National Children's Hospital: Motion [Private Members]

Deputy Mattie McGrath

I move:

That Dáil Éireann:

notes:

— the urgent need to develop appropriately sited, world class prenatal, perinatal and paediatric medical services for all the nation’s children and their families;

— the critical need for a short corridor-linked or full service maternity hospital, integrated with the National Children’s Hospital to prevent the current situation of avoidable death and disability in newborn infants;

— that the existing hospital infrastructure that caters for sick children is no longer fit for purpose;

— that the shortage of specialised nursing and medical staff is a serious impediment in attaining optimal medical outcomes for children, which will be aggravated by the proposed site;

— that the cost of construction of the National Children’s Hospital has increased from €404 million in 2012, to approximately €1.1 billion and rising in 2017;

— the recent doubling of the estimated cost of building the National Maternity Hospital on a brownfield as opposed to a greenfield site, at St. Vincent's University Hospital, and that differential would also apply to the St. James's Hospital site;

— that the creation of a site at St. James's Hospital to accommodate a maternity hospital will prove hugely expensive, requiring major additional rebuilding of the adult hospital;

— that the assessment of the National Children’s Hospital project by An Bord Pleanála did not adequately address several important aspects of the proposal relating to the medical functioning of the site;

— that, due to the restricted nature of the proposed St. James's Hospital site, parking provision for the National Children’s Hospital is dramatically lower and hugely more expensive than that of international comparator hospitals;

— that the Independent Review of the National Children’s Hospital project (2011) and the Review Group on the National Children's Hospital (2012) stated that it would be 25 per cent less expensive to build on a greenfield site than on an urban site; and

— that accessibility to the proposed St. James's Hospital site for patients, staff and medical personnel will lead to extreme levels of congestion and increase the risks of adverse medical outcomes;

acknowledges:

— the commitments given in the Programme for a Partnership Government to develop a world class National Children’s Hospital;

— the desire of all political parties, groups and members to improve and prioritise medical outcomes for the nation’s sick children; and

— the significant financial commitments given by the Minister for Health and the Government to progress the National Children’s Hospital project; and

calls on the Government to:

— provide evidence to support their repeated claim of improved clinical outcomes resulting from adult hospital co-location;

— undertake a full cost-benefit analysis on all aspects of the National Children’s Hospital project, as required by the Department of Finance’s Guidelines for the Appraisal and Management of Capital Expenditure Proposals in the Public Sector;

— ensure that all the requirements of the Public Spending Code have been met;

— clarify the exact mandate, statutory and legal standing of the Children's Hospital Group Board and the National Paediatric Hospital Development Board;

— justify the costs related to the construction of the National Children’s Hospital at St. James's Hospital;

— reconsider the co-location of the National Children’s Hospital with the new Rotunda Maternity Hospital, and in the event of opposition to this reconsideration, to justify, on clinical grounds, why such co-location cannot occur;

— ensure all the requirements of the Public Spending Code in relation to the maternity hospital development are met before the construction contract of the children’s hospital is awarded by Cabinet, as absence of such an assessment would indicate failure of the Government’s duty of care to its newborn citizens, and that trilocation is not a commitment by the sanctioning authority (the Department of Health); and

— utilise any site preparation work already started at St. James's Hospital, to develop a satellite Children’s Urgent Care Centre and further adult services.

I am sharing time with Deputies Michael Harty and Michael Healy-Rae.

Deputy Michael Harty

The Rural Independent Group has formulated this important motion on the proposed national children's hospital and is happy to bring it to the floor of the House for debate for several reasons. This will be the most expensive infrastructure project in health and in the history of the State as well as being possibly the most expensive children's hospital in the world.

It is essential and of paramount importance that we have a new tertiary paediatric hospital built to give the highest quality of care to children. Our children should be foremost in all of this debate. At present, paediatric care is fragmented and scattered across Dublin city in Crumlin, Temple Street and Tallaght hospitals. This leads to significant disintegration and fragmentation of child care which needs to be centralised in a tertiary hospital in Dublin. That is of paramount importance.

