Seanad debates

Thursday, 7 March 2019

National Children's Hospital: Statements

 

10:30 am

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I am very grateful for the opportunity to update the Seanad on the new children's hospital project. Over the past number of weeks there has been significant debate and discussion regarding the development of the new children’s hospital and the increase in the cost of the project. I advised Government in December 2018 that the overall cost to complete the project is €1.433 billion, €450 million more than advised to Government in April 2017 when it gave the green light for the construction of the hospital and the two satellite centres. Some €319 million of the additional cost relates to construction costs and the balance of €131 million, which includes €50 million in VAT, relates to costs associated with staff, consultants, planning, design team fees, risk and contingency, and management equipment service.

I have already made myself extremely clear in this regard; the Government and I, and all those involved in this project, were and remain deeply unhappy at the cost escalation of this project over what was originally committed to by the Government. On 18 December, at the same time as the Government approved the construction investment to allow phase B of the hospital to be instructed, the Government also approved the commissioning of an independent review of the escalation in cost. As the House will know, this independent comprehensive review process is under way and will examine the contributory factors and associated responsibilities so that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds. The terms of reference also require the review to develop recommendations which may identify any areas of potential cost savings or reductions which are consistent with the applicable contractual undertakings and the delivery of the project. It is also required to address major residual risks, control and oversight issues and bring greater oversight of performance and value for money. The report from this review process is expected to be completed by the end of March.

This debate, however, would not be complete without a reminder of the progress made on this project and the game-changer it represents in the delivery of services for children. It is important that we do not forget the purpose of this project, which is to deliver transformational change in the delivery of healthcare for children in Ireland. I have said many times before, and will reiterate here again today, that the children and young people of Ireland have been waiting far too long for a modern healthcare facility. This new children’s hospital project will transform the delivery of children’s healthcare. The capital investment will be underpinned and complemented by a new model of care for the delivery of services to children. We will be replacing outdated hospital buildings with modern and appropriate infrastructure, including fit-for-purpose, single en suite rooms for every child designed to best serve the needs of our children, of their families and of the staff who care for them. There are currently 14 theatres, including one cath lab, in the three existing hospitals, which has to be supplemented by outsourcing procedures to other hospitals. This limits our ability to tackle the long waiting times for surgeries for our children. In our new hospital there will be 22 theatres, including two cath labs, which will have a profoundly positive impact on activity levels and on theatre waiting times for children.The equipment at the new children's hospital will include five MRI machines, with space for two more, three CT scanners, 30 ultrasound machines and seven X-ray rooms, all of which will be state of the art. As part of the project, new outpatient and urgent care centres will also be provided at Connolly and Tallaght hospitals. These centres will expand outpatient and urgent care capacity and provide services in modern facilities. Overall, the three new sites will significantly increase capacity across all types of care, including increases of 16% in inpatient capacity, 7% in emergency department attendances, 26% in day case capacity and 47% in outpatient capacity. These are significant figures indicating the scope of improvement that children and their parents will experience.

Commentary relating to the new hospital sometimes seems to be about a project that only exists on paper and has not yet commenced. I invite Members to go down to the St. James's site or to Connolly hospital and see that this is certainly not the case. Considerable work has been undertaken on the project since April 2017. Phase B works are under way at the St. James's site. Works at Connolly hospital are on target for practical completion of the building this year, with the opening scheduled for this summer. The outpatient and urgent care centre at Connolly will start delivering improvements to healthcare for children this year, under the responsibility of Children's Health Ireland.

Works at Tallaght are under way, with a target handover date of July 2020. The establishment of Children's Health Ireland by legislation passed by this House at the end of last year was a major milestone in this project and will further assist the ongoing operational integration of the three hospitals in advance of the opening of the new children's hospital and outpatient and urgent care centres. The hospital will have a leadership role nationally in the implementation of the national model of care for paediatrics and neonatology, working closely with paediatric service providers in other hospitals across the country, in the primary care service and in the community.

We have an unprecedented opportunity to deliver a considerably positive change in healthcare for Ireland's children and young people. While we must, and will, learn from the issues that have arisen in the project thus far, the priority is and continues to be delivering on the vision to improve health services for the children and young people.

Photo of Ned O'SullivanNed O'Sullivan (Fianna Fail)
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The Minister will be called to reply no later than 2.24 p.m. Group spokesperson have eight minutes each and may share time, with the agreement of the House.

