Oireachtas Joint and Select Committees
Thursday, 22 May 2025
Public Accounts Committee
National Paediatric Hospital Development Board and Children's Health Ireland: Discussion
2:00 am
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I remind all those in attendance to ensure their mobile phones are in silent mode or switched off. The committee has elected Deputy McAuliffe as Leas-Chathaoirleach. I congratulate the Deputy and look forward to working closely with him over the course of our important work ahead.
I will explain some limitations to parliamentary privilege and the practice of the Houses as regards references witnesses may make to other persons in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant both to the Constitution and statute, by absolute privilege. This means that witnesses have an absolute defence against any defamation action for anything they say at the meeting. However, they are expected not to abuse this privilege and it is my duty as Cathaoirleach to ensure that this privilege is not abused. Therefore, if witnesses' statements are potentially defamatory regarding an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction. Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory regarding an identifiable person or entity, they will be directed to discontinue their. It is imperative that they comply with any such direction.
The Comptroller and Auditor General is a permanent witness to the committee. He is accompanied today by Ms Paula O'Connor, deputy director of audit at the Office of the Comptroller and Auditor General. This morning, we will engage with representatives from the National Paediatric Hospital Development Board to examine its financial statements from 2023. We are joined by the following representatives from the board: Mr. David Gunning, chief executive officer; Mr. Phelim Devine, project director; and Dr. Emma Curtis, medical director. We will also engage with representatives from Children's Health Ireland to examine its financial statements from 2023. We are joined by the following representatives from Children's Health Ireland: Ms Lucy Nugent, chief executive officer; Mr. John Fitzpatrick, interim chief financial officer; Ms Julia Lewis, transformation director; and Dr. Ike Okafor, clinical director.
We are also joined by the following officials from the Department of Health: Ms Tracey Conroy, assistant secretary, acute hospitals oversight and performance; and Mr. Derek Tierney, assistant secretary, health infrastructure. From the HSE we have Mr. Patrick Lynch, national director of planning and performance. All the witnesses are very welcome.
Before I call on the Comptroller and Auditor General for his opening statement, I would like to a make a comment regarding the briefing material provided for this meeting. Last October, the previous Committee of Public Accounts expressed disappointment and concern when a meeting with Children's Health Ireland, CHI, and the the National Paediatric Hospital Development Board, NPHDB, due to be held on 7 November could not proceed because the accountable persons for both organisations were unavailable. My welcome to them this morning is a belated one. In its invitations to both CHI and NPHDB to attend this meeting, the committee requested that briefing material be provided by end of business on Friday last, 16 May. Some documents were received on Friday but some briefing material was only provided late on Tuesday. Similarly, there was a request that opening statements be provided at least 48 hours before this morning's engagement. One of the statements arrived less than 24 hours before the meeting and the other arrived on Tuesday evening. It is the expectation of this committee that witnesses provide comprehensive briefing material and opening statements in good time in order that Members have time to analyse them before meetings. Not doing so is unacceptable and disrespectful to the committee. As we will hear this morning, deadlines are really important. As representatives of their organisations, I expect the witnesses know the importance of deadlines. This committee does not have a lax relationship with deadlines. I wanted to make that point.
I call the Comptroller and Auditor General to make his opening statement.
Mr. Seamus McCarthy:
As members are aware, the NPHDB is responsible for the planning, design, construction and fit-out of the new national children's hospital's facilities. In addition to the main hospital at the St. James's campus in Dublin, where construction is ongoing, two satellite paediatric outpatient and urgent care centres located at Tallaght and Connolly hospitals have been completed and are now functioning under the management of Children's Health Ireland. A number of parallel subprojects, outside the remit of the development board, will be required to integrate and transfer staff, equipment and services into the new facilities at St. James's to bring them into operation. These subprojects are being progressed by Children's Health Ireland, which will manage and deliver care in the new hospital and the satellite centres into the future.
I turn to the NPHDB's financial statements for 2023. The development board is funded by Oireachtas grants, provided via the Health Service Executive. In 2023, the grant funding provided amounted to €156 million. This matched the expenditure incurred by the board in 2023, meaning the financial statements record a break-even outcome. As outlined in note 2, total accumulated capital development costs incurred by the board to the end of 2023 amounted to €1.396 billion, inclusive of the costs of developing the satellite centres. This includes payments to the main contractor, BAM, as well as the board's own costs in respect of administration, project design, and project monitoring and oversight.
Note 12 to the financial statements discloses that the board has been notified of a very large number of additional payment claims by the main contractor. The note outlines the structures in place for the resolution of such claims, including determination by the employer's representative or a project board through a conciliation process and, ultimately, if required, in the courts.
In my report, I drew attention to note 13, which discloses that in May 2024, the standing conciliator issued a recommendation that the board pay €107.6 million, excluding VAT, to BAM in respect of a claim for critical delay events on the construction project over the period from December 2019 to February 2023. When VAT of 13.5% is added, this brings the recommended payment value to around €122 million. This is not included in the capitalised development costs of €1.396 billion. The development board considers that very little of this claim is valid and has appealed the conciliation recommendation to the High Court. In order to do so, it was required to pay BAM the full amount recommended. The funding to make the payment was provided from the Health Vote, via the HSE. If, in due course, it is found by the court that BAM is not entitled to some or all of the payment, the company will be required to repay that amount plus interest to the development board. The potential repayment is underpinned by a bond purchased by BAM.
Note 8 indicates that the value of the development capital spending commitments outstanding at the end of 2023 stood at €235.2 million. Combined with the development costs incurred to the reporting date, this indicates a projected overall development cost of a minimum of €1.63 billion. This exceeded the budget of €1.443 billion approved for the board in December 2018. Note 13 explains that in February 2024, the approved budget available to the board was increased to €1.88 billion.
The 2023 financial statements were certified by me on 17 December 2024. My opinion was qualified on the basis that in complying with the standard direction of the Minister for Health, the board's financial statements account for pensions only as they become payable. Otherwise, in my view, the financial statements present a true and fair view in accordance with Financial Reporting Standard 102.
Children's Health Ireland was established as a legal entity on 1 January 2019 through an amalgamation of the existing children's hospitals located at Crumlin, Temple Street and Tallaght. It operates as one of the section 38 agencies supported by grant funding from the HSE. CHI's financial statements for 2023 recognise income totalling just under €589 million. Recurrent and capital grant funding received amounted to €541 million. Retained staff superannuation contributions amounted to a further €18.4 million. Income from patient charges amounted to just under €14.4 million, and other income, including donations and fundraising, was €14.4 million.
Expenditure for 2023 totalled €580 million. This comprised €406 million spent on pay and pensions and €174 million on non-pay. After transfers of a net €16 million to capital reserves, the financial statements indicate there was a deficit for the year of €7.8 million.
The 2023 financial statements were certified by me on 1 November 2024. As with the development board, the financial statements were qualified on the basis that in complying with the direction of the Minister for Health, Children's Health Ireland accounts for pensions only as they become payable.
Separately, the audit report draws attention to non-compliant procurement undertaken by CHI, losses incurred due to out-of-time claims for payment being rejected by health insurers and that CHI made a formal settlement with its former chief executive officer.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Mr. McCarthy. As set out in the letter of invitation, I ask Mr. Gunning to make his opening address, for which he has five minutes.
Mr. David Gunning:
I thank the Cathaoirleach and Deputies for inviting the NPHDB to discuss our 2023 audited accounts. I am the development board's chief officer. I am accompanied by Phelim Devine, project director, and Emma Curtis, medical director of NPHDB and a paediatric consultant at Tallaght. The NPHDB was established by statutory instrument in 2007 with the purpose to design, build, equip and furnish the children's hospital.
In November 2021, the Government strengthened the governance structures for the project. This led to the appointment of the HSE lead director and the creation of a national oversight group, which is chaired by the Secretary General of the Department of Health. The function of this group is to oversee, monitor and support the project’s progress regarding timeline, scope and budget, and provide an effective and consistent challenge to the programme implementation.
In February 2024, the Government approved an increase in the capital budget to €1.88 billion. The increase addressed long-standing budget requirements that were not included in the original 2018 budget, including construction inflation above 4%. Like other areas of the construction sector, the project costs have been affected by external pressures, including the impact on supply chains as a result of the pandemic and global events such as the war in Ukraine and Brexit.
In addition, the approved increase in the budget addressed areas identified in the 2019 PwC report. That report found that the children’s hospital was unique in scope, scale and complexity in comparison to any other health infrastructure project in Ireland's history. The authors were explicit in stating that the project's complexity should not be understated. The 2019 PwC report also noted a number of risks that had the potential to place further cost pressure on the approved capital budget. These included the contractor entitlements; an outturn of provisional sums, which were items for which there could be no cost certainty until their procurement closer to the end of the project; recovery of construction inflation above 4%; and the need for additional capacity and capability in the NPHDB executive team. All of the recommendations from that report have been implemented in full.
The NPHDB’s 2023 accounts have been audited and approved by the Comptroller and Auditor General. Expenditure for that year was €156 million, as Mr. McCarthy mentioned, including accruals and VAT. The audit for 2024 is continuing. There is a table in the slide with the key areas; I do not propose to go through it.
On claims management and legal proceedings, claims are a part of all major construction projects. When the contractor submits legitimate claims, they are paid. The NPHDB, acting on behalf of the State, vigorously defends any claims it believes to be without merit or inflated. The contractor - BAM - continues to submit a high volume of claims. However, based on the outcomes from the dispute resolution process, which includes adjudication, conciliation and determinations made by the employer’s representative, the net increase to the overall contract value to date is approximately €50.5 million, excluding inflation. This represents less than 6% of the original contract value of €910 million. The information pack provided in advance included an overview of the claims process, a summary table of the most recent claims and details of the five sets of current High Court proceedings.
Regarding a project update, the centres in Tallaght and Connolly hospitals, which opened in 2021 and 2019, respectively, were handed over to Children’s Health Ireland and are fully operational. We have provided the images and the documents where members have seen the final stages of the construction approaching at the new children's hospital. In addition, the Ronald McDonald House family accommodation unit at the main entrance to the children's hospital is being progressed by Clancy Construction. It is approximately 75% complete as of now, with a scheduled completion in quarter 3 of this year. Work is ongoing on fit-out, including 52 family rooms, communal kitchens and dining and support areas. Mechanical and electrical work is progressing well and power-on is scheduled very soon.
While the NCH is reaching the final construction phase, progress has not been made at the expected pace. Most internal and external areas have been brought to an initial stage of completion. As per the contract, these areas must undergo a four-stage inspection and sign-off process, and the stages are set out in the statement. Stages 1 and 2 are approximately 80% complete and stage 3 is expected to begin shortly. Technical commissioning, which concerns the hospital’s mechanical and electrical systems, is also under way and is approximately 70% complete. It will continue until the substantial completion.
As far as equipping is concerned, advanced specialist medical and non-medical equipment, including MRIs, scanners, X-ray machines, dental suites and so on, have been installed and final commissioning is currently in progress. The construction of the hospital’s helipad is complete. It now needs to be commissioned, and following test flights, we would sincerely look forward to the licensing being completed by the Irish Aviation Authority. The NPHDB has appointed ClearSphere to carry out four specialist fit-outs within the hospital. These are scheduled for completion very soon.
On the timeline, when we appeared before the Oireachtas Committee on Health in September 2024, BAM had committed to a completion date of June 2025. In the past seven months, BAM has achieved approximately 60% of its planned progress as set out in that programme. We hold BAM to account across several KPIs, and all of these are currently indicated as being behind schedule. On 6 May, BAM indicated to the employer’s representative that it had extended the programme's substantial completion date to 30 September. Accordingly, the employer’s representative has formally requested that BAM submit a detailed programme setting out its actions and reasons for delay.
This further delay is a cause of great frustration. While we acknowledge that progress is happening, the pace at which it is happening is insufficient to meet the 30 June deadline that BAM committed to. At a meeting in early October 2024 with the former Minister for Health, BAM committed to permit early access three months prior to substantial completion. Early access for CHI has not yet commenced, as the areas identified for early access have not yet been completed to the standard required by the contract. We have been engaging intensively with BAM and CHI to enable this early access as soon as possible.
The NPHDB continues to utilise all levers in the contract to compel BAM to conclude its work and fulfil its contractual responsibilities. The NPHDB is focused on ensuring that the quality of every room, clinical space, operating theatre, play area and so on meets the quality standard that is required by the contract. Any rooms or spaces that do not meet that required standard will be rejected.
In conclusion, I assure the committee that the NPHDB is working with our colleagues in CHI, the Department of Health and the HSE and with the contractor to bring this world-class hospital to completion as soon as possible. We understand and share the concern that it has not been completed. Once completed and operational, however, this hospital will be transformational.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Mr. Gunning and now call Ms Nugent. As outlined in the letter of invitation, she has five minutes to make her opening statement.
Ms Lucy Nugent:
I thank the Chair, and good morning. I thank the committee for the opportunity to address it today about CHI’s financial statements for 2023 and to give members an update on service delivery across our children’s hospitals as well as an update on the commissioning programme for the new children’s hospital, which includes an extensive integration and transformation programme. I note the committee has also referenced other areas it would like to discuss and I hope our correspondence submitted was of use.
I am the recently appointed chief executive of CHI. I am joined by my colleagues: Mr. John Fitzpatrick, interim chief financial officer; Ms Julia Lewis, CHI’s transformation director, who is charged with leading CHI’s efforts to be ready and able to move into and open the new children’s hospital; and Dr. Ike Okafor, one of our three clinical directors who manage the 39 specialties across our services. I regret that CHI was not in a position to accept the invitation to attend the previous meeting of the Committee of Public Accounts but we welcome the opportunity to appear before members today. I will endeavour to answer all of their questions to the best of my ability.
I assumed the position of chief executive four months ago. Having started my career as a nurse in what was formerly Temple Street Children’s University Hospital, I am conscious of both the privilege and responsibility I have as CEO to ensure that we at CHI provide the highest quality care to the children who come to us when they are at their sickest.
Last year, CHI treated more than 148,000 children who attended our emergency departments. Almost 29,000 children underwent day case procedures, more than 17,000 children underwent theatre procedures and almost 29,000 children and young people had an inpatient stay with us. Specialised care was delivered to these children despite being in old and not-for-purpose buildings. We continue to lead on paediatric research and innovation on an international stage because we strongly believe our children and young people deserve the best that medicine and science can offer.
