the concrete in in the right period of time, for whatever reason, perhaps the wrong beams or the wrong type of concrete were ordered - that is clearly its problem - but who is responsible for the knock-on effect and the effect on other people's time? Whose problem is it if, let us say, there is a delay in getting the M&E guys in because the frame is not built? Is there a time cost, for example, if a contractor who was booked to come in has to be cancelled?
Mr. Fred Barry:
Generally speaking, yes, that is the builder's problem. An exception would be if we did something on our side that delayed the contractor, then the cost would fall to us. The contractor bears the risk for delays arising because of resource issues or because there is so much to be done, as part of the GMP.
Mr. Barry referenced that the pressures are all upwards, which is reflective of what is going on in the real world. If hypothetically, psychic Steve was with us today, in terms of inflation, if we had a recession, technically, the costs could go down.
Okay. I have one other question. It struck me the other night in Crumlin that everybody had new name tags with "CHI" on them. I am probably being petty but I get concerned when branding is a priority. Who is responsible for rolling that out? Everybody had new CHI tags. I think back to how difficult it was to implement a pay system, PPARS, in the past yet somehow the hospital has managed to get the name tags out first, which is great, and the leaflets were there telling me the urgent care centre was closed, which was great as well. I am concerned if the priority is to have a swipe card with the CHI logo on it.
Was a marketing company involved in that or is it just that that box was ticked-----
Dr. Emma Curtis:
This ties in with something the Deputy may be aware of. There was a doctor in the UK who died of cancer, and one of her observations as a patient was that hospital staff did not introduce themselves. This gave rise to the #hellomynameis campaign, whereby every clinician meeting a patient says "hello, my name is" and his or her name. This tied in with the formation of CHI and the realisation that we should all have name badges that read "hello, my name is" and our names. This is to encourage staff to introduce themselves to patients. It is not marketing; it ties in with the commitment to communicate better with patients and to explain who we are when we meet them. It is timely.
Mr. Fred Barry:
Yes. The vacancies have been advertised by State Boards, which is the wing of the Public Appointments Service that deals with appointments to State boards. The applications are in and the date is up. There will be a short-listing process within the coming weeks and from that the recommendations will go the Minister.
Mr. Fred Barry:
We have procurement expertise both on the board and within the organisation. In that regard the procurement phase of the hospital is really behind us. Good, bad or indifferent, the main building works have been procured. We do have to procure equipment, and there is a lot of it, but we are working on that very closely with the HSE, which is of course our expert in the procurement of hospital equipment. I am therefore quite happy that, between our internal resources and the support we are getting from the health system, we have the expertise to deal with the equipment procurement, which is the main procurement left to us.
Mr. Fred Barry:
Rather than saying they are absent, I would say we would like more of them. We would like more on the accountancy side for our audit activities, we would like ICT expertise and we are looking for general commercial, big-business experience. It is that sort of thing we are looking for to reinforce what we have.
There are a number of recommendations in the PwC report on the processing or assessing of claims. Recommendation No. 2, for instance, states:
Comprehensive plans should be developed to mitigate the residual risks identified. Once developed they should be subject to a rigorous peer review to "stress test" their robustness and comprehensiveness.
Is that peer review external or internal?
Mr. Fred Barry:
We have got external support on the claims, which has been very helpful in ensuring that we are properly structured internally and that our information management systems, which are so important, are in place and robust and will allow us, where we have a defence to the claims, to present that defence in a timely and fully evidenced manner. Claims will come in where the contractor is entitled to be paid. I have no doubt about that. Some issues will arise. We are not suggesting in any of this that the contractor should not get what he is entitled to but our concern is to ensure that the State does not pay for anything that has already been paid for within the guaranteed maximum price.
Mr. Fred Barry:
Most claims are reviewed internally by the employer representative team. There is an employer representative. This is an individual but she has a team of people with her. They are the ones who do the initial review. On our side we are copied on all this and we give our input on any of the issues. We take a very strong view, naturally enough, and, where necessary and appropriate, bring in external support on that.
