Mary Fitzpatrick (Fianna Fail)
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I thank the Minister of State for coming to the House to respond to my Commencement matter, which calls on the Minister for Health and the Department to commit to providing €2.5 million in funding for the Rotunda Hospital on Parnell Square in Dublin. For those who are not aware, the Rotunda Hospital is the world's oldest maternity hospital. It is the country's busiest maternity hospital. It delivers on average 8,000 babies a year. One in every six babies in the country is born at the Rotunda Hospital and one in every four neonatal babies is born in the Rotunda Hospital. It is not just a local hospital for me or the women in central Dublin, it is a hospital that serves women from throughout the country. Some of the most vulnerable of patients and the most complex of pregnancies are enabled and supported in the Rotunda Hospital.

It dates back to 1745 and as well as being a very busy maternity hospital delivering babies and caring for mothers, it receives 500 gynaecological referrals every month. A woman only gets referred for a gynaecological appointment after her routine appointment has thrown up some anomaly. There are more than 3,500 women on the waiting list for basic female health services. Far too many of them have been waiting for more than 12 months for an appointment. To my mind, and in the mind of the Government, it should be totally unacceptable that women in Dublin today would be waiting more than 12 months for a gynaecological appointment.

According to HIQA, the Rotunda Hospital building and infrastructure is overcrowded, out of date and not fit for purpose. Essentially, it delivers 21st century health services in 18th century facilities. Going back to 2018, I brought the then Fianna Fáil spokesperson for health, the now Minister, Deputy Stephen Donnelly, to the Rotunda Hospital. Following our visit and lobbying by others, the then Minister, Deputy Harris, commissioned an independent report. KPMG completed that report and I understand it has been delivered to the Minister. The report examined nine different options to help deal with the overcrowding, lack of space, poor infrastructure and high risk of infection. It concluded the best option is the development of a new critical care wing on the west side of Parnell Square.

There is a one-storey outpatient department at present. The proposal is to demolish this and replace it with a fit-for-purpose critical care wing in a four storey building over a basement. It is considered the most cost-benefit advantageous solution with a 2:1 ratio. It would provide the greatest range of benefits and is consistent with the long-term plans for the Rotunda. To move the project forward next year will only cost an investment of €2.5 million. It is a very modest investment not just in the women, babies and mothers but also the 1,000 staff who work in the Rotunda Hospital. I was lucky enough to have my three babies in the Rotunda Hospital. Given the care provided to everybody when they walk in the door by the amazing security man, cleaners, doctors, nurses and midwives they deserve to be provided with fit for purpose facilities. The mothers and babies of Ireland deserve it too. I hope the Minister of State can give us some good news on this request.

Mark Wall (Labour)
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The Rotunda Hospital is also very important to me as my two sons were born there and my wife trained as a midwife there. It is very important.

Mary Butler (Waterford, Fianna Fail)
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Many people are interested in this Commencement matter. As Senator Fitzpatrick has quite rightly said, the Rotunda Hospital is the world's oldest and Ireland's busiest maternity hospital, with the phenomenal number of 8,000 babies being delivered every year. I thank her for raising the issue and giving me the opportunity to outline to the House on behalf of the Minister, Deputy Stephen Donnelly, the position on the Rotunda Hospital.

Project Ireland 2040 provides €10.9 billion for health capital developments throughout the country, including funding to support implementation of the national maternity strategy. Co-location of maternity services with adult services provides mothers with access to a full range of medical and support services should the need arise. The availability of these services helps ensure the delivery of an optimum, safe service, particularly for high risk mothers and babies. Work on the co-location of the Rotunda Hospital with Connolly Hospital Blanchardstown, in line with health policy, is progressing. The programme for Government includes a commitment to "Progress the planning, tender and design stages for the relocation of the Coombe Hospital to St James's, the Rotunda Hospital to Connolly, and Limerick University Maternity Hospital to University Hospital Limerick." A master plan has been prepared for the Connolly campus in support of the co-location of the Rotunda Hospital.