I am very proud to lead our almost 5,000 staff, who work at the front line of paediatric care provision across our four sites in CHI at Temple Street, Crumlin and Tallaght, and at our urgent care centre at Connolly Hospital.
We are a place of excellence in paediatric healthcare and we have dedicated and diligent staff – a message that is sometimes lost and especially in the current climate. We want every child, patient and family who meet us to feel safe and cared for. Acknowledging when things go wrong in healthcare is essential for building trust, learning and ultimately improving patient safety and outcomes. We are committed to transparency and openness with the children, young people and families we care for. In that regard, I acknowledge the children and families who were impacted by the events highlighted in the recent HIQA report. What happened should not have happened and children should have been protected from harm. We are deeply and unreservedly sorry to those families. CHI fully accepts the recommendations of the HIQA report and we will publish updates to our resulting quality improvement plan on our website to ensure transparency and openness around improvements to services.
I also acknowledge those families impacted by other issues related to the orthopaedic service, specifically where reports are awaited. I know families are anxiously awaiting the publication of these reports. The committee will appreciate that the most important people with regard to this audit are the families involved and they will be communicated with in the first instance.
Since being appointed to my role, I have prioritised the delivery of safe and excellent care, fostering an open and supportive culture for children, families and staff and strengthening all aspects of our governance. The events I referenced have broken trust with our families, staff and stakeholders. I am committed to rebuilding that trust and leading a wonderful team of people across CHI.
The financial statements before the committee have been audited by the Office of the Comptroller and Auditor General for the year ended 2023. The committee will note CHI returned a deficit of €7.8 million for 2023. This compared with a deficit of €0.9 million in 2022. The increase reflects the net impact of the incremental cost of provision of services as offset by increased funding received from the HSE by CHI. The cumulative deficit at 31 December 2023 amounted to €18 million. This includes the €7.8 million deficit for 2023, just referred to, and a substantial element of the balance relates to legacy deficits incurred prior to the establishment of CHI.
In relation to governance and risk management, we have a detailed governance statement provided as per the requirements of the code of practice for State bodies. We also draw the committee's attention to the statement on internal control in which CHI confirms it has undertaken an annual review of internal control and makes specific disclosures regarding procurement non-compliance and rejected insurance claims.
As the client for the new children’s hospital, I welcome the opportunity to provide this committee with an update from CHI’s perspective about this wonderful and exciting project. Together with the NPHDB, we are focused on doing all that we can to ensure the hospital opens as soon as possible and is operational to international standards. In line with Sláintecare principles, the national model of care for paediatric healthcare services will ensure a child is treated as close to home as possible. This will put the new hospital at the epicentre of a network of care, in collaborative partnership with our colleagues in regional centres, to deliver comprehensive paediatric care for Ireland’s children and young people.
The new hospital will also support an all island of Ireland approach to the delivery of paediatric care, building on the success of the all-island congenital heart disease network, and will stand with our two satellite centres at Tallaght and Connolly hospitals, ensuring children receive the right care, in the right place, at the right time. However, a building does not provide care - people do - and we must ensure our staff are fully prepared and supported through this process. Delivery of this project of exceptional transformation, digitalisation, integration and change is the largest in the history of the Irish healthcare system. I am committed to ensuring that CHI delivers a return on this investment by the state with our vision of healthier children and young people throughout Ireland underpinned by living our values to be “child-centred, compassionate, progressive and we will act with respect, excellence and integrity”.
All of this activity will take place while 36,000 pieces of equipment are placed, installed and commissioned in 6,000 rooms and spaces while we continue to deliver essential services for children and young people on existing sites. It is a complex operation requiring meticulous planning, which is well advanced.
In finishing, our primary focus in CHI is, at all times, to deliver timely access to quality, safe care to children and young people. The journey to the new hospital is a once-in-a-generation change, and we are working hard to make sure everything is safe, ready, and right for patients, families, and staff so that we can maximise the impact that this wonderful new hospital will have on those we care for.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Ms Nugent for her opening statement. Before I move to members, whose time I know is precious, I want to try to establish some facts for the record which may help their work in the limited time they have to extract specific data. To hear the further delays and that BAM has only achieved 60% of its targets over the last seven months is bitterly disappointing. How many times has the substantial completion date has shifted? I have lost count as to whether it is 12, 13, 14 or 15 times. For the record, how many times has the date shifted now?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
The substantive completion date is now set for 30 September.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Mr. Gunning for that. How confident is he that the new date, 15 September, will be met this time?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
It is too early to express confidence.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
-----whether the board is confident that date will be met.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
What are the best-case and worst-case timeframes for the commissioning process? If the 30 September date were to be met, what is the best case?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Therefore, the best-case scenario is that the first patients would be seen in June 2026. How many outstanding contractor claims are there currently?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Mr. Gunning. I will now hand over to the members. The lead speaker is Deputy Neville who has 15 minutes. All other members will have ten minutes to put their questions and get responses from our witnesses. I will allow members back in for a second round if time permits and at 12 noon we will take a short break.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
I am a newly elected TD. I went through two elections last year and one of the key issues that kept coming up on the doors was the children’s hospital. I ask the questions today not just for me as a TD but on behalf of the public who elected me and, I suppose, the Government as well.
I was an auditor in PriceWaterhouseCooper and this brings me back to those days. I have the opportunity to ask the questions and I look forward to doing so. We all know the cliché that auditors are watchdogs, not bloodhounds, so I hope my questions will be received with that in mind. I will ask direct questions and I would like if I could get direct answers, where possible. Based on the answers to the Chair's questions, I know that will be the witnesses’ plan.
Does the board have faith in BAM at the moment?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Does it trust the timelines BAM has put in place?
Mr. David Gunning:
This is our 15th new timeline. As I have already commented, we have not yet had the opportunity to forensically review the programme that was provided last night. We will take some time to do that but at the moment, on yesterday's programme, I cannot say exactly what the position is.
Our team has not had the opportunity to interrogate this.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I caution members to be careful in naming BAM because it is not here to defend itself.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
It will be referred to as the primary contractor. When does Mr. Gunning expect the hospital to be kitted out with medical equipment?
Mr. David Gunning:
As outlined in the opening statement, there is a considerable amount of medical equipment that was already in the hospital. All the diagnostic equipment and all the other items are already in there, as listed. Then there is a phase between. The early access that is referred to in the opening statement allows both NPHDB and CHI to get access in advance of substantial completion. The purpose of early access is to allow us to, shall we say, de-risk or move forward with some of the aspects of hospital fit-out in advance of substantial completion.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
That is what I was going to say. I was going to link it in with the tied question I had on the phased early access. Would that essentially be before the building is complete? Before you get the keys, we will say. Mr. Gunning would expect to get the keys in September under the current timeline, notwithstanding what has to be gone through ahead of that? There would be early access before then.
Mr. David Gunning:
I will ask Mr. Devine to deal with the detail on that but I can give the Deputy one sentence which is that early access is in advance of substantial completion. As I am sure the Deputy is well aware, once a contractor takes over a site like that, it is theirs. Therefore, allowing us or anybody else onto it is what they call privileged or early access, which is what we have negotiated with BAM. There was an element of early access in the contract that was signed back in August 2017. We are now looking at a slightly larger - 30% of the floor area - early access, which will allow a meaningful opportunity for CHI to get into those particular areas.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Will there be technical commissioning for machines as part of that?
Mr. Phelim Devine:
Yes, there will. On early access, what we have scoped out with BAM is about 30% of the building that we get about three months prior to substantial completion. That gives us the ability to install and commission circa 25,000 pieces of the equipment in the building at a maximum. They will be put in place working with our vendors and then commissioned in place and connected. That helps de-risk then the operational commission period that follows.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Does that mean Ms Nugent's staff will then have access to go through, use the machines to get used to them and familiarise themselves with them.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
This is during that early access phase.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
I think in the note we received yesterday €853 million was the figure given for claims, and €793 million was listed for the end of 2023. It is obviously increased by €60 million, but it is roughly static because it was €700 million in the 2022 accounts. That number has sat there. It obviously relates to BAM. It is a number the witnesses do not believe has credibility judging by the fact that they have not accrued in the accounts on any of basis of that €800 million.
Mr. David Gunning:
Correct. The public work contract is the contract we are using on this project. It is the contract approved by the Department of public expenditure and it is what is used on the vast majority of public works in Ireland. It has stages in it in terms of disputes and claims and how these are managed. If the contractor feels there is a delay event or a compensation event, they fill out a claim under clause 10.3 of the contract and that claim has to be processed. There are a number of stages where the claim can be either validated and agreed to or moved on to another stage. I am not going to go through it now. From that initial stage, it is presented to the employer's representative, who is the impartial independent reviewer of these things. So far, she has identified that BAM is entitled to 6% of what it is claiming as its entitlements.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
That is where the number of roughly €50 million-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Theoretically, there is another €55 million that could potentially have accrued in the accounts.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
The €50 million is in the accounts.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Another item raised by the C and AG was the €107 million listed on page 30 of the financial statements. Just to clarify, none of that has accrued yet. It has been paid to BAM and, obviously, there is a bond in place.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
At the same time, however, it has been felt, more so than the rest of the claims, that there is a reason. What is the difference between the €800 million and the €107 million? The €107 million had to have been paid. Why is that sitting separate from the €800 million and recognised in two completely different parts of the financial statements?
Mr. David Gunning:
Back to the four-stage process, stage 1 is the employer's representative determination. Then it goes to what is called a project board that may or may not agree what has happened. Then it goes to conciliation. In the case of the €107.6 million, the standing conciliator, who is another engineer appointed for the entirety of the project, has reviewed BAM's claim and he has made a recommendation that this claim should be paid to the value of €107 million. In relation to that, the development board has issued, again under the contract, a notice of dissatisfaction that has the effect of negating, if you like, the recommendation. However, under the contract, if the contractor does two things, we are required to make the payment, but it is a bonded payment. The contractor has to initiate court proceedings which it has done in this case regarding this critical delay conciliation and it must also raise a bond. There is a bond with Zurich, the large financial institution, regarding that €107 million that we hold.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Obviously that supersedes the €50 million. It would be double the number, but that would be similarly related.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
-----but the NPHDB has had to pay double that amount.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
A third party has ordered it to be paid.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
The initial cost of the project was €800 million. That rose to €1.2 billion, the €1,74 billion and now stands at €2.24 billion. What is the key driver of that increase on the NPHDB's side? The contractor indicated that it relates to design change. Does Mr. Gunning agree?
Mr. David Gunning:
I agree that that is what the contractor maintains. I absolutely refute and rebut that. Just to be clear on the numbers, the contract value is €910 million. We have agreed that, as I have indicated, there is an additional €50.5 million that currently is crystalised in relation to that, so that can be added. That is the current liability on the project. Regarding the escalation, the vast amount of any increase is due to extension of time and the fact that the timeline has gone on. When the contract was signed to complete to project or, more specifically, when the phase B instruction was issued instructing the contractor to proceed with phase B in January of 2019, the project was to take 46 months to complete. It should have completed in August 2022. That was the time. We are now a considerable number of months beyond that and that has to be paid for. In the development board's case, we have to pay for our design team and the development board which is in the order of €2 million per month. This continues to increase the costs relating to the project.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Mr. Gunning is saying the escalating costs are tied in with the escalating time. What contractual levers are in place for the NPHDB to manage BAM's performance?
Mr. David Gunning:
There are three levers in the contract.
At one end, we have the right to terminate on a basis of certain situations arising. That is the extreme end. At the other end, we can reduce BAM's payments by 15% in the event it does not provide us with a programme. We have done that numerous times throughout the course of the project. When BAM then submits a programme, all of that money gets repaid. The only other option is the application of liquidated damages. That is extreme.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
If those opportunities are not available to us, from Mr. Gunning's own perspective, does he feel the full resources are on the contractor's side to enable it to do the work? Is it his view, from a project perspective, that that is the case?
Mr. Phelim Devine:
No, we do not believe that. We have said to the contractor and in this forum on multiple occasions that we think there are insufficient resources and supervision on the site. If the contractor is only making 60% of its planned programme, obviously there are not enough resources. There should be enough resources there to make 100% of its committed programme and it has not done that. In the 18 months the contractors have been on the project, I would say they have hit their committed or planned progress fewer than ten times. There have never been sufficient resources on the programme, in our opinion.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Jumping across to CHI, is the previous CEO still in the employment of CHI?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
How is that so? Was that person in a contracted position?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Even then, is there not a protocol in place whereby CHI would not enter into confidentiality agreements with CEOs?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
No, but we are discussing having confidentiality agreements in place. There would be a protocol against something like that, surely.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Okay. Were legal costs incurred in that regard?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
This is taxpayers' money at the same time and there is a free legal avenue as well. Does Ms Nugent know if the free legal avenue was explored or whether costs were incurred to the State?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
To clarify, the Code of Practice for the Governance of State Bodies states that a body "should not enter into confidentiality agreements which preclude it from disclosing details." A protocol is in place. It is contained in section 8.4, entitled "Oversight Agreements".
From the other perspective, given the issues we have had from the children's perspectives and the letters that were sent out, notwithstanding the impact it will have, when does Ms Nugent believe she will have the information from the report? When will we have sight of that?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Notwithstanding the difficulties with the families and everything else to be gone through, has Ms Nugent looked at the implications across all spectrums and, as this is the public accounts committee, from a financial perspective as well?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank the Deputy. I hope we will have an opportunity for a second round of questions from members. We move to our second speaker, Deputy Bennett.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
I thank everybody for coming today. Regarding the children's hospital, the public is completely outraged at what seems to be a ballooning budget all the time with no end in sight. I am trying to get a handle on the scale of the mismanagement. The National Paediatric Hospital Development Board was established in 2007 and in 2009, the then Taoiseach, Brian Cowen, announced that the children's hospital would open in late 2014. In 2015, a report was commissioned by the board and indicated at that stage that the hospital would cost €650 million. Is that all correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That is what was stated at the time, going back through the-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That is what was stated at the time. In the 18 years since the board was established, as Mr. Gunning stated today, there have been 15 completion dates and the most recent cost estimate was €2.24 billion. From my calculations, we are now being told that the hospital will open in June 2026. BAM has been the contractors and claims and disputes have cost €853 million. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
When we go back, we can blame BAM for everything but I want to know who bears the responsibility for this and who gave this build-as-you-go contract that has left us in this situation. Was it the witnesses, the board or the Minister?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
A contract was signed for a blank cheque, therefore.