Photo of Catherine ArdaghCatherine Ardagh (Fianna Fail)
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I thank the Minister for coming to the House. He has given us a great run down of what exactly we will get in the hospital, and we are grateful for that. While we do not dispute the need for the hospital, we dispute the cost management associated with the rolling out of the project. This is where the grievance lies. The Government found out the project was €450 million in the red in November. In February 2017, I divided this House and called on the Minister to come in to discuss cost overruns after comments made by Mr. Tony O Brien at a meeting of a health committee. At that time, the Minister sent in Minister of State, Deputy Catherine Byrne, who said the cost overrun was just 5%, which we now know was untrue.

The Minister was told of an overrun of €191 million in August of last year and of another €200 million that was disputed. A month later, it was learned through a parliamentary question that the budget for the project was on track. The Minister told members of my party that the Government overrun was on track. In December 2018, Mazars pointed to a lack of early warning systems. It materialised that costs were ballooning and issues with estimating costs accurately had been evident from the very start. It is clear that structures needed to be implemented to ensure individuals were held accountable.

The estimated cost of the new hospital on the campus of St. James's has risen from the original cost, €450 million, to in excess of €1 billion. A significant proportion of the €450 million increase, which was undisclosed during Fine Gael–Fianna Fáil budget negotiations, can be traced back to this time, including some €100 million in omissions and an underestimation of material costs. The preliminary investigations by Mazars, delivered last December, determined that a 56% increase in construction costs led to the cost per square metre of the new hospital jumping from €3,600 to €5,600. It is clear that construction inflation was an issue. It seems not to have been taken into consideration at all by the board. The report examined a number of issues, including the cost increases and the reporting of those increases. Among these issues was the fact that the final design added some €94 million in cost to the original budget due to the apparent understatement of the quality and quantity of materials needed.

The National Paediatric Hospital Development Board has seen four chairman come and go along the way. It was reported on 6 February in The Irish Timesthat the children's hospital project steering group, the body overseeing the €1 billion project, consistently flagged issues related to capital costs as far back as October 2017. To say this is a saga is an understatement but now the project is having serious knock-on effects in other areas. Yesterday, the HIQA report into fostering services, which the Minister's Department oversees, showed that Dublin South-Central alone has been greatly affected and that there has been a regression in care for minors in foster care. There is a serious lack of oversight. We have been promised primary care centres in Drimnagh and elsewhere but they have not materialised. It seems this is because the cost overrun at the hospital is taking funds from projects run by the Department and from other Government funds. The total in funds to be paid out in SUSI grants will drop by more than €2 million in 2019. The Minister for Education and Skills, Deputy McHugh, has proposed a cut to third level funding in the region of €15.5 million from the education budget. An analysis published by the Parliamentary Budget Office, PBO, clearly indicates the Government is deprioritising education.

This mismanagement by the Department of Health is having a serious knock-on effect on other Departments, and we are seeing deprioritisation of projects within the Department of Education and Skills and, more seriously, the Department of Health itself, particularly in regard to primary health care centres promised in 2011 by the Fine Gael–Labour Government. The latter have not been delivered. One of the excuses we are given is the cost overrun at the children's hospital.

Not only has the cost of the hospital increased by €450 million but we do not know at this stage what the exact final cost will be. We are aware that residents living near the hospital have brought actions against the hospital because of subsidence at their homes. This is before the courts and we do not know what the court actions will cost. The Department will have to pay these costs to compensate the residents. I have made inquiries and have been told by the Department that the matter is sub judice. Nothing is being done, therefore, to help the residents. The Minister has invited us to see the hospital site but I invite him to go to Clancourt and see the destruction caused to many residents' homes owing to subsidence.

The project is worthwhile and it is important that it proceeds but the cost overruns and management not only of this capital project but also of many others around the country have to be considered. Anyone who builds an extension, even on a small scale, is conscious of costs overrunning and the cost of bricklayers and electricians. It is something we all keep an eye on to ensure projects proceed according to plan. If one does not have the money, one cannot go ahead with a project. There is basic mismanagement in the case of the children's hospital. Taxpayers are disappointed the money has been spent without any proper consideration as to what it is being spent on and without any departmental foresight.

Photo of Maire DevineMaire Devine (Sinn Fein)
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Cuirim fáilte roimh an Aire. It took a while to get here. As my colleague said, we have been asking for him-----

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I am here.

Photo of Maire DevineMaire Devine (Sinn Fein)
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-----to star in the Seanad regarding the national children's hospital for several weeks now.

Photo of Catherine ArdaghCatherine Ardagh (Fianna Fail)
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Years.

Photo of Maire DevineMaire Devine (Sinn Fein)
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Not quite years.