However, there have been many problems in developing a national children's hospital in Dublin. It is now ten years in gestation but not one block has been built. Ten years ago, the Government was offered a children's hospital to be built at cost in Tallaght by Noel Smyth but the offer was rejected. The Mater hospital site was then chosen but planning permission was refused for there. Subsequently, the St. James's Hospital site was approved by the Government in 2012 and planning permission was delivered last August. The choice of this hospital, however, has been hugely controversial. Ten years later, after its initial mooting, not one block has been laid. We should hang our heads in shame in that regard. In 2012, there was an almost unanimous decision in the Dáil that the St. James's site would be the preferred site and we have to accept that for the moment.

The principal difficulty with the St. James's choice is the escalating costs. It has gone from €405 million to €650 million to €950 million, plus fitting out costs. In reality, we do not know the eventual cost or what any or each of these figures represents. We do not know what the premium is in building the hospital at a brownfield site. There must be a huge premium in building the hospital at St. James's in clearing and developing the site in a very constricted area. Will the Minister justify the escalating costs for building on a brownfield site as opposed to building on a greenfield site such as Connolly Hospital in Blanchardstown? We believe the escalating costs are related to the development at St. James's.

The Government has mentioned that the core cost of this development is €650 million for the hospital at St. James's and for the satellite sites at Tallaght and Connolly hospitals. Does this include the clearance costs of the site at St. James's? Does it include the fitting out costs and how does that feed into the eventual cost of the site? In general terms, the cost for building a bed in a hospital is €1 million. The paediatric hospital for construction at St. James's will have 473 beds, which equates to €473 million. Yet, the projected cost for this site is twice that, at least €2 million per bed. This is a concern, particularly when there is a significant deficit in our health service, as well as significant capital infrastructure need. If the paediatric hospital will eat into practically 50% of capital costs made available by this Government between now and 2021, other projects will be pushed down the road, in particular the building of a new central mental hospital in Portrane, the transfer of the national maternity hospital to St. Vincent's, the transfer of the Coombe hospital to Connolly Hospital and the building of primary care centres. How will the escalating costs of the national children's hospital be managed?

The Minister proposes to bring a memorandum to the Government in the next few weeks setting out full details of the costs. We are looking forward to this because it will give us detail as to how the escalating costs have developed and from where the extra costs have come. Will the Minister give us some extra information this evening? Has a cost-benefit analysis been done on the actual cost of building at St. James's as opposed to building at a greenfield site? Is the premium cost of building on a greenfield site justified?

Other difficulties with the St. James's site relate to the location of the hospital in a city centre location and difficulties with access. While there are substantial public transport access links to the hospital, most patients will come to the hospital by car. Parking for both patients and staff is also a concern. While patients can pre-book parking spaces, will there be enough? Would location of the paediatric hospital be better at a more peripheral site?

Another aspect to this is the bilocation and trilocation of the paediatric hospital. Bilocation with an adult teaching hospital was the deciding point in choosing St. James's. Does that trump the additional cost of construction there? Medical opinion is divided on bilocation with an adult teaching hospital. We have attended briefings where the paediatric board outlined the positives of bilocation, but it was not entirely convincing. Of course we want the best for our children. If bilocation with an adult teaching hospital has been proved to be of benefit, then of course we would accept it. There is a lack of consensus about bilocation among clinicians. That is why there are two sides to this argument.

There is a proposal to build the maternity hospital on the site of St. James's. If one is constructing on a constricted site, it would be logical to build both hospitals at the same location and at the same time. It would certainly be a cost-saving venture. The location at St. James's is a restricted site and the ability to expand freely is not possible. While there is a limited ability to expand and put in a maternity hospital, which may be 15 years down the road, one has the ability to expand in every direction on a greenfield site. We all know that we will require a larger hospital and infrastructure in 15 years because we have an increasing population and better technology. How can all of that be accommodated on such a restricted site such as St. James's? On a greenfield site, one can extend quite openly with spacious surroundings, parking spaces for whatever number and the opportunity to develop new access points.