Mr. David Gunning:
No, there were no blank cheques. Where we are as of right now is that when that initial budget of €1.433 billion for the NPHDB component was approved - this is all set out in that PwC report - certain areas were not included within that sum. To pick out one example, I do not think people anticipated at the time that there would ever be Brexit, a war in Ukraine or the level of construction inflation we have experienced. The contractor agreed to pay for the first 4% of any inflation and to absorb that cost and the figure above 4% was the State's cost. The construction inflation we have had to pay to the contractor over and above what was agreed has cost the State roughly €50 million over the period until the middle of 2022. Inflation is one element-----
Mr. David Gunning:
----- and there are other elements of cost increases. I mentioned in the opening statement the provisional sums, for example. They have also been affected by inflation, which has increased costs. For example, we are just finishing the helipad. There was an allocation for that but the outturn cost will be significantly higher.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Was that in addition to the first plans that went to-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Should that not have been budgeted for in the initial cost?
Mr. David Gunning:
It is provisional because they are not in a position to put in the absolute detailed amount for it. That is what provisional costs are. I think that if they had been able to put it in, they would have done that. That is something that would have been built much later, however, and therefore it is very difficult to provide a full and complete cost for. I would say it would be impossible to provide that in the current inflationary environment.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
It is a build-as-you-go contract being handed out by the board and the Minister. To go back to my question, was it Mr. Gunning, the board or the Minister who decided to go with this build-as-you-go contract that has a blank cheque?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
I just want a name. I just want to know who is to blame.
Mr. David Gunning:
A process was engaged in by the various parties, namely, the development board and representatives from Government procurement of different kinds, such as the Office of Government Procurement for the Government contracts, that decided to proceed. Again, this is based on a standard contract the State uses in all of these public works.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
I will ask the question again. Was it the Minister who signed that contract?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
To reiterate, there was gross incompetence in respect of that and what has happened in the years following that. Does Mr. Gunning agree that there has been incompetence in this having gone this far? The people are very angry.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Who is the board directing that anger at? It is at BAM? Does the board not blame itself in any way?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That is okay. It is the State's approach.
I want to keep that in mind as I go on to my next point. In 2017, the then Minister for Health, Deputy Simon Harris, gave a commitment that no child would wait for the treatment of scoliosis for longer than four months by the end of the year. How many children are currently waiting for longer than four months? At what point will that commitment be met?
Ms Lucy Nugent:
I understand that as of last week, 56 children had been waiting for four months. That is 56 children too many. I appreciate that. Much work and focus has been on reducing our spinal waiting times. Our waiting times for our outpatients are down by 40%. As for our waiting list, while we have had an increase in additions of 12.5% overall, it is down 8%. The activity itself has increased. There are children behind every single percentage.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That commitment was never reached. It was not reached in four months and still has not been reached at this time. Those non-medical grade springs were placed in the bodies of children with scoliosis who were under CHI's care. One line that stood out to me in the HIQA report was that children were not protected from the risk of harm. Does Ms Nugent accept this has been the case?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Does Ms Nugent accept that Children's Health Ireland has failed abysmally to keep children safe under its care?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
In a separate and distinct review, the Nayagam report was also commissioned regarding clinical outcomes for patients who had spinal surgeries. That is because there were high rates of return to surgery and infections. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
I believe that report was completed in September 2023. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
It is still not complete. Is there an interim report that was supposed to be produced?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
CHI still has not got that and that has been going on since September.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Is the consultant who was in that report still practising?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
He is on leave; not suspended then.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Another issue I have relates to the 2,200 families that recently received letters from CHI about the unnecessary hip dysplasia surgery. Parents are coming to me, saying that they have received these letters. Why were these letters sent out?
Ms Lucy Nugent:
The letters were to advise the families of the audit. One of the early recommendations from the audit was that children should be followed up to skeletal maturity, which is when their bones fuse. The auditor found that this was not a consistent practice. It is a newer international practice guideline so we felt it appropriate not to wait until we got the final report but to advise the parents of that, and that we would be following up with them. The follow-up with those children to skeletal maturity is in process.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Is Ms Nugent saying that any parent can come back to CHI for a review?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
CHI's former CEO had legal bills. Did they go through the civil and public mediation service?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
It cannot be confidential. Ms Nugent is working for a State body.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Will I bring that to the Minister, maybe?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
I thank Ms Nugent for answering my questions.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
I thank all our witnesses for being here today and for the work they are engaged in. When completed, the children's hospital will be an important part of the health service, although I share the frustration of many other members. I want to focus on the accounts of Children's Health Ireland and, in particular, the references that the Comptroller and Auditor General made. Let us start with the issue of the settlement of the former CEO. How did a situation arise where a settlement was required?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
It was not possible for a reappointment to be made. In that case, the board had to consider the question of whether to try to retain that person in another role and whether any sort of severance or redundancy was due. Is that essentially the challenge that was put forward?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
The decision of the board to appoint a CEO or a replacement CEO is not confidential, however.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Ms Nugent said the Minister directed that a third term would not be approved. I accept that and will come back to that. Did the board consider whether any settlement had to be made as a result of that decision?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
I disagree. The confidential process was the settlement that CHI made. I will come back to that in a second. The decision of whether CHI should or should not make a payment was a decision of the board.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Did the matter come before the board?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Given that it is an item referenced in the Comptroller and Auditor General's reports, is that not something Ms Nugent would have expected to have been asked here today?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
I can understand Ms Nugent's argument that she is not at liberty to discuss the details of the settlement with the person. That is not the same as the reasoning as to why the appointment had to be made or a settlement had to be made.
Ms Lucy Nugent:
The board felt that it was a critical time for CHI and it was important to retain the institutional knowledge and experience of the previous CEO. She was appointed to the role of strategic programme director. Some of the roles encompass building on the all-island of Ireland network, which is important. We recently signed a service level agreement with Northern Ireland regarding managing young people with chronic pain. She is also looking at the benefits of co-location.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
That was an attempt to retain her and her knowledge in the organisation. That is essentially what Ms Nugent is saying. Ms Nugent had to get sanction from the Department for this. Is that correct?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Is there anybody from the Department who wishes to comment on that?
Ms Tracey Conroy:
Just as Ms Nugent has outlined, in general, CEOs, including hospital group CEOs, are appointed for one five-year fixed-term contract. In exceptional circumstances, a case can be made to the parent Department for the reappointment for a second, final, fixed-term contract, up to a maximum of ten years. The previous Minister was very cognisant of the guidelines for the appointment of CEOs to non-commercial State bodies and so did not consent to the appointment of the CEO for a third time.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Would it be reasonable-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Would it be reasonable for the public to accept that a fixed-term contract is for that purpose, a fixed term, and the organisation should not be exposed to any liability as a result of it coming to an end? I am at a loss about why there was a need to enter into any sort of discussions at the end of a fixed-term period if the board itself was deciding not to renew the contract.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
As a result, the board did not renew the contract.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
If it was a fixed-term contract, why did the liability result?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Exactly. My question is why the liability arose.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Surely the Department, in signing off a severance package, would have had to consider why a liability arose as a result of a fixed-term contract.
I am saying that as a general point. Our job is only to investigate why public money is being spent. I am asking a very basic question. Why did we decide to spend public money on this? I think the answer should be “The rationale is X, Y and Z”. It is not a complicated question.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
My question is why did a severance-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
I am sorry. Why did a settlement arise? That is the question. Why was there a need to pay an additional payment - a settlement, as the C and AG points out? Why was a settlement paid at the conclusion of a fixed-term contract? It is a reasonable question.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
I have limited time. I am very unhappy we do not have an answer to that.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
It is a very reasonable question.
Turning to the failure to secure €250,000 from private insurers as a result of late payments, does Ms Nugent have a response to that?
Ms Lucy Nugent:
Yes, indeed. We were 98.5% compliant with our private health insurance claims, but €250,000 is a significant amount of money, which I fully accept. The invoices were raised in a timely fashion. However, we are reliant on a fully collated submission to go into the private health insurers. There was a delay in some of the third parties providing that information. That is across the continuum of care of the patients' episodes, so it would include laboratories, diagnostics and additional consultations. That arose. I am pleased to say that, in 2024, we were able to recoup €400,000 of rejected claims. It is an area of focus for my colleague in the finance department.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Is it likely that any of this €250,000 might be recouped in a future year?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Which office has responsibility overall for this claim process?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
The CEO referenced third parties. Third parties are necessarily part of that process - I understand that - but the responsibility to claim the amounts falls with CHI. Why did that not take place?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
They were issued to the insurers.
Mr. John Fitzpatrick:
No, not to the insurer. I mean once they were processed. The insurer will only accept them as part of what we call a fully collated claim. That is where we have the invoices from all the third parties. We actively engage with those third parties. We hold biweekly meetings with them. We also hold internal meetings. We are driving to ensure there is an improvement in structures to mitigate issues, but we are ultimately reliant on those invoices being submitted from the third parties in the same timeframe as our own to ensure that the-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Was it the case that some documents were missing from third parties and others were available?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Some €250,0000 is a very substantial amount of money. We have all returned things late, but it is a whopping waste of public money.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
There must be a process for following up with the third parties.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
There must be penalties for third parties not complying with that. There has to be a better process than losing €250,000.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Is Mr. Fitzpatrick saying that there is no sanction or ability to compel? CHI is entirely dependent on the third party and, therefore, it is likely to arise again.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Ultimately, if they fail to provide the documentation-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
And the State loses money.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
That is not acceptable. It is not acceptable that a State body with responsibility for controlling public money would be entirely reliant on third parties not accountable to this body. There has to be a better system put in place for that. That is a question.
Mr. John Fitzpatrick:
The rule for the submission is that the insurer will only accept the claim if all the documentation is included with it. That is outside our immediate control. We can seek to influence it. What we do is try to work with the third parties and the billing providers to ensure that claims are submitted in a timely manner. We have made improvements and put controls in place in that regard.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
There is one other issue I wish to raise. I will allow my colleagues to take up that point because I think a number of them will want to. Regarding-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Sorry, Chair. I thought you would give me a notice.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Sorry. I will give the Deputy flexibility.
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Apologies. I will be very brief. Regarding the orthopaedic operations that were discussed, what legal provisions are being put in place for potential claims? What costs has CHI incurred as a result of carrying out the review? Is the cost with any third parties, consultancy firms and so on?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
What does Ms Nugent expect it to be?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
Is the auditor operating within a budget?
Paul McAuliffe (Dublin North-West, Fianna Fail)
Link to this: Individually | In context
What is the agreed budget?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I thank the witnesses for attending. Returning to the children’s hospital and the big picture items, the Government approved in February 2024 the budget of €1.88 billion. Is it fair to say that budget will not be sufficient to complete the hospital?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Is that a high degree of confidence?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
The opening statement referenced the original contract value, which was of the order of €910 million.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
It is a doubling of that original contract value.
Mr. David Gunning:
The contract value is the contract with BAM - that is the €910 million. Then, in addition, there is the cost of the design team, the development board's costs and all the advisers and various other costs that come into this. I commented earlier about the project going on for three years longer than anticipated. Our costs on a monthly basis are approximately €2 million. Every month that goes by is an additional €2 million on the project costs for the development board and the design team.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Mr. Gunning is making a distinction between the contract with the contractor and additional items.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Where is the value of the contract with the contractor right now?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
That went through the resolution process.
Mr. David Gunning:
-----through the first stage of that process. There are 2,200 claims currently at various places in dispute. We cannot give certainty on those but we are fighting every one of those. There have also been payments of inflation, which I mentioned, of €50 million on top of that, which has been paid under the contract to the contractor. The last payment of that was made in or around the end of 2022.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Regarding the contract with the contractor, the opening statement referenced a 6% variance. Is that correct?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
What is the value of the inflation?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Okay. Returning to the €1.88 billion, what was the original estimated figure of the combined costs?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
And Mr. Gunning is confident we will come in at that.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Is that the total cost? Is that fit-out, equipment-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
To make the hospital-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Into a fully operational hospital.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Can anyone estimate where we are in terms of the total cost of making it a fully operational hospital at this point in time? Do you have your own-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Are you confident on the €1.88 billion, which is your side of the house, in terms of fully operational equipment and fit-out?
Mr. John Fitzpatrick:
The €362 million comprises various workstreams. There are 14 workstreams covering integration, EHR and the ICT programme to deliver on a digital hospital. At the end of 2023, €208 million of that was unspent, against 2024, when €156 million of that was unspent. We continuously have to review those workstreams and the profile of them. If you asked me a week ago was there sufficient funding to see the project through to completion, I would have said "Yes." If there are new dates now, we have to review, revalidate and extend out the programmes again. We have curtailed some of those workstreams to pause them, as delays have arisen, to ensure then that the costs are incurred and can be deferred out further.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
The combined cost of the project will land somewhere between €2.2 billion and €2.3 billion. Is that a fair estimate?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Are you confident, on your side, about the figures?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I will go back to the claims. In terms of a progress report on the claims, it was mentioned that more than 2,000 were outstanding. What level of progress is there as regards resolved versus unresolved? Will you give us a snapshot of where we are with that? Of the claims that were lodged by the contractor, how many have been resolved versus those that have not?
Mr. David Gunning:
It is safe to say that the resolved claims are included in that €50 million of additional cost. On the claims that have gone on to the second, third and fourth phases of the disputes process, all remain unresolved. That is 2,200 or so individual claims. I will give one sentence on the claims. It will give a sense of the question I am sure committee members will have - "Where is the money?" At the small end, there are 1,637 claims that are all for under €10,000 each, which amount to €2.1 million. That is 1,600 claims. At the other end, there are 16 claims that account for approximately €800 million. The money is in 16 large extension-of-time claims, which is where a lot of our time, money, attention and expertise have been focused in defending these particular significant claims.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
If there is such an outstanding array of claims, how can we then be confident about where the final figure will land? We cannot, really.
Mr. David Gunning:
I am confident we can finish the hospital. On the final settlement, the public works contract contemplates the four phases, including court. We currently have five sets of proceedings in the High Court. I would be confident in saying others will go there. I cannot possibly comment on the possible outcome of that-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I understand.