Where does one start? The scenarios presented to us regarding ever-increasing costs, or the runaway train, are not so much fairytale-like as nightmarish. The public have found them incredible. The train has no driver. The Minister is the driver but seems to have taken the day off sick because the train keeps going. I hope the brakes have now been applied and that some prudence has been exercised to address the waste of public money. I am not saying the children's hospital itself is a waste. The mothers, fathers and children of Ireland need it but do not need the waste arising from the ever-increasing costs, which should have been capped at the beginning. The public purse is being robbed time and again. Perhaps we are used to it but this time the public was just gobsmacked by the extent of the increase.I also juxtapose the optics of a few weeks ago of nurses on the picket line at St. James's demanding something that would have cost perhaps €260 million and standing under the shadow the foundations of the children's hospital that we believed then would cost at least over €1 billion, if not, as many say, over €2 billion. That was not lost on the people. They were able to do the maths when they looked at those images.

I refer to the conflicting timelines, unanswered questions, and who knew what and when. It is incredibly important for this to be certain for accountability. It was simply not credible that the Minister did not discuss the catastrophic overrun with his Cabinet colleagues earlier than November last given that in May the joint construction and finance subcommittee noted that the capital programme for the project would have to be submitted before mid-September to ensure funding prior to budget. If that was the case, they would have known the overrun much earlier. However, it did not happen. The explanations thus far are unsatisfactory. In simple terms, the Minister and the HSE still need to explain why this occurred.

There is loads going on with this hospital.

Photo of Colm BurkeColm Burke (Fine Gael)
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It is being built.

Photo of Maire DevineMaire Devine (Sinn Fein)
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It is my turn to speak. I thank the Senator.

Photo of Ned O'SullivanNed O'Sullivan (Fianna Fail)
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I will adjudicate on that. Senator Devine, without interruption.

Photo of Maire DevineMaire Devine (Sinn Fein)
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I thank the Acting Chairman. I do not know where to start. I have lots of notes and I will just to through them quickly.

The mental health services in the hospital will be an improvement on what we have throughout the country, given that Linn Dara day patient services remain closed and I am still not getting answers on that. I acknowledge this is a hospital and the Minister is concentrating on inpatient services, especially mental health services, and the eating disorders which are prevalent and for which medicines have to be imported. In terms of Brexit, what will happen seeing as this hospital will not be operational for another few years?

While the emphasis of a hospital is on inpatient services, what community services will it offer to day patients or children attending for outpatient services? Home is the best place for children, in particular, children with mental health needs. How will we encourage community day care and what will the hospital offer on a national level apart from inpatient services in those instances?

I keep asking about the future of the Temple Street and Crumlin sites. Rumours abound about land being sold off. In particular, the deed for Our Lady's Children's Hospital stipulates the need for part of the site to retained for medical purposes. If the Minister could get me that deed to have a look at it, I would be grateful. We need to know the position. It is owned by the people. I would like to see what clauses the deed contains if the hospital, or part of it, was up for sale.

I refer to the impact that this overrun will have, as did Senator Ardagh. She and I are from the same area. My street is right underneath the children's hospital. I have put up with much inconvenience but I will go into that later. On the re-profiling, who dreamt that word up? It is a great word, and it is very American. Basically, it is the diluted way of saying that it will not happen. Whoever came up with it should get a pat on the back. In the use of language, Trump might be proud of us.

This is a local issue, in particular, for me and my neighbours and the surrounding areas off the South Circular Road in Kilmainham, Ceannt Fort, Mount Brown. I refer to the significant impact that this has had on these areas. Dublin City Council has now designated all our areas for 24-7 parking much to the disquiet of some residents who did not vote for it. There is a push to commercialise our historic neighbourhoods in that area. It is part of the inner city and it is obviously in high demand as the city grows. However, we have not protected residents in that area. We have taken away much of what there was previously. There is BAM, St. James's Hospital and the development board of the children's hospital and nobody will answer a question. They send one from Billy to Jack and nobody seems to take responsibility. I would be grateful if the Minister could have a little word with them, in particular, BAM, which apparently is a considerate contractor and is on the considerate contractors' scheme. If the Minister talks to anybody in the vicinity of the hospital, he will find that it is not considered to be a considerate contractor. Traffic management is chaotic and dangerous. I refer to the rat infestation and the subsidence of houses which has resulted in a legal wrangle for their owners with no response yet. It has taken two years so far. In 2015, the board was told about the unsuitability of the black soil at Ceannt Fort both by myself and residents. Engineers 100 years ago pointed out on a map prior to the estate being built that this land was not suitable for building. We were told not to worry that it was black soil but 100 years ago, without the technology we have today, engineers were able to point that out. However, that was ignored in the rush to get this hospital built. It was decided to ride roughshod over any objections at the time and to placate us in the hope that we would go away. The residents will not go away. However, I would like the Minister intervene and ask BAM to be more considerate and address the needs and questions of the local residents.