In the short term, it is acknowledged that there is a need to address the highest infrastructural risk and capacity issues at the existing hospital on Parnell Square on a prioritised and interim basis pending development of the new hospital in the medium term. The Rotunda Hospital has proposed the development of a critical care wing to address its identified key clinical risks. There has been engagement between the Department of Health, the HSE and the Rotunda to clarify the scope and extent of the development needed at the Rotunda to resolve patient safety risks arising from infrastructural challenges at the hospital. In the context of the long-term objective of relocating the Rotunda, however, any infrastructural development on the site should be confined to the minimum necessary requirements and designed only to address the priority patient safety risks.

In 2020, €4.6 million was provided by the HSE to the Rotunda Hospital to address capacity and infrastructural needs in the foetal assessment unit, neonatal intensive care unit, emergency theatre and delivery suites. Given the age and condition of the original hospital buildings, however, other issues remain. In this regard, additional funding of €100,000 has been provided by the HSE to the Rotunda to prepare a strategic assessment report and preliminary business case in support of the proposed critical care wing, as required under the public spending code. These reports have recently been submitted to the HSE and are under consideration. A projected €250,000 will be allocated in 2021 to assist further in progressing proposals to address areas of critical risk in the existing hospital buildings.

Mary Fitzpatrick (Fianna Fail)
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I appreciate the Minister of State's reply, but I am disappointed. I cannot be satisfied with it. I do not mean that personally where the Minister of State is concerned, but this saga has been ongoing for years. I believe the first proposal to move the Rotunda dates back to the 1990s. The women of Dublin and the women of Ireland deserve better. There was a planned move in 2007. In 2015, an announcement was made by the then Minister to the effect that the three maternity hospitals were going to be relocated. The other maternity hospitals have received significant investment and I accept that the HSE has given some funding to the Rotunda, but there was no point in spending €100,000 on a strategic assessment if we were not going to act on it now.

The Government's spend is €10.9 billion. That is a great investment in health services, but the women of Ireland deserve some of that. This is a modest, pragmatic and sound investment proposal. The total cost of creating a critical care wing in the Rotunda would be €61 million. The Connolly proposal is over €500 million. What will be the period involved? Will it be 15, 20 or 30 years? I implore the Minister of State to speak with the Minister. I would like him to meet the master of the Rotunda. If the Minister of State could attend that meeting as well, it would be great. It is important that we not ignore the risks facing not only the mothers, babies and families every day, but also the staff. It is unfair to put staff into these risky situations. It is also unfair on the mothers and babies who are relying on the Rotunda for their health services.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for her subsequent statement. In 2020, €4.6 million was provided by the HSE to the Rotunda Hospital to address capacity and infrastructural needs. Given the age and condition of the original hospital, additional funding of €100,000 has been provided by the HSE to the Rotunda to prepare a strategic assessment report and preliminary business case in support of the proposed critical care wing, as required under the public spending code. A projected €250,000 will be allocated in 2021 to assist further in progressing proposals to address areas of critical risk in the existing hospital buildings.

The proposed interim upgrade works are intended to address the key clinical risks and capacity concerns identified by the hospital prior to its co-location with Connolly Hospital Blanchardstown in line with programme for Government commitments. All capital development proposals must progress through a number of approved stages in line with the public spending code, including detailed appraisal, planning, design and procurement, before a firm timeline or funding requirements can be established. Approval must be received for each stage to ensure that the proposal delivers value for money and remains affordable and that sufficient moneys are available to fund the project to completion, including equipping and commissioning costs.

The delivery of capital projects is a dynamic process and subject to a number of key considerations, including service prioritisation, classification of scope, determination of affordability and the successful completion of the various capital project approval stages, which can impact on the timeline for delivery. However, I will bring the Senator's concerns to the Minister. I suggest that she write to him. There has been a previous visit. It is the oldest hospital in the world and the busiest in Ireland, with more than 8,000 babies delivered per year, and that is aside from the gynaecological work that is done in the hospital. This matter is of major concern to the Senator and many other people, including me.

Mark Wall (Labour)
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I thank the Minister of State for her engagement with Senators.