Mr. David Gunning:
-----but I will say we have a high degree of confidence that the contractor has not demonstrated real entitlement for the claims it has. In that €800 million, there is a very large degree of duplication and triplication of claims for the same time multiple times. We are dealing with all of this.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
It is also likely that they will succeed in some of those claims. That is also likely.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Of those that-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Of those that are resolved - I know the €15 million plus figure - what percentage of the claims were successful versus those that were not, of those that have gone through that process?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
If they get 6% of the outstanding €800 million that is-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I understand.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I am caught for time. On legal costs so far, how much have we spent on legal costs defending our claims?
Mr. David Gunning:
We have two categories of legal cost. I will just look at the 2023 accounts. Legal expenses in 2023 were €224,000. We then separate and do not give the detail, if you like, or break out the detail on litigation and claims defence, which is where we are defending the State against these claims for €800 million. We do not break that out but that was €1.8 million. You will see that on page 23 of the 2023 accounts.
Legal expenses are ongoing day to day. On procurement advice and running procurement programmes, we have just finished, for example, a procurement process for the car park in the hospital. These are ongoing day-to-day business that require some degree of support.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I am caught for time but might get a chance to come in again later. I will go briefly to Children's Health Ireland to finish on a different note. When this hospital is operational next year, will CHI give us a sense of what it will do for children's health? Will there be a seismic change in treatments and waiting lists? We need to get some sense of where we are with this. Obviously, the project is bogged down in a quagmire of rising costs, legal costs, disputes and so on. Where are we as regards children's health, which ultimately is the important issue?
Ms Lucy Nugent:
It is a great question. We are bringing together the 39 specialties. These are currently disparate across multiple sites. That gives us an opportunity to have the best of the best in one location for the children of Ireland. We want to work with our regional partners to ensure a child in Donegal, Cork or Kerry gets the same level of care as if they were in a quaternary centre, such as ourselves. It will enable us to leverage that expertise but it will not be the same way of working that it is today. For example, we will be a fully digital hospital at HIMSS level 6. This means that we can leverage data and information. We can forecast and trend, not only from an activity point of view but also from a children's health point of view. We will initially open an additional three operating theatres. That will mean we will be able to provide in excess of an additional 3,000 operating procedures, which is fantastic. We have increased opening capacity, again, enabling us to expand our services.
It will impact on waiting lists and patient outcomes. We are a research and innovation focus. We feel very strongly that our children should have access to the best available treatment, which is really important. We are doing that on an all-Ireland basis. From that perspective, we will have a quaternary neonatal ICU, the first of its kind in the country. Newborn babies are being resuscitated earlier and earlier. It will be amazing to provide that service to the entire country. There will be 18 beds in that new facility. We are very excited about it.
In addition, there will be a new CAMHS unit. While it is not under the governance of CHI, it is fantastic that we will be able to work alongside our mental health colleagues to try to address some of the challenges young people are experiencing from a mental health point of view. That is another opportunity.
While Ronald McDonald House is not under CHI but operating under licence to it, 52 families will be able to be reunited with their child there. There is nothing worse than fragmenting a family, particularly for a child who has to spend long periods in hospital. There will be an underground tunnel, which means families will not have go outside in the middle of the night, if their child needs them. There will be 14 gardens over 4 acres. Children will be able to play outside in a safe environment.
Having a raised helipad will mean we will be able to transport children from all around the country quickly. It will also serve our colleagues in St James's Hospital. There are lots of things. I am quite passionate and I could keep talking about it.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I am conscious of the time. While there are a lot of positives, unfortunately the clock is against us.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I appreciate it. I thank Ms Nugent for her response. I can see the passion coming through and I thank her for indulging that. It is important to see that side of the whole project as well.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I very much look forward to it becoming operational.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I know this might be Mr. Gunning's ninth time before a Committee of Public Accounts, but it is his first time before this Committee of Public Accounts.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I am conscious of the time. I propose we suspend the hearing for ten minutes.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Before I call our next speaker, the Comptroller and Auditor General wishes to make a clarification.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Mr. McCarthy for the clarification. I now call our next speaker, Deputy Boland.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I thank the witnesses for attending today. I am sure it is not one of their favourite parts of their job, so I really appreciate it. Have any of them received external witness preparation training in advance of attending today?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Is there anyone else?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Was the training provided by third-party provider?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Did all four have preparation training from third-party providers?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Would that be done every time before coming before a meeting of the Committee of Public Accounts?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
What is the rough cost?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Mr. Gunning said he had absolutely no confidence in the main contractor in meeting its deadlines. We are now on to the 15th advised deadline. That is a pretty outstanding position for the State to be in regarding one of the biggest pieces of infrastructure that is going to be delivered. How are day-to-day relationships working? Has there been a complete breakdown in them? How can we sit here and have any confidence or agree more money should be paid out if Mr. Gunning is telling us he has absolutely no confidence in the main contractor?
Mr. David Gunning:
The Deputy has asked many questions, for which I thank her. I will try to unpick some of it. If I were to describe the overall relationship with the contractor – I have been in this role since September 2019, or for five and a half years – I would say we have gone through various undulations or ups and downs. We have always tried to remain absolutely focused on the objective, which is to get the hospital done, and we have always tried to be extremely professional. I would say that is the case on the BAM side and in relation to ourselves. We acknowledge there are 600 or so people from BAM or its subcontractors on site every day. We are making progress, but it is not at the stage we would like.
The money to be paid to BAM is all governed by the contract that was entered into in August 2017. The contract sum is €910 million, and there will be some variations on top of that, with a variation of €50 million determined by the employer’s representative and the €50 million in inflation that went on top of that. That is exactly where things stand at the moment.
On our intention regarding all the claims, I can take the Deputy through the claims table, which we provided in advance. It shows the number of claims provided. Some have been withdrawn. The ER has determined the vast majority of those claims at this time. It has been determined by an independent authority that the €800 million is equivalent to €50 million. The next phase of the disputes process is conciliation. Each of the processes involves very significant, almost quasi-legal, engagement. We have legal representation at each, generally counsel-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
On that, have there been any learnings on the contractual arrangements put in place for the State so this fiasco will not happen again?
Mr. David Gunning:
I can comment on that from the development board’s point of view. As the Deputy can well imagine, we have ongoing relationships with the Department of Health and the HSE. I have been involved in many conversations on the takeaways from this and how they might be applied to the new maternity hospital, for example, and various other things. The Department of Health – the representatives here might want to comment on this – has co-ordinated a kind of arrangement whereby the learning could be transferred. However, independently, we have had discussions with the senior people in the HSE on capital projects.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I assume the legal contracts, the legal arrangement, the structure, etc., could be far better.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
The main contractor is tendering for projects of other State bodies. Would Mr. Gunning issue a note of caution to any other State body that is considering a tender from the main contractor?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Have any issues been raised by any of the employees on the arrangements for moving to the new hospital?
Ms Lucy Nugent:
This is a seismic change for our staff, so we have regular engagements with them. We have started what we call a role-mapping exercise. Everyone has a personalised journey moving to the new hospital because, obviously, teams are merging. We have commenced the process and it will be completed shortly. In addition, we have a form with our trade unions whereby any issues that arise can be raised. Since taking up my role four months ago, I have started doing monthly city hall meetings for all staff to attend whereby we give updates not just on the day-to-day business but also very much on the move to the new hospital as we approach it.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I am conscious of time. Are there any common themes among those raised by employees on the move to the new hospital?
Ms Lucy Nugent:
There are the usual things, such as car parking and the location of offices. More important, because we are doing clinical integration, staff are asking which team they will be on. I referred to neonatal care earlier.
At the moment, there are some high-dependency beds in a neonatal ward. Some of those nurses may wish to go to the neonatal intensive care unit or may stay at a step-down level at the neonatal ward. Those are the kinds of conversations people are having to decide their future and we are there to support them through that.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
What are the top three common themes?
Ms Lucy Nugent:
The top three themes are parking, start times - because people could be on different rosters so it is a case of whose roster - and how we do our business. We started off with 6,000 policies and procedures across our three entities. We have now merged and reduced them to 1,025, which is still a significant number. They are done against joint commission international standards so it is not the Tallaght, Temple Street or Crumlin way. Again, this has brought staff on a journey with us. There has been fantastic engagement. In the first quarter of this year, there were 185 meetings with our clinical staff, which is phenomenal. That is on top of their day jobs so we are asking a lot of them and I do recognise that.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Will any contractual changes allow for the employees of the hospital to work on a 24-7 basis in terms of the rota? Is that the intention of CHI at the new hospital?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
What is it percentage-wise?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Could Ms Nugent come back to me on that? I assume CHI's intention is to move 100% of those contracts being a 24-7 rota basis?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Is it the intention of have 100% of those that CHI does need.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I assume radiographers and blood tests-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
CHI is aiming for 100%.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
When does CHI hope to have that 100%?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I note the new technology system is going to be integrated. Will the other HSE hospitals have access? Will it talk to that system? Will GPs be able to talk to the system? Is there a global picture for an IT system in the healthcare service and does this fit into it?
Ms Lucy Nugent:
CHI had to go out before the national electronic healthcare records tender could be put in place. The vendor product will be able to do data extracts, for example, into the national summary healthcare record, which is progressing. It is the same system that is used in Northern Ireland so, again, we ease the transfer of information. There will be a GP portal and a patient portal so parents will be able to access a certain amount of information regarding their individual child.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I assume there was a very thorough procurement process for that third-party IT provider.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
The witnesses are very welcome. I am back as a member of the Committee of Public Accounts, of which I was a member in the period before 2020.
I noticed that Mr. Gunning referred to the report. It should not be necessary to have training for today. All the witnesses are doing a job and we should respect that. It is our job to question and it should stand on what the witnesses are telling us. They should reflect on the notion that they need training. It is the wrong way to go.
The report from 2019 referred to by Mr. Gunning set out the cost overruns, which were of such significance and size that the report was commissioned. It acknowledged how complex the project was but it also said that the baseline had not been established, basic things had not been done and, therefore, it needed to be changed. Here we are now in 2025 and we are asking the same questions all over again. When I hear the word "transformational" used about a hospital, I think it is fantastic but we need a transformation in the processes so that we do not need to bring Mr. Gunning or the board in here nine times and we do not need to ask the same questions over and over again and we still have no hospital.
I will deal with CHI first. Is a board in place?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Has the board a full complement?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Has the chair been appointed?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I just want to know what is happening with the board.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
So there is no chair at the moment.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Is the deputy chair here today?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
How many members are on that board?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
How many are on it?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Is anybody from that board here today?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
The CEO is here and I wish Ms Nugent the best of luck in her new role. An external review of that board was carried out. There is a statement in CHI's internal processes. Is an internal review of CHI's governance issues carried out every year?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Not best practice - has it been done for this board?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Does Mr. Fitzpatrick know?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I do not mind that. I just want to know-----
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
There are internal reviews and then there is an external review. Is that right? When was the last one carried out?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
There is a reference in CHI's financial statements of 2023 to a report being carried out.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
That is good. There is an external review. Will that be published?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Who does CHI get to do that?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Does CHI tender for that? How was that entity appointed?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
An external entity has been appointed to review CHI in terms of governance and all that goes with that. Where is this review at the moment?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Has Mr. Fitzpatrick read it?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Mr. Fitzpatrick would not know if it was significant or not.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
There is nobody here from the board to tell us if that was or was not significant.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
There is a reference in CHI's financial statements to a review being carried out. All I want to find out is whether that was an external one. Can the witnesses say "Yes" or "No" to that?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
-----are included.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I thank the Comptroller and Auditor General for that. If we get a letter to the Cathaoirleach clarifying how many external and internal reports have been carried out in recent years, it would be very helpful.
Regarding cases settled, some of which were with the Workplace Relations Commission, WRC, CHI has given us figures in its financial report for WRC cases. I think the number is 125,000. However, CHI has not given us any breakdown of the other cases. Could the witnesses elaborate on those?
Mr. John Fitzpatrick:
There were 38 settled by the State Claims Agency. Not all of those would attract legal fees for us, but it shows the quantum of activity that is happening. Clips of those might be clinical related and there are also properties. Reference was made to the car park and then leases.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
May we have a breakdown? There is no breakdown of them.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
No, there are 38 cases and six went to the WRC. We have a figure for that, and then for the others we do not have any breakdown of the nature of the cases or what they were settled for, and CHI worked with the State Claims Agency. Would it be possible to get details on that?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
It is the nature of the claims.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
What Mr. Fitzpatrick is telling me now would be helpful for us. Lots of us are learning about this all the time, and that is only one tiny aspect.
I return to the paediatric board and move to the children's hospital. When does it envisage winding up? It was a special purpose vehicle set up for a specific purpose, to build ,design and get a hospital.
Mr. David Gunning:
As the Deputy is aware, when it happens is a ministerial decision. However, when would it be logical to do so? Perhaps I might suggest what we have discussed with the HSE, for example, because when we disappear, all the intellectual property and warranties have to be transferred to someone and, under the Act, they are transferred to the Health Service Executive. The realistic thing is that the end of the warranty defects period is 18 months after substantial completion. It should be some time after that. The Minister will obviously decide, but we will already be winding down the development board. Staffing will already be winding down once we hit substantial completion.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
After 18 months-----
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
-----the board will be redundant. It is just to understand.
Mr. David Gunning:
It is not my decision. However, in terms of risk management and dealing with the warranty defects issues, we have some experience in both Tallaght and Connolly. When there were issues that had to be fixed post substantial completion, it took quite a bit of time to get the contractor to get those closed out. I think it will take those 18 months, and after that would be the appropriate time for the Minister to consider that particular wind-down.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I will not have time to go into the minutiae of anything and the witnesses have given figures. Those figures are on the record, but when I look at them, it is less than €1 billion to build the hospital. The additional sum relates to the board, the design and consultants appointed. Is that fair? It is almost a 50:50 balance.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Lovely. It would be helpful to get a breakdown of all of that.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Many things have changed since then.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
On a rough estimate it seems to be nearly balanced. Maybe I am wrong. Maybe it is 60:40. I am looking at the administration costs, however, and the costs are rising all of the time. I understand inflation and the different reasons, but the board was set up and then there is an oversight body after that under the Department, which I have not even got to. Maybe at some stage we might get information on that, because, from day one, it was not staying within costs. Still, the costs have gone up. We have a board doing its best, and I am not here to castigate or cast aspersions, but there is no learning from this unless we have a complete breakdown of the figures, and on a rough estimate it seems to be 60:40.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Mr. Gunning is lucky I am out of time.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
The Deputy will hopefully get an opportunity to come back in.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
I thank all the witnesses for coming in. As a first-time TD I am learning the ropes in asking questions of those who come before committees. The children's hospital and Children's Health Ireland have been spoken about on a number of occasions since my election. What do the witnesses believe are the key completion risks facing the project at this stage?