There is much more to say.

Photo of Ned O'SullivanNed O'Sullivan (Fianna Fail)
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There is not. The Senator has no time.

Photo of Maire DevineMaire Devine (Sinn Fein)
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I am out of time. This national children's hospital is badly needed and it is a shame that it is being mismanaged.

Photo of Colm BurkeColm Burke (Fine Gael)
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I thank the Minister. My apologies for being slightly late and for not being here when he arrived.

It is important to outline what the children's hospital will contain because some are giving the impression that it will have only 473 beds. As I understand it, there will be 380 inpatient beds and 60 acute beds. This must be considered from the overall context of the young population we have in this country. More than 1.25 million people are aged under 18 years and a state-of-the-art facility is needed to look after that population. The health, both physical and mental, of the vast majority of that population will be perfect but some people will run into difficulties. Even from the day they are born, some will have healthcare problems and it must be ensured the best system is in place to look after them from start to finish.

A number of hospitals currently deal with paediatrics. There has been a long process. It is interesting that we have gone through 22 Ministers for Health since this hospital was first talked about. Instead of talking about it, the Government is building it. That is the difference. We will have a hospital which will have more than 6,150 rooms, run 140 clinics at any one time, and will have 380 inpatient beds, 93 of which will be for day care. It will also have 53 rooms for parents who want to stay overnight. One must bear in mind that the 60 acute beds will be for children whom staff will not know, at 11 p.m. or midnight, whether they will come through by 8 a.m. It is important, therefore, as well that parents are looked after because they play an important part in making sure that the best care is provided for these children.

There have been delays but the Government had a choice to make. An Bord Pleanála turned down the planning permission for the Mater site in February 2012. On the new planning permission, the Government had to go back to the design stage and go through the planning process. The new planning permission was granted by An Bord Pleanála in April 2016. That is less than three years ago. Ministers have got on with doing the job of getting in the tenders and going through and getting the work done to excavate the site, lay the foundations and building, most importantly, rather than putting it back for further consideration.

Yesterday I was on a conference call with people who are developing a children's hospital in Ontario in Canada. I had been in touch with the Canadian embassy and officials gave me the contact names.In fairness to the people in Canada, they rang me at a set time yesterday and I spoke to three people. As much as $800 million Canadian dollars has been raised for the children's hospital project there. The total cost of the project is $3.7 billion Canadian dollars, which includes the building of an office complex and the children's hospital. The target is to raise $1.3 billion Canadian dollars and I understand the state will provide about $2 billion Canadian dollars for the project.

Interestingly, the people with whom I spoke yesterday advised me that in Toronto building inflation has increased by 1% each month over the past 15 months and they expect it to continue to rise over the next number of years as the project proceeds. They must first build new office accommodation for more than 3,000 staff in the form of a 22-storey building, which will be funded by their own resources. It is intended to decant all of the existing administration staff into the new office building, after which a major demolition job will be required before the children's hospital can be started. Another interesting point is that they must provide all of the funding for the equipment that will be go into the hospital. I am not saying we should go down that road but when people compare and claim various projects were done for X number of euro or pounds, they have obviously not considered the real issue.

The children's hospital in Manchester, which I understand has 370 beds, cost £504 million or between €650 million or €660 million. It started in 2004 and took five years to build. When we make comparisons, let us do so properly. Let us consider the national children's hospital project on the basis that we are providing a state-of-the-art facility alongside an existing adult hospital, which will have more than 1,020 beds and key expertise for adult care across a range of areas, including a burns unit. These experts will also be available should the need arise in terms of children facing major health issues. That is why the co-location with St. James's is so important and the project needs to be fully endorsed as the best way forward for healthcare in this country.

We can talk all we like about a lack of full transparency. I am a member of the Joint Committee on Health and every document and set of minutes that I have sought has been produced. People were concerned and expressed concerns about the way things had changed but we had a choice. Planning applications do not include a definitive and detailed description of each and every room. The planning permission was for the basic structure, the supply of all the services, emergency exits and so forth but the application did not feature the fine details of each and every room. The board had a choice, which it was advised of, to wait 12 months to have the fine detail worked out and then invite tenders, or it could invite tenders and get on with the project, which is what it did. That was the right decision because we are now between a year and 18 months ahead of schedule in dealing with the project. We can park the issue, decide not to go ahead and have another debate but that would mean going through another five Ministers for Health before the hospital is finally built. Our challenge and job is to go ahead and get the project built. We are accountable in terms of cost and taxpayers are entitled to know exactly how much everything costs. That information has been provided. It is important that people study the documents that have been published and made available. We should also wait for PricewaterhouseCoopers to produce its report and if issues arise, we need to deal with them.

