Michael Harty (Clare, Independent) | Oireachtas source

The Rural Independent Group has formulated this important motion on the proposed national children's hospital and is happy to bring it to the floor of the House for debate for several reasons. This will be the most expensive infrastructure project in health and in the history of the State as well as being possibly the most expensive children's hospital in the world.

It is essential and of paramount importance that we have a new tertiary paediatric hospital built to give the highest quality of care to children. Our children should be foremost in all of this debate. At present, paediatric care is fragmented and scattered across Dublin city in Crumlin, Temple Street and Tallaght hospitals. This leads to significant disintegration and fragmentation of child care which needs to be centralised in a tertiary hospital in Dublin. That is of paramount importance.

However, there have been many problems in developing a national children's hospital in Dublin. It is now ten years in gestation but not one block has been built. Ten years ago, the Government was offered a children's hospital to be built at cost in Tallaght by Noel Smyth but the offer was rejected. The Mater hospital site was then chosen but planning permission was refused for there. Subsequently, the St. James's Hospital site was approved by the Government in 2012 and planning permission was delivered last August. The choice of this hospital, however, has been hugely controversial. Ten years later, after its initial mooting, not one block has been laid. We should hang our heads in shame in that regard. In 2012, there was an almost unanimous decision in the Dáil that the St. James's site would be the preferred site and we have to accept that for the moment.

The principal difficulty with the St. James's choice is the escalating costs. It has gone from €405 million to €650 million to €950 million, plus fitting out costs. In reality, we do not know the eventual cost or what any or each of these figures represents. We do not know what the premium is in building the hospital at a brownfield site. There must be a huge premium in building the hospital at St. James's in clearing and developing the site in a very constricted area. Will the Minister justify the escalating costs for building on a brownfield site as opposed to building on a greenfield site such as Connolly Hospital in Blanchardstown? We believe the escalating costs are related to the development at St. James's.

The Government has mentioned that the core cost of this development is €650 million for the hospital at St. James's and for the satellite sites at Tallaght and Connolly hospitals. Does this include the clearance costs of the site at St. James's? Does it include the fitting out costs and how does that feed into the eventual cost of the site? In general terms, the cost for building a bed in a hospital is €1 million. The paediatric hospital for construction at St. James's will have 473 beds, which equates to €473 million. Yet, the projected cost for this site is twice that, at least €2 million per bed. This is a concern, particularly when there is a significant deficit in our health service, as well as significant capital infrastructure need. If the paediatric hospital will eat into practically 50% of capital costs made available by this Government between now and 2021, other projects will be pushed down the road, in particular the building of a new central mental hospital in Portrane, the transfer of the national maternity hospital to St. Vincent's, the transfer of the Coombe hospital to Connolly Hospital and the building of primary care centres. How will the escalating costs of the national children's hospital be managed?

The Minister proposes to bring a memorandum to the Government in the next few weeks setting out full details of the costs. We are looking forward to this because it will give us detail as to how the escalating costs have developed and from where the extra costs have come. Will the Minister give us some extra information this evening? Has a cost-benefit analysis been done on the actual cost of building at St. James's as opposed to building at a greenfield site? Is the premium cost of building on a greenfield site justified?

Other difficulties with the St. James's site relate to the location of the hospital in a city centre location and difficulties with access. While there are substantial public transport access links to the hospital, most patients will come to the hospital by car. Parking for both patients and staff is also a concern. While patients can pre-book parking spaces, will there be enough? Would location of the paediatric hospital be better at a more peripheral site?

Another aspect to this is the bilocation and trilocation of the paediatric hospital. Bilocation with an adult teaching hospital was the deciding point in choosing St. James's. Does that trump the additional cost of construction there? Medical opinion is divided on bilocation with an adult teaching hospital. We have attended briefings where the paediatric board outlined the positives of bilocation, but it was not entirely convincing. Of course we want the best for our children. If bilocation with an adult teaching hospital has been proved to be of benefit, then of course we would accept it. There is a lack of consensus about bilocation among clinicians. That is why there are two sides to this argument.

There is a proposal to build the maternity hospital on the site of St. James's. If one is constructing on a constricted site, it would be logical to build both hospitals at the same location and at the same time. It would certainly be a cost-saving venture. The location at St. James's is a restricted site and the ability to expand freely is not possible. While there is a limited ability to expand and put in a maternity hospital, which may be 15 years down the road, one has the ability to expand in every direction on a greenfield site. We all know in 15 years, one will require a larger hospital and infrastructure because we have an increasing population and better technology. How can all of that be accommodated on such a restricted site such as St. James's? On a greenfield site, one can extend quite openly with spacious surroundings, parking spaces for whatever number and the opportunity to develop new access points.

We understand that all sites have their strengths and weaknesses and that there is no perfect location. There will always be differences of opinion on what is the best location and how the best care can be provided, but we must provide the best care for our children. We also need to know what is the exact function of Tallaght and Connolly hospitals. They will be satellite centres which will provide urgent care but they will not provide overnight care. Patients kept overnight will have to be transferred to Connolly Hospital for ongoing treatment. I would like the Minister to comment on the clinical and logistical grounds for justifying the siting of the hospital at its present location. Why is a maternity hospital not being built at the same time? It must be less expensive.

We must learn lessons from this difficulty and controversy. Proper governance from the HSE and the Department of Health is essential. We need proper initial planning. Ten years down the road we still do not have the beginnings of a hospital. We need proper initial design. Consultation with all the stakeholders, especially with patients, is required. That was lacking in this endeavour.

I do not believe the Government will revisit the location of the hospital but escalating costs must be forensically examined. If we were starting from a clean sheet, I and many of my colleagues here would no doubt choose a greenfield site as the best option and to build a maternity hospital at the same time and have that as a co-location, because that is the co-location and the bilocation that will have the most significant benefits.

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