Mr. Phelim Devine:
To get to the completion of the project, there are a number of KPIs we look at, but there are two main KPIs, one of which is bringing the hospital up to the completion standard. We talked about 5,740 room spaces in the hospital. They have to be brought up. The opening statement talked about the four-stage process. We are now going into stage 3, which is when, after they have been offered to the design team, the design team inspects them. There are approximately ten snags per room and the contractor has to de-snag those and offer them as snag free. That process is about to complete. We have 5,740 rooms to be offered back to us officially from the contractor for sign-off. The second KPI is the technical commissioning of the hospital. That includes all of the mechanical, electrical and building systems like lifts, opening vents, fire alarm systems and all that. That system commissioning is approximately 70% through, as we talked about earlier. Following that, those systems have to be integrated together and then the functionality of the hospital has to be demonstrated in a fire alarm situation. Things have to turn off and turn on. They are the two main drivers of getting to the end date. They are the ones, in terms of KPIs, that are tracking behind the programme.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
The witnesses are all experienced in their own fields. In their opinion, do they think June 2026 is a viable date for children to enter that hospital?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
In Mr. Gunning’s personal opinion.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Is the appropriate resourcing provided now?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Does Mr. Gunning think it will be provided?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Is CHI confident it will have children in there?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Does Ms Nugent believe the date of 30 September is possible?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
From her own personal conversations, or conversations with CHI and the board, does she believe that they will be in there?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
This question is for Mr. Gunning. In 2021-22, there were tuition fees paid for the Harvard Business School in 2022 and Glasgow Caledonian University in 2021 which amounted to €25,557 without travel and subsistence fees. What is the total figure with regard to expenses claimed by him for travel and subsistence fees?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Has that been provided to the Comptroller and Auditor General?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
The figure of €4,000 in 2021 rose to €15,000 in 2022 for travel and accommodation. Is that because of the fact-----
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
If that was approximately €3,000, it would bring it up to €7,000. What was the other-----
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
In 2021, €4,000 was spent by the board on travel.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Not personally on Mr. Gunning-----
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
-----but the amount went to €15,000 in 2022. What accounted for the increase in travel expenditure?
Mr. David Gunning:
I ask the Deputy's forgiveness. I thought he was talking about the cost for me personally. We have very little travel within the organisation. We have a number of overseas board members who travel to Dublin on a monthly basis. I can only assume the figure relates to the cost of flights and accommodation for the number of UK-based board members who attend in person. That is and can be the only source of that expenditure.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Can Mr. Gunning remember his personal claim?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
I appreciate it is very important that board members continue to upskill. I wholeheartedly agree with the need for upskilling. As chief officer at the time, did Mr. Gunning bring the proposal to the board for approval? Was he the one who suggested he should upskill or did the board suggest it?
Mr. David Gunning:
My experience of this over 40 years or so is that there are two Venn diagrams here, that is, what the organisations needs and what the individual, without personalising it, seeks to do. I would have discussed the need for some further governance training, which is what we are here to discuss, and come to that conclusion. My participation in the course was approved by the board and the need identified through my performance management discussions with the chair.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Did Mr. Gunning suggest at the board meeting that he needed upskilling?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Did Mr. Gunning suggest to the chair that he, Mr. Gunning, needed upskilling?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Did Mr. Gunning believe he was not competent in the role or something like that? Is that why he needed upskilling?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
I ask it with total respect.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
How long was Mr. Gunning away on that course?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
How often does the NPHDB meet with CHI?
Mr. David Gunning:
Mr. Drew can help me out if needs be because there are multiple layers. Starting at the top, there is a meeting between the chairs and chief executives of the two organisations that happens on a quarterly basis just to check where we are at. Then I meet with Ms Nugent and in attendance at that meeting are Mr. Devine, project director, and Ms Lewis from CHI. That happens on a monthly basis. Then there is a layer below that where all the commissioning and other issues are discussed, which is chaired by Mr. Drew on our part alongside Ms Lewis from CHI. Below that we have the engineers and the people in the detail of this, with one of Mr. Drew's direct reports dealing with that. There are also multiple other interfaces across the two organisations. A lot of us are in the same building and we meet each other every day. We are absolutely integrated.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Have the board and the CHI together met with the new Minister for Health?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Would it not be appropriate for the NPHDB and CHI together to meet with the Minister?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Has the Minister made that call to both organisations?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Will the witnesses from the Department indicate whether the Minister has any intention of meeting with the NPHDB and CHI together?
Mr. Derek Tierney:
The Minister met with the chair of the NPHDB on 19 February. She met the chairs and executive CEOs of both CHI and the NPHDB on 27 February. Most recently, on 28 April, she met with the board of CHI for discussion on the NCH programme. There has been very good engagement since her appointment.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Note 13 in the report of the Comptroller and Auditor General refers to the claims by BAM of critical delay events. What was the nature of those events?
Mr. David Gunning:
There was a claim whereby the contractor sought to be compensated for delay over a period of the project. It was not from the start but for a particular period. The contractor put forward that claim; I do not recall the exact figure. The recommendation from the conciliator was for €107 million.
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
What was the particular delay?
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
Does Mr. Gunning expect further claims-----
Eoghan Kenny (Cork North-Central, Labour)
Link to this: Individually | In context
-----in regard to the same?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
I thank all the witnesses for attending. I wish Ms Nugent well in her role as CEO of CHI at such an important time. In her opening statement, she acknowledged and apologised to families. Who was she acknowledging and apologising to?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
How many families were investigated in the HIQA report?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Ms Nugent is apologising to and acknowledging those three families. Is that correct?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
In addition to those families, to be clear, who is she acknowledging and apologising to?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
I do not mean to trip up Ms Nugent. There are three families involved, according to her, in the HIQA report. She is acknowledging and apologising to other families affected by the events dealt with by HIQA. To be really clear in number terms, who are those families, who are those children and to whom is Ms Nugent apologising?
Ms Lucy Nugent:
There is a secondary review, which one of the Deputies referred to earlier, namely, the Nayagam review, and there are a number of families involved in that. I think I know the right number but I will double-check it, if I may, as I do not want to mislead the committee. It is all children who are attending CHI. Families are worried and are going to ask whether what happened to those children will happen to their child. It is not in terms of numbers; it is in terms of all the children and families we serve. There is a breakdown in trust in us. I acknowledge that and that we have to rebuild the trust.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I apologise for interrupting, Deputy Geoghegan. Would it be possible for some of Ms Nugent's team to check that number and provide that information today?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
What about the families who received the letters that were issued by CHI arising from the audit that is not yet complete? Is Ms Nugent acknowledging and apologising to those families?
Ms Lucy Nugent:
We are apologising for any distress the letters may cause. The reason we wrote to those families, as I explained earlier, was that there was an early recommendation that any child who had any type of hip surgery for dysplasia - all children - should be consistently followed up to skeletal maturity. Rather than waiting for the final report to be issued, we wanted to advise families that they would be contacted by us, and some of them have been already, to start that process of skeletal follow-up to maturity. We understand that in trying to communicate openly, there was a balance between being open and transparent and the possibility of causing concern because we did not yet have all the answers. We felt it was better to err on the side of saying we will be calling people for skeletal maturity follow-up. That is an international best practice recommendation - I think the Deputy is wondering about this - irrespective of whether the surgery was necessary.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Am I correct that over 1,200 letters were issued from Children's Health Ireland?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Of those 1,757, what has been the response in, for example, the interaction with the email address in the letter?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Before looking at the issues arising from the orthopaedic surgeries and the audit, is the audit complete?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Ms Nugent does not have the final audit.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
The audit goes to CHI initially; is that the process?
Ms Lucy Nugent:
CHI and the National Orthopaedic Hospital Cappagh were the joint commissioners of that report. It will come to us in the first instance and I have committed to the CEO of the HSE that I will share with him and the chief clinical officer as soon as I receive it.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Does the audit go to the chief executive of CHI or to the board?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Is the chief medical officer here today?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Has the chief medical officer received the audit?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Okay. Can we clarify something relating to the former CEO? Ms Nugent seems to be very well briefed on the circumstances that led to the decision by the Minister not to consent to the appointment. Will Ms Nugent clarify that it is the position that the then board wanted to reappoint the then CEO as CEO for a third term?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Would Ms Nugent be able to share with the committee all correspondence that CHI had with the Department and the Minister relating to the appointment of the CEO or reappointment of the then CEO? Is that something she could do?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Thank you. There was a slight disparity between what Ms Nugent was saying about how the CEO was not reappointed and what Ms Conroy was saying on behalf of the Department of Health. Ms Conroy was very firm and clear that the Minister did not consent to that appointment. The clear implication and inference of the decision of the Minister not to consent to the reappointment is that it related to all the issues we are discussing with regard to orthopaedic surgeries, notwithstanding what is contained in the HIQA report relating to the CEO. Is that Ms Nugent’s understanding too?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
It would be highly unusual for a board of a hospital to recommend the appointment of a CEO and then for the Minister to intervene and not consent to that appointment. Would Ms Nugent accept that contention?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Ms Nugent was the chief executive of Tallaght hospital, however, am I right?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
So Ms Nugent is very familiar with the appointment processes of chief executives as it relates to hospitals generally. Does she agree with the contention that it would be highly unusual for a Minister not to consent to the appointment of a CEO on the recommendation of a board?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
In Ms Nugent’s opening statement, she made absolutely clear that CHI accepts in full the findings and recommendations of the HIQA report. In terms of the position that the outgoing CEO currently holds within the hospital, does that sit in the governance framework recommendations that HIQA has recommended? Have there had to be any changes to where her role currently sits arising from the HIQA recommendations?
Ms Lucy Nugent:
No, but like any new CEO, I would review all our executive structures. The HIQA recommendation did refer to the role of the clinical directors, that they were not aligned and located with their directorate triumvirate team. I have changed that. We have revised the job descriptions for the clinical specialty needs to reflect HIQA’s recommendations that it is not only a leadership role but also a management role, and I have met all the clinical specialty leads.
On the wider governance of CHI, we are constantly evolving, as any organisation should. I have a workshop with my executive colleagues next week regarding, for example, how we do all this-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
So there has been no change to her role arising from the recommendations of the HIQA report-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
-----and it does not impact on CHI’s governance structures?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
And none were recommended.
I will conclude on insurance issues. Is Ms Nugent aware – the Comptroller and Auditor General can correct me if I am wrong on this – that CHI is the only hospital that the Comptroller and Auditor General audits where issues relating to insurance claims not being processed correctly have been flagged? CHI is an outlier in that respect.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Deputy Geoghegan is in his last minute.
Mr. John Fitzpatrick:
I am aware of other hospitals. They may not be audited by the Comptroller and Auditor General but I am aware. To clarify, we endeavour to ensure everything is done in a timely manner but we are reliant on the third parties with whom we work. However, our focus is to work with them to ensure that we do -----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
One final question. Who are the third parties? Is Mr. Fitzpatrick talking about doctors?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Getting down to brass tacks, CHI emails or contacts the consultant to say, “You need to send us a form here. Could you please send us that form so we can send it in?” and in 70 cases that did not happen, amounting to a loss of €0.25 million. There is a report in The Irish Times that next year it will be €200,000. That is correct, yes? Does CHI think it will get to a point where what is essentially free money will end at zero? By free money I mean that this is money owing to CHI. The consultants just have to submit the forms and the money comes back to the hospital. Think of all the parents who have benefitted from the extraordinary services that CHI provides to children; they go out and fundraise, they might raise a cheque for €5,000, they support the hospital and they see this €250,000 or €200,000 not being claimed when it is owed to it. One can understand the upset and frustration arising from it. Can CHI say that in 2025 or next year it could get to a place where it is close to zero in that regard?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
I thank Ms Nugent.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Deputy Geoghegan and call Deputy Farrelly.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I thank the witnesses for their time this morning. It is good to have the opportunity to discuss such an important issue with them.
I will begin with a somewhat open-ended question for Mr. Gunning. How much does he think the hospital will cost?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Okay. We spoke at length this morning about the substantial completion date. It is really unfortunate that NPHDB received the latest programme review after close of business yesterday. How many other programme reviews has NPHDB received over the duration of this project? How long on average does it take NPHDB to analyse their contents?
Mr. David Gunning:
We have already mentioned that we have had 15 different programmes with different completion dates. However, on a monthly basis, under the contract, the contractor is required to provide a monthly programme update. We receive what you might call a mini programme on a monthly basis. Then, if the programme is deemed to go out of compliance, as in the completion date is no longer achievable, we require the contractor – the employer’s representative on behalf of the State, if you like-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
If we go to the last monthly update NPHDB received, ignoring yesterday’s, would that give Mr. Gunning confidence that September 2025 is doable?
Mr. David Gunning:
They are all pretty much aligned in leaning towards the September date. However, we have our analysis, which Phelim Devine has given us. The programme is there. We have five key performance indicators that we monitor. All of those key performance indicators are currently behind the target that BAM has given itself in its own programme, so we are behind schedule on these points.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Okay, so we are not confident.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I ask Mr. Gunning for the timeframe.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Can he furnish us with his most recent analysis?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I would appreciate it if Mr. Gunning could furnish us with the most recent analysis of that.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
What is the average number of workers currently on site on a weekly or monthly basis? Is it an upwards or downwards trend or is it staying steady?
Mr. Phelim Devine:
I will go back to give a bit of context. When BAM made that commitment to the Minister in October to deliver the hospital for June 2025, there were approximately 750 productive resources on the site. Following that commitment, there was a bump to approximately 900, which was great. That number endured until around Christmas. Since January this year, however, it has been slowly dropping off every month. We are now down to fewer than 600 productive resources. Despite this, regarding the programme, they are not meeting their commitments.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
There has essentially been a 30% decrease in staff on site from January to now.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
On note 13 of the financial statements, which we have covered quite considerably already, I have a question about the contingent liabilities directed to Mr. Gunning. What is the estimated liability if the court rules in favour of the contractor?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I understand that.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
With respect to the €107 million claim, what is the value of the bonds the contractor has-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
It is the full amount. Okay.