I thank the Minister for being here to deal with this matter today.

Photo of Rónán MullenRónán Mullen (Independent)
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The Minister may see this debate as an opportunity to update the Seanad on the "new children's hospital", to use his words. I see this debate as an opportunity to ask him certain questions that he has not satisfactorily answered. This comes down to two core issues. The first issue, which I asked him about at a meeting of the Joint Committee on Health, is whether the massive cost overrun associated with this hospital is associated with the complexity of the St. James's site, as opposed to building this hospital on a greenfield site. The answer to that question is obvious and the political system has been at fault for not holding the Minister to that question.

The second issue is related. The Minister and Government have made much of the ultimate desirability of the children's hospital somehow justifying and excusing all errors along the way. The issue, however, is whether the Minister is failing to build the hospital that is needed to guarantee, inasmuch as is possible, children's health and welfare in future, in particular having regard to the inability to co-locate a maternity hospital at this site. In other words, in addition to the insult to the taxpayer caused by the appalling management of public funds that has occurred, the Minister is adding the future injury to children's health and safety, as many people believe, including eminent medical people associated with the Connolly for Kids project. I am astounded at how little the media and the main Opposition parties have attended to that fundamental question of children's welfare in addition to the question of the spend. The reason is that there has been a failure of the imagination to consider whether even now the Government should withdraw from this location as being the ideal location for the hospital

In recent weeks, we have been drip-fed news of construction delays, huge cost overruns and suggestions that bidders for projects are trying to extract maximum profit from the taxpayer. Above all, we have seen a total lack of accountability and contempt for any notion of democratic accountability of the Government to the elected Members of the Oireachtas. We have been here before. It happened before during the planning stage of the original site at the Mater Hospital. Before that, the same pattern emerged during a wide range of public projects from the Dublin Port tunnel to the building of the motorway network. The scale of the proposed cost overruns for the children’s hospital is almost difficult to believe, the original tender having been €636 million. We have had a gradual attempt to deflect the blame for this catastrophe from the Minister and his Department. We had a remarkable statement from Mr. Robert Watt, Secretary General of the Department of Public Expenditure and Reform, reported today that the State will no longer commit to projects until the design and price are clear. Is that not an absolutely scandalous statement? Does it not reflect on the shambolic management of public finances and projects that have gone on here?

Initially, the blame was directed at the board of the hospital project and its chairman resigned. Next up, were the bidders for the project who were accused by Taoiseach of "low-balling" their tenders. Last weekend, it emerged that the Government intends to shift the blame yet again by pointing the finger at consultants who made the initial examination of the St. James's site. All I see here is skilful public relations, a sea of headlines and scrum of recriminations that allow the Government to avoid the fundamental question at the heart of this issue, namely, whether it was correct to choose the St. James's’ site in the first place when other greenfield sites were on offer. The Minister's fingers are on this, as are those of the Taoiseach and Senator Reilly. What I hear now is political ass-covering by Government and its supporters in government.

Photo of Gabrielle McFaddenGabrielle McFadden (Fine Gael)
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That is unparliamentary language.

Photo of Rónán MullenRónán Mullen (Independent)
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I do not hear fundamental concern for the best option, having regard to children's welfare.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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I am sorry for interrupting but the Senator may wish to rephrase his previous remark about a certain part of the body.

Photo of Rónán MullenRónán Mullen (Independent)
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As soon as I think of a better phrase, I will offer it to the House. The question strikes at the heart of the Government in view of the political damage caused by the abandonment of the previous Mater site. Surely any examination of the cost overruns must address whether the choice of the St. James's site is part of what caused the problem.It is certainly possible, if not likely, that the complexity of building the hospital in a congested city centre location, rather than on a greenfield site, is what has caused the escalating costs. The Minister was unable to deal with that question satisfactorily when I asked him in the Joint Committee on Health. The Minister's defence of the choice of site at this point is that there can be no further delays to the project and that the new children’s hospital must be co-located with an adult teaching hospital. He will know that I do not rate him as a protector of children anyway in view of what happened in relation to abortion legislation and the endangering of children's lives.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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The people made their decision. That is an unfortunate remark and it should be withdrawn.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Senator Humphreys, please.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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The remark should be withdrawn.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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One moment.

