Oireachtas Joint and Select Committees
Wednesday, 25 March 2026
Joint Oireachtas Committee on Health
National Children's Hospital: Discussion
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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Apologies have been received from Deputy Peter Roche and from Senator Nicole Ryan who will be substituted by Senator Maria McCormack. I wish Senator Ryan the best with her upcoming maternity leave and the time ahead. On behalf of the committee, I send condolences to Deputy Burke on the recent passing of his mother-in-law. The minutes of the meetings of 3, 4 and 18 March have been circulated. Are the minutes agreed? Agreed.
I remind members of the constitutional requirement that members must be physically present in the confines of Leinster House in order to participate in public meetings. I will not permit a member to participate when they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside of the parliament will be asked to leave the meeting. In this regard, I ask any member participating via MS Teams that prior to making their contribution to the meeting, they confirm they are on the grounds of the Leinster House complex.
Today the committee will consider issues related to the completion of the national children's hospital and preparations for bringing it into use. I welcome from Children's Health Ireland Ms Lucy Nugent, chief executive officer; Ms Paula Kelly, clinical director; Dr. Michael Riordan, clinical director; Ms Julia Lewis, transformation director; and Mr. Adrian Carroll, programme director for EHR. From the National Paediatric Hospital Development Board, I welcome Mr. David Gunning, chief officer; and Mr. Phelim Devine, project director.
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 may be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be asked to discontinue their remarks. It is imperative that they comply with any such direction.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person or an entity outside the Houses or an official either by name or in such a way as to make him, her or it identifiable.
Today's meeting is looking at the delivery of the national children's hospital and, crucially, the preparations under way to finally open the hospital and treat the country's sickest children. Over the past six year,s 17 substantial completion deadlines have come and gone. With the 18th completion deadline on the horizon, we need assurances that the latest commitments will be honoured and that there will be an end to this endless cycle of missed deadlines.
Today we also need to find out what has been agreed with BAM to finally finish the project and get it over the line, when the hospital will open and how prepared CHI is for the transition to the new hospital. Given that the Minister for Health recently told the committee the contractual structure is not one the Department would do again, it is also important that we gain insights on what has gone wrong to ensure future governments do not repeat the mistakes of the past. To commence today's proceedings, I invite Ms Nugent to make her opening remarks on behalf of CHI.
Ms Lucy Nugent:
We welcome the opportunity to appear before the committee and we will endeavour to answer its questions as openly and clearly as possible. Children’s Health Ireland has a unique responsibility in our health system. We are the national provider of specialist and complex paediatric healthcare, caring for children and young people throughout Ireland as well as partnering with colleagues in Northern Ireland on the delivery of cardiac care, delivering treatments that are simply not available elsewhere in the system and, at times, internationally. At the same time, we play a central role in delivering the vision of Sláintecare as set out by Government, working with hospitals and community services across the country to ensure children receive the right care, at the right time, and as close to home as possible. Our responsibility is, therefore, both national and collaborative, providing the most complex specialist care while supporting a strong network of paediatric services across Ireland.
The scale of activity across CHI reflects this role. Through our hospitals at Temple Street, Crumlin and Tallaght, and our urgent care centre at Connolly, we deliver care across 40 specialties, including at a quaternary, tertiary and secondary level. Each year our services care for tens of thousands of children and young people across emergency, inpatient, outpatient and surgical care. Almost 145,000 children attend our emergency departments and our urgent care centre at Connolly Hospital. We deliver care to more than 55,000 inpatient and day-case patients and more than 162,000 outpatient appointments each year. Behind each figure is a family who relies on CHI during some of the most challenging moments in their lives and we understand how disruptive hospitalisation is to the whole family. Each of the 40 different specialties in CHI, has a dedicated team of expert multidisciplinary members. I acknowledge the commitment and professionalism of those staff, 365 days a year, 24 hours a day. Almost 5,000 people work across CHI and they deliver highly specialised and exceptional care every day. Their dedication to children and families is extraordinary.
While we are focused on delivering further improvements in all areas, it is important to highlight the work done in spinal care and the progress that has been made. The spinal waiting list is not static, it is like a moving queue. Every month patients receive their surgery and leave the list but their space on the list is filled by another patient who is newly referred for care, and our focus remains on reducing the time a patient waits on that list. While 524 patients were added to the list between January and December last year, 534 spinal surgeries were carried out in the same timeframe. The list changes constantly, reflecting both progress and rising demand. Any wait is too long but I am happy to report that times have improved. In December 2024, the average wait time for an outpatient appointment was 9.7 months. By December 2025, this had dropped to 3.9 months.
The inpatient day case weighted average wait time dropped from 5.9 months in December 2024 to 4.2 months in December 2025. While challenges remain, CHI’s spinal service has seen significant improvements in both surgical outcomes and in how we support families through their care journey. We will work to continue making improvements and minimising delays, while maintaining high standards for the delivery of care for our patients.
The past number of years have been challenging for CHI and the families we serve. Various issues that have arisen within our services have raised understandable concerns for families and for the public. Where care has fallen short of the standards that children deserve, we have acknowledged those failings and apologise to the families affected. I have promised and I continue to promise that when things go wrong, we will be responsible and accountable. We are an evolving and learning organisation and what we learn from our mistakes must improve care for our patients. Our focus now is firmly on ensuring that the governance and organisational culture within CHI supports the highest standards of safety, transparency and accountability. It is imperative that our families have confidence in us and the care their children receive. We are working hard to ensure meaningful partnership with our families in the care delivered to their children.
The opening of the NCHI is one of the most significant developments in Irish healthcare in generations. While much of the public discussion has understandably focused on the construction of the building, it is important to recognise that the new hospital represents a fundamental transformation in how paediatric healthcare is organised and delivered in Ireland. The hospital will provide state of the art operating theatres, advanced diagnostic and imaging facilities, expanded critical care capacity and a fully digital clinical environment designed around the needs of children and families. I can understand the widespread concern around the opening date. No one wants this hospital more than the staff who are on our current sites. If you were to ask me when will the new hospital open, my answer, from a CHI perspective, remains when it is safe to do so and approximately seven months after we get the keys.
While it is an iconic building in Dublin’s skyline, a building does not provide healthcare - people do. Thousands of staff will be trained in new systems and technologies to prepare them for this transformative change. Almost 60,000 pieces of equipment will be installed, commissioned and integrated to make the building a working hospital. Entire clinical teams will be tested in new ways of working, with new colleagues in new teams, within a fully digital hospital environment - the first in the country. A lot of this work has already started and all of this work is taking place while we continue to deliver essential healthcare services for children and young people across our hospitals every day. My colleagues in CHI are among the most dedicated and talented community of people that I have had the privilege to work with and we all have a shared purpose of enhancing every child’s healthcare experience. It is a complex transition but it is also an extraordinary opportunity to realise a modern, integrated national paediatric service for Ireland’s children.
Along with my colleagues today, we hope to be able to illustrate the focus and innovation that is guiding us in preparation for the move to the new hospital. Imagine a world where stepping into a children’s hospital feels less like entering a place of illness and more like walking into a space designed for wonder, healing, hope and possibility, where play is woven into every corner. Imagine a world where robots glide quietly down hallways delivering meals and supplies and there is digital clinical monitoring freeing nurses to spend more time at a child’s bedside, where interactive walls turn waiting areas into adventures and gardens and sensory spaces help calm anxious minds. In this new hospital, technology and compassion work hand in hand. Families stay close in thoughtfully designed spaces, treatments can happen faster and more gently and even the hardest days are softened by surroundings built with children in mind. It is not just a new hospital; it is a transformation in how care feels, where imagination becomes part of the medicine.
Alongside educating and training the healthcare staff of the future, our ambition is to build our partnerships internationally in terms of research and innovation, ensuring our children and young people access the best available treatment options and ways of care. In conclusion, CHI is entrusted with providing the most specialised healthcare services for children and young people across Ireland. We take that responsibility and role very seriously. At the same time, we are preparing for one of the most important transformations in the history of Irish healthcare with the opening of the NCHI. Every decision we take in CHI serves one purpose: ensuring that the children of Ireland have timely access to safe, high-quality and compassionate care. I thank the committee for listening and we are happy to take any questions.
Mr. David Gunning:
I thank the Cathaoirleach and the committee members for inviting the National Paediatric Hospital Development Board, NPHDB, here this morning to provide an update on the construction of the hospital. My name is David Gunning and I am chief officer at the NPHDB. I am joined this morning by Phelim Devine, my colleague who is the project director. The NPHDB was appointed by the Minister for Health in 2013 to design, build and equip the NCHI on the campus shared with St. James’s Hospital, a paediatric outpatient and urgent care centre at Connolly Hospital and a paediatric outpatient and emergency care unit at Tallaght Hospital. The latter two facilities were handed over to CHI, in 2019 and 2021, respectively, and are fully operational.
What is also within the remit of the NPHDB is the construction of the new Ronald McDonald House family accommodation unit. Construction commenced by Clancy Construction in February 2024 and the completed building was handed over to the HSE and Ronald McDonald House charity teams in December 2025. This family accommodation unit is located directly across from the main entrance of the NCHI and is connected at the basement level. It will provide accommodation for 52 families each night, more than double the accommodation available at the current Ronald McDonald House at CHI at Crumlin.
The main contractor, BAM, started the above ground works on the NCHI in January 2019. Over the past seven years, it has delayed its programme 18 times regarding the expected substantial completion date. This is shown in appendix 1 of the pre-read we provided to the committee. Its most recent programme updates, received in January and confirmed on 27 February 2026, state that the substantial completion will be on 30 April 2026. This is approximately 40 months later than the revised contract date of 2 December 2022. The independent third party administering the contract, the employer’s representative is currently reviewing the most recent programme update received on 27 February 2026 to evaluate its compliance with the contract.
As of 19 December, BAM provided partial early access to the NCHI. This enabled CHI and the NPHDB to commence operational commissioning works on level 6. That work is now complete. On 24 February and 6 March 2026, BAM provided early access to the lower ground level and level 0. The works completed on these three levels to date comprise clinical cleaning and the delivery, installation and commissioning of over 5,500 pieces of medical, non-medical and ICT equipment. We are currently awaiting early access to levels 1 and 2, operating theatres and critical care departments to complete BAM’s early access commitments. These levels are crucial to support the operational commissioning schedule for CHI post substantial completion.
In order to deliver substantial completion, BAM must deliver in excess of 400 rooms per week. As of 20 March 2026, 3,726 of the 5,728 rooms have been offered by BAM to the design team to validate compliance with the contract standard. As of 20 March, 2,854 of the 5,728 rooms have been validated as meeting the contract standard. These areas must be delivered logically and sequentially and ensure the quality meets the standard set out in the contract. BAM must complete the technical commissioning of the hospital in accordance with the contract, which requires compliance with the building regulations and standards, including the health technical memorandum. BAM must submit to the assigned certifier documentation and certificates to enable the NCHI to be placed on the building register by DCC, and complete the safety file and the training to enable CHI to operate the hospital post substantial completion.
The ER and the NPHDB will not accept the NCHI if it is not in compliance with statutory regulations and standards. The NPHDB and CHI have undertaken due diligence studies and considered lessons learned from other large international and complex hospitals. These reviews have evidenced that unresolved compliance issues can cause operational disruptions and safety risks for patients. Acceptance by the employer representative of substantial completion is dependent on all statutory and contractual requirements being fully satisfied.
