Robbie Gallagher (Fianna Fail)
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The Minister of State is welcome to the Chamber this morning and I thank him for taking time out of his busy schedule to come here.

There has rightly been much outrage at the savage and massive overruns with the children's hospital, the detrimental effect that is going to have on the health services in the future, and how taxpayers' money has been squandered by those who failed to do their jobs properly. Indeed the HSE has warned that it would be almost impossible to deliver the planned, multi-billion euro investments in new healthcare facilities in the coming years because of the cost overruns at the national children's hospital. A recent report showed that the overrun means healthcare will need an additional €107 million in 2020, €120 million in 2021 and €150 million in 2022. The HSE has been concerned for some time, apparently, that the €11 billion funding arrangements for new hospitals, nursing homes, ambulances and equipment under the Ireland 2040 capital development plan are not balanced and that most of these large-scale projects are pushed out to the last ten years of the plan.

The HSE stated that the issue, along with having to deal with cost overruns from the new children's hospital in the years 2020 to 2022, "has made what was a very difficult situation now almost impossible". I understand the Cabinet was told last December that a number of health projects might have to be curtailed and others might have to be suspended completely due to the soaring costs of the children's hospital.

A letter to the Secretary General of the Department of Health, dated 3 May, from then acting director general of the HSE, Ms Anne O'Connor, outlined growing concerns about the capital funding position of the organisation and the emerging impact of the children's hospital on its overall capital programme. Crucially, Ms O'Connor highlighted the impact of the quality of care that the HSE can offer, in many instances directly affected and even compromised by the quality of infrastructure.The news comes as it has emerged that the financial position of the HSE for 2019 is now more serious than had been understood to date. In the first three months of the year, it recorded a total overrun of almost €103 million. This followed a €600 million deficit last year. The Government needs to come clean on what projects will proceed and what projects will not.

On healthcare projects in County Monaghan, I would like the Minister of State to give some clarity on the status of all those projects, particularly with the primary care centre promised for the St. Davnet's complex in Monaghan town. This is a project that has been earmarked for some time but has been dogged by delay after delay. I would like the Minister of State to confirm to me this morning that this project will proceed without delay and will be delivered on time and that no other health projects in County Monaghan will be affected or delayed by the cost overruns in the children's hospital.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for raising this issue and for giving me the opportunity to outline to the House the capital projects under way in County Monaghan. The HSE has advised that projects to deliver a primary care centre and an upgraded mental health residential unit on the St. Davnet’s campus in Monaghan town are under way. The north Monaghan primary care centre will be developed by way of a major refurbishment of Blackwater house at St. Davnet’s campus in Monaghan town.

The appointed design team is engaging in pre-planning meetings with Monaghan County Council's planning department. The project is expected to be completed by the end of 2020. In addition, the HSE is extending and refurbishing a building on the St Davnet’s campus to provide accommodation to allow for the decanting of services that utilise some of the space in Blackwater house. This upgraded residential mental health unit is under construction and is a key enabler for the primary care centre development project. These developments will enable staff to deliver optimal quality care and treatment in facilities which afford dignity, respect and privacy to all.

Funding for these development projects in Monaghan has been included in the Government’s Project Ireland 2040 policy initiative, announced last year. This provides €10.9 billion for health capital developments, including both national programmes and individual projects, across acute, primary and social care. The delivery of these projects and programmes, including developments in County Monaghan, will result in healthcare facilities that allow for the implementation of new models of care and for the delivery of services in high-quality modern facilities.

The new children’s hospital is a vital and much-needed project and the Government has examined the funding pressures associated with delivering this important project. In meeting these funding pressures, the Government has examined all projects and programmes across Government and has made adjustments to ensure that the much-needed new children's hospital will be delivered and will facilitate the delivery of the overall investment programme as set out in Project Ireland 2040. The Government provided an additional €75 million of capital funding in 2019 towards the increased costs of the new children's hospital. The summer economic statement provides a capital expenditure reserve of up to €200 million in 2020 to accommodate the funding requirements for the new children's hospital and the national broadband plan. This will allow my Department and the HSE to finalise a multi-annual capital plan.

The health capital allocation in 2019 is €642 million for the construction and equipping of health facilities. This represents an increase of €224 million on last year's capital provision for the public health sector. This Government will continue to invest in the public health sector and will deliver the new children's hospital and a wide range of health capital projects in hospitals, social care and the community.

Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for his response and I look forward to the delivery of the primary care centre and other health projects on time and without delay in County Monaghan. Last year, the Minister, Deputy Harris, made a comment that he proposed building new hospitals to take on elective surgery to deal with the long waiting lists, despite the fact that small hospitals such as Monaghan Hospital could do more. Clearly, projects will not go ahead because of the cost overruns and I would imagine that building new hospitals to deal with elective surgery would be one of the projects that will not proceed. Surely the Minister of State would agree that maybe we should have a second look at our smaller hospitals to see exactly what additional capacity they have and what additional work they could do to deal with the ever-increasing length of waiting lists that people are suffering on at the moment.

Jim Daly (Cork South West, Fine Gael)
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We can keep going around in circles all day long and we can challenge every single project that is proposed by the HSE and say it is not going to happen because of the children's hospital, but I have just outlined in my answer that there is an additional €75 million included this year to allow for the increased costs associated with the children's hospital. Next year, there is a €200 million additional reserve included in the summer economic statement to allow for any increased costs associated with either that or the national broadband plan, so there is no reason for us to challenge and question continually the validity of the building programme. A total of €10.9 billion has been committed to delivering those projects. In the grand scale of things the children's hospital is a tiny and minute fraction of that overall project. The idea that we can politically continue to challenge the sustainability and viability of every promised delivery will not continue to stand up to scrutiny into the future.

I assure the Senator again that the two projects he is concerned about are on track, will be progressed and are progressing. Meetings are taking place with Monaghan County Council as we speak on that front. That development will continue.

Denis O'Donovan (Fianna Fail)
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These small hospitals are very important. I recently made a visit to Bantry General Hospital for a minor procedure and it is an amazing little hospital that does tremendous work. I am sure the Minister of State will make sure that Bantry General Hospital is kept going as well because only for it there would be long waiting lists in south Kerry, west Cork and Cork city. I thank the Minister of State for that. That is an unexpected observation which I am sure he will not mind.

Robbie Gallagher (Fianna Fail)
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Those are wise words from the Cathaoirleach.