James Browne (Wexford, Fianna Fail)
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I raise the issue of the runaway bill for the new children's hospital and the impact that will have on other health projects. The original bill was €650 million but the Taoiseach said yesterday that the final project cost has now risen to more than €1.4 billion or €450 million higher than the figure approved by the Government in 2017. It has been reported that the Minister for Health warned the Cabinet that the project could cost up to €1.7 billion, although there will not be a single extra bed for this extra money. This massive overspend demonstrates a clear and grievous failure of competence that will have a dire effect on the delivery of other necessary health projects throughout the country. Projects may now be significantly delayed at a cost to patients' health. It is patients, ultimately, who will lose out. Concerns have been raised, for example, regarding the provision of a second catheterisation laboratory in University Hospital Waterford and the development of the National Forensic Mental Health Service in Portrane.

Why should we believe these new figures as opposed to previous ones? How will the additional costs be funded? How much will be taken out of the existing health capital budget? When will the Minister for Health set out the projects that will now be delayed and the length of delay involved in each case? I ask the Minister of State to confirm that neither the catheterisation laboratory in Waterford or the National Forensic Mental Health Service will be delayed.

Jan O'Sullivan (Limerick City, Labour)
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I am concerned on behalf of my constituents and the people of the mid-west that the planned 96-bed inpatient block and the 60-bed interim accommodation solution, both promised for University Hospital Limerick, could be put at risk or delayed because of the overrun in the national children's hospital capital project. Our hospital was consistently at the top of list for numbers of patients on trolleys last year. It was the only hospital in the country that had more than 10,000 people on trolleys in one single year. It is at the top of the list again to date in 2019. This cannot be allowed to go on and I want an absolute assurance that there will be no delay, prevarication or hold up in the appointment of staff because the current situation is intolerable for patients and their families, as well as for the people who work in the emergency department. Statistically, the mid-west has been under-served with beds in comparison with other regions, as illustrated by figures published recently. That is why Limerick is consistently at the top of the list when it comes to trolley numbers. This issue must be addressed and prioritised. I want a clear answer to the effect that progress on both projects will be maintained to deliver the beds that are so urgently required in the mid west.

Mattie McGrath (Tipperary, Independent)
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I want to know where the Minister for Health is today. Where is he hiding? We were told that this project would cost €1.433 billion, which is €450 million more than what was advised to the Government in April 2017. I warned the House about this. Indeed, the Rural Independent Group tabled a Private Member's motion in the House a month before the decision was made to go ahead with this project. The parties whose representatives are raising this matter today, namely the Labour Party and Fianna Fáil, supported the Minister of Health and did not support our motion. We warned Members of this very issue. The reply I received today to a parliamentary question on the matter is staggering. I am as concerned about South Tipperary General Hospital as Deputy O'Sullivan is about Limerick University Hospital, which serves the other part of County Tipperary. A 50-bed unit there is in jeopardy. Every project in the country will be delayed.

The staggering costs involved are outrageous. Apparently €319 million of the additional costs relate to construction cost overruns, while the balance of €131 million, including €50 million in VAT, relates to costs associated with staff, consultants, planning and design teams, fees, risk contingency and management equipment services. This is an appalling vista but we warned Members about this project. It will not stop at €2 billion because the wrong site has been selected. The group Connolly for Kids warned the Department about this. There was a site available at Connolly Hospital. There will never be a maternity hospital co-located with the new children's hospital as promised because there is no room for one. Nurses cannot get in or out of the hospital. There are no parking spaces and the site is totally unsuitable. One cannot make a silk purse from a sow's ear. This is an appalling vista on the watch of the Minister for Health and this Government, as well as the parties that supported them, despite the warnings. Those parties are now crying crocodile tears.

Jim Daly (Cork South West, Fine Gael)
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I thank Deputies for raising this issue.

The new children’s hospital project includes a state-of-the-art facility being developed on the campus shared with St. James’s Hospital and the associated two outpatient and urgent care centres on the campuses shared with Connolly and Tallaght hospitals. The new hospital will become the single national tertiary-quaternary centre for highly specialised paediatric care for children from all over Ireland and will have the critical mass necessary to deliver best outcomes. Together with its two paediatric outpatients and urgent care centres, it will provide all secondary, or less specialised, acute paediatric care for children from the greater Dublin area.

The health capital allocation in 2019 is €567 million for the construction and equipping of health facilities. Following the publication of its national service plan for 2019, the Health Service Executive, HSE, is developing its capital plan for this year. The latter will determine the projects that will progress in 2019, having regard to the available capital funding, the number of large national capital projects under way and the relevant priority of each. In this context, the Deputies will be aware of the increased capital costs associated with the new children’s hospital and the approval by the Government of the investment to proceed with the building of the facility. In developing its capital plan for 2019, the HSE must consider: the amount contractually committed in 2019; its annual requirement to meet risks associated with clinical equipment, ambulances and healthcare infrastructure; and the total capital Exchequer funding required for the new children’s hospital in 2019. The Government has agreed that the project will proceed in 2019 to completion in 2022.

The impact on non-contracted capital commitments for the health services is that a selection of health capital projects and programmes will be delayed to contribute to funding the increased capital cost of the new children’s hospital project from within the existing health capital allocation. Health capital projects, including the development of additional beds at University Hospital Limerick, will be considered in the context of developing the HSE’s capital plan for 2019. The additional costs associated with building the new children’s hospital are of grave concern to the Government. While it fully supports this project, the Government must have assurance that construction will be delivered within the current budget and timescale. The Government will work to minimise the effect of the increased costs of developing the hospital. We must remember, however, that we are developing a world-class facility which will support the implementation of a new model of care for the children of Ireland. It will have a profound impact on all paediatric services when open.