The NPHDB is exercising all rights and remedies available under the contract to compel BAM to achieve substantial completion. The NPHDB has on multiple occasions withheld 15% of payments due to BAM when BAM's programme was deemed non-compliant by the ER. As the ER has not certified that the works have reached substantial completion on the contractual date, the NPHDB has previously issued an employer's claim under the contract to deduct liquidated damages. Based on BAM's forecasted completion date of 30 April 2026, the NPHDB has estimated potential liquidated damages to be €40.2 million. In addition, the NPHDB has pursued alternative dispute resolution options outside the contractual framework, including a moratorium on disputes, during which the parties actively engaged with the objective of achieving programme and cost certainty. On 13 March the Minister for Health, the HSE, Department of Health officials and the NPHDB met with senior representatives of Royal BAM, including the chief executive and chairman of the executive board, to receive assurance that BAM Ireland will meet its committed substantial completion date of 30 April. This is a crucial date to support the operational commissioning timeline for the NCHI. One focus of that meeting was to ensure early access to the NCHI's levels 1 and 2, comprising theatres and critical care rooms, and to ensure that all clinical rooms and patient areas are completed to the required clinical standards. During the meeting, BAM committed to provide a resource-loaded close-out plan to achieve SC by 30 April.
In terms of progress to date, in appendix 2 we have shown that the first phase of early access was provided by BAM to levels 6, LG, and 0 on 19 December, 24 February and 6 March, respectively. The Ronald McDonald House is complete and will open in line with the NCHI. All medical, non-medical and ICT equipment is now installed at level 6 and is ongoing at levels LG and 0. The procurement of equipment is practically completed, with a small number of items postponed to ensure that we get the most contemporary and most innovative equipment. All specialist inbuilt equipment - MRIs, CTs, X-rays, C-arms, dental suites, etc. - is now installed. Installation of the AGV system, the robot carts, is now complete, and final testing and simulations will commence post substantial completion. The public realm works and all external landscaping are complete. The technical commissioning and snagging of the NCH are nearing completion. What remains is completion of system commissioning, such as ventilation, cause-and-effect testing and final system integration to provide stable environmental conditions as per the contract.
In February 2024 the Government approved enhanced capital and current budget sanctions, bringing the total approved capital budget to €1.88 billion for the NPHDB component of this important project. To date, the total cost incurred by the NPHDB is €1.644 billion, including VAT. The Government-approved budget increase included provisions to address areas not originally included in the 2018 budget, a number of which were clearly set out in the independent review completed by PwC in early 2019. The PwC report, which noted that the NCHI was unique in scope, scale and complexity, also noted the number of project risks that had the potential to place further cost pressure on the approved capital budget. These risks included contractor entitlements under the contract, the outturn of provisional sums, recovery of construction inflation above 4%, the need for additional capacity and capability in the exec team of the NPHDB, and the contractor's right to claim for additional costs in line with public works contract provisions.
Regarding contractor claims-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Mr. Gunning, you are over time so I ask you to move towards a conclusion.
Mr. David Gunning:
Thank you, Chair.
We have set out the claims in appendix 3. I would simply draw the committee's attention to the second paragraph under "Claims". Of the 3,141 claims determined, 2,619 claims made were challenged by BAM, totalling just over €1 billion. Eighteen of these claims for extensions of time make up €926 million of the disputed total, representing 87% of the overall amount.
There is mention in my opening statement of the High Court proceedings. I do not propose to go through that. It is set out there.
I would like to make an addendum to this statement. We submitted our statement to the committee on Monday, but I would like to add this statement based on information since then. At a meeting with the senior BAM team yesterday morning, 24 March, BAM confirmed that it would not deliver on its 30 April substantial completion date. This is obviously a huge disappointment as BAM has already delayed the SC date 18 times. However, while BAM is not achieving SC, BAM advises us that it expects to have areas of the hospital completed by the end of April. In accordance with the contract, BAM's most recent programme provided in January 2026 is non-compliant. The employer's representative is now in the process of writing to BAM to formally request an updated contract programme. In the meantime, our focus in the NPHDB will be to continue to seek opportunities for further early access to the areas BAM offers once those have achieved the required completion standard. This will allow the NPHDB and CHI to continue to progress additional fit-out and equipping activities. We will also ensure that BAM makes all necessary progress to complete all the rooms and the commissioning of systems to the required completion standard as soon as is practically possible.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Mr. Gunning. It is certainly disappointing that the 18th deadline will be missed and that we will move to a 19th deadline.
We will now move to questions from members. Members will have eight minutes each for questions. We will take a break before 11 o'clock and we will aim to conclude by 12 o'clock. I will start with Fianna Fáil and Deputy Daly.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank both teams, the CEO, Ms Nugent, Ms Paula Kelly, Dr. Michael Riordan, Ms Julia Lewis and Mr. Adrian Carroll, and Mr. Gunning and Mr. Devine's team.
First, it is deeply disappointing that this date has been put out. Has BAM given the NPHDB a new date? If 30 April is not the date, what is the new date?
Mr. David Gunning:
As I suggested, the process under the contract requires the employer's representative to require the contractor to provide a new date. That is happening at the moment. The contractor has 15 working days to respond to that, and when we get that response we will understand what the new date is. That is the process.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Under "Compelling BAM to fulfil its obligations", there is a dispute of €40 million. Can Mr. Gunning explain that to me? That is because the substantial completion on the contractual date has not been achieved, and that would have been 30 April. Will that figure climb?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Yes, please.
Mr. David Gunning:
-----it is the liquidated damages amount. I am often asked in committees what the State's response to BAM's delays is. The State's response is embedded in that item of liquidated damages, in that because BAM is in delay the contract would allow the State to levy, currently calculated to the end of April, that figure of €40 million. If there is further delay, that will still increment up further to a particular amount. That is the State's claim against the contractor for delaying. BAM, on the other hand, as Deputy Daly will be aware from what I have said, has €1 billion in claims against the State. We can elaborate on that in more detail.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Yes, I would like the witnesses to do that. I would like them to walk us through the claims section in the NPHDB's opening statement and what that actually means in layman's terms for the State, for the delivery of the hospital and for the exposure of the State to additional cost. A sum of €1 billion is a large one in the context of a €1.8 billion capital budget. This is appendix B.
Martin Daly (Roscommon-Galway, Fianna Fail)
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The employer's representative has signed off on only €53.16 million, 6.6% of the value claimed, so there is a dispute over almost €1 billion.
Mr. David Gunning:
That is correct. The employer's representative is the first level of the disputes process.
If the contractor has a claim, it submits that to the employer's representative. She makes the determination of that claim. The Deputy is right to point out that, on average, if BAM is claiming €100, then it is getting €6.60 on each of those claims. That is what the employer's representative is adding to that.
Martin Daly (Roscommon-Galway, Fianna Fail)
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How can there be such a disparity? What are the reasons for such a disparity between €1 billion and €53 million? That is enormous. This is not marginal stuff. It is nearly 90% of the claim, or more.
Mr. David Gunning:
If I could talk about BAM’s claims, I mentioned in the opening statement that 18 of the claims make up nearly 90% of the entire amount. The money is in 18 individual claims, and all of those are about the extension of time from the contractual completion date, which is December 2022. When BAM signed the contract, that was the date, mid-2022. That has been moved up a few months but just for the purposes of this discussion, the end of 2022 was when we were meant to get this hospital.
Martin Daly (Roscommon-Galway, Fianna Fail)
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We are 40 months over.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Is this an additional €1.8 billion?
Martin Daly (Roscommon-Galway, Fianna Fail)
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That is the exposure to the State.
Mr. David Gunning:
Exactly. What I am saying is that if I were to dig into that in more detail, there is €1 billion there and many claims in there have been submitted twice and three times, so there is a significant degree of duplication and triplication. I think a more realistic extent of the company’s claims, if we take out the duplication, is a third of that amount. As I said, we do not believe BAM has any real entitlement to even that money, based on what it has said.
Martin Daly (Roscommon-Galway, Fianna Fail)
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This is an international construction company that has failed to deliver on all its targets, repeatedly, still cannot satisfy many of the requirements of the contract, and it has a claim in for an additional €1 billion. It is just simply unbelievable. Not only that, but BAM is not delivering. We are 40 months over the schedule, and we still do not have an opening date for the hospital. It is unconscionable that the State has invested so much money in this project and the infrastructure has not been delivered on time. Not only that, but it is 40 months over the schedule and without a definite date for delivery. It is just mind-boggling as are the sums of money involved, in the context of the overall cost of the delivery of this national infrastructure. I do not know what more to say on this except that there will be deep disappointment and severe public disbelief at the lack of delivery and that this company seems to have this State over a barrel at every juncture. It is very difficult.
Turning back to Ms Nugent, I also want to recognise the hard work and commitment of the staff in CHI. In the past, and I hope this is not the case now, they were often working in an organisational structure that set them up to fail. I do not think I am overstating that. I sincerely hope that has changed, and that will be the case as we go forward. The individual people who work there -are to be commended for their commitment. If we do get a date, what preparations have been made in terms of staff moving to the new hospital? Over what period of time would that take place?
Ms Lucy Nugent:
There is a role-mapping process in respect of what the future role of every member of staff in the hospital will be. It is easy for me. I will, hopefully, still be the CEO of the new hospital. For a staff nurse who worked on a ward such as orthopaedics and surgery, that will just be an orthopaedic ward in future. Staff are being asked to choose their preference, so a whole role-mapping exercise is being done.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Does Ms Nugent think she will have an adequate number of staff to open the hospital?
Martin Daly (Roscommon-Galway, Fianna Fail)
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If we were told today that 30 April would be the date when the hospital will open, would Ms Nugent have the staff to open it?
Ms Lucy Nugent:
Our target for day one opening is seven months after the substantial completion date. With the support of the HSE and the Department of Health, we have been approved for 576.6 additional whole-time equivalents for the additionality of the building. Not only do-----
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Nugent. We are over time.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I am sorry but we ran out of time. I thank Ms Nugent for her answer. I appreciate it.
Pádraig Rice (Cork South-Central, Social Democrats)
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We can return to that issue. I call Deputy David Cullinane.
David Cullinane (Waterford, Sinn Fein)
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Go raibh maith agat. I will start with Mr. Gunning. It could be argued that he dropped a bombshell by saying that BAM has now informed the board, and he has informed us, that the completion date at the end of April, which was completion date number 18, will not be met. It is not a bombshell because nobody believed that it was going to be met in the first instance. Clearly, from the data provided even for this meeting, that was not going to be the case. This is just an illustration of how bad this process and project has been. It has been a disaster from start to finish. We are dealing with massive cost overruns, billions of euro of taxpayers’ money, 18 completion dates which have come and gone, design changes and all the problems we have had with the project. Fundamentally, there was a flawed contract that was an absolute disaster. I hope we never see the likes of that contract again. Bizarrely, it was a contract signed off on by the current Minister for Finance, Deputy Simon Harris, which is even more bizarre.