Mr. Fred Barry:
I am not sure they are over and above what might be expected. Managing safety is such a tough job on a congested and very big site. We are very committed to and very focused on helping support the safety effort. I am absolutely certain that our main contractor is committed to safe management. There is no divide between us and the contractors on these issues. We are all trying to do the right thing. It is a very difficult task. There will be times when we see things we do not like. We will communicate them to the contractor and we expect the contractor to be responsive. If the contractor is not responsive at a low level, we elevate the matter to a senior level. We elevate safety issues to the most senior level. We are all working together on this but we think claims will be a problem. Maintaining a safe site when there will be so many people working on it over the coming years requires non-stop vigilance, support and attention from everyone on our team and on the contractor's team, but we are all dedicated to that.
Mr. Fred Barry:
It certainly makes it harder. As I said, what has happened thus far, as far as delay is concerned, is within the purview of the main contractor. I am not really speaking for it but just making an observation, as anyone here might. The nature of the site certainly does not help. We have the resources stretched all over the city and even the country. We have a very confined site. I think we all know that access to the site from the outside is very difficult and that it is a busy area.
Dr. Emma Curtis:
In Connolly, it is working really well. I do a clinic there once a month - many of us do. There is a cohort of people who do a lot more clinics there. The response from the patients I meet is really positive. Almost 1,400 patients have been seen in outpatients and almost 1,900 have been through the urgent care centre. I was talking to the clinical director yesterday. Fifty-nine patients were seen yesterday between 10 a.m., when they open, and 5 p.m., when they stop taking patients. Staff are there until about 8 p.m. or 9 p.m. to finish that care or arrange transfers. The triage categories attending are appropriate, so people seem to understand the nature of the urgent care centres. All in all, the transfer rates for admission or further care in the three hospitals are at approximately 4% to 5%, which is very appropriate.
Recruitment of emergency and radiology consultants is required in order to open seven days a week and to extend the opening hours. That is still ongoing. Recruitment in that area has continued to be difficult. Until the appropriate staff are in place, the opening hours cannot be extended but the intention and the desire is to extend them.
The committee has been doing substantial work on workforce planning, recruitment and retention of staff. If a satellite centre cannot be staffed, how will the hospital itself be staffed when it is commissioned? This committee can see significant difficulties in recruiting consultants. Dr. Curtis mentioned two specialties. It is a failure of the process that the centre cannot open from 9 a.m. to midnight, seven days a week, as planned. That is surely a significant disappointment.
Dr. Emma Curtis:
It is a considerable disappointment. It is a CHI responsibility. We are here on behalf of the NPHDB but I am a clinician in one of the hospitals and work closely with CHI. We have to acknowledge that there were a number of successful areas of recruitment in moving towards providing the services we are providing. There are particular areas of difficulty in recruitment, which have been discussed. On the ground, it is considered that the inequity in starting salaries for consultants compared to their colleagues who are doing the same job is a significant deterrent to people who are applying for consultant posts. There are a number of issues regarding consultant recruitment across the board in the country. There are areas where it has been successful and we have been able to progress to delivering a significant service in Connolly. It is an area that will need continued attention. With the opening of CHI at Tallaght and the opening of the major hospital, having the right staff in place would be essential.
We will do our very best. This is the first time that I have spoken with Mr. Gunning and these are not the questions I would like to ask him at his first time before the committee, so I apologise. I do not mean to question his suitability or skills at all and I hope that he does a phenomenal job. I did not realise until today that he had never built a hospital or any other building which, in and of itself, might be fine, and I hope it is. Has anyone on Mr. Gunning's teams who reports directly to him ever built a major hospital before?
I hope many of them have. I thank Mr. Gunning. I would like to ask about private patients. The Minister replied to a parliamentary question yesterday when I asked about taking private patients out of public hospitals. He said that other countries with strong public hospital systems do not tolerate the inefficiencies and perverse incentives that arise from having a stream of private patients. That is pretty unambiguous. The last time the committee discussed this, we found out that dedicated private facilities were being designed into the public children's hospital, which I think is perverse and should not happen. Since then, has the board had any instruction, since this has been debated in the Dáil and in committee? I do not think the public really knew that while on the one hand the Government was saying that it would take private facilities out, it was, on the other hand, designing them as part of the children's hospital and the maternity hospitals. Has the board had any instruction from the Government to not design in the private facilities?
Dr. Emma Curtis:
If I could comment on that, those rooms have been designed as generic consult-exam rooms and, without difficulty, can be assumed into the general outpatient capacity and deliver service publicly. From a construction and project viewpoint, it is a set of rooms that is no different to the other 122 public outpatient rooms. They are exactly the same in the way they are designed and built. Integration into the general outpatient service would be an operational matter.