Photo of Maire DevineMaire Devine (Sinn Fein)
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The Senator is right, it should be withdrawn.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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It is my job to interpret what should or should not be.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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It is a total slander. I am no fan of the Minister but I would not like to see people being slandered in this House.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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I wish to make it clear that Senator Mullen is making a political charge in his contribution. He is entitled to do that. If people want to take issue with it, and they have yet to speak, they may do so when they speak. The Minister will have an opportunity to do so in his closing remarks, if he wishes. Senator Mullen has a minute remaining.

Photo of Rónán MullenRónán Mullen (Independent)
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I think I am entitled, in view of interruptions.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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That time is including the interruptions.

Photo of Rónán MullenRónán Mullen (Independent)
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I am drawing a line between what I regard as the Minister's position on one issue and the cynical dressing up of Government choices as being about protecting the best interests of children in this case, when many experts, people at the coalface of children's medicine, are tearing their hair out at the choice this Government has made. The most cynical thing of all, and I have heard the Government and its supporters go on about it, is the claim that the co-location of the children's hospital with an adult teaching hospital somehow meets the needs involved when the experts are saying quite clearly that where co-location is desirable is the co-location of a maternity hospital with a children's hospital or perhaps a maternity hospital with an adult hospital. The third matter, and well down the list, is the argument about the co-location of a children's hospital with an adult hospital. The Government and the Minister for Health have spun mercilessly on that particular point which is an indictment of the Minister's stewardship. I am not a medical person, no more than the Minister is not one, but I quote Professor Chris Fitzpatrick who said "with neither money nor space, plans for a tri-located maternity hospital are now a pie-in-the-sky fantasy." That would be all right if it was not so important. However, according to the 2012 O'Reilly expert group, if we wish to improve the clinical outcome for sick children, the most critical adjacency for the national children's hospital is with a tertiary maternity hospital where high-risk babies can be delivered. The Minister has heard this many times because he heard from the Connolly for Kids people. They briefed every single member of the Government extensively on the crucial importance of the issues that were at play here yet the Government went its own way. It did so, I think, because of political cowardice because it was not, in the end, primarily motivated by welfare of children. It was motivated by the idea that we could not countenance backing out of the wrong choice yet again, no doubt because of the attitude that would have been taken by other political groups. Frankly, the Minister's job is to govern in the best interest of the children and families concerned. Even now, the Minster is showing a failure to unthink the unthinkable. The Government's argument that it could not delay any longer for the sake of the children of Ireland holds no water when medical experts, people who care and who know about caring for children, say even now it should be revisited. Yes, there would be-----

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Thank you, Senator.

Photo of Rónán MullenRónán Mullen (Independent)
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-----a significant financial cost but the Government has already exposed us to that anyway. I put my questions and I stand over my points.

My core questions were whether the financial overrun is connected with the complexity of the site the Government chose, whether in persisting with the site it chose, it is endangering children's welfare into the future, as many medical experts claim, and whether that is not the ultimate indictment of the Minister and the Government's handling of these issues.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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I call Senator Humphreys who has eight minutes.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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The national children's hospital is a very important point of discussion and we should put children first. Yes, it should be a game-changer in relation to care for children. We have not provided good facilities for children. Yes, it should be a state-of-the-art facility and I look forward to seeing it. It must move on as quickly as possible. Yes, there should be accommodation for parents to stay with sick children and support them during their time there and there should be the best quality theatres open on a 24-7 basis to ensure we can guarantee the proper care of our children, which has not happened in the past.

However, the cost overrun has led to a serious loss of faith among the public, not only of the Government's capability but also that of the Civil Service, to deliver a hospital on time and within budget. This is part of the frustration because so many capital projects are happening and the public no longer has faith that they will be delivered on time and within budget. We need to rebuild that faith and trust among the people, and we need to do so quickly.

I have two questions for the Minister. I hope the National Maternity Hospital which is being co-located in Elm Park will be delivered on time and within budget. Will the Minister update the House on it? He may not be able to do so but I would appreciate it if he could update me on the National Maternity Hospital at a later stage as I place that on a par in terms of the delivery of a good and proper service. Will the Minister outline also the mechanisms that have been put in place in relation to projects of this size? There needs to be a level of expectation in respect of costs and delivery times so that people can have faith that projects such as the National Maternity Hospital and the national children's hospital will be delivered within budget? This morning I questioned the Minister for Transport, Tourism and Sport, Deputy Ross, on bus corridors, the metro line and whether we were getting proper estimates for costs. He said the National Transport Authority reports to the Department of Public Expenditure and Reform on a fortnightly basis. Do the same mechanisms apply to the HSE to ensure that if there are overruns, they are identified early on so that corrections may be made? We must be honest with the citizens because they demand these services but want them at a reasonable cost.

