Kieran O'Donnell (Limerick City, Fine Gael)
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I understand that the Deputy is enquiring specifically about projects that are defined as major capital projects under the Department of Public Expenditure, National Development Plan Delivery and Reform’s (D/PENDR’s) Infrastructure Guidelines.

The largest health infrastructure investment in the history of the State, the New Children’s hospital, is nearing construction completion and is being planned, designed and delivered by the National Paediatric Hospital Development Board rather than by the HSE directly.

The HSE is developing a significant number of proposals which are, or are likely to be, classed as major capital projects to advance Programme for Government commitments and priorities including:

• Increasing capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country
• Increasing ICU bed capacity by at least a further 100 beds
• Providing more community beds
• Building four new elective hospitals (Cork, Dublin (2 sites) and Galway)
• Establishing six surgical hubs in Cork, Dublin (2 sites), Galway, Limerick and Waterford, and explore the provision of an additional surgical hub for the North-West in a timely manner
• Expanding trauma services, including facilities in Dublin, Cork and Galway
• Continuing to increase capacity and open more beds at UHL and across the Midwest and take account of the HIQA recommendations
• Protecting diagnostic pathways and invest in infrastructure and equipment to meet target treatment times outlined in the National Cancer Strategy
• Building the new National Maternity Hospital

There are significant proposals across our hospital campuses where major capital projects are more likely to occur due to the scale and complexity of hospital buildings. Many of these proposals are to address historical infrastructural deficits and provide modern, future proof infrastructure to support cutting edge treatments and patient care.

It is imperative that we plan and build our new hospital infrastructure at an appropriate height and density, to ensure the optimal use of space in our congested hospital campuses. In order to achieve the necessary clinical adjacencies and the optimal use of space, some capacity programmes cannot be delivered in isolation, and proposals will often need to incorporate elements from a number of programmes and strategies. For instance, on some campuses, it will be important that acute inpatient bed capacity is delivered alongside critical care and trauma beds, as well as new diagnostic capacity.

The following table includes a list of projects and proposals that are known to the Department and are very likely to be classified as major capital projects under the current Infrastructure Guideline thresholds. The scoping and evidence informed needs of many service developments and associated infrastructural proposals remains ongoing by the HSE and, as such, a list of all major capital projects or proposals only represents a snapshot at a point in time and should not be considered as exhaustive.

It is also important to recall that the vast majority of infrastructural investments across our Health Estate fall below the €200m threshold and include a number of significant and critical investments in our hospital and community estates. This significant capital investment plays a critical role in enabling and enhancing health service provision. At any given time there are over 500 capital projects in train in the HSE through the country of various sizes and at various stages.

The Capital Plan 2025 will outline the planned investment in Health infrastructure throughout the country, and will also provide details of current HSE capital projects.

It is expected the capital plan will be published in the coming weeks, in line with established procedures.

Project/ Proposal	Current Status in line with Infrastructure Guidelines
National Maternity Hospital (NMH) relocation to Elm Park	Final Business Case - In July 2023, Government gave its approval for the NMH to proceed to tender and the proposal moved through Approval Gate 2 of the Infrastructure Guidelines. - The tender process began in September 2023 and is currently running over a period of c.18 months. - Once this process is complete a final business case will be updated, and Government approval will be sought to proceed through Approval Gate 3 enabling the HSE to proceed to sign contracts with the successful tenderer(s) and begin the main building works.
Development of 4 Elective Hospitals in Cork, Galway and Dublin	Pre-tender Final Business Case - In December 2022, the Government approved Preliminary Business Cases for the Programme as a whole and for emerging preferred sites in Cork and Galway to move through Approval Gate 1 of the Infrastructure Guidelines. - An Integrated Design team is actively working with HSE to progress the detailed planning and design of the facilities in Cork and Galway to inform the pre-tender business case at AG 2 of the Infrastructure Guidelines. - It is expected that that design principle will also apply to the two proposed Elective facilities in Dublin.
University Hospital Galway	Strategic Assessment Report/ Preliminary Business Case Campus Masterplan and SAR being finalised with a PBC under development for a programme of significant developments on the Galway campus including new in-patient capacity, laboratories, ambulatory cancer care and Emergency Department
St. James's Hospital Dublin Critical Care ICU and Burns Unit	Strategic Assessment Report/ Preliminary Business Case Under development
National Orthopaedic Hospital Cappagh	Strategic Assessment Report/ Preliminary Business Case High Dependency Unity, Ward Blocks and Theatres
St Vincent’s University Hospital Surgical Ward and Critical Care Unit	Strategic Assessment Report/ Preliminary Business Case Under development
Cork University Hospital	Strategic Assessment Report/ Preliminary Business Case Proposals for Trauma, Acute and Critical Care Capacity as well as a new Paediatric Department are under development
Relocation of University Maternity Hospital Limerick	Strategic Assessment Report/ Preliminary Business Case Under development
Mater Misericordiae University Hospital Major Trauma Centre	Strategic Assessment Report/ Preliminary Business Case Under development for Phase 2
Phase 2 of the National Rehabilitation Hospital redevelopment	Strategic Assessment Report/ Preliminary Business Case Under development for Phase 2

In the longer term there are also proposals for the co-location of the remaining stand-alone maternity hospitals which would also represent major capital investments.

When Strategic Assessment Report/ Preliminary Business Cases are developed, the HSE will seek to move each proposal through Approval Gate 1, the approval in principle stage of the Infrastructure Guidelines process. This will entail Departmental review, an external assurance process, and submission to D/PENDR’s Major Projects Advisory Group to ensure proposals are robust and appropriate. Business cases are then submitted to Government for consent to proceed to develop more detailed designs, undertake statutory planning processes, and development of a pre-tender Final Business Case.

The recent Parliamentary Budget Office publication on Hospital Construction Costs notes the benefits associated with conducting this extensive planning, project simulation and consideration of risks before the commencement of a capital project in order to mitigate subsequent delays and cost overruns.

All projects being progressed must be compliant with the Infrastructure Guidelines. The final decision to proceed with the construction of a given project cannot be made until the tender process has been completed and the costings reviewed to ensure that the proposal remains affordable and delivers value for money.

In order to enhance capital investment, the Department of Health has developed and published a Strategic Health Investment Framework (SHIF) to ensure that investments are evidenced based, equitable, and ensure Sláintecare reforms are achieved, with the overall objective of having better health outcomes for the population of Ireland.

We also need to modernise health technology to enable increased productivity and greater efficiency in the health sector to meet the increasing needs of a growing and aging population.

The Digital for Care 2024-2030 strategic framework, published by the Department of Health in May 2024, provides a clear roadmap for digitising the health service and delivering digital health records for all. The Programme for Government commits to increased capital investment levels to deliver full digitisation of Irish healthcare records and information systems.

Increased capital investment and digitisation of our health service will only be delivered by using the required expertise within the HSE, the wider public service and the private sector.

The Health Service Executive (HSE) is taking several measures to manage the costs associated with using consultancy and private sector services to support the development major capital investment proposals in line with Infrastructure Guideline requirements and with the digitisation of the Health Service. These include ensuring that the use of consultancy services is for proposals that are aligned with the Strategic Health Investment Framework, provides value for money and aligns with the digital priorities. Competitive tendering processes are used to ensure that it gets the best possible prices for consultancy services.