My first question is a request for documentation to be supplied to the committee. Can we have all the NPHDB board minutes, unredacted and up to date, sent to the committee? On 3 April, the board met and the minutes state that a presentation was received by the finance and construction committee, from the design team, wherein it was reported that additional monetary risk had been identified on provisional funds. Can we get a copy of that presentation and any other related documents? If not, why not? The third question is about the minutes regarding the procurement subcommittee from 29 April and the executive summary of the cost report overview. Can we get that too? That is my first question about three sets of documents, and I have two other questions.
I respect commerciality, but there is always a nervousness about the scale of redaction when it extends to non-commercial legal issues and to sensitive issues that may apply in other areas. I have looked through all of the minutes and I can see a range of information is redacted way beyond what I would have expected. Will Mr. Barry have a fresh look at this, please, and supply them?
Mr. Fred Barry:
I will have to go back and look at the documents but, again, I have a suspicion that if we are dealing with commercial matters and commercial risk negotiations, and so on, the subject matter will probably be redacted. I will go back and personally review these documents and ensure that nothing has been redacted that has not been appropriately redacted.
The presentation was received from the design team when it was reported that additional monetary risk had been identified on provisional funds. Is Mr. Barry saying that presentation will not be in any way suppliable?
There is also the second document relating to the executive summary of cost report from the minutes on 29 April.
Regarding cost claims, Mr. Barry said earlier they amounted to €1 million, which is fine, and he said that accounted for approximately 50% of claims to date - he can correct me if I am wrong as I am just working from the notes I wrote down earlier. While I am not an engineer, I presume the smaller claims are easier to kill off or to settle more quickly, and that would be common sense, so that leaves 50%. Of those that have been settled, how much relates to Connolly Hospital?
I want to know the percentage of those that are settled that relate to Connolly and not to the main site at all. Will Mr. Barry tabulate this and come back to us with the number of claims to date? I understand he cannot give us the total cost of claims. However, he can give us the volume that has been settled and then tell us which site they relate to. Is that okay? None of that is commercially sensitive, so it is all fine.
Mr. Fred Barry:
There is nothing I said there that Mr. Barry cannot give me. This is reasonable. I am asking which site the claims were settled and when. I am not asking for who and all of that. That will show us, as a committee, sitting here on 27 November 2019, where they have been settled and how much is to do with the main site.
Mr. Fred Barry:
There is the main contractor but the various subcontractors are going to be stretched as well. We all know that Intel has got its new planning permission through, so this is just not a commentary about the stretch on the main contractor, BAM, as the other contractors are all going to be pressed.
I accept that. In some cases, some of these people might have been misrepresented in the past, but that is just a generic issue and I am not getting into anyone or any company specifically. Have any critical milestones been missed since Mr. Barry took up his position? If so, has he documented them and told his board, or any of the four layers, including the Department and the Minister, in any way, shape or form? Basically, since he took the role, have any milestones been missed and, if so, has he communicated them, when and where?
I want to ask about fire safety and fire resistance in respect of the site in general, knowing that lagged pipes are a great conduit for fire when it wants to move long distances quickly. Have adequate provisions been made in that regard? Has the city fire safety officer given his or her approval, and how did he or she rate the project? What is the position with the cladding? We have seen a number of incidents, particularly in the UK, were cladding was not fire resistant and, in fact, was an accelerant. To what degree have the witnesses learned from those experiences and put in place measures to address this?
Mr. Phelim Devine:
There is an existing fire certificate in place for the building and the building is fully sprinklered and has a high level of fire safety, well in excess of part B of the current building control regulations but also well in excess of the HBN, which is a particular UK design standard for hospitals. Related to that, we have an amending fire certificate in with the Dublin Fire Brigade at present. We got our original fire certificate in 2017, before the GMP was finalised, and there are slight tweaks and amendments, which is normal in a project of this scale. We are in the middle of a process with the Dublin Fire Brigade on that.
Regarding cladding, we are all aware of the tragic accident that happened in UK. At that point in time, we took a full review of the cladding we have on the hospital, and we changed certain elements of the installation behind the cladding. We anticipated there might be a change in regulations forthcoming, and while they have not happened as yet, we took measures to ensure that, when the building is built, we would have done a risk assessment in terms of what might change. We do not have any cladding on the hospital like that in the UK.