We understand that all sites have their strengths and weaknesses and that there is no perfect location. There will always be differences of opinion on what is the best location and how the best care can be provided, but we must provide the best care for our children. We also need to know what is the exact function of Tallaght and Connolly hospitals. They will be satellite centres which will provide urgent care but they will not provide overnight care. Patients kept overnight will have to be transferred to Connolly Hospital for ongoing treatment. I would like the Minister to comment on the clinical and logistical grounds for justifying the siting of the hospital at its present location. Why is a maternity hospital not being built at the same time? It must be less expensive.

We must learn lessons from this difficulty and controversy. Proper governance from the HSE and the Department of Health is essential. We need proper initial planning. Ten years down the road we still do not have the beginnings of a hospital. We need proper initial design. Consultation with all the stakeholders, especially with patients, is required. That was lacking in this endeavour.

I do not believe the Government will revisit the location of the hospital but escalating costs must be forensically examined. If we were starting from a clean sheet, and many of my colleagues here, would no doubt choose a greenfield site as the best option to build a maternity hospital at the same time and have that as a co-location, because that is the co-location and the bilocation that will have the most significant benefits.

Deputy Michael Healy-Rae

I thank my colleagues in the Rural Independent Group for their work on this motion. I also thank Deputy Mattie McGrath's office staff, his daughter, Triona, and David in his office for their hard work on this motion. I also thank and welcome the people in the Public Gallery who kindly came here today to support this motion.

I honestly believe the Government has dropped the ball big time on this issue. First, it is never too late to admit a mistake was made or never too late to reverse a decision. The location and the cost of this project are my biggest concerns. On the location of a national children's hospital, it is a building of paramount importance for all our children and the children of the next 100 years. Staff at the children's hospitals were never consulted regarding the choice of site, nor were many patients or parents' groups. A total of 73% of members of the public believe it is the wrong site, as do the majority of the city and county councils. It is the worst site for access in the country.

The Government has stated that its decision that the new children’s hospital should be co-located with St. James’s on its campus followed a lengthy process of examination led by three professors of paediatrics in the three universities. It stated that Our Lady’s Children’s Hospital, Crumlin, Temple Street Children’s University Hospital and the National Children’s Hospital, Tallaght, collectively support the campus at St. James’s Hospital as the selected location for the new children’s hospital. This is very misleading. The medical board of Crumlin hospital was never asked and never gave its approval. The children’s hospital in Tallaght does not have its own medical board, being part of the main adult hospital board. Members of the faculty of paediatrics were never consulted regarding location and neither were staff of the children’s hospitals.

It is recorded in the minutes of the Dolphin group that on meeting the chief executive officers and chairpersons of the medical boards of Crumlin, Tallaght and Temple Street - the meeting was held on 26 April 2012 - the hospital representatives stated that they would support the decision on location when made. The location decision is a function of Government. Had Connolly Hospital been chosen by Cabinet, this statement to the Dolphin group indicates the three children’s hospitals would be fully supportive.

No report ever recommended the St. James's site. There is no such claim in the Dolphin report. It states that St. James’s Hospital best meets the criteria to be the adult co-located hospital from "a clinical and academic perspective" and that from "a design and planning perspective the sites adjoining Connolly and the Coombe hospital offered the best potential for future expansion and a landscaped setting". The Dolphin report never claimed that the St James's had the best site; in fact, it states it has "drawbacks in terms of site suitability". It was also stated that:

The vast majority (78%) of children currently attending the existing three children’s hospitals come from within the Greater Dublin Area ... that is Dublin, Meath, Kildare and Wicklow. These children will be served in the future by the hospital and the two new Paediatric OPD and Urgent Care Centres at Tallaght and Connolly Hospitals. This arrangement means that General Paediatrics and Urgent Care services are local and convenient in the Dublin area. 22% of the patients currently attending the three Dublin children’s hospitals are children from outside the Greater Dublin Area who require specialist services ... [which] will be provided in the new children’s hospital on a campus shared with St. James’ Hospital when it opens in 2021.