I have no intention of grandstanding and calling for the national children's hospital to be moved or whatever the populist opinion is now. We need to get on and build the national children's hospital.

Photo of Rónán MullenRónán Mullen (Independent)
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It is not grandstanding, it is medical experts-----

Photo of Kevin HumphreysKevin Humphreys (Labour)
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We need to get on and build-----

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Senator Humphreys, without interruption.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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It is fine. I do not find the interruptions at all unhelpful. If one looks at the track record, it has been proved on many occasions that others are a lot more in tune with the public than the Senator.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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It is my job to ensure the Senator is not interrupted.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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I am speaking through the Chair and I accept I am eating into my own time.

Photo of Rónán MullenRónán Mullen (Independent)
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I am only returning the compliment to Senator Humphreys.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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I gave the Senator no compliments, so he should not take it that way. I think he slandered the Minister in relation to the health of children. I do not think the Minister goes out to purposely damage any children.

Photo of Rónán MullenRónán Mullen (Independent)
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The Senator does not care about the children.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Senator, please.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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I am quite happy with my record on repealing the eighth amendment and I will take no nonsense from Senator Mullen.

Photo of Rónán MullenRónán Mullen (Independent)
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The Senator has no credibility on children.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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Let us get on and build a state-of-the-art facility for children. Let us do so quickly and make sure the care of our children is the best in the world.

Photo of Rónán MullenRónán Mullen (Independent)
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We cannot do so.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Senator, please.

Photo of Kevin HumphreysKevin Humphreys (Labour)
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Let us make sure we have a National Maternity Hospital we can be proud of and that we build it as soon as possible. I hope I kept within my time, Chairman.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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The Senator certainly did and I thank him.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I thank all the Senators who made contributions to the debate today. I have listened carefully to the views and concerns, many of which I share. What I have heard from most speakers is two things: will we please get on and build the hospital, which we are going to do, and will we please make sure, in the building of the hospital, that we get value for the taxpayer and that lessons are learned in regard to other capital projects. I heard a number of local but legitimate and important concerns for the community raised by Senators Devine and Ardagh, and I will certainly follow up in regard to those matters and will revert directly to both Senators. However, I hear a general agreement from most that the children of Ireland and their families deserve this modern hospital and have been waiting too long.

A very important point that I made in my opening contribution is that this is now under way. I will answer Senator Mullen's questions shortly but when I hear debates about where it should be, I find it odd at this stage because the hospital is under way, €200 million has already been spent and the foundations are well in place. Anyone visiting or driving by the St. James's site who looks down will see building well under way. The Connolly part of the hospital is actually due to open this year, will start serving children this year and will see outpatient appointments take place this year, and the X-ray facilities, for example, were delivered to the hospital in recent weeks.

With regard to Senator Mullen's specific questions, I thought I had dealt with this issue at the health committee but perhaps not to his satisfaction. When we deal with the cost overrun, it is important to point out that the cost overrun relates to a decision to build on the St. James's site and the approval for that in April 2017, and the cost of the St. James's site now. It is not a comparison with the building of another site. The amount the Government budgeted, which was €983 million in April 2017, was for the St. James's site and the current cost projection is also for the St. James's site. The Senator asked would it have been cheaper to build it on another site but I think that misses a number of points. It misses the fact that building on a greenfield site would not have seen the benefits of not just bilocation but of trilocation. A point on which I agree with Senator Mullen, and I am sure we all agree, is that we need a maternity site located there as well. It is the plan for the St. James's site to have the St. James's adult acute teaching hospital, which is there now, serving our population, and to have the new national children's hospital and the Coombe Hospital relocated to that site.

Photo of Rónán MullenRónán Mullen (Independent)
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That is pie in the sky.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Senator may call it pie in the sky.

Photo of Rónán MullenRónán Mullen (Independent)
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Professor Chris Fitzpatrick calls it pie in the sky and he knows more about it than the Minister and I do.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Senator may call it pie in the sky but let the record show those comments in due course. That is the intention and has been the intention.

With regard to the site, the Senator talked about accountability and standing over the decision. I did not pick the site and I was not a member of the Government when the site was picked, but I fully support it. It was a decision taken after great scrutiny and great debate following consideration of the Mater site and the €40 million wasted there. It was democratically tested in the Houses of the Oireachtas. When I was not long Minister, and before construction had started, some Independent colleagues of the Senator's, perhaps, tabled a Private Members' motion in the other House asking that the location be changed. The Dáil, democratically elected by the popular vote of the people, and a Chamber of these Houses, voted to reject that motion.

Photo of Rónán MullenRónán Mullen (Independent)
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I agree. They are all in this together. That is why they are getting away so lightly. The parties cannot point a finger at the Minister without pointing it at themselves as well.