In the event of a fire starting in any particular part of the hospital, is Mr. Devine satisfied there is ready access for fire tenders and in regard to how to restrict or retard the fire as quickly as possible? Many things can contribute to the acceleration of a fire, which bring it totally outside of normal control. For example, is the cabling fire resistant? There is a series of issues on which I would like to have reassurance.
Mr. Phelim Devine:
To clarify, the design at the hospital is well in the excess of current standards across all of those issues, such as cabling and access for the fire brigade, and we have dedicated fire fighting lists for fire brigade access - I think we have eight within the hospital. We are well in excess of current standards.
With regard to what I should not call the out-of-control expenses because that gives the wrong view, but the expenses or claims that are outside of the immediate control of the board, what are they? The witnesses mentioned they are managing the ones that are within their control. I do not want the narrative to go out that there is some element that is out of control, which is not what is going on.
Mr. Fred Barry:
I did not mean to convey the impression that a lot of things are out of control because we are doing our very best to ensure that is not the case. The things I would see as being outside our control, and I do not want keep labouring this, include the question of inflation, legislative matters and regulatory changes.
If there are changes in medical practice that say we need to introduce a design change or an equipment change, we are going to be the recipients of that, and somebody else is going to decide whether money should be spent. These things are outside of our control.
In regard to the bloods in Connolly Hospital, what is the plan for the future in terms of all CHI's bloods? Will the bloods from this hospital be processed on-site in the new children's hospital? What is the long-term plan for Tallaght, Connolly and Temple Street hospitals in terms of lab work? I understand it is probably okay to take a taxi but it is probably not equitable or handy for people. I get that the results are online, but I do not think there is any substitute for having a lab in the same hospital that one can pop down to if one is in a panic for something.
Dr. Emma Curtis:
As I said, this is more of an operational CHI issue, but my understanding, as a clinician working in the hospital, is that the laboratory in Tallaght University Hospital currently processes children's bloods because there is a paediatric unit within the hospital. There is a very significant and complex lab design within the main hospital on the St. James's site, which will bring in all the generic and highly specialist national lab services that are currently in CHI Temple Street and Crumlin. In terms of the provision within the main build, there is a very significant lab development within the children's hospital on the site of St. James's and almost everything will be done there apart from some very sophisticated tests that will always be international. As I said, there is always the provision within point-of-care testing, which has become much more sophisticated than it would have been historically. If a child were to come to an urgent care centre and bloods were needed immediately, the facility for that is available.
There have been questions as to whether any of the witnesses have ever built a hospital. There would be very little point in having somebody on the board who built a hospital 50 years ago, because there has been such a change in the way we deliver healthcare. I would like to make the point that it is fairly irrelevant whether someone has built a hospital, because the hospital being built here is unlike anything that has been built before in this jurisdiction. Globally, it is to be the most advanced in the world, so I do not think the person exists who has done this before. All we can hope is that with Mr. Gunning and the rest of the witnesses we can apply all their experiences and learnings and deliver the best hospital possible that will not go on fire and that will deal with children in the best possible way.
I will finish on the following point. I was really uncomfortable with Crumlin hospital on Sunday night. Unfortunately I have been a regular enough visitor over the last ten years and, as it turned out, I had the least sick child in the place, but it is just not acceptable. This committee has to get the message out that it is unsustainable to have children in an accident and emergency department. I was into my eighth hour by the time I gave up. In terms of provision of health care, it is really not acceptable in a country like this to have that kind of scene. As a Deputy, I was embarrassed to be there and I was afraid someone might recognise me. I was trying to keep undercover. I wish the witnesses good luck with the project and I hope they make up the time that has been lost and that we deliver in 2022.
Mr. Fred Barry:
I thank Deputy O'Connell very much for that. Everybody on this side of the table is motivated by the fact that this is a much-needed children's hospital. We would not put up with all the grief that goes with the job if we did not see that the prize at the end was improved and needed facilities for our children.
This committee would be delighted to accept the witnesses' invitation to visit. There were a number of visits earlier this year. I would encourage another visit by the committee to look through that window and at other installations on the site. We will take up Mr. Barry's offer. Thank you very much.
On behalf of the committee, I would like to thank Mr. Gunning, Mr. Barry, Mr. Devine and Dr. Curtis for their evidence this morning. Undoubtedly, we will return to this issue for an update on the progress in a number of months.