I wish to highlight again that the world does not stop at the Red Cow roundabout. This is all a grossly misleading use of statistics. Approximately 66% of children in the greater Dublin area live outside the M50 and a significant proportion of the remaining 33% who live inside the greater Dublin area live close to the M50. In fact, 90% of children in the country live outside the M50. Postal addresses are not an indicator of frequency or intensity of hospital attendance. Tertiary patients are intensive users with longer stays in hospital and nine out of ten of them live outside the M50.

The expected cost of this hospital in 2012 was €440 million. By the time the contract was awarded to the St. James’s site, it had jumped to €485 million, when the application for planning permission was submitted two years ago it leaped to €650 million and today the estimated figure is to exceed €1 billion. Where is the name of God will this debacle stop? Before the monster gets any bigger, I ask the Minister and the Government to examine this matter and take on board this motion.

Deputy Mattie McGrath

I thank everybody who assisted in the work on this motion. I thank everybody who assisted with this motion including the staff in my office, Triona, David and Maureen. I also thank my colleagues in the Rural Independent Group for agreeing to the putting forward of this motion and putting so much time, energy and effort into it. I welcome our guests today, the sick children and their families, little Corey and her mum, Jonathan from the Jack and Jill Foundation and his team. I thank them all for giving up their time. I thank the Minister and the Minister of State for being here today but I am disappointed with the attendance for the debate around the House. I thank the ushers for their forbearance with all the guests to the House today.

First, I extend my thanks and admiration to all the families of sick children. In the limited time I have, I want to pay tribute to the amazing work that has been done on this issue by the Jack and Jill Foundation, Connolly for Kids and the New Children’s Hospital Alliance. I know many of them will be extremely frustrated at having to sit through this debate and listen to the same old spin and the same false and misleading statements being made.

It is a national disgrace that the interests and vanities of medical academics, certain third level institutions like our neighbours, Trinity College, and the political inability to admit a mistake has taken precedence over the pleas of parents and sick children.

None of the arguments put forward by the Minister or his party have allayed the fears of the parents of all these sick children. What is equally galling is that we know there are members in each of the main parties who explicitly accept that this is the wrong site but have somehow convinced themselves that getting the hospital built now is more important than getting it built in the right place. That is another falsehood I want to debunk because we believe - and have evidence to support this and doctors who agree with this - the hospital would be built as quickly on a greenfield site. I am involved in construction, as are other Members, and they know that it would be much easier to build the hospital on a greenfield site and where the best clinical outcomes could be achieved with co-location where one has the necessary space. I will reiterate a saying of Mahatma Ghandi, "It doesn’t really matter how fast you’re going if you’re heading in the wrong direction." I truly believe that and I will continue to believe it until I am proved otherwise.

All of the assurances of the National Paediatric Hospital Development Board ring hollow to the parents' ears because they know what it is like to sit with terror in their hearts as their sick children sit in congested traffic and struggle for their tiny lives. We need to think seriously about this issue. Let us imagine the scene. A frightened mother or father in the back of an ambulance and beside them their child is getting weaker and weaker and the journey seems to be getting longer and longer with every passing breath. The paramedic in the back calls out to his colleague asking how far is there left to go. He does not think the child can survive. There is panic. There is also heavy traffic and narrow streets to get through. This is not a figment of our imagination. This is taken directly from the experience of ambulance drivers who cannot conceive why the madness of this project is being pursued and they were also never consulted on it.