This has been a disaster but I want to concentrate on where we need to go now. For a long time to come, we will be talking about this hospital because all the cost overruns and all the claims in the High Court will still be being adjudicated on when the hospital is built, whenever that will be, and when it is open, whenever that will be as well. I just want to come to some of the main dates, which we now have. We do not have them now because they have changed again. I want to get some sense for the public as to when this hospital will be open. There are so many moving parts to it. I just want to start with the obvious place, which is the completion date at the end of April. It is now not going to happen. As Mr. Gunning said, the employer’s representative has to seek a new update. We will see what that new date will be. The majority of the rooms, 51%, still have to be completed. That is 400 rooms a week needed to meet that target of April, which, obviously, will not be met.
I also understand that there are problems with commissioning services, which is obviously a really big problem in terms of getting to an end date. One of those areas is ventilation. Can Mr. Gunning talk to me a bit about these issues, namely the rooms that need to be completed and the ventilation system that is still not fully commissioned? From Mr. Gunning's perspective, how troublesome is this in terms of getting to a completion date?
Mr. David Gunning:
I thank Deputy Cullinane for the question. I will ask Mr. Devine to come in on the detail because that is his area. As I said in the opening statement, and I think it is critically important to get this right, we will not accept anything that is not at the required standard from this contract. We cannot. Even if the pressure was on to get this done sooner, if it is not right, then it has to be made right. I just want to make that point.
David Cullinane (Waterford, Sinn Fein)
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I ask Mr. Gunning to talk to me about the lack of commissioning in those circumstances. What is going on here? We need to know what is happening.
Mr. David Gunning:
I will hand over to Mr. Devine on those matters. We have been monitoring BAM’s progress in great detail from the very start. We have been doing so even more closely since November 2024, when we started a very strong engagement process. Perhaps Mr. Devine can talk about the room completion and the ventilation and commissioning issues.
David Cullinane (Waterford, Sinn Fein)
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I thank Mr. Gunning. We have very limited time, so I just want to hear about those services that have not been commissioned, like ventilation, and the rooms that have not been completed. In Mr. Devine’s estimation, how long is it going to take to get that done?
Mr. Phelim Devine:
The Deputy mentioned 400 rooms per week. BAM is averaging about 200 rooms per week. That is what the run rate is. This is all about just bringing these rooms to the right standard. We are talking just about marks and scrapes on floors and scrapes on walls and resolving fire doors to make compliance with the contract, that kind of stuff. It is a volume exercise. All that is needed to deliver that quicker is more resources on the project. It is as simple as that. It is a volume exercise.
It is a little bit more complex in terms of the commissioning. Mr. Gunning illustrated the importance of this aspect. This is a very highly regulated hospital. It is a tertiary hospital. The ventilation systems, in particular, are really important. This is all about the right air changes, which we do have. It is all about ventilation systems that do not create a lot of acoustic or noise issues. The challenge we are having currently on the project in meeting and being compliant with the contract is that some of these ventilation systems, while operating correctly, are creating more noise than they should. This is important because if they are too noisy, they will disrupt the clinical surgeons at CHI.
David Cullinane (Waterford, Sinn Fein)
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What is causing it?
David Cullinane (Waterford, Sinn Fein)
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How big a problem is it to solve?
David Cullinane (Waterford, Sinn Fein)
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Could this delay the hand-over by weeks or months?
David Cullinane (Waterford, Sinn Fein)
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We still have rooms that need to be validated.
David Cullinane (Waterford, Sinn Fein)
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We have problems with commissioning services. We have resources not being deployed by the contractor. We have another completion date which has come and gone. I am sure the witnesses can understand our frustration because I do not know how many times we have had the development board before the health committee. However, again we have another session of the health committee in early 2026 and we still cannot tell the public when the hospital will be open. It is really frustrating.
I will turn to Ms Nugent. I agree the hospital obviously has to be opened when it is safe to open it. Children's Health Ireland need the keys. I know it has early access. Ms Nugent said Children's Health Ireland hopes the hospital will be ready to open seven months after it gets the keys. Obviously that will depend on when it gets the keys because there are timeframes when it would be best to move and decamp staff. Is that what Ms Nugent means when she says "when it is safe to do so"?
Ms Lucy Nugent:
I know there is a lot of interest regarding the prolongation of the substantial completion date and subsequently the opening date potentially being pushed into the winter period. We are looking at all options for opening this hospital as soon as possible. For example, we will be looking at how the flu season in the southern hemisphere is, to indicate how it might potentially play out for us in the winter. We are looking at vaccination rates. We have also partnered with a lot of other hospitals around the world that have moved. So far we have engaged with one hospital in Norway that actually moved in the winter of November last year. However, they were not moving on the scale and size we are. It was a small unit. We continue to evaluate the situation. When it comes to the actual opening date, day one, we will risk assess whether it is safe to do so.
David Cullinane (Waterford, Sinn Fein)
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Okay, that is fine.
I want to raise the issue of scoliosis waiting lists. Ms Nugent said when CHI gets it wrong, it puts its hands up. There was a very harrowing case in the public domain recently of a 23-year-old from Coolock named Chloe Maher. Her family are devastated. They have criticised CHI. They say that person's death was entirely preventable. She died in pain. They talked about her timing out of the system. Will there be an investigation into her death and her treatment or lack of treatment? Her family are having to take to the media to ask questions, which is really difficult in those circumstances. Can Ms Nugent respond to that and tell us if there will be an investigation into her care or, importantly, lack of care?
Pádraig Rice (Cork South-Central, Social Democrats)
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I ask members generally to not put their really important or sensitive questions towards the end of their time because I do not want to be cutting witnesses off when answering important questions when there are families concerned. I will allow a minute to answer this question.
Ms Lucy Nugent:
The death of any young person is devastating and I offer our condolences to the family. I cannot discuss the nature of any one individual case. However, in relation to an investigation, in CHI when we have unexpected deaths we investigate them. Regarding timing out of surgery, we have a transition process. When an adolescent is approaching the time when they may have to transition to adult services we have a transition clinic with the Mater hospital to ensure there is continuity of care because the timing of when someone gets surgery is dependent on many factors such as their cardiac state, their respiratory fitness for surgery, etc. There is a process there.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you. Next we have Deputy Colm Burke from Fine Gael.
Colm Burke (Cork North-Central, Fine Gael)
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I thank all our guests for their presentations and detailed analysis of what is going on in this project. My first question is for Mr. Gunning and relates to the 5,728 rooms and the 2,854 which have now been validated. Does that mean for the 2,854 rooms we can start putting in equipment and doing the various things which need to be done in order to allow the hospital to open? Where are we around access to those rooms now?
Mr. Phelim Devine:
The purpose of early access is to get that equipment in a little bit earlier to help with the operation and commissioning programme and to help de-risk it. Today we have three floors. Ourselves and CHI we have pretty much fully equipped level 6. We have access to level LG and level zero in the hot block -which is basically imaging, emergency department and laboratories- in the last month. The NPHDB delivered about 8,500 pieces of equipment into the building and we have commissioned and placed 4,000 of that. That will be a rolling programme.
Colm Burke (Cork North-Central, Fine Gael)
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If we take it floor by floor, Mr. Devine is saying-----
Mr. Phelim Devine:
To go back to the question on the 2,800 rooms, yes, we have all of level 6 in the ward. We have all of level LG and level zero in the hot block. However, all the rest of the rooms are in different parts of the hospital. We have a lot of rooms on level 1 and level 2 but we need all of them to do the early access.
Colm Burke (Cork North-Central, Fine Gael)
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Going back to the issue around 18 claims for extension of time representing an amount of €926 million, how does that add up to €926 million for 18 claims? Is there an allegation that there was some delay on the employer's side as opposed to the contractor's side?
Colm Burke (Cork North-Central, Fine Gael)
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Why is the contractor saying it is the employer's responsibility? It got a contract. It was for 5,700 rooms. It was a complex contract. How can it then say that the State in some way has delayed the delivery of that contract?
Colm Burke (Cork North-Central, Fine Gael)
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How is it alleging that? BAM had possession of the site. BAM is employing all of the workers. How is it alleging it is the State that delayed it?
Colm Burke (Cork North-Central, Fine Gael)
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We were talking about 5,700 rooms and it is a very complex contract. We are talking about a design that was done literally ten years ago. Would there have been substantial changes made in the design within individual sections of the hospital? Was the new change in design presented in a timely manner?
Mr. Phelim Devine:
There has been no material change to the design of the hospital. The number of rooms has not changed. The facade has not changed. The floor area has not changed. The number of boilers, the number of air handling units, the number of ventilation systems have not changed one bit. Our public works contract is no different from the standard public works contract once we got to the guaranteed maximum price, GMP, stage. We cannot specify materiels under EU procurement rules. They have to be incorporated and there are minor changes associated with that but most of our changes that were made, and the updated drawings, were made before they actually construct the hospital, so BAM had the information. It is not as if something is built and we are actually ripping it out and replacing it. There has been a little bit of that because of regulatory and statutory compliance changes we have made. Things have moved on in terms of legislation so we have had to update certain things.
Colm Burke (Cork North-Central, Fine Gael)
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Is Mr. Devine saying that overall there has been no substantive change to warrant-----
Colm Burke (Cork North-Central, Fine Gael)
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What is the process for dealing with those 18 claims? If the NPHDB comes back to the committee in three months' time, might some of those claims have been dealt with and adjudicated on or are we waiting until the handover occurs before there is a resolution of these issues?
Mr. David Gunning:
There is a process set out in the contract for dealing with these claims. It starts with the employers' representative and goes to the project board. It then goes to conciliation. The next step is the High Court. Pretty much all of these claims have been through those phases, and four of the six proceedings involving the High Court are before that court.
Colm Burke (Cork North-Central, Fine Gael)
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What is the timeframe for when they are likely to be dealt with? I presume the four claims that are before the High Court will set a guideline as regards how the other 14 claims are going to be dealt with.
Colm Burke (Cork North-Central, Fine Gael)
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There are 18 claims. There is the likelihood that all of them could end up before the High Court.
Colm Burke (Cork North-Central, Fine Gael)
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I have been involved in arbitration, so I am very much aware of the whole issue and have been before the High Court. There are 18 substantial claims amounting to almost €1 billion. That is a substantial sum of money. I am just concerned about the final figure and the timeline.
I return to the handover and the moving in of staff. From the time we have everything completed, there will be a seven-month period as regards getting everything ready. When do we see that period starting?
Ms Lucy Nugent:
From the date of substantial completion, there is a seven-month commissioning period. It was meant to be 30 April. We await the new date. We will recalibrate our critical path method schedule as a dynamic process in order that we can change all the tasks that have to be done when we the date is confirmed.
Colm Burke (Cork North-Central, Fine Gael)
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When the seven months are up, from the time of transferring of services, what kind of period are we talking about after that?
Pádraig Rice (Cork South-Central, Social Democrats)
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Could we get a brief answer because we are over time?
Ms Julia Lewis:
The seven-month operational commissioning period is quite complex. What we are doing is just loading the building with equipment. In that seven-month period, we have to train a lot of our staff. A total of 5,000 staff have to learn to use the electronic healthcare record. We have to integrate the electronic healthcare record with the new equipment. We have to run 300 scenarios of live workflows in order to ensure that what is being physically built will work clinically for us. We also have to run a major emergency plan, which is a joint exercise with St. James's Hospital,. That will happen about three weeks prior.