Mr. David Gunning:
The Zurich bond from the Zurich financial organisation is for the full amount. It is an on-demand bond with a number of conditions. Before we accept that bond, we are given a chance to review and approve it, and there is a whole process around this. Regarding the State's liability in that regard, when the State hands over €107 million, we are absolutely confident in those circumstances that if something were to happen, we can go to the bondsman and get that money back.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I appreciate that. I thank Mr. Gunning for his time. I will now turn to Ms Nugent. While I appreciate she spoke about transparency and openness in her opening statement and I appreciate the approach she has taken, maybe I am wrong but when we speak about training and preparation for meetings like this and then use those words in the same line as openness and transparency, it is a bit unfortunate. We are trying to come at this from an open and transparent point of view. I hope the purpose of that training was not to go against that. She spoke about the Government practice to appoint chief executives to State bodies on five-year contracts. We have heard about that this morning. Who instigated the mediation process with regard to the former CEO's position?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
The board instigated the mediation process. To use myself as an example, I have been on a number of fixed-term contracts. My expectation was that when that fixed term came to an end, I would no longer be a part of that contract. Why would the board instigate a process like that when the duration of the contract was coming to an end?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Was it a new role that was created for the former CEO?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Am I summarising correctly that it seems to be that a role was created for a person as opposed to a person being found for a role? As such, is that the CHI's recruitment policy?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
For individuals.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
That is okay. I appreciate that. Is there a job description available for that role?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Is that publicly available?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Thank you. Was there an NDA signed?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Okay. What were the legal fees costs associated with that incurred by CHI?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Does someone else here have that information?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
About the legal fees? Okay. We have spoken a bit about the new hospital. A total of 120 staff members are responsible for the transition. How many of those are in place currently?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Okay. And they are all in place, bar the 47?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
In terms of staffing at the new hospital, have contract start dates been signed and sealed?
Ms Lucy Nugent:
We have been working in conjunction with the Health Service Executive colleagues on day one staffing numbers. Obviously, there are the existing staff who will move over and then there is the additionality. As I mentioned previously, we are opening three additional theatres in the first phase and an 80-bed NICU, and we are staffing these to international best standards. We have had very positive engagement in that regard and we are hoping to conclude that exercise at the end of this month.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Thank you, Ms Nugent. What is the nature of the relationship between Temple Street public hospital and Temple Street private clinic? Is there any relationship between those in terms of a lease agreement? Does Temple Street private clinic lease premises from Temple Street public hospital? Is there any situation where public funds are used, whether that is secretarial or anything else, in the private clinic?
Ms Lucy Nugent:
Under the new public-only consultant contracts, POCC, there is no provision for private activity on site. Under the terms of historical older contracts, which approximately 30% of CHI consultants are still on, we have to provide private clinic facilities. On the lease arrangements, I defer to my colleague.
Mr. John Fitzpatrick:
Under the contract referred to, the old consultant contract, we have to provide space for private facilities to be undertaken. We provide space and cover overheads like light and heat. The clinic, that is, the team of participants in the clinic, employ the staff who work there. If they need to buy equipment, they buy it themselves.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I ask the witnesses to follow up on the piece around the legal costs. There seems to be some ambiguity between what is in the C and AG’s report versus what has been said here today, that if the CHI instigated a mediation process, incurred legal costs associated with that process, and the person was still employed in the role. I would appreciate clarity if there were legal fees incurred by the CHI in that process.
Mr. Seamus McCarthy:
For clarification, my understanding is that the individual concerned was retained on the same remuneration level. There was not a settlement payment to that individual in relation to a dispute, but there was a contribution to her legal expenses that had been incurred in the process.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
Who would choose to do that?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
The witnesses are all welcome. I appreciate them coming before the committee today. At the outset, I want to frame this conversation. It is vital to say we have a job to do and the witnesses have a job to do, but what we are talking about here today is children’s health, taxpayers’ money and the dedicated staff working day in and day out in our hospitals. I say that to be mindful of the fact that when I am asking these questions, I am asking them because I want to see the very best outcome for the children of Ireland. I must also say that this is a serious matter.
This is the ninth time that officials from the NPHDB have been here. I hope that when the witnesses leave here today, they do so with a renewed vigour to see this project to completion for the betterment of the children of Ireland and the future of this country. I want to start with that.
Conveniently, BAM landed the document at 5.12 p.m. yesterday, as Mr. Gunning said. I understand that he has not had a chance to go into it in depth. However, does that document state that there is a new date for completion?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
Does that date align with what the document received yesterday states?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
Okay. I thank Mr. Gunning. We have been told that the best case scenario is June 2026. Does Ms Nugent believe that, in June 2026, staff and patients will walk through that door?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
If the building has been completed by the contractor in September, Ms Nugent is fully confident that CHI will be through those doors in 2026.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
No, that is perfect.
The expenditure in 2023 was almost half of that in 2022. I have a graph here from the Comptroller and Auditor General that shows that, between 2022 and 2023, the expenditure fell by half. Does this reflect that progress fell by half or is this because the board started contesting the claims?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
How does expenditure go from €316 million down to €156 million if we are ramping up progress?
Mr. David Gunning:
It is entirely an indicator of the progress of the contractor. The contractor is paid for the work that it does. The level at which it has achieved is way below what we would have expected would have happened if it was delivering on the timeline to which it had committed. Therefore, it is purely a lagging indicator of progress.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
What is the highest claim value submitted by BAM to date and what was the nature of that claim?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
Are those for aggregated items or are they for one-off expenditures?
Mr. David Gunning:
No, for delay. The money is all in the delay. There are 16 claims that amount to approximately €800 million and each of them is for a component of the delay that BAM claims the employer - the State side - has delayed its progress from August 2022 up until now. It accounts for individual components of that or contributors to it or whatever. As I mentioned, there is duplication and triplication even in those 16 claims, but that is what we are defending.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
What contractual obligations does BAM have regarding timelines? What punishments can be put in place should those timelines continue to not be met?
Mr. David Gunning:
I have briefly summarised the three levers in the contract, all of which we have used. Termination is one; can we terminate the contract? When BAM failed to return to site for another seven or eight weeks after the Government-mandated Covid shutdown, the board had no option but to commence termination proceedings. BAM, in return, came back to site and those proceedings were brought to a conclusion. We also have the application of liquidated damages to effectively compensate the development board for the costs we are incurring. If we just run the liquidated damages summary from when the project should have finished in November 2022 up to the end of August, the amount the State could apply is approximately €31.5 million. That is all subject to disputes already and possible court resolution of those issues. They are the main levers we have. That is the primary motivator. That is the-----
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I thank Mr. Gunning. I appreciate that. I sincerely hope the witnesses can go from this meeting and really deliver for the children of Ireland.
I want to read something out with regard to CHI. CHI's stated objective is to "improve, promote and protect the health, mental health and well-being of children in a manner that embodies the values of child-centred, compassionate and progressive care provided with respect, excellence and integrity". When non-CE-marked equipment was inserted in human beings' bodies, did that equate to the statement I just read out?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
Okay. In her earlier remarks, Ms Nugent said she wanted staff to feel that they had "psychological safety" around making disclosures. Is there something toxic about the culture in CHI that staff would not feel safe in coming forward with disclosures?
Ms Lucy Nugent:
There is a lot of work being done to speak up for safety. HIQA noted that we needed to work on our culture. We have three very different cultures that we need to bring together. I am also conscious, though, that all our staff share the same values of caring for children. There is a piece of work that we have to do.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
Obviously, a part of good governance is having those structures in place so that people can confidentially bring forward information to the organisation. I know Ms Nugent will work on that because we can never see something like this happen again.
Why did the chair resign from the board? Could we be provided with a copy of the letter of resignation?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
However, Ms Nugent does not know why the chair resigned.
Ms Lucy Nugent:
The former chair made a statement publicly available whereby he felt that, after having given many years of dedicated service to CHI - all our board members are voluntary, so they are not remunerated, and they give their skill and expertise, which we greatly appreciate - it was time for a new opportunity for someone else to lead the board.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I just want to link this in. One of the issues the Comptroller and Auditor General found in his audit was that there was material non-compliance in public procurement. Does that material non-compliance in public procurement and the instances he found speak to the wider issue in CHI with the non-CE-marked items getting approved? The reason I ask is that there obviously had to be a supplier for these. That supplier had to be approved and had to be on the books of and dealing with CHI. Who approved or raised the purchase order for this non-CE-marked, not approved equipment?
Ms Lucy Nugent:
One of the challenges we previously had was that we did not have centralised procurement. In Temple Street particularly, where this incident happened, there were several different departments that could directly order things. In that situation, the items was ordered through the clinical engineering department, although as well articulated in the HIQA report, the individual was unaware of what they were being procured for. The individual thought they were part of an external traction system. What we have done since January 2023 is to have centralised procurement across all of CHI.
Regarding the non-procurement-----
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I thank Ms Nugent; that is okay. That is an important point because we know there is material non-compliance within it and then we have issues like this that arise. There is a disconnect between the controls and the reality that the patients are experiencing. I hope CHI endeavours to rebuild trust within the organisation because I have serious concerns around the culture. People place their trust when they bring their children to these hospitals. That is just something to be aware of.
I am conscious that I only have a minute remaining. I want to move on to the CEO - not Ms Nugent; the former CEO - and I want to get this completely clear. It was reported in The Journal and The Irish Times that the CEO salary for CHI was in excess of €180,000. This person finished a fixed-term contract as CEO, entered into a legal battle with CHI, a settlement was agreed and now the individual is a strategic director still earning in excess of €180,000. Is that correct?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I understand that a CEO has massive responsibility and needs to be compensated for the fact that he or she is managing a budget in excess of a couple of hundred million euro. What is the role of this person now as a strategic director?
Ms Lucy Nugent:
The individual is focusing on developing and leveraging what the new hospital offers to us. We are looking at the all-island services and pathways that we can have. The individual is also looking at leveraging social and economic development in partnership with St James's campus from an academic perspective for the future of healthcare.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I will ask one last question, Chair. Does this person have the same responsibility as when the person was CEO?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Deputy Dolan. I call Deputy Ardagh.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
I thank all the witnesses for attending. I understand there is an invitation. I have actually been to the site of the hospital, although I have not been inside. It is a huge building and will be a landmark building that I hope will be there for our children and the children to come.
The constant change in delivery dates - 15 times at this stage - does not fill me with huge confidence. Listening to the witnesses, I do not get the sense they are 100% filled with confidence either. Ms Nugent is managing a lot of staff and they are probably wondering whether they are going. Would it be sensible to set a date into the future - perhaps in late 2026 or 2027 - that we could adhere to so that CHI could prepare its staff properly for the transition?
Ms Lucy Nugent:
When I was notified earlier this week of the change in date, I emailed all staff. I also told them I was coming here. I am conscious of the impact it has on our staff from the point of view of morale and getting energised about this project.
We are opening this hospital in 2026. The important thing is - and I have said this to staff - that, as soon as I have information, I share it with them. Yes, this is a setback because we expected to move in on the Easter weekend of 2026 but we will use this opportunity to further enhance our preparations. Take our new electronic healthcare record, for example. One usually starts with the basic package and then adds on the models. We are already testing and using those models.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
I do not mean to cut in but the witness is eating into my time, unfortunately.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
I thank Ms Nugent. We know that there are 81 grade 8 staff in CHI. I presume Ms Nugent is a grade 8 staff member.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Is Ms Nugent grade 9?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Is that grade 10?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
There are 81 grade 8 or above staff.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
From CHI's report, I can see that there are 81 grade 8 or above staff at the hospital. When grade 8 was established across the HSE in 2005, there were only eight grade 8 staff in total. It seems like there is a huge amount of staff now. Will Ms Nugent confirm whether the former CEO is at the same grade as herself?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
On her retaining her salary at CHI, she had been on two fixed-term contracts. We know that she was then, subsequent to mediation, offered a fixed-term contract. Is that what she is on now?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Is the former CEO on a fixed-term contract?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Regardless of what contract she has been offered, she is probably on what we call a contract of indefinite duration, so she is now a permanent employee of the hospital. Did the Department of Health know she was going to be staying on in this new role?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
I presume that, as part of the mediation agreement, CHI had its own lawyers and was aware it was retaining her in what would turn into a full-time contract of indefinite duration with all the ancillary benefits that go with that.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Does the Department of Health wish to comment?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
The Department of Health was kept abreast during the whole process of the mediation agreement?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Regarding litigation claims, we know the contractor has made claims of up to €853 million in costs. Is that correct?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Apologies. The board has potential claims against BAM for €31.5 million under the terms of contract. I believe Mr. Gunning gave that information.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
They are the liquidated damages that the board might possibly reclaim. There are also PC sums that must be worked out and other ancillary claims that are perhaps available.
I am a TD for Dublin South-Central. The hospital is in the heart of the constituency. There are many houses around the perimeter of the hospital that have had different claims, perhaps against the board of CHI, relating to subsidence in their homes. Do the witnesses know how many claims, if any, were brought and if any compensation was paid out on foot of them? Is that figure included in the board's legal litigation costs?
Mr. David Gunning:
I will ask Mr. Devine to answer because he has been dealing with this. As the Deputy can imagine with the scale of the project and the piling that went on, many claims were incurred in several areas. We are now coming to the end of that in terms of the works being carried out. I will ask Mr. Devine to summarise.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Sorry. I meant to refer to Mr. Gunning.
Mr. Phelim Devine:
I agree with what Ms Nugent has said. There was one particular case - it was a court case and settlement - along one avenue where there was some damage to houses because of the piling. That has all been resolved and all work was completed more than a year ago. We have rebuilt the boundary, which was due even before the damage was done. They got extended gardens, which was part of the planning agreement we made with the HSE.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Are those amounts already accounted for?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
One of my colleagues asked the question of how long the board would be in existence. A period of 18 months after the guarantee was mentioned, or was it once the guarantees expired?