It is my great fear that we will be back here in a few short years talking about the completely avoidable deaths that have unfortunately taken place when vulnerable, high-risk babies had to travel from rural Ireland, or even some parts of Dublin, to gain access to the congested St. James's site. I hope that day never comes but I fear it will if we persist in the madness of pursuing the present location of the national children' hospital. Some of my colleagues have outlined the reasons the project at its current site should not continue and other colleagues will also do so. There will be some repetition in the debate. We are dealing with fake news. We all know where that comes from, but this is fake news if we ever saw it, right here on our doorstep, and we must rebut it at all costs.

It is has been almost a full-time job trying to counter the professional spin and aggressive tactics used by the National Paediatric Hospital Development Board to push the project over the line. No fewer than 18 hired guns, as I call them - pretty eminent people in their own right - arrived this day last week into the audio-visual room. I am not questioning their professionalism but I am questioning the fact they came in to convince everyone. There were 18 of them, all paid people, yet Connolly for Kids could only come in with two or three guests or volunteers who are passionate about what is right and what is wrong. We did not need 18 people to half fill the audio-visual room in case we thought we would not have a crowd. The 18 were a kind of rent-a-crowd. I am not questioning their professionalism as medics but I am questioning their professionalism regarding this site. On the one hand, we have families and passionate medical professionals and, on the other, those who will stoop to any level to see their trophy project kicked over the line and out of the reach of the parents and their campaigners.

Minister for Health (Deputy Simon Harris)

I move amendment No. 2:

To delete all words after “Dáil Éireann” and substitute the following:

“notes:

— the urgent need to develop an appropriately sited, world class facility to care for children and young people from all over Ireland who are in need of specialist and complex care;

— that clinical considerations were paramount in the decision by the Government in 2012 to co-locate the new National Children’s Hospital with St. James’s Hospital, in line with independent reviews affirming the importance of co-location with a major adult academic teaching hospital;

— that the Government decision to proceed with the construction of the new National Children’s Hospital on the St. James’s Hospital campus was endorsed by the Dáil in 2012;

— the Government decision to re-develop the Coombe Women and Infants University Hospital on the St. James’s Hospital campus, in the context of achieving trilocation of adult, paediatric and maternity services on that campus as the optimum configuration to best support paediatrics, highly complex foetal and high risk maternal medicine, and chronic disease management in young people;

— the capacity of the site at St. James’s Hospital to accommodate the new National Children’s Hospital and maternity hospital, and the incorporation into the design of the National Children’s Hospital of the required operational links with both maternity and adult hospitals on the St. James’s Hospital campus;

— that St. James’s is the hospital best served by public transport in the country, including easy access to the M50 and Heuston Station, and that safe underground car parking for 1,000 cars, including 675 dedicated to patients and families and 31 drop-off emergency spaces, will be provided and be commercially funded;

— the Government decision to develop satellite centres on the campuses of Tallaght Hospital and Connolly Hospital which will be easily accessible to local populations for the management of minor illness and injuries, and attendance at outpatient and chronic disease clinics;

— that planning permission, unanimously granted by An Bord Pleanála in April 2016, supported the development of the hospital on the St. James’s Hospital site and the satellite centres at Tallaght Hospital and Connolly Hospital; and

— the vision of the new National Children’s Hospital as a research-intensive, academic healthcare institution and the potential to attract and retain specialised nursing and medical staff and health and social care professionals;

acknowledges:

— the commitments given in the Programme for a Partnership Government to develop a world class children’s hospital;

— the desire of all political parties, groups and members to improve and prioritise medical outcomes for the nation’s sick children;

— the significant financial commitments given by the Minister for Health and the Government to progress the National Children’s Hospital project, including the availability of €650 million Exchequer funding earmarked for the core construction costs of the hospital and associated satellite centres;

— the progress made to date as the first phase of construction (site clearing works) on the site of the new hospital will be substantially completed within a matter of weeks;

— that the new National Children’s Hospital accommodation is being designed to ensure that children and young people receive their care in the best organised and most clinically suitable setting, with facilities for parents to comfortably stay overnight;

— the link between the hospital and local and regional paediatric units, through an integrated national clinical network aimed at delivering services to children as close to home as possible;