We also have some work to do in terms of fit out. When we receive the hospital upon substantial completion - that is the end of the building work for BAM, etc. - CHI will a number of things to fit out. We have to fit out the car park, the staff restaurant, the public restaurant, the cash office and a retail shop. All of those things will be required before opening.
Pádraig Rice (Cork South-Central, Social Democrats)
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People at home will be really disappointed that the project is being delayed again. They will also be disappointed to hear about the cost of the overruns and the huge cost to the Exchequer. People just want to see this hospital open. They want to see the sick children of Ireland being treated in this hospital and receiving the best care they can receive. I have no doubt that will happen once we get this hospital open and that really good care will be delivered. However, it is really frustrating to hear for the 19th time that the deadline has been moved. There are no real assurances that there will be a final deadline in order that there will not be a 20th or 21st deadline. That is deeply frustrating. In some ways, it makes many of our conversations here redundant. If we do not even know when the project is going to be completed, it is possible that a proposed move into the hospital in winter is not even on the horizon. It could be spring, summer or autumn before the move happens. In some ways, that is deeply disappointing and frustrating. There are serious lessons that the State and the Department of Health need to learn around both the contract and how it was structured. We need to tease that out at some point.
What is crucial now is that people want to know what has changed and what is going to change in order to get the hospital built and completed. The Minister wrote to us on 10 February and set out the number of workers on site. The letter indicated that there were 900 productive staff on site in December 2024. By December 2025, that had fallen to 500. By the end of January of this year, it had fallen to 418, which is a 16% reduction. Has the number of staff on site increased?
Mr. David Gunning:
No. I think 560 is still the average. An important point to remember is that way back at the time of contract signature, it was anticipated and expressed by BAM that it would peak at about 1,700 workers on the site. The maximum number it has ever achieved was 1,250. We are currently at about 560. It is entirely a matter for BAM how many workers it has on site. What is not a matter for BAM, however, is the progress it is achieving. The progress BAM has achieved, which gives rise to the Cathaoirleach's point about 19 missed deadlines, is that it has never achieved the required progress to deliver on the particular commitments it has made regarding timelines. Our view is that its resources have been a significant issue throughout the entire project.
Pádraig Rice (Cork South-Central, Social Democrats)
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At the board's recent meeting with BAM, did it commit to increasing the number of staff on site?
Pádraig Rice (Cork South-Central, Social Democrats)
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How many workers would BAM need in order to get there?
Mr. David Gunning:
Mr. Devine has already talked about the rooms. Regarding getting all the rooms ready, it is possible to have multiple parallel teams working on this. It is a more technical issue in the context of commissioning. It requires the right resources, but there can be multiple teams progressing these issues in parallel. We would like to see resources flooding the site in order to get us to completion.
Pádraig Rice (Cork South-Central, Social Democrats)
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And there is nothing the board can do to increase the resources-----
Pádraig Rice (Cork South-Central, Social Democrats)
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That is another flaw in the contract. Mr. Gunning stated earlier that 3,726 of the 5,728 rooms have been offered by BAM to the design team to validate compliance with contractual standards and that, as of last Friday, 2,854 of the 5,728 rooms had been found to meet contractual standards. Have any of the 872 rooms that are still with the design team for validation been found not to meet contractual standards?
Mr. Phelim Devine:
That is an ongoing process. These rooms were pre-inspected by the design team at different stages. Some of them were inspected ten times. Most of the rooms would have had an average of about seven to ten defects or snags. It is up to BAM to rectify the latter and close them out to zero. At that point, they get to the design team. In some cases, when the design team goes in, it says that everything has been done and it is happy, and the room is validated. In other cases, the design team says it is not happy with the standard of the defect remediation and it goes back to BAM to fix. That is why it takes a bit of time between what is offered and what is ultimately validated. The difference is that those 872 rooms would be near completion. They might have one or two outstanding issues.
Pádraig Rice (Cork South-Central, Social Democrats)
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Car parking was mentioned. I understand that the hospital will have 994 car parking spaces, 319 of which will be for staff and 675 for patients and families. Is that correct? Is it still the case that 100 of those spaces will be offered to families free of charge? Is CHI still planning to go ahead with a €10 daily cap?
Pádraig Rice (Cork South-Central, Social Democrats)
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What concessions will be available for regular patients? The cost they face is an issue that comes up again and again.
Ms Julia Lewis:
There is a sliding scale. There are 100 spaces that will not need to be paid for. They will be given out on a criteria-led basis. It goes through social services in terms of whether people meet that criteria. The charge for a patient or family there for a prolonged period of time decreases to the point where there is no charge at all. There will also be a greatly reduced charge for someone coming to the hospital frequently. We are also providing spaces to Ronald McDonald House. A lot of the children and families who require non-payment of car parking charges will be using Ronald McDonald House.
Pádraig Rice (Cork South-Central, Social Democrats)
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Is CHI still going ahead with a for-profit operator for the car park?
We will pay the car park operator's operating costs to it.
Pádraig Rice (Cork South-Central, Social Democrats)
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Okay. Has this operator been selected?
Pádraig Rice (Cork South-Central, Social Democrats)
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The concern is that we should be lowering costs for people, families and patients using hospitals and not imposing charges on them. We should consider not having charges at all for patients using the hospital. That is crucially important.
In regard to staffing, how many existing staff in total will be moving to the children's hospital?
Ms Lucy Nugent:
I hope as many as possible but, obviously, it is a personal decision for each member of staff. With the prolongation of the date, some people have not yet declared their intentions. We know a number of staff coming up to retirement age and are saying they will not be moving to the new hospital because they do not particularly want to learn all the new ways of working for a short period of time. We do not have a definitive figure yet.
Pádraig Rice (Cork South-Central, Social Democrats)
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How many additional staff will be needed to run the hospital?
Pádraig Rice (Cork South-Central, Social Democrats)
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How many of those additional staff have been hired?
Pádraig Rice (Cork South-Central, Social Democrats)
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How many have been hired?
Pádraig Rice (Cork South-Central, Social Democrats)
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Given that CHI has hired none of the new staff, is it confident it will have all the staff in place when the hospital opens?
Marie Sherlock (Dublin Central, Labour)
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I thank all the witnesses for coming in today. I am sure they will all be glad when they no longer have to come in to the committee. It will be a wonderful building when it is open but "when" is obviously the important word there. I acknowledge also that the witnesses are working under very difficult circumstances. It is important to put that record. We look forward to the day the children's hospital opens.
I was going to start my contribution by saying I was bewildered at the reason CHI and the development board had not said the hospital would open in 2027. I think we got an answer to that this morning in the correspondence received last night. We have a situation now where 65% of the beds have been offered by BAM. It seems 50% are compliant, so there is obviously a gap there. We had the news last night that the substantial completion date of 30 April is now not happening. A meeting took place on 13 March to say that 30 April is happening but just six working days later, BAM updated the board and said it is not. Did Mr. Gunning believe BAM when it gave the date of 30 April at that meeting on 13 March? I do not mean that as a "catch you" question. A statement issued indicated that substantial completion would be 30 April and we were all led to believe that was happening. Did Mr. Gunning personally believe BAM when it said that?
Marie Sherlock (Dublin Central, Labour)
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His professional belief.
Mr. David Gunning:
If I think about my experience on this project since September 2019 and the 19 missed dates, I have very little confidence in the dates expressed by the contractor. We now need to see action. What I have seen, when walking around the hospital, and I know Deputy Sherlock has been there-----
Marie Sherlock (Dublin Central, Labour)
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Yes, it is wonderful.
Mr. David Gunning:
Of course, Chair, everybody on this committee is welcome to visit. They will see that we are inching closer to it but there are some trickier issues, such as the one Mr. Devine has talked about, the ventilation and overhead vents. You cannot have a nurse in a nursing station working underneath a noisy ventilation system. You cannot have a patient in a room with noisy ventilation system, especially a very sick patient. We have been monitoring the key performance indicators in respect of where we are going with this. We have been somewhat sceptical in regard to what we have been done but we would be, with 19 missed dates.
Marie Sherlock (Dublin Central, Labour)
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Of course.
Marie Sherlock (Dublin Central, Labour)
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The public is obviously left wondering what the consequences are for that. I think that is-----
Marie Sherlock (Dublin Central, Labour)
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Yes, of course.
Marie Sherlock (Dublin Central, Labour)
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Of course. In regard to the operational preparations, I know Ms Lewis has been leading on those. Specifically, with regard to staffing, to be clear, it is 576 extra whole-time equivalents that are needed. Is CHI recruiting to a specific date, 1 July, at this stage?
Ms Lucy Nugent:
We are phasing in our staff. On 1 July, the first tranche of staff will be employed. There is a timing to this because certain cohorts of staff take longer to recruit, like consultants. In relation to our neonatal intensive care unit, it is a new unit so, again, we are front-loading those staff. For example, some of our neonatal nurses are now undergoing the higher diploma in neonatology nursing in the maternity hospitals and they will return to us. We have a plan in that regard.
Marie Sherlock (Dublin Central, Labour)
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CHI will have staff ready on 1 July but does not have a hospital building for them to go into. Where are they going to be on 1 July?
Marie Sherlock (Dublin Central, Labour)
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Will we have a situation where staff will be effectively paid not to work because we do not have a specific opening date for the hospital?
Ms Lucy Nugent:
No. What we are also doing is looking to try to maximise our activity before we get to the substantial completion date. Six weeks prior to our moving date, we have to ramp down all of our elective activity to get to 50% occupancy. We are going to try to push more activity through prior to the ramp-down. Believe me, these staff will not be lying idle.
Marie Sherlock (Dublin Central, Labour)
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That is reassuring to hear. With regard to surgeons, how many theatres will be open when the hospital finally opens?
Marie Sherlock (Dublin Central, Labour)
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Sure. That is an increase of how much at the moment?
Marie Sherlock (Dublin Central, Labour)
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On the number of surgeons, last year 12 surgeons expressed very serious concerns. They said the national model of care indicated that there needed to be 17 surgeons across paediatric surgery and urology by 2028. Is that now going to happen?
Ms Paula Kelly:
There is a process. This is specifically around general surgery. There is a model of care, which is to roll out general surgery for children across the country. Those 17 surgeons are required for the model of care to work. There will also be surgeons in Limerick, Cork and Galway. It is a phased opening and we will not have an additional surgeon on day one, but that is okay. We will be able to get in stabilised services. We will have an additional three theatres we will be able to utilise and increase activity with. In the phasing out over the next two to three years, we will be able to employ those surgeons and network with Cork, Limerick and Galway, so we will be able to deliver care closer to home as well.
Marie Sherlock (Dublin Central, Labour)
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There will still be a shortage of surgeons in regard to that target of 17 by 2028.
Marie Sherlock (Dublin Central, Labour)
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I am not sure who exactly my next question is for, perhaps Mr. Gunning or Mr. Devine. Concessions have to be negotiated for the operation of the car park, maintenance contracts and the canteen. I am sure there are lots of contracts required as part of the operation of a hospital. Is the board operating to a specific date or an unknown date in those negotiations?