Mr. David Gunning:
It is the warranty defects period in the contract, which expires 18 months post substantial completion. The Health Act sets out that this is the Minister's decision. We have an opinion as to when it would be appropriate to wait until but the Minister could do this tomorrow if she desired.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Mr. Gunning intimated that the development board may be engaging in its own litigation. Mr. Gunning mentioned the €31 million that could stem from litigation. Obviously, that litigation could take more than 18 months.
Mr. David Gunning:
If we look at major projects, these issues mount up. We expect there may be some kind of attempt at a final settlement that may or may not meet the expectations of the State or the contractor in terms of what is proposed. Therefore, issues might possibly run on to the courts for resolution.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Obviously, the board will have to continue as is until all the disputes are resolved.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Otherwise, the development board will not be able to recoup moneys due to it.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
Even for the legal entity to remain so that money can be paid over.
Mr. David Gunning:
Correct. There is no doubt about that. However, it could be transferred to the HSE or the State Claims Agency, which would take on the work. There could be ways to do this, but the expertise to defend these claims is currently very much resident in the development board.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
That is all. I wish the witnesses the best of luck and I hope the hospital opens in June. Looking at it from the sky, it is a fantastic piece of architecture.
The taxpayers are disgusted at the cost. There is a sentiment out there that people spending taxpayers' money do not take as much care as when they are spending their own money. I mean that across the board. We all need to be more vigilant when spending taxpayers' money in the future.
Mr. David Gunning:
I assure the Deputy that we are being extremely robust in defending the State in all these claims. The liability on the project has gone from a €910 million design to €50 million plus and another €50 million on top of that for inflation. That is where things currently lay. We have managed to keep it within those bounds and we intend to keep fighting these claims.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context
The best of luck with the litigation.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank Deputy Ardagh for that.
I wish to ask some questions of our witnesses. Mr. Gunning is very confident that the hospital will be delivered with the revised budget of €1.88 million. He mentioned 16 claims totalling €800 million approximately. Is that correct?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
He said that they were predominantly to do with the extension of time.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
What is the largest claim within those 16?
Mr. David Gunning:
I think I answered this in a slightly different way. We have claims of hundreds of millions, or several hundred million. I do not want to put numbers on them. We are dealing with these. I responded to the question earlier from Deputy McGrath in terms of getting the hospital open. We can get the hospital open within the €1.8 billion. I obviously cannot foretell what the court or the dispute process may deliver, so I cannot give certainty to the committee in relation to-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
You cannot give certainty, However, of those 16 considerable claims totalling €800 million, you might give us an example. What is the highest figure within those 16?
Mr. David Gunning:
One claim is between €200 million and €300 million. One claim is in that ballpark. We are dealing with all of these. They are very complex in terms of the way they are put together. Our job is to defend the State against those. The contractor has to prove quite a lot to make these claims stick. We talk about delays, but they have to prove that the actual claim is causing a delay and that it is not some other issue that is causing it. It has to be dealt with, examined and analysed in a great degree of detail.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I acknowledge there is additional cost in terms of fitting out and all of that. The approved funding from the Government is €2.24 billion. I might ask Mr. Tierney if I am correct in stating that.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Are you confident that that figure will not increase? Are you as confident as Mr. Gunning that it will be delivered within the revised budget?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Mr. Gunning made reference to his staff a number of times. How many staff are working for the development board?
Mr. David Gunning:
No, none of us is permanent. We have six employees on fixed-term contracts and the rest are contractors who have been brought in to deliver different services, such as engineers, mechanical engineers, electrical engineers and architects. Then we have the design team, which is made up of the architects, the designers, the inspection team that is shadowing BAM and making sure everything is done correctly, and the QSs.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
To be helpful, Mr. Gunning might send on the details.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Regarding communication between CHI and the development board, it has been stated that they came together to prepare for this meeting, and I hear what some of the members have said in relation to that. Apart from meeting in advance of this particular meeting, how often do they meet?
Mr. David Gunning:
Very frequently. We are in the same physical office in Rialto, right beside St. James's Hospital. We have one side of the building - I would say the less salubrious side - and CHI is on the other side. We share all the meeting space and all the meeting rooms. We are constantly engaged.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I imagine there are minutes for every meeting.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
We appreciate that. In relation to CHI and the reviews that have gone on, members have already touched on the HIQA report, the governance failures and the use of unauthorised springs. Does CHI agree that the report is a damning indictment of the failed governance and oversight within the organisation at that point?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
The standout line within that report, which was put to the board of CHI, is that children were not protected from the risk of harm. CHI has already agreed with that line.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
The report makes reference to surgeon A and Ms Nugent made reference to a surgeon in her earlier contribution. I will not name surgeon A, who is referenced, or anything like that. However, what is the status of surgeon A to whom reference is made in the HIQA report?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Are they still employed? Are they still practising?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
How long have they been on leave at this point?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
They are on leave since 2023.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
It is the end of 2023. Ms Nugent says there is a process.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Is that a HR process or a clinical process?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context
I understand that Ms Nugent does not want to jeopardise the process. If it is possible, we ask that the payments be reviewed purely from the perspective of it having taken two years of paid leave to try to resolve this situation. I am not sure if that is the contractual obligation. I ask CHI to review the payments.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Thank you. There is also the Nayagam review, which Ms Nugent said earlier is ongoing.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Does Mr. Tierney or one of his team want to comment?
Mr. Patrick Lynch:
All I know is that it is being managed through the chief clinical officer in the HSE. I know it is progressing but it is not something I have been involved in because of the nature of it.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Does anyone have information about the remit?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
You are expecting it to conclude. Is surgeon A, who is involved in the HIQA review, part of that particular review?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Sorry, Deputy. Surgeon A is part of that. Is he one of a number of surgeons or is he - or is that person - the only surgeon?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Surgeon A is involved but you are not sure as to whether-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I appreciate that. On the clinical audit into hip dysplasia, which is an issue of great concern, Ms Nugent made reference to the imminent report and the process of that being produced to the chief medical officer. I imagine that will then go to the Minister at that point. We are not sure what imminent means in this regard. It could be after this meeting or it could be tomorrow. Are matters that advanced?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I was asked to put the following information on the record because people hear about hip dysplasia and what it means is important. We are talking about children and their families. If the witnesses do not mind, I want to read this. It was given to me by Senator Maria McCormack, one of my colleagues, and involves a person in the constituency in which the Senator lives. The people involved said they do not mind being named but I am not going to name them. It involves a boy who is now 11 years old. He was originally referred to Temple Street Hospital where a doctor, who I will not name, advised that his left hip required replacement but that the right hip was fine. The left hip was subsequently operated on. However, in 2018, they were called back and told that the right hip also needed replacing despite this young boy having no issues with that hip.
Trusting the medical advice, the family agreed to the second surgery. That turned out to be a devastating decision, in the family's own words. From the moment of the second operation, the little boy's quality of life deteriorated dramatically. He went from being fully toilet trained to fully incontinent. He lost feeling in his hip area and is now unable to tell when he has soiled himself. At just 11 years old, he now wears nappies daily and has to be changed up to five times a day. The little boy has been left with permanent bowel issues, going from 14 to 20 days without any bowel movements. The only response from the hospital has been to increase laxatives, which have brought no real relief or improvement.
The family are absolutely heartbroken. Not only did the surgery change their son's life in the worst possible way, but they are now faced with the reality that it may have been unnecessary in the first place. They say the psychological and emotional toll of that realisation is immeasurable. It is important to put that on the record as to what this actually means. Correct me if I am wrong on the figure, but did Ms Nugent say that 1,757 letters had sent out?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
This is just one of the families who have received this letter. They are in absolute limbo.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I appreciate that. Initially with these letters, it was a small window of 21 to 23 letters, then 500 letters were sent out.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Okay. Am I correct in saying that it was backdated to 2010?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Were there no surgeries prior to 2010?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Are they not part of this process or is it planned to expand this process?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Initially. Okay. I suppose the logic would say that the 1,757 letters that have been issued could run into many thousands if and when-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I have already mentioned surgeon A. It has now been established that this person was the primary individual in respect of the HIQA report and was also involved in the Nayagam review. I am not sure whether there are others. We might get information on that, if possible, and how broad the terms of reference were. It has been established that surgeon A was a central figure in that review. Is surgeon A part of this audit?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Does this involve surgeon A solely?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Would it be safe to say that this audit is centrally revolved around the practices of surgeon A or does it involve other surgeons that carried out operations?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Not predominantly, but it does include surgeon A-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
-----who has been out on garden leave since 2023. Was surgeon A employed back as far as 2010?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I thank the witnesses for that. It is pretty damning. It is critical that children and their families be key to all of this. The quicker that families can be engaged with, the better. The witnesses have outlined some of the measures in the action plan for families that have received those letters. For the record, will the witnesses say again what the process is if a family has received a letter?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
If families want a second opinion, is that something that will be provided by CHI or independently?
Ms Lucy Nugent:
We are in discussions with the HSE and the Department of Health as to the action plan. That will be made available, if the committee wishes, once approved.
My apologies. It is a nine-member board, not a ten-member board. I forgot about one vacancy.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
My final question relates to the ex-CEO. I find it astonishing that this individual has been moved into a position. A number of members made reference to a position that was created to suit the individual. Was there a job description before that appointment? Was there an active process around filling an identified need within the organisation?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
There was no need identified prior to this appointment.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I appreciate that. Those are all the questions I have for now. I am conscious of the time. I know members are anxious, if possible, to try to ask supplementary questions, but I put the questions to our witnesses in the first instance because I know some of them are under time pressure. If our witnesses are available to hold on for another half an hour or thereabouts, we will restrict the time allocated to each of the members to three minutes. We will suspend for five minutes for a comfort break.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Of course you may. We will suspend for five minutes, if that is acceptable.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
We will try to keep the questions for this round to three minutes. I am aware that a number of Deputies have given their apologies. We will try to move along quickly. We will now open the discussion to our first speaker, Deputy Neville.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
I was not quite expecting to get back to it, but at the same time I have been racking my brains. There is quite a bit to go through.
I am not sure whether my first question is for Mr. Devine or Mr. Gunning. How much has been paid directly to the primary contractor to date?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Around a billion euro. So only 2% or whatever outstanding in accounts receivable.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
As regards the overrun itself, how much is related to spending on the NPHDB’s own administration design team and business services team?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
The delta between €980 million and €1.88 billion.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
I am talking about the complete overrun on, say, the €900 million.
Mr. David Gunning:
The Government approved the increase in February 2024. At that stage, on the basis of a late 2024 assumption on completion we added another six months in terms of the budgeting to give us some leeway. We have eaten into that, obviously, and we are going to go a bit further, but we have some further contingency to deal with that in the budget.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Perfect.
Could Ms Nugent clarify whether surgeon A took voluntary leave or was told to take it? There is a big difference between the two.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Ms Nugent did use the phrase “voluntary leave”. We can take it that he is on leave but we do not know if it is voluntary or not.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
Ms Nugent just has to clarify that he is not necessarily on voluntary leave.
I want to check back in on the report. Ms Nugent has said it is coming out. Could she confirm that it was not held back because she was coming here today?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
I just do not want it coming out tomorrow, Monday or later next week and then-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context
It might just be a coincidence, unfortunately.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
On surgeon A, could Ms Nugent clarify and confirm that surgeon A was actually involved in both the non-surgical scoliosis springs and hip dysplasia scandals?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That is okay. What really gets me is that the surgeon is still employed. The children of our country have suffered under this man and he is still in employment under the HSE.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Is Children’s Health Ireland not under the HSE?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Completely separate.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Funded by the HSE. The circumstances are damning. I do not know whether the person is male or female but what happened should not have happened. There should be some kind of court of law that does not allow this to happen in our country at this stage of the game.
I am wondering where the oversight is. Ms Nugent said earlier to my colleague Deputy Connolly that CHI does not have a board or chairperson in place at the moment.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
That board has complete oversight over everything going on.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
On the former CEO who was working immediately before Ms Nugent, will we get a report on the legal bills and confidential settlement? CHI is required by law to produce that report, and it should be in the audited accounts.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Ms Nugent said she has staff employed who are all ready to go at the moment. Is that not correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
At the moment, they are not recruited. Ms Nugent has no staff recruited.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Okay. CHI is not ready to go then.
Ms Lucy Nugent:
What I was explaining was that the day-one workforce is the additional staff required for the additionality of the new hospital. We are nearly the end of that process. Obviously, we need to prove why we need the staff. Again, it is a cost, and we appreciate that. We are about to conclude with the HSE by the end of this month, and then it will obviously be referred to the Department of Health.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
My last question is on the HIQA report. Will Ms Nugent be willing to come back in here so we can question her more on when the recommendations are due------
Ms Lucy Nugent:
There are nine recommendations. They have been broken down into 32 sub-actions. Over 50% have already been completed. For example, one of the recommendations was to have a medical device management committee. That is in place. The remaining 37.5% have been started or are partially complete. The remaining 6% are not yet due.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Did this come out of the interim report?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context
Where is that report, the interim report? Ms Nugent told me earlier that she still has not received it.
Ms Lucy Nugent:
That is the HSE commissioned report that is expected. My understanding is the interim report of that is expected.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Deputy McAuliffe is not here. I call Deputy McGrath.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I thank everyone for staying with us this long. It is appreciated.
I will go back to the big picture in terms of the opening of the hospital. Not to put words in Mr. Gunning's mouth, he indicated earlier that he has little or no confidence in the contractor. I am paraphrasing there. The opening date that Ms Nugent has given us of June of next year is predicated on the handover of the hospital in September from the contractor. If we do not have a lot of confidence in the contractor, that surely opens up a big question in terms of the opening schedule for the hospital.
Mr. David Gunning:
I think the question is there. To be very correct, what I hope I said was that I certainly do not have confidence in the contractor and the 15 different dates is evidence as to why the development board should not have that confidence, but I cannot express or provide assurance to the committee today in respect of the September deliverable until such a time as we interrogate the contractor's programme in detail. We may interrogate that and find it is a realistic programme and the contractor is going to deliver it if it resources. I just cannot give that assurance today.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I understand. I am caught for time. The update that was received yesterday evening confirmed the September handover-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
-----but Mr. Gunning has not interrogated the detail.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
When was the last update in terms of a date and what was that date? When did the contractor previously indicate a date?