— the robust governance arrangements in place to manage and oversee the new National Children’s Hospital project;

— the adherence to the Public Spending Code requirements at all stages of the project;

— the Minister for Health’s intention to bring a Memorandum to Government shortly on the new National Children’s Hospital, setting out full details of the project costs; and

— the Minister for Health’s intention to bring a General Scheme to Government shortly, seeking permission to draft legislation establishing the new National Children’s Hospital as a statutory body to take over the services provided by the three existing Dublin paediatric hospitals; and

supports the Government priority to make progress on the new hospital on the St. James’s Hospital campus and satellite centres at Connolly Hospital and Tallaght Hospital as soon as possible, to support best clinical outcomes for children and young people in Ireland.”

I very much welcome the opportunity to address the House on the new children's hospital. I thank Deputy Mattie McGrath and the Rural Independent Group for tabling their motion and for the opportunity it provides to the Dáil to debate a very important issue. I am quite sure the Deputy did not mean to refer to some doctors and nurses and the like who work to care for our children and who came to the audio-visual room as being in any way hired to be there. I am sure he will clarify that statement. They are certainly not hired guns. I accept the bona fides of his views but I would not like a slur to be made on their bona fides and their views in looking after our sick children. I am not in a position to accept the Deputy's motion and I am moving the Government's counter-motion on the development of the new children's hospital and satellite centres.

We are closer today than we have ever been to providing Ireland with a state-of-the-art children's hospital that it badly needs and deserves, following not just years but decades of discussions and debates about paediatric acute services and sites for such services. Throughout those years, we have been well served, it is fair to say, by the dedicated staff of the three children's hospitals in Dublin. However, let us not forget that Temple Street Children's University Hospital is housed in a 19th century building and Our Lady's Children's Hospital Crumlin was built in 1956. Both hospitals have infrastructural deficits and challenges in delivering paediatric health care services to the standard warranted by a 21st century society. Most children and young people are cared for in multi-occupancy rooms and, across the children's hospitals, parents - indeed, many of the parents here tonight - regularly sleep on the floor or in a chair beside them at night. I think we can agree that this is not right. The truth is that the infrastructure of these children's hospitals is simply not fit for purpose to deliver the best possible service for children and young people in Ireland, who do after all represent 23% of our population. The patients and their families know it, hospital staff know it and we in the Dáil know it.

Furthermore, the historic development of services across three separate hospitals has resulted in an inefficient approach to paediatric service delivery, with fragmentation, duplication and, on occasion, triplication of some clinical services within a 14 km distance in one city. Again, this is not right. There is an imperative clinical and societal need to deliver a single children's hospital in one location with suitable infrastructure to meet the standards of care that are warranted. I trust we can all agree on that.

We are now at a point at which a world-class design, with child-friendly, high spec, modern interiors and acres of outdoor space, has been completed and has received planning permission following a robust planning application process. It is important to note that there was a planning application process. The announcement 11 months ago that planning approval had been secured was a huge and very welcome milestone for this important project. We now have an extraordinary opportunity to enhance health care services for children. I do not believe anyone would argue - indeed, I do not hear anyone arguing - with the need now to create a world-class facility to provide specialist and complex care for children and young people from all over Ireland.

I know that some people have different points of view about where to site the hospital and questions about whether we as a country can afford it. There are sincere differences of opinion, and I am respectful of this. People hold genuinely different opinions on the best site, and Deputy Harty correctly said there will be strengths and weaknesses to nearly any site chosen. It should be remembered that we had the Mater project first, and now we have this site. It has been a long gestation. I wish to try to address some of the concerns I have heard. I will begin with the sites chosen. We are building the main hospital on the St. James's Hospital campus. We are building an outpatient and urgent care centre on the grounds of Tallaght hospital. We are building an outpatient and urgent care centre on the grounds of Connolly Hospital. I will talk first about the satellite centres as they will be built and commissioned first.