Marie Sherlock (Dublin Central, Labour)
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CHI is footing a bill for services from 30 April that it will not require.
Ms Julia Lewis:
The tenders will be completed because the contracts will have been awarded but they do not start until the appropriate time. For example, we already know who will run the retail shop within Children's Health Ireland. We know it has a four- to five-month fit-out period in its contract. It must be ready to run from day one and, therefore, it will pay rent from day one.
Marie Sherlock (Dublin Central, Labour)
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There is no financial implication arising from the delay in the opening date. That is what I am trying to understand here.
Marie Sherlock (Dublin Central, Labour)
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I thank Ms Lewis.
Tom Clonan (Independent)
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I echo Deputy Cullinane in remembering Chloe Maher, the 23-year old woman from Coolock who died for lack of timely surgical intervention in relation to scoliosis. This is a recurring theme. I think there were suboptimal outcomes for Harvey Morrison Sherratt as well. There are other people in that situation. I am aware of it. For the record, it is possible to comment on individual cases. This is a rhetorical device that is regularly used by the HSE and others to avoid confronting issues. If families revoke their anonymity and come forward to tell their stories of crisis, it is precisely so their cases can be discussed and we can learn from them. Otherwise we would never have heard of Vicky Phelan and so on and so forth. I want to put that on the record.
On role-mapping, which is great, has a clinical risk assessment been carried out for the movement of children to the hospital?
Tom Clonan (Independent)
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I am delighted to hear there is a clinical risk assessment. That covers the migration of all the children and adolescents from Crumlin, Temple Street and Tallaght-----
Tom Clonan (Independent)
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It is one of the largest migrations of patients. This is using an app called STOPP-----
Tom Clonan (Independent)
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Okay. Who is responsible for the clinical risk assessment?
Tom Clonan (Independent)
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Migration I understand but my question is about clinical risk assessment. Who is the clinical lead on that?
Tom Clonan (Independent)
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I did not catch the name. What is the name, please?
Tom Clonan (Independent)
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Is she a medical doctor?
Tom Clonan (Independent)
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So she will hold responsibility for the clinical oversight of the risk assessment.
Tom Clonan (Independent)
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That is all I needed to know. Thank you. I am relieved to hear there is clinical risk assessment taking place. I do not mean to sound rude or brusque – it is just that we have very little time.
I welcome this is Ireland’s first digital hospital. That is great news. Who is the chief information officer at CHI?
Tom Clonan (Independent)
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Is he also a full professor of health informatics at UCD?
Tom Clonan (Independent)
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No. Is he the full professor? That is what he has on his LinkedIn profile.
Tom Clonan (Independent)
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It is a simple question: “Yes” or “No”. Is he the full professor of health informatics at UCD?
Tom Clonan (Independent)
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Is he in receipt of two public service salaries simultaneously while carrying out this role?
Tom Clonan (Independent)
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Okay. Does Ms Nugent think it is consistent with this migration to have a person doing this as a full professor. I know as an academic that a full professor is a very onerous task. Is it appropriate for a person to be holding that role and also overseeing the transformation of Ireland’s first digital hospital at the same time?
Tom Clonan (Independent)
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What was the process by which he was recruited?
Tom Clonan (Independent)
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Will Ms Nugent write to me and let me know what the process was?
Tom Clonan (Independent)
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Because I have seen similar overlaps with HSE and university professors and it is a mystery to me how they are recruited, seconded or how they can be in receipt of two public pay salaries. I am also concerned about how one could possibly have meaningful oversight when one is carrying out two very onerous roles.
Where will the staff for this new digital system be located?
Tom Clonan (Independent)
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So the nerve centre of the digital systems will be on the South Circular Road and not the hospital.
Tom Clonan (Independent)
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As Ms Nugent said, it is not a building. It is the people who provide the service.
Tom Clonan (Independent)
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So the service providers are going to be offsite.
Tom Clonan (Independent)
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But they are off-site.
Tom Clonan (Independent)
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No, I just wanted to know about the location. Is that consistent with best practice in other hospitals internationally? My information is this is extraordinary and that it is unprecedented to have the IT nerve centre and the people off site.
Tom Clonan (Independent)
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No, I am not asking where they are. Again, I am conscious of the time. Is it normal for these key staff to be off site?
Tom Clonan (Independent)
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Is that the case in other hospitals?
Tom Clonan (Independent)
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Can Mr. Carroll give me an example of international best practice where that is the case?
Tom Clonan (Independent)
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Colocated. Were they contiguous to the building?
Tom Clonan (Independent)
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So they had to go outdoors to get access to the building.
Tom Clonan (Independent)
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Okay. When Mr. Carroll says “colocated” how far is it from the hospital? I am assuming that is on the hospital campus.
Tom Clonan (Independent)
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When Mr. Carroll says colocated, specifically in relation to IT, is that next to the hospital?
Tom Clonan (Independent)
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Is it next to the hospital, colocated?
Tom Clonan (Independent)
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It is next door to it. Okay. It is not far away.
Was the Epic system subject to a tender process?
Tom Clonan (Independent)
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Was it the most competitive tender?
Tom Clonan (Independent)
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I just want a “Yes” or “No”.
Tom Clonan (Independent)
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Will you write to me and confirm that was the most competitive tender?
On Epic, where did the staff who will operate that system get trained?
Mr. Adrian Carroll:
We have to stand up a significant team to keep that skillset in-house for both designing and implementing that service. We recruited that team in 2023. We have 106 full-time equivalent in that team. They would have undertaken specialist training in the US as well as attending virtual training to provide them with that skillset to be able to implement that system.
Tom Clonan (Independent)
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Where are they located now, those 106 staff?
Tom Clonan (Independent)
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When it is up and running will they still be in Rialto or will they be in the hospital?
Tom Clonan (Independent)
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So they are dispersed across three locations now.
Tom Clonan (Independent)
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Rialto, South Circular Road and the hospital.
Tom Clonan (Independent)
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No, I am sorry for the brusqueness. I had very limited time. I thank the witnesses for their answers.
Pádraig Rice (Cork South-Central, Social Democrats)
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At this point we will take a five-minute break.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will now continue the committee's consideration of issues related to the completion of the national children's hospital and preparations for bringing it into use. Senator Boyle is next.
Manus Boyle (Fine Gael)
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I thank everybody for coming in. As somebody from Donegal, this is new but I am glad to be learning. This is a very important project. It started a long time ago. To be honest, I am saddened. I have heard today that it will be kicked down the road for another while. However, I know the hospital is coming and there are a lot of good people working behind the scenes to make it happen. This is going to be positive for our children in the future. It is worth the wait.
I have just a few questions. Mr. Devine said that BAM is delivering approximately 200 rooms per week. Can he see it moving the number up so we can speed up the process? Is it a manpower problem? Are there just delays on site?
Mr. Phelim Devine:
We have consistently said before this committee and at the Committee of Public Accounts that this is a volume exercise. As Mr. Gunning has said, you could have parallel teams working across the hospital. More resources will increase output and the number of rooms being offered. That is absolutely the case. We have been saying this to BAM for years now. There are insufficient resources. If you are not meeting the milestone commitments set out in your programme, there cannot be sufficient resources on the project.
Manus Boyle (Fine Gael)
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Mr. Gunning spoke earlier. There have been delays, and it has been delayed further today. I know this is the $1 million question but does Mr. Gunning think that the next timeline that BAM offers when it comes back within 15 days will be the last timeline we will need?
I know I am putting the witnesses on the spot here, but it is to give the people at home who are listening in a bit of an idea of what is involved. Many people in Donegal are looking at these proceedings because their children will be coming down to this hospital. It is a million-dollar question, but the purpose of asking it is to get a rough idea.
Mr. David Gunning:
As I outlined earlier, when you have been through 18 or 19 resets, it is really difficult. The Senator would think I was naive if I were to say, having been disappointed 18 or 19 times, that I am going to believe the next one. We will arrange a visit for members to see just how close to completion the hospital is. We are inches away from getting this ball across the line. I am referring to the rooms in that regard. The rooms will get done. There is no doubt about it. They will be done to the right standard. The systems have to be commissioned. They will all get done.
On the Senator's first question, under the contract, the programme is the responsibility of the contractor. The contractor owns the resources, the management of the resources and the delivery. It is entirely up to the contractor. While we have been disappointed with what we were told yesterday, in a long meeting with them yesterday morning, the contractor's representatives went through some areas of the hospital that are almost at the completion standard. We can see some brightness on the horizon. At the same time, we have concerns about some of the commissioning activities. They will be difficult to get completed. In the face of all this, I want to convey a degree of optimism that this hospital will, of course, be done. There is no doubt about that.
Manus Boyle (Fine Gael)
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How many contractors are on site each week?
Mr. David Gunning:
BAM is the primary contractor. There are two main contractors for the mechanical and electrical work. Jones Engineering Group is the mechanical contractor and Mercury is the electrical contractor. Underneath this, there are a range of other contractors involved. Mr. Devine might have a clearer picture. There are large numbers of contracting organisations in the whole worker group.
Mr. Phelim Devine:
There are about 30-odd contractors and entities working under BAM, whether it be painters, decorators, flooring experts or commissioning people working with Jones Engineering Group and Mercury. There is also some expertise. I refer, for example, to Bayards, the contractor for the helipad. There are 30 or so contractors, adding up to 560 on average productive resources. That is people on the tools actually doing the work. They are under supervision. If we include all the supervisory staff, there are over 700 people.
Manus Boyle (Fine Gael)
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What we are really saying is that we need more people on the ground to move this forward.
Manus Boyle (Fine Gael)
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I have a few questions for Ms Nugent. When the hospital is opened, it will be state of the art. Will any new programmes or anything special be on offer once it is opened?
Ms Lucy Nugent:
The short answer is "Yes". Bringing the three hospitals together gives us a volume of activity. We are very much focusing on research and innovation. We have an innovation centre in the centre of the building. We have already signed a memorandum of understanding with Alder Hey Children's Hospital innovation centre. The CEO and I signed that last month. We want it to not only be the best level of care that we deliver, but we are continuously looking forward and partnering, both nationally and internationally, to make sure, for example, that if there are clinical trials taking place that our children can avail of them, that they have access to them. Again, we are trying to ensure that we give the best possible outcomes to the children we serve.
Manus Boyle (Fine Gael)
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One positive that was mentioned earlier is Ronald McDonald House Ireland. I have a family who come down to that. The biggest problem is getting in there. It is small. It was stated that there will be 56 rooms available.
Manus Boyle (Fine Gael)
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I know a family who use it. Many people in Donegal use it when their children have to come down to Dublin. It is a great asset to have. I thank the witnesses for that.
Going back to Mr. Gunning and Mr. Devine, is there any way we can put pressure on BAM to put more people on site in order to get the project done quicker?
Mr. David Gunning:
There are three levers that we have in the contract. One is to do with the programme and the requirement of the contractor to have a programme that can allow the employer's representative, namely the independent contract administrator, to monitor progress. The second is around the liquidated damages. The third lever is termination. At many times throughout the seven years I have been on this pitch, we have deployed all those levers. It is a limited set of levers. On a day-to-day basis, there is a meeting with the contractor in some form involving people on the design team or ourselves. From a senior leadership point of view, we are meeting with BAM at least weekly at the moment to continue to share information around our assessment of its progress, to discuss issues and to try to move things forward. It is very dynamic at the moment in terms of where we are at. That is extent of where we are.