James Browne (Wexford, Fianna Fail)
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I am dissatisfied with the Minister of State's reply. When the project was officially launched by the Minister, Deputy Harris, in 2017, there was outrage at the suggestion that it could be the most expensive hospital in Europe. Little did we know that the Minister was far more ambitious than that. It now appears that the hospital will be the most expensive ever built in the world. The Minister has the authority in this regard. He controls the Department of Health and he is responsible for addressing the capacity crisis in the health service. He must accept that his performance in the delivery of the children's hospital has not been good enough. We need accountability in healthcare provision and the Minister needs to ensure that value for money is delivered in the context of the expenditure for which he is responsible. The Minister is politically responsible and accountable for this matter. Thus far, however, his response has demonstrated that he is neither.

Jan O'Sullivan (Limerick City, Labour)
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The Minister of State's response was alarming, particularly where he stated that his "selection of health capital projects and programmes will be delayed to contribute to funding the increased capital cost of the new children's hospital project". He indicated that it will be delivered within the budget and timescale, but that other commitments were made. The Minister went to Limerick and gave a commitment on the timescale for the interim 60-bed unit and the 96-bed unit. I reiterate that Limerick has the highest numbers on trolleys in the country week on week. The units are urgently needed. If the children's hospital is to be delivered within the timescale, the other commitments made by the Minister must also be delivered in that way.

I will pursue the matter to ensure we in Limerick receive the beds we need because people, often elderly people, are in pain on trolleys for hours and hours with no beds for them to use. It is entirely unacceptable. There is an expectation that the beds will be delivered on time, and that must happen.

Mattie McGrath (Tipperary, Independent)
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I am not surprised by the Minister of State's response. It is as clear as the nose on one's face that the money will not be available for projects such as that at South Tipperary General Hospital, Limerick hospital and many other locations. It is galling to have to endure the belated and disingenuous bleating of all the other groupings and main political parties in the Dáil, when those of us in the Rural Independent Group, working with Connolly for Kids and the Jack and Jill Foundation, clearly laid out in our Private Members' motion the likelihood of this exact scenario coming to pass in March 2017, a full month before the Government signed off on the original estimate. Not one member of those parties supported us. They were all in bed together, putting the matter aside, and now we have the mess and trauma of people sick and waiting on trolleys and so on.

I have zero confidence that the national paediatric hospital development board or the Minister are capable of ensuring that phase B of the project will be delivered. Similarly, the national maternity hospital was meant to be developed alongside it. Sick children need to be rolled in from the maternity hospital to the same campus, but it will not happen. There is no helipad. Rather, there is only the side of a building. There is no access by car because of chronic traffic. There is no safety for nurses or retention of nurses, and we are unable to get nurses to work here. It is a fiasco over which the Government is presiding with the support of the political parties of the House. They can all cry wolf but it is too late.

Jim Daly (Cork South West, Fine Gael)
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Perhaps it is to be lamented that more members of the Rural Independent Group did not accept ministerial responsibilities when they were offered to them at the formation of the Government because they have an answer for everything.

Mattie McGrath (Tipperary, Independent)
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We would not have this mess anyway. The Government has Independents but it cannot handle them. It has the Minister for Transport, Tourism and Sport, Deputy Ross - an Independent - and he is wrecking the country.

Jim Daly (Cork South West, Fine Gael)
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Sometimes the Deputy should listen.

Charles Flanagan (Laois, Fine Gael)
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Deputy Mattie McGrath is in with Deputy Ross. Deputy Ross is one of Deputy Mattie McGrath's.

Mattie McGrath (Tipperary, Independent)
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Deputy Ross is not one of mine. I would not touch him with a barge-pole. He spent Christmas Eve canvassing until 9.30 p.m., instead of stuffing his turkey at home.

Pat Gallagher (Donegal, Fianna Fail)
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The Minister for Justice and Equality, Deputy Flanagan, is normally orderly and does not invite interruptions. The Minister of State has a minute and a half remaining.

Jim Daly (Cork South West, Fine Gael)
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I apologise for being provocative.

Mattie McGrath (Tipperary, Independent)
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The Minister of State started it. He wanted the distraction.

Jim Daly (Cork South West, Fine Gael)
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While the Government fully supports the project, the additional costs associated with it are of great concern and we must have assurances that phase B of the construction project will be delivered within budget and timescale. Accordingly, the Government has approved the commissioning of an independent review of the escalating costs and the effective management of public funds. Arrangements for the commissioning of the independent review are under way. The hospital development board will be required to provide ongoing assurances that phase B of the project is being delivered within budget and timescale.

Development is also well advanced on the two paediatric outpatient and urgent care centres at Connolly and Tallaght hospitals. Works at Connolly are on target for practical completion of the building in spring 2019, with the opening scheduled for July 2019. Works at Tallaght are under way with a target handover date of July 2020, while the main hospital is to be completed in 2022. Integration of the three existing paediatric hospitals, the opening of the outpatient and urgent care centres and the transfer of services to the new hospital facilities represent a highly complex project in its own right. The recent establishment of Children's Health Ireland under the Children's Health Act 2018 to run the children's hospital supports the major programme of work of service and clinical integration required to run integrated services on the existing children's hospital sites and commissioning required to achieve a successful transition to the new facilities when they open.