Photo of Maire DevineMaire Devine (Sinn Fein)
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It is a conspiracy.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Order, please.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Senator talked about democratic accountability. Deputies in the Dáil had an opportunity to vote before construction started, thanks to the Independent Deputies who tabled the motion, and that House spoke very clearly in that regard.

There is a benefit, which the Senator somewhat accepted, of being co-located with an adult teaching hospital.

Photo of Rónán MullenRónán Mullen (Independent)
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A benefit?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Let me tell the Senator what the benefit is first. I have not slandered the Senator or used unparliamentary language in my contribution.

Photo of Rónán MullenRónán Mullen (Independent)
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I did not slander the Minister either, by the way. He has an opinion with which I disagree, as many people do.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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And more people do not.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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The spokespersons from each group had an opportunity to make their contributions and the Minister is now being given an opportunity to respond, without interruption. This has to end within the next four minutes. In fairness, if we want questions answered, we need to please give the Minister the opportunity to answer them.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I want to do that. I want to make a point about the children in our paediatric hospitals today, for example, teenagers who travel to hospitals like St. James's for their cancer treatment. As many of us will know from personal experiences and political experiences concerning our constituents, teenagers of 17 or 18 might not want to go to adult services and the idea of being co-located benefits a number of specialties, including cancer treatment for our teenagers.

Photo of Rónán MullenRónán Mullen (Independent)
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Does the Minister accept there is much less benefit, given the lack of-----

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Senator Mullen, please.

Photo of Rónán MullenRónán Mullen (Independent)
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For him to stress that, when medical experts are pointing out how relatively-----

Photo of Colm BurkeColm Burke (Fine Gael)
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What medical experts are we talking about? The medical institutions came down in favour of St. James's. Go read the reports.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Order. I am not allowing this to descend into a cross-examination of the Minister.

Photo of Colm BurkeColm Burke (Fine Gael)
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It is incorrect information.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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The Senators had the opportunity to make their contributions. They have asked their questions. Please give the Minister an opportunity, in the limited time that remains, to answer them. That is if they want them answered.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Senator Humphreys makes a very fair point that, clearly, lessons need to be learned, and that is 100% correct. I am pleased to inform him and the Seanad that, when we were looking at this issue recently, the Minister, Deputy Donohoe, brought forward a number of sensible, constructive proposals in regard to the approval process and the oversight process, not, as the Senator rightly said, just for this project but also for all large capital projects. Thankfully, we are back in a period when we will be spending a lot of capital, and we need to see that spent on delivering projects and minimising overruns. I agree with him on that.

Senator Humphreys asked about the National Maternity Hospital. I will write to him to reply but let me tell him this much now. I was able, just before Christmas, to inform the Government that enough progress had been made on a number of important issues in regard to governance and ownership that I could advise the Government that we should proceed with the new pharmacy building and the car park at St. Vincent's. That approval has been given and those works are, therefore, under way. As the Senator knows, given he has taken a very active interest in this project, the planning permission is in place. I hope we will be able to go to tender later this year, around the summer, but that is subject to the finalisation of some agreements. Obviously, the final costs of the project will not be known until the tender is in, so I do not wish to second-guess that. I will certainly keep the Senator informed on this matter.

I do not feel I need to convince Senators of this. There is huge benefit in regard to this hospital. We are not just going to build one hospital but a hospital with a centre at Connolly and another at Tallaght. This is not about a Dublin hospital; it is going to transform the model of care for all of our kids. We will go from 14 theatres to 22 theatres, from two MRIs to five MRIs, with room for more, and there will be an increase in the number of CAT scan machines. This will have a dramatic effect on waiting times for our kids. Recruitment is actively under way for these facilities and a huge body of work has already taken place that we have not even had a chance to discuss. At the end of last year, these Houses passed the Children's Health Bill, where we took Crumlin Children's Hospital, Temple Street Children's Hospital and the paediatric part of Tallaght Hospital and brought them together as a new statutory entity to deliver for children's healthcare in Ireland. That is now the entity. Even though we have three sites at Crumlin, Temple Street and Tallaght, we have one body, Children's Health Ireland, delivering healthcare for children across the country, which is real progress.

I look forward to the Connolly facility opening later this year, the Tallaght facility opening next year and the St. James's facility opening in 2023. I look forward to the lessons of the PwC report being learned by all, as Senator Colm Burke said, and being published so we can scrutinise them in these Houses and at committees, and to keeping the Seanad informed as we deliver this transformational project.

The Seanad adjourned at 2.30 p.m. until 12 noon on Tuesday, 12 March 2019.