Manus Boyle (Fine Gael)
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If BAM had more people on the ground, would this hospital would be finished quicker?
Teresa Costello (Fianna Fail)
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I missed part of the discussion, so if I apologise if I ask questions that have already been asked.
Mr. Gunning stated that three levers have been deployed. When BAM misses a target or when something is not working, Mr. Gunning said that they are meeting with it all the time. If the board is not happy with what is happening, what is being done differently? If they are meeting every day or every week, what is being done differently? When a contract is given out, I assume that there are service level agreements involved, there is a project management team and targets are set and meant to be met. What penalties are being imposed for breaches of contract? If the work is not being done to the agreed deadlines and for the agreed price, what is happening? Meeting with the contractor is great. Sure, people can meet every week. What actions are being implemented as a result of these meetings?
Mr. David Gunning:
I summarised some of the levers in the contract that are available. Ultimately, that is what it is about. It is not about meetings; it is about how we enforce our entitlements and how we enforce the contractor's obligations via the contract. That is where the rubber meets the road. As stated, we have a number of levers in the contract. I have just summarised those. When the contract was signed in 2017 or whenever, the completion date for this element was 2022. We are now 40 something months beyond that particular time. In relation to the element of the contract that applies to that type of delay, this is the liquidated damages clause. If we use the calculations of the contract, we estimate that the delay cost that we will seeking to levy on the contractor is something of the order of €40 million. That is outlined in the papers we have presented to the committee. Is that a sufficient incentive? That is what is in contract and that is what we will plan to enforce once we reach a conclusion. As the contract delays further, that amount of money increases over time.
Teresa Costello (Fianna Fail)
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The contractor is aware that the more it misses targets and the more it is not doing as expected under the contract, at the end of all of this, when the hospital is delivered - and it is going to be amazing - it is going to be slapped with a monetary penalty.
Teresa Costello (Fianna Fail)
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I hope there are minutes of all those meetings being had. What can be done with what is completed inside? What work can be done with installation of equipment and training? What can be done with what is there at the moment?
Ms Julia Lewis:
Level 6, as Ms Nugent has said, is completely kitted out. We have used level 6 almost a storage area. Once we completely kitted it out. we started to put additional equipment into it, between us and the NPHDB. It has now been closed down for people to visit because it is complete. The only thing we can do is physically put equipment into the building. We cannot connect anything because, at substantial completion, we have to wait for a lot of certifications from the contractor that systems, etc., are ready to use. On the lower ground we also have access to the health technology management suite. Lots of equipment for both the lower ground floor and the ground floor have come into the hospital. Equipment has also been brought in for levels 1 and 2, the next two floors we are hoping to get. It has unboxed all of that equipment, tagged it all and put it back in the box with a label to say that goes to theatres when it is ready. ICT is also utilising the early access period. There are 384 computers or workstations on wheels to be built. There are 60 for the sixth floor and the rest are throughout the remaining areas of the hospital. Currently, one room on the lower ground floor has about 150 built. They have about eight components that have to be put together which takes a number of hours. We are utilising early access as best we can with what we are able to do but what we are able to do is really limited to loading the building at this point. In terms of laboratories, we have brought in all of the general laboratory equipment. We were meant to do that in four days, but we actually did it in three because the company helping us sent a larger team so we managed to get a day back and were able to bring in extra deliveries that week to the ground floor. CHI and NPHDB are utilising the time and space we have.
Teresa Costello (Fianna Fail)
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To Mr. Devine, how many people are there working on the ground? How many contractors are there in a week?
Teresa Costello (Fianna Fail)
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There were no increases on a weekly basis.
Teresa Costello (Fianna Fail)
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How many are there to finish it out? How many are needed? Is there a shortfall between the two?
Teresa Costello (Fianna Fail)
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What is Mr. Devine's opinion?
Mr. Phelim Devine:
There are metrics we take from BAM's programme in terms of the end date. It is hitting about half of that productivity. In our view, it should have twice the number of resources to hit its productivity targets, but that is our view. BAM may have a different view. Ultimately, it should be hitting its programme targets.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Apologies, I needed to step out to speak in the Dáil for a few minutes. I am trying to get a timeline clear in my own mind. When the notification came from the contractor that the previous, most recent completion date would not be reached, Mr. Gunning said it had 15 days to respond. What is the final date?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Has that happened?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I presume 15 days is three working weeks. That brings us up to the end of April, give or take. Will Mr. Gunning notify the committee of that specific date when he has it?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It is important the committee is notified. Mr. Gunning spoke earlier about the tendering of some pieces of equipment being postponed to ensure what was provided was the most up to date. I have some concern particularly after what Ms Lewis said about items being delivered, unboxed, tagged and reboxed. What is the risk the taxpayer is potentially exposed to for equipment or materials that will need to be disposed of because by the time the doors of this building finally open because they may simply be non-effective, obsolete or need to be replaced?
Mr. David Gunning:
I will ask Mr. Devine, who deals with it, to reply. We have been acutely aware of that issue and working closely with CHI. The HSE has been of great assistance to the NPHDB in all that equipping.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Does Mr. Gunning understand why I asking the question?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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This is constantly coming back to extra costs on the taxpayer. This is one area that needs a level of scrutiny which I have not seen to date. I am not saying it does not exist; I am saying I have not seen it.
Mr. David Gunning:
The NPHDB is responsible for designing, equipping and commissioning. We are responsible for the equipment; we hold that budget but we have run a process which is deeply connected to CHI and the clinicians in CHI to design. Our procurement team is effectively loaned from CHI to us for the purpose of that exercise. I will ask Mr. Devine to comment to give the details of the procurement and the obsolesce issue, which I think is what the Deputy is getting at.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Will Mr. Devine give an example?
Mr. Phelim Devine:
A recent one just out to tender, which is probably one of our final tenders, is the navigation system for the neurology theatre. I am sure Ms Kelly can talk about that in detail from a clinical perspective. We held that back as late as possible to get the most up-to-date technology. There are very few things left. For the stuff that is built into the building, such as MRIs and CT scanners, we have got the latest model. It was installed just last year and commissioned this year. At the day of use, if there is a software upgrade, no different from your phone, we will get the latest software upgrade. We have built that into contract so that it will be the most contemporary and innovative by the time we open the hospital.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Ms Nugent spoke in the opening statement about the 40 specialties, the teams around them and the fundamental transformation of healthcare. We all want this hospital open no more than the children who need to be treated in the hospital and the parents who will accompany them. Does Ms Nugent anticipate any requirement gaps that, once the hospital is ready to be open, may have an impact on it actually being able to provide services?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Approval does not equal staff.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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One of many.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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With the greatest of respect, every other hospital that has staffing gaps would say the same.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How does the NPHDB go about a recruitment process for a new hospital - which in all fairness will be state of the art when it does open eventually - when it does not have that date?
Ms Lucy Nugent:
We have recruited a specialised project manager to manage recruitment for the new hospital. That runs in parallel and is integrated with our ongoing recruitment for any vacancies we have.
We have approval from the HSE for the first tranche of staff to start on 1 July and the second tranche on 1 January. Even if these staff are with us and we have not opened, we will ramp up our activity to compensate for the ramp-down we have to have for the move itself. These staff have to have training and it will free up other staff to have training.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Okay. Talk us through the seven months from when the keys are received to when the patients start coming through the door. Mr. Devine has outlined the equipment needs. What specialist training will be provided for staff, or what will staff be asked to undertake, that they would not have had in their current place of employment?
Ms Julia Lewis:
The first month of the seven-month operational commissioning period involves finishing loading the building with equipment. At the end of month 1, the electronic healthcare record will start to integrate the equipment. That will continue for a number of months, during which we will have lots of fit-out, as I described earlier, in the concourse area.
For the training of the staff, we have a dedicated programme, called the eolas programme, whereby we train all staff in electronic healthcare records, medication workflows, medical devices and all the new equipment in the hospital. We have worked with NPHDB on ensuring the new equipment is similar to, or an upgrade of, current equipment so there is the smallest amount of brand new equipment for staff to learn.
We have a content build of a programme which is 85% complete. Staff will register on the system to complete their training. They will complete the modules they are required to do. There are 111 training classes across EHR alone. Staff do classes depending on their role, grade and responsibilities in the children's hospital.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Who is delivering the training?
Ms Julia Lewis:
We deliver the training in-house. We are currently recruiting to train trainers. After the first month of operational commissioning, the trainers have eight weeks in which they learn what they have to teach. We will then have a month of superuser training because once we get to day one, we will need people to be on the shoulders of staff and ensure they are able to work with all the new equipment and EHR. The last four months of the operational commissioning period involve ramping up the training for all 5,000 staff. That is why we have to ramp down the activity in the hospital. It is imperative as many staff as possible get through training in those four months. The reason we do it at the end is international best practice suggests people forget if they are taught something and do not use it.
Maria McCormack (Sinn Fein)
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I thank everyone for coming in. I found it really stark to look at Ms Nugent's opening statement and see "Imagine a world...". I cannot help but think of the families who do not have the luxury of imagining that world any more. We think about little Harvey and the family of Chloe Maher, grieving the loss that should never have happened in a functioning healthcare system. There is a stark contrast between the reality and the vision. There is a big gap for us to bridge.
I spoke last night in the Seanad on the motion on the Data Protection Act 2018 (Section 60(6)) and (Section 51(3)) Regulations 2026, which relate to a scoping exercise for the establishment of the long-awaited public inquiry into spina bifida and complex scoliosis services at CHI. The witnesses can imagine what came up in that debate. Families are still living with the failures today.
When I was writing notes for the committee last night, I saw we were on 18 delays and wondered what was to stop us being at 19 or 20. Of course, here we are again. We have another delay now.
I want some accountability or some answers for the public watching in. This seems like a horrific circus. It is one delay after the other. At the end of the day, this is Children's Health Ireland. I ask all the witnesses to answer briefly - in one sentence because I am conscious of time - and explain to the public the difference between substantial completion, handover, operational commissioning and opening to patients?
Is there any single agreed integrated timeline shared by the board and CHI? If there is, can we publish it? On 13 March, we saw the completion date was 30 April. Did all the witnesses agree that was possible? When we look at what is happening in the hospital now and everything that is going on in the background, it seems to me looking in that we are very far off a date when children can receive care in this hospital. Maybe the witnesses can tell me differently.
What are the current top five risks on the critical path and who owns each of them? Who is responsible here? Is it BAM, CHI, HSE or the Department?
The date was 30 April but that has changed. What is the earliest credible opening date? I know we have to have seven months after. I appreciate Ms Nugent has to make sure everything is safe from a clinical point of view and that patients will not be going in until it is safe to do so and it is a safe environment for staff as well. Can we give anything to the public about the earliest credible opening date?
Mr. David Gunning:
I will start on the substantial completion date. To give an overview, the NPHDB is responsible for the construction, design, build, equip, commission and handover to CHI. That is up to substantial completion. At substantial completion, the employer's representative, who is the contract administrator and is independent, will certify that BAM has concluded all the works in line with the requirements in the contract. There will still be a number of minor defects. It will not be finished; it will not be perfect. The administrator will also certify that all the tests required to certify all the systems and commission everything are complete and, essentially, that the work of CHI can commence. The development board is responsible to that point of substantial completion.