I understand there are some concerns that every child in the Dublin area needing acute care will have to go to the St. James's campus. This is not the case. It is important to recognise that an integral part of the new children's hospital project is the development of the two satellite centres at Tallaght and Connolly hospitals. These satellite centres will be easily accessible locally for many families in the Dublin area, but also in Meath, Kildare and Wicklow. Each centre is projected to deal with 25,000 urgent care attendances per annum, with urgent care delivered by consultants and staff of the new children's hospital. The satellite centres will also provide general community and paediatric clinics, including developmental paediatrics, multidisciplinary care for children with chronic stable conditions and other outpatient services catering for a minimum of 15,000 outpatient attendances per annum. This will reduce emergency department and outpatient attendance at the main site. Children in need of urgent care do not all have to travel to the city centre site. The satellite centres will also meet the needs of general practitioners for access to specialist opinion in the general paediatric rapid access clinics. Their strategic location in Tallaght on the south side of Dublin and Connolly in the north west is based on the projected population of families with children in the greater Dublin area. In each case, co-locating with an adult hospital facilitates the sharing of clinical and non-clinical support services, such as pathology, pharmacy, sterile services, biomedical engineering, facilities management and diagnostics. Connolly, for the information of the House, is scheduled to open at the end of 2018 and Tallaght at the beginning of 2019.

The main hospital will provide national services of the kind that can only be provided in a centre with the required scale of services and critical mass of clinical sub-specialist expertise and highly specialised health care facilities. The Government decision in 2012 to locate the hospital on the St. James's Hospital campus was made in the best interests of children. It is important to note, as others have, that Dáil Éireann endorsed this decision by a vote in this House in November 2012, so the Dáil took a decision on this site. St. James's has the broadest range of national specialties of all our acute hospitals, making it the hospital that best meets the criteria to enable the children's hospital to achieve our vision of excellence in modern paediatric practice.

Why is co-location important for this project? It is because close access to the right kind of support from adult-based services will allow for better clinical care for our children. For example, co-location facilitates the joint management by adult specialists and paediatricians of conditions in children and young people which are more common in adults. This is particularly true in respect of specialist care for adolescents and our young adults and specialist surgery, where such cases are often managed by surgical specialists who work across the adult-child age range and are based in St. James's. The new children's hospital will be the national paediatric oncology centre. As St. James's Hospital is the largest adult cancer facility in this country, there is already a radiotherapy centre on the campus which will facilitate easy on-site access for children and young people who require radiation for their cancer treatment. They will not have to travel from one hospital to the next. Practising clinicians have expressed their support for the St. James's site, including the clinical directors and directors of nursing of all three children's hospitals. By bringing together the full spectrum of sub-specialties in paediatrics and neonatology on a single campus, supported by adult services sub-specialties, a degree of scale and critical mass can be attained which will support better outcomes from the most complex treatment and care for the sickest children and young people in this country.

In addition, the new children's hospital will also be a research-intensive academic health care institution, aided by its co-location. Why is this important? It is important because St. James's has a strong, well-established education infrastructure and a strong research platform in areas such as cancer, infection and immunity and neurosciences.

On the issue of trilocation and maternity services, I believe we are all convinced of the benefits of close proximity of maternity services to children's and adult services. The benefits of trilocation are maximised where the adult hospital provides the broadest possible range of clinical sub-specialties and expertise. At its most basic level, trilocation will facilitate the transfer of sick newborns from the maternity hospital into the children's hospital and the transfer of critically ill mothers from the maternity hospital to St. James's. Again, the depth of clinical services and research on site will enhance the potential to drive the best clinical outcomes for mothers, babies and children. Government policy is for the trilocation of paediatric, adult and maternity services on the St. James's campus.

The national maternity strategy published last year reaffirms this commitment. A site for the proposed maternity hospital is identified in the site master plan for the campus at St. James's Hospital. The new children's hospital design incorporates the required links with maternity and adult hospitals. While the construction of the new maternity hospital on the campus will not commence until the new children's hospital is complete, I met last week with the chief