Mr. David Gunning:
I am trying to go back. The last time we were with the health committee, in September or October of last year, the date was then June of 2025. It did move out two weeks, back one week. There was a bit of smaller movement in the interim period but this is the most significant change in that date out to 30 September.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
As we draw closer, Mr. Gunning will be hoping that there will not be too much movement.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
I will turn to Ms Nugent regarding the operation and the question of staffing. If the hospital is open in June of next year, will the additionality Ms Nugent referred to be there in June? Will the hospital be 100% operational or are we talking about a phased opening?
Ms Lucy Nugent:
We are talking about a phased opening insofar as, for example, the hospital has been built for generations to come. For example, we have 22 theatres. We currently have 15, we are opening 18 and we will open the remaining four over the subsequent years. That makes sense from a workforce, but also from a demand, perspective.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
In terms of additional equipment, I imagine there has to be a lot of equipment procured and sourced, etc. That is well under way.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
Has some of that equipment arrived? Is it in storage? What are the logistics around that?
Mr. Phelim Devine:
I might come in on that. We have procured 80% to 90% of the equipment. Approximately €30 million or €40 million of it is embedded in the contract or we bought it and it has gone into the building. For instance, the CTs and MRIs are all in. Automatic guided, AG, vehicles are all in and they are being commissioned. On the group 3 and 4 items, which plug into data points or power, we have only €10 million of procurement to go and it is all in procurement. We have a lot of equipment sitting in warehouses ready to go into the building.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
It is in warehouses, in storage and inside of the building.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context
It is waiting to be used. I will make a final point, if I can. On Ronald McDonald House, which is a critical project, the indication is quarter 3 of this year. Did that project come in on budget on time?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Does the code of practice for the governance of State bodies apply to CHI?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Who is responsible for ensuring that CHI complies with it?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
Returning to the settlement arrangement done with the previous CEO, it is a requirement of that code, under paragraph 8.4, that in light of freedom of information, "in concluding settlements a State body should not enter into confidentiality agreements which preclude it from disclosing details of the settlement reached in the financial statements, save in exceptional circumstances and on foot of legal advice ...". Is Ms Nugent in receipt of such legal advice?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
That would be important. If Ms Nugent is in receipt of legal advice, I am not asking for the legal advice but I would like to know the grounds - the headings in which the legal advisers are saying that this falls to be exceptional circumstances. It is really important that we understand that because it is important that CHI complies with the code of practice.
In terms of the opening and the transition arrangements for the hospital, CHI is also at Crumlin and Temple Street. Is it envisaged that people working there will transfer to the new hospital? What are the plans for Crumlin and Temple Street?
Ms Lucy Nugent:
Temple Street will revert back to the ownership of the Mater Misericordiae company. In relation to Crumlin, the Crumlin hospital board, when it was dissolving, ceded the asset of that to Children's Health Ireland. Children's Health Ireland, in engagement with the HSE, is ceding approximately 60% of that site to the HSE in recognition of the investment we have got for the purposes of the elective hospital, and the remaining 40% of the site is being worked through with regard to the options for its use.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
What of the transfer of the employees?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
And they will-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
There no issues with any of them moving to the new hospital.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
That is just part of their contract.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
There is no renegotiation of their contract.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I asked Ms Nugent about the three biggest challenges that Children's Health Ireland is facing from the employees. She referred to car parking. I did not get a one-word answer for the other two. Could Ms Nugent respond?
Ms Lucy Nugent:
Obviously, we need to make sure that we can staff this hospital - that is important - and we need to make sure that we have the operational budget to run this hospital. Having said that, with every merger there are efficiencies, from both service delivery and from finance. They are the major things.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context
I asked about the employees. Is car parking the biggest challenge for employees?
Ms Lucy Nugent:
Apologies. From the employees, it is car parking and rostering. For example, in one entity, they start 15 minutes later than the other entity, so the question is which start time it will be. Those are all part of our staff engagement.
The other element is we just need to make sure our staff are fully trained. This is a huge change-management project. We have an Eolas programme - it is our training programme with staff. We cannot do it until four months before the actual opening date because if you are shown a system, you will forget about it if you do not use it until a year later. The Eolas programme looks at the training needs of staff and also familiarisation with the building. We have a challenge to do all that for staff while also running business as usual. That is probably one of biggest ones.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I thank the witnesses for staying. As regards the €2 million per month, is it Mr. Gunning's best estimate that it will be ongoing until the completion of the programme?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
That will no be longer necessary.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
As regards the board, is there a board functioning now for Children's Hospital Ireland?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
How many are on the board?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
How often are they meeting?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
What about the interaction between that and the National Paediatric Hospital Development Board? How often do they meet? What is the communication like there?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
What is the process?
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
So there is a whole process-----
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
----- and Ms Nugent has no concerns about that.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Let us move on to the Department and the oversight. That was another level that was put in because, obviously, notwithstanding all of these processes and procedures, it has not worked, notwithstanding its best efforts.
An oversight body was then set up. I am taking this from the time it was set up, in 2013, to date. How is that functioning? If I get a chance, I would love to come back to agency staff. I might not, but we will ask the Department to come back with a note.
Mr. Derek Tierney:
Regarding the Department's structure, we have a national oversight body. That was one of the key findings from the 2019 PwC report. It is chaired by the Secretary General. Ms Conroy, the CEO of the HSE, the director of the HSE and I attend. The project sits between the paediatric hospital development board and CHI in the context of that integration, going from build through the transition to pre-operations. As Ms Nugent and Mr. Gunning said, as agencies in their own right, the NPHDB and CHI communicate and integrate at an operational project level. That is the architecture that we have put in place since 2019 or 2020.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Notwithstanding all of that architecture, there is no penalty for the builder when he or she does not deliver, as a result of a contract and difficulties that were identified way back in 2019 and before. The board is reporting to us that there is no penalty at all.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
If the developer delays and delays, he or she is paid anyway, eventually.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
Absolutely, but if the contractor delays and then does it six months later, he or she is paid. There is no penalty for the delay.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context
I understand the three levers. They were there in the beginning in 2019 and it was to be terminated, but it was decided it would not be and here we are now. I hate the word "learning". Is there something wrong somewhere in the contract that there are no penalties?
Mr. Derek Tierney:
We are in an existing contractual relationship. We cannot change that because we are governed by the construct of the public works contract, but what we have done is taken learnings across a number of headings and we are now applying them to our next projects and programmes. Earlier there was a discussion by one of the Deputies regarding what we have learned as we face into the next capital build and how we will apply it. Equally, we have taken those lessons and engaged with the OGP and the Department of public expenditure and reform. I will provide a note on it. We supplied a note to the Joint Committee on Health. I think it was on 6 February of this year. I am happy to provide that to show the learnings we are applying and building into new programmes.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
I thank the witnesses for staying on. It is greatly appreciated.
When Ms Nugent phoned the Chief Medical Officer this morning about the audit, she asked whether the audit was ready and she said-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
He said. I am sorry-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
In terms of the call, however, Ms Nugent phoned the Chief Medical Officer and asked whether the audit was ready. He said-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Presumably he said to Ms Nugent that it could come within the next hour or tomorrow.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
It will arrive today or tomorrow.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Going back to the former CEO, I have no difficulty with Ms Nugent having training before coming to the Committee of Public Accounts, given it is Ms Nugent's first time appearing before it. Her answers on the former CEO, however, were clearly a trained response. Ms Nugent does not own this situation that she has found herself in, but it was a clear case of a certain line being given out. For the public watching in and understanding this story, something is missing or awry here. The Minister refused to give the consent on the board's recommendation for this person's appointment as CEO, an unusual step, which Ms Nugent has acknowledged, as someone who has worked in hospitals for a long time. That person, who did not get appointed, had to hire a lawyer to advise her on her position with regard to whatever processes were going on. Presumably, Children's Health Ireland had to pay a lawyer as part of the mediation process. The outworking of that mediation process was that this person received a new position that did not previously exist at precisely the same salary Ms Nugent is currently on, and CHI had to pay its own lawyers and the other person's lawyers. Is that correct?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context
Ms Nugent can see that, for the public listening in and watching on, this is a most unsatisfactory outcome from a process whereby a Minister has taken a decision and we do not know the full reasons for that decision. We know the context and what is taking place surrounding that decision not to provide the consent, but we have absolutely no clarity regarding it.
For Ms Nugent, as CEO of the hospital, it cannot be a satisfactory situation for her that a former CEO is lurking around the corridors as she is trying to build a new vision for the hospital and trying to move forward with the action plan. Does she agree that, all things being equal, if she could have some control over this, she would not have wished to have a former CEO sitting in the hospital working away, with her as the new CEO trying to deal with the issues that are before her?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I thank Ms Nugent for staying with us. If there is a likely 16th or 17th delay, will there be any operational or clinical consequences for the transition?
Ms Lucy Nugent:
We have been using these altered timelines to make sure that, where we can, we are going beyond what we were originally going to have on day one. For example, Children's Health Ireland at Tallaght is currently on the ICT systems in Tallaght. Because of the delay, we are considering things. We were not going to move CHI at Tallaght. The urgent care centre will be there in perpetuity even when the inpatient and outpatient sections close. We were going to leave them on the TUH systems but are now going to move them over earlier to CHI systems. What that means is we are bringing all our data together. That is an advantage-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
A potential 16th or 17th delay will not impact on the transition.
Ms Lucy Nugent:
What we will keep on doing is preparing ourselves. We can never have enough trial runs. There is a go-live register assessment tool, which we do not have time to get into but will talk about again. Again, it gives us more opportunities to practice, trial and make sure our staff are ready, which is very important.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
In 2022, €19 million was announced by the Minister specifically with regard to scoliosis and spinal surgeries. I was expecting that to be crystallised in the 2023 accounts. Was it? Will Ms Nugent very briefly tell us how that was spent? Was it spent directly on surgeries? Has CHI received that funding?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I will find that publicly. I have a third question regarding CHI. There were reports last year of additional halo-gravity traction wheelchairs. Has CHI purchased any more and how many are available to CHI and the children in the service?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context
I thank Mr. Gunning and his colleagues for their time this morning. Are there any vacancies on the board? Has the board had an opportunity to reflect on the learnings? If it were day one tomorrow, would the board do anything differently overall with this significant infrastructure project?
Mr. David Gunning:
We have a 12-member board. There is one vacancy at the moment. It is a very recent vacancy. The board is made up of two construction lawyers and a senior counsel, all with very strong experience and the senior counsel being a former Government Minister. We have a former Secretary General of the Department of Finance. We have a number of engineers from large construction companies with great experience in large projects, including healthcare projects, who are household names in Ireland in terms of where they worked during their working life. We also have three former NHS commissioners of services - two from Northern Ireland and one from Scotland.
They have built hospitals, brought them into use and that skill set is on our board, with a wonderful chair. We have a very strong high-performing board. We discuss these matters at great length as members can imagine because there is an awful lot to take away from it. The board, however, is focused on one thing: get this hospital open as soon as possible. That is our focus. That is not to say that we do not look at how we can learn. Mr. Tierney mentioned various processes earlier. We have been part of an ongoing dialogue with the Department of Health, OGP and various other entities on what are the possible takeaways from this whole area and how that might be brought into use in future projects.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I have a couple of concluding questions. On the implications for missing the fifteenth revised timeline, are there any financial consequences for missing that deadline? It was referenced in real terms. Mr. Gunning made reference to the three levers that are open to the development board but what are the financial consequences, if any, for the missing the latest timeline?
Mr. David Gunning:
The section in the public works contract that deals with this issue is referred to as liquidated damages. We have attempted to apply these in the past. The contractor has not agreed and various issues are in dispute relating to that. The amount of liquidated damages that has accumulated since the contractual period for completing the contract in November 2022 up until 31 September 2025 is €31.5 million. Forgive me, I cannot give the Cathaoirleach a monthly rate. I am looking for my notes here but I cannot find that slide. We have provided this to a number of public accounts committees in the past. There is an amount that accumulates but there is a question as to whether the court would support the levying of that. That is a matter we face from-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I appreciate that. The 16 top claims that Mr. Gunning referenced equate to approximately €800 million. Can we get a note on the breakdown of what the cost is of each of those 16 claims - I am not looking for specific detail - and whether any of those subject to the High Court proceedings to which he alluded?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Mr. Gunning will provide that note. I would appreciate that. To go back to surgeon A, one of the most damning statements I have heard today is that this individual is responsible across all of those reviews. I wish to get a little more detail. What is the nature of that individual's contract? It was stated that he is out on leave since late 2023 in receipt of full salary. What is that salary?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Maybe we can get a note on that. I would appreciate that. With specific reference to surgeon A, is that individual subject to any other investigations or reviews currently?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Is the report to the Medical Council relating to the hip dysplasia operations?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Springs. Have other reviews or issues been brought to CHI's concern?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Is that a live investigation with the Medical Council at the moment?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
I appreciate that.
On the issue of staffing, what will be the full complement of staff required for the new hospital when it opens eventually? Hopefully June 2026 will be that date. There was reference made -----
Ms Lucy Nugent:
We are in discussions on that. A total of 86% of the additional staff will be clinical staff because that is where the majority of the additionality comes. There are some administrative staff needed because we are going to be a fully digital hospital. Again, we are looking at role profiling. We are providing some people with the opportunity to reskill because they may want to, for example, move into the digital team. There is a whole process ongoing in that regard.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Ms. Nugent does not have a-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Have concerns been expressed to the CHI by the representative organisations of nurses and doctors on the ability to be able to staff the new hospital when it is open?
Ms Lucy Nugent:
It has been well documented and aired in the public domain. There are some posts that take a longer lead-in time than other posts will, for example, specialist nurses and consultant posts, but, again, we have a good track record of doing both on the island of Ireland and international recruitment. Anecdotally, we have been told that there are a lot of nurses in Australia who are only dying to come home when this hospital is opened.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Anecdotally is different from reality-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
Is Ms Nugent confident that CHI will be able to recruit a full complement of nursing staff once the hospital is opened?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context
On that note, we will leave it at that. I thank our witnesses and the staff of CHI, the National Paediatric Hospital Development Board, Department of Health and the HSE for their work involved in preparing for today's meeting. I also thank the Comptroller and Auditor General and his staff for attending and assisting the committee in its deliberations.
Is it agreed that the clerk to the committee will seek any follow-up information and carry out any agreed actions arising from the meeting? Agreed. Is it also agreed that we note and publish the opening statement and briefing for today's meeting? Agreed. In our next meeting, we will engage with the Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media, the Arts Council and the National Gallery.