On the integrated timeline, the development board takes it to substantial completion, and then CHI takes over the building and the development board supports that in terms of issues such as further fit-out and placement of equipment to finish the hospital. It is fully co-ordinated and set out.
The gap is in terms of the when. We got the notification yesterday at a meeting that the when is now moved out. It will be 15 working days from today, or whenever we get the BAM programme, that we can confirm what its latest date is. We will then need to go through-----
Maria McCormack (Sinn Fein)
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When does Mr. Gunning think this will be, if he was to put something on it? Was 30 April achievable? No, it definitely was not.
Mr. David Gunning:
We are beyond frustrated with where things are at. We understand the committee. We live this every day. It is completely unacceptable for a tier 1 contractor to offer commitments and simply dismiss them 18 times but that is what we are dealing with. They own the resources, the timeline, the management and everything required to get this done. I cannot give the Senator that, inviting and all as her invitation to put a date on it is.
Of course we have our theories, but I cannot possibly do it. It is the contractor's responsibility under the contract. I will hand over to CHI on the operation, commissioning and other matters.
Ms Lucy Nugent:
What is within our responsibility and control is the seven month commissioning of the hospital from the date we get the keys, which is the substantial completion date. It was originally to be nine months. Ms Lewis and her team have been able to reconfigure the programme to reduce it by two months, which is fantastic. We will open the hospital as soon as we can after we get the keys.
Maria McCormack (Sinn Fein)
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What information do families and staff need to hear from the witnesses today? I am conscious that the public are watching this. Will the witnesses say something to the families and staff? All that is going out in the media today is that this is another delay and it will affect more children. How much more affected will children and parents be by this new delay?
Ms Lucy Nugent:
Our current facilities are no longer fit for purpose - and we apologise for that - in the sense that Temple Street hospital was not built as a hospital, for example. However, care will continue to be delivered right up until the day we move. For our staff, we know it is demoralising to have another change of the date. As the Senator said, it is for the families and children we serve, as well as for our staff. However, as soon as we get the keys we will open the hospital and it will be wonderful.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have approximately 30 minutes left so we will have time for an additional round if members are interested. Members might indicate whether they wish to contribute and then we can decide how much time to allocate to each. We will take slots of five minutes, starting at the top of the list with Deputy Colm Burke.
Colm Burke (Cork North-Central, Fine Gael)
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All the admissions and so on will be computerised. The witnesses may have touched on this already this morning. I presume the process of transferring records to the new system is already in place. When we dealt with the maternity services recently, the issue of the co-ordination of services and computerisation within the healthcare sector was indicated to me. Remember there are 19 maternity units around the country, of which only six are fully computerised and another 13 are still to be computerised. I understand the computerised system in the maternity services at the moment will not necessarily be able to connect automatically to the computer system that is going into the new children's hospital. Will there be co-ordination between the different elements of the health service to make sure we do not run into a situation where something is computerised in one hospital but people have to start from scratch in the new children's hospital?
Ms Lucy Nugent:
We have already started scanning our existing paper records onto an evolved platform, which is integrated into the new electronic healthcare record. The electronic healthcare record, however, will not go live until the day-one opening of the hospital. The national summary records is a national strategy so I cannot really comment on that. I can say that there is functionality in the Epic system, whereby GPs or other hospitals can have a read-in function in the system so they can see their patients' records. I will hand over to Mr. Carroll on that.
Mr. Adrian Carroll:
To transfer current patient information to our new electronic health record, we are undergoing an electronic migration project at the moment. We are identifying the key information required to treat patients on day one in the hospital. Everything within that remit that can be electronically transitioned from its existing systems to the electronic health record is being transferred and we will take a snapshot close to the time we are opening the hospital to make sure we have the most up-to-date information. To transfer information from paper or non-digital records we will have to do a cut-over process at the point when we are moving patients from our existing hospitals to the new hospital. That will happen on the day of the move or in the preceding days. That is to make sure we have the most up-to-date information for our existing inpatients to make sure we can continue their care seamlessly in the new hospital, using the new technology and system.
On the Deputy's question about connectivity to other health service systems, we are already planning to integrate with many of the HSE national systems, including the shared care record and Healthlink and Healthmail, which allow us to communicate with other healthcare professionals-----
Colm Burke (Cork North-Central, Fine Gael)
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We have 19 maternity hospitals, for instance, and 13 of them are not computerised. Is it not logical for us to work together to make sure one system can connect to the other?
Mr. Adrian Carroll:
That is correct. By utilising the intermediary systems in the HSE, such as the shared care record, we will be able to send information to that record and take information from it to make sure we have the most up-to-date information for our patients.
Colm Burke (Cork North-Central, Fine Gael)
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My next question relates to the buildings that will be vacated. The witnesses may say it is a bit down the road, but what is the forward planning for the buildings that will be vacated?
Ms Lucy Nugent:
The Temple Street building is owned by the Mater Misericordiae hospital group. There have already been discussions with the Mater hospital about its use of the building. It will revert to its ownership. The Tallaght space will revert to Tallaght University Hospital and we are in ongoing discussions with the HSE regarding the use of the Crumlin site. Part of it could potentially be another elective hospital and part of it may remain in use for a period by CHI.
Colm Burke (Cork North-Central, Fine Gael)
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One of the issues that will be a challenge for all the Dublin hospitals is retention of staff. Staff retention is a combination. Is anything being looked at from an accommodation point of view for staff, especially nursing staff, care assistants and junior doctors?
Ms Lucy Nugent:
They are some of the things we are exploring. For example, we could potentially use the Crumlin site for a period because there is an old nursing home there and staff stay there currently. Some people come up from the country. They might work three long shifts and stay for two nights in that nursing accommodation so, yes, it is something we are exploring.
Colm Burke (Cork North-Central, Fine Gael)
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There is forward planning, because a lot of people will be working on one site, whereas previously they were spread over three sites. Therefore, there will be huge demand for accommodation in the immediate area so I am concerned about trying to hold staff.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Deputy. We will stick to the five minutes so I can try to get everyone in for a second round.
Marie Sherlock (Dublin Central, Labour)
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I will ask about scoliosis care and the spinal waiting list. As of January, 45 children were waiting six months or longer. That is an increase on the previous January. Will the witnesses explain some of the delays? A lot of good work is being done, but I would like to understand, particularly for those waiting a long time, what is happening at the moment.
Ms Paula Kelly:
I thank the Deputy for acknowledging that a huge amount of work has been done by the teams in recent years. There has been huge investment and support from the HSE and the Department on that. The spinal management unit is active. There is a robust process to make sure each child who is treated receives quality care and that their outcomes are measured. That is absolutely key. Our current waiting list as it stands for surgical treatment is 4.2 months. A target has been agreed for the numbers for this year. We will do everything in our power to achieve that target, but we must remember there is a child behind every number. We will have to have a period of ramp down before we go to the new hospital as well. We have investment to open an additional theatre in Crumlin in the next few weeks, which will allow for an additional case to be done. We are trying to front-load the first two quarters of the year to try to get through as much activity as we can.
Marie Sherlock (Dublin Central, Labour)
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It is, and my concern that CHI will have to reduce activity.
Ms Lucy Nugent:
Some reasons some children are waiting are multi-factorial. It can be that they are still in the pre-assessment process and in that pre-ablement period we are trying to build the child up nutritionally or they might have a respiratory or cardiac issue. They have to be in optimum health because it is major surgery. Another reason might be that children are doing their junior certificate examination and so on. However, I assure the Deputy that there is a spinal track for every patient on the waiting list in the spinal unit. I have looked at it and we have visibility of every child.
Marie Sherlock (Dublin Central, Labour)
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The very tragic passing of Chloe Maher at the start of March would have been another reminder of the failings, or so it seems, in care for patients with scoliosis over the past number of years. Obviously, Chloe had aged out of CHI but she was a patient of CHI until a number of years ago. Has Ms Nugent, as CEO, reached out to the family since her passing?
Marie Sherlock (Dublin Central, Labour)
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Will Ms Nugent reach out to the family?
Marie Sherlock (Dublin Central, Labour)
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It is devastating.
Parents say to me that they feel a commitment was made when Ms Nugent became chief executive to hold a town hall-type interaction for parents with children with scoliosis or other spinal conditions. They feel that has not happened yet. I do not know if Ms Nugent recalls making that commitment and whether she believes that commitment is in place or if she intends to do that. To my mind, there is a bit of a disconnect between what parents are saying to me about their frustrations with the care their children are getting and the information they are getting about the care of their children under CHI and what we hear from the witnesses. I do not know if Ms Nugent recognises the disconnect there. What can be done to address it?
Ms Lucy Nugent:
I have said it in this committee before that I am happy to meet any family. I have met many parents across many different services we provide. We have a family advisory network, a representative body of parents, which we have engaged with, for example, on how we communicate. We are doing a survey at the moment across a number of specialties about what is the lived patient experience and parent experience. We have the spinal task force which has representative of some of the spinal groups on it.
Caring for a child is in partnership with parents. The parents know their child best. Are we perfect? No, we are not. Is there more work to be done? There absolutely is, and that is part of what we have been doing. We have reviewed our patient charter and communications strategy.
David Cullinane (Waterford, Sinn Fein)
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I want to come back to what happens next. In fairness to Mr. Gunning, he answered the questions very well over the course of the meeting. There is a completion date that will not be met and Mr. Gunning said the employer's representative has to seek a new date and there is then a process. Briefly, what is that process? There are two weeks for BAM to respond?
David Cullinane (Waterford, Sinn Fein)
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It has three weeks.
David Cullinane (Waterford, Sinn Fein)
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Let us just say we eventually get a new completion date, whatever that is. What comes with that? Does that come with a new programme update?
David Cullinane (Waterford, Sinn Fein)
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I am trying to get a sense of what that programme update would look like. Does that commit to weekly or daily targets?
David Cullinane (Waterford, Sinn Fein)
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I am trying to establish how the board can hold a contractor to account. This is the frustration we have because we come in periodically, we get a completion date, it is pushed out a couple of months and then a certain amount of work has to be done, services have to be commissioned, rooms have to be done, a certain number of staff need to be deployed to make that happen and it is all very general. I assume Mr. Gunning gets something much more substantial. Is Mr. Gunning saying it is almost impossible to hold a contractor to account on a daily and weekly basis? Is that what is happening here?
Mr. David Gunning:
To be clear, the way the contract is constructed - we have talked about it a number of times - is that the contractor is responsible for the programme and the achievement of the programme. The contractor employs all of the staff and subcontractors, it puts in all of the management and it delivers this.
David Cullinane (Waterford, Sinn Fein)
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I understand that.
David Cullinane (Waterford, Sinn Fein)
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Given where we are now, it seems that despite all of the bad news, we have a hospital that is built. I passed it today while coming in and we can see the building. Everybody just wants it built. There is a growing frustration as to why it is taking so long to get there. The board will get a new programme update, which will give more commitments. It is likely that some of those commitments will not be met again. We are well past the boy who cried wolf. It was missed 18 times and has now been missed 19 times. I am trying to understand or ask if there is a way in which we can have much more strident checks for holding to the contractor to account? For example, the board met with BAM's parent company recently.
David Cullinane (Waterford, Sinn Fein)
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Should those meetings be on a weekly basis?
Mr. David Gunning:
Just to be clear, the contract exists in terms of what the contract sets out. Over and above the contract, we are meeting with BAM on a regular basis. Yesterday morning, we met with the head of BAM UK and Ireland, who is a member of the BAM management board. That is the senior level-----
David Cullinane (Waterford, Sinn Fein)
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What I am saying is-----
David Cullinane (Waterford, Sinn Fein)
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-----that whatever has been done so far has not worked. Has Mr. Gunning looked at alternative ways in which-----
David Cullinane (Waterford, Sinn Fein)
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Is the problem simply the contract?
David Cullinane (Waterford, Sinn Fein)
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Of course, it is not being resourced but if it is not being resourced-----
David Cullinane (Waterford, Sinn Fein)
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I understand that, but it is not happening.
David Cullinane (Waterford, Sinn Fein)
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Exactly. It is not happening but it is Mr. Gunning's job and our job to make sure it is done within the timeframes that are set. Clearly, that has not happened on 18 occasions.
David Cullinane (Waterford, Sinn Fein)
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It seems to me - I will be blunt - that we really cannot hold the contractor to account.
David Cullinane (Waterford, Sinn Fein)
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In terms of Mr. Gunning's estimation, April will obviously come and go. Is it likely to be months? Are we likely to be into the summer, at the earliest, for a new completion date? Is that what we are looking at?
David Cullinane (Waterford, Sinn Fein)
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We have had 18 programmes, have we not?
David Cullinane (Waterford, Sinn Fein)
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On one final note, what does Mr. Gunning say to the public who are looking in when they see this? We are sitting here again today. I do not know how many times this committee has had exchanges and Mr. Gunning still cannot give a date, even today.
Tom Clonan (Independent)
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I want to revisit some of the issues I raised earlier. Forgive me as my time is compressed. In relation to Great Ormond Street, we attended that hospital as a family because we were unable to access a diagnosis here. I just double-checked with a colleague there and Great Ormond Street Hospital was built in 1875. It is a consequence of those legacy issues that the IT is co-located within a separate building. However, the national children's hospital is a new build. It is brand-new and probably the most expensive hospital in the world. I ask Mr. Carroll to write to the committee and explain the rationale, in a brand-new, state-of-the-art hospital on a greenfield site, for having the IT people dispersed between the hospital, Harold's Cross and the South Circular Road. What is the rationale for that?
I would like to know what is the rationale for relocating 100 IT staff who were originally intended to be in the ground floor of the building. Why have they been removed to a separate location? In responding to that in writing to the committee, could Mr. Carroll also explain how Professor O'Hare is a full professor of health informatics in UCD and, at the same time, the chief information officer of Children's Health Ireland at this critical juncture? I ask him to set out the salary arrangements and advertising or competition process for that job and how Professor O'Hare was appointed. I ask the secretariat to follow up so that we get that information. It is crucial.
Very briefly then - this is a question with a "Yes" or "No" answer - has Ms Nugent had a town hall meeting with the parents yet?
Tom Clonan (Independent)
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But not a town hall meeting with the parents.
Tom Clonan (Independent)
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Ms Nugent previously gave a commitment to have a town hall meeting with the parents, in particular those affected on the urology wait list and the spinal wait list. Is she going to have that town hall meeting with them?
Tom Clonan (Independent)
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It is up to Ms Nugent to organise the town hall meeting. Parents cannot rent a town hall and turn up in the hope and expectation that Ms Nugent will be there. It is up to her to organise it. Will she organise it?
Tom Clonan (Independent)
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I am not talking about that. I am talking about the town hall meeting, on which Ms Nugent previously gave a commitment. Is she going to have it?
Tom Clonan (Independent)
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No, it was specifically for parents. That is the question I am asking Ms Nugent.
Tom Clonan (Independent)
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No. Is she going to organise a town hall meeting for the parents?
Tom Clonan (Independent)
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So is Ms Nugent going to do that?
Tom Clonan (Independent)
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Could she write to the committee and let us know when that is organised?
Tom Clonan (Independent)
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I thank Ms Nugent. Finally, does the NIMIS or other system record if a child is discharged without surgery?
Tom Clonan (Independent)
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Or any of the systems. When children are discharged from the system does it record the fact that they had no surgery?
Tom Clonan (Independent)
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So it is not recorded. Is it recorded on NIMIS whether a child is inoperable?
Tom Clonan (Independent)
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Yes, it is the national integrated medical imaging system, which is problematic in and of itself. Does CHI record on that or any of its other systems when a child becomes inoperable in its care? It is a "Yes" or a "No".
Tom Clonan (Independent)
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When CHI says the wait list has improved, how much of that is due to discharges without medical intervention due to age, that is, medical negligence?
Tom Clonan (Independent)
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No, they are failed. That is a lovely way of putting it – that they do not benefit from surgery. They did not get the surgery within the therapeutic timeframe, as they would in any other jurisdiction in the EU. It was a simple "Yes" or "No" answer but what I am hearing is "No", CHI does not record those who become inoperable.
Tom Clonan (Independent)
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CHI does not incorporate those statistics into its wait list because the witnesses cannot tell me how many children have been discharged from the service who have had no surgery or who have become inoperable. They cannot tell me how many people that has happened to on their watch.
Tom Clonan (Independent)
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Tell me then how many children have become inoperable?
Tom Clonan (Independent)
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Does CHI not know how many children have left the service, having become inoperable or who have not had any surgery?
Tom Clonan (Independent)
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That is a fair question.
Pádraig Rice (Cork South-Central, Social Democrats)
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Senator Clonan's time is up.
Tom Clonan (Independent)
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It goes to the heart of the social contract between us and CHI.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Senator Clonan. His time is up. He should allow the witness to answer the question.
Tom Clonan (Independent)
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That is scandalous.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will allow the witness to respond and then we will move to the next speaker.
Tom Clonan (Independent)
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Children are dying because of this.
Tom Clonan (Independent)
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They migrate and they die, like Chloe Maher. It is a scandal.
Pádraig Rice (Cork South-Central, Social Democrats)
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Do the witnesses have anything else to add to that or are they happy?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Mr. Carroll might be the best person to answer this question for me. The committee has looked at various issues relating to the digitisation of health records. There is a broad agreement that this is a very positive step and that it is something that needs to happen but there is not a uniform approach to it and it is certainly not happening at scale in the vast majority of hospitals. Could he walk me through a scenario where a parent from outside of Dublin – let us say Kerry, for example – has a child attending the new children's hospital, where the records will be digitised, but an event happens that is related to the condition for which they are attending CHI, and they need to present at their local accident and emergency unit. The accident and emergency unit is down the road. They are not travelling to Dublin. If that child receives treatment in a Kerry hospital, how does that record feed back to CHI to ensure the records CHI holds are complete?
Mr. Adrian Carroll:
Part of what we are delivering for the electronic health record in CHI is a patient portal, which allows patients to access elements of their healthcare record. They can share that information with whoever they choose. A second mechanism we are implementing is the ability for other healthcare providers nationally to have a view-only access to a patient's chart in CHI. That will enable healthcare providers in any jurisdiction in the Republic to access information that was recorded in Children's Health Ireland. When a patient is discharged from another organisation, usually they are provided with discharge letters, summaries and information.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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That is the crux of my question. Is that a paper record that the parents of a child need to bring with them to CHI? Is there no direct communication between the outside hospital and the new children's hospital?
Mr. Adrian Carroll:
Yes. I cannot speak to every organisation in Ireland as to what their process is to provide that information both to the GP and the patient but any paper that comes with the patient when they present for care in our organisation would be scanned electronically within 24 hours and that forms part of the digital record in CHI.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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That is really important. That is something parents and guardians need to be aware of – that the record is only going to be digitised in CHI. Any other treatment outside, relating to the same condition, needs to be brought back so that the medical records there can be fully complete.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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That should be communicated quite strongly. There may be a hope or a perception that all of the record will become digitised if the parents or family are familiar with working with CHI. It would be important to communicate that to patients for the avoidance of any confusion.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Yes, at some point but that is way off.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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That is not even on the horizon at this point. I thank the witnesses.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have just two questions and then we will conclude, hopefully around 12 noon. CHI provided us with a list of six different High Court disputes. How much has been spent on legal fees and High Court cases on this project so far?
Mr. David Gunning:
I have the number. I believe the total on general legal services since 2014 is about €5.5 million.
In relation to what we call claims defence and various other aspects, we do not disclose that number, simply because it is commercially sensitive in relation to the disputes we are involved in.
Pádraig Rice (Cork South-Central, Social Democrats)
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Is the figure Mr. Gunning gave in relation to the High Court cases?
Pádraig Rice (Cork South-Central, Social Democrats)
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It was €5.5 million for legal services and an undisclosed-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Is it more than €5 million, €10 million or €15 million?
Pádraig Rice (Cork South-Central, Social Democrats)
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Will we get this information after the project is completed?
Pádraig Rice (Cork South-Central, Social Democrats)
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At what point will we know how much has been spent?
Pádraig Rice (Cork South-Central, Social Democrats)
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It links back to the piece about the contract and the flaws in it. So much has been spent teasing this out in the courts. The State has to take these cases to court in order to try to get this project done. It is a point of interest for people.
I have another point for CHI which relates to contract providers at the new hospital. There was an article in the Irish Independent about a contract provider. It was reported that an Oireachtas committee heard about a "bizarre" decision whereby CHI received €30,000 from a concession holder for a Christmas party. Is the contract provider linked to the children's hospital? Will it have a contract?
Pádraig Rice (Cork South-Central, Social Democrats)
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Who is the contractor?
Pádraig Rice (Cork South-Central, Social Democrats)
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Ms Nugent referred in her opening statement to the importance of transparency and accountability, so I think it is important that there is.
Pádraig Rice (Cork South-Central, Social Democrats)
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What has changed since that situation arose?
Ms Lucy Nugent:
We do not have a large Christmas party any more. We did not have one last year. It was recorded in our CHI accounts ledger as deferred income.
It was received but not used. It should have turned up in reconciliation of our accounts. It was highlighted to us last year by the Comptroller and Auditor General and as soon as it was brought to my attention, I consulted the audit and risk committee and the board of the hospital and we felt the most prudent action was to return it to the supplier, which we did.
Pádraig Rice (Cork South-Central, Social Democrats)
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Why did it take a Comptroller and Auditor General audit for the funds to be disclosed and then returned?
Pádraig Rice (Cork South-Central, Social Democrats)
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We can come back to that at a future date. Some members asked that Ms Nugent write to them on some of the questions. If she provides those letters to the committee directly, we will share them with all members. That would be appreciated.
I thank CHI and the National Paediatric Hospital Development Board for engaging on this matter and for their ongoing work. A huge amount of work is under way and has been for many years now. I thank them all for that work. The committee will continue to reflect on the proceedings today and to monitor progress towards the completion and commissioning of the hospital and would be happy to take them up on the invitation to visit at some point. We would be happy to arrange a date for that. The meeting is now adjourned until 3 p.m. on Tuesday, 14 April when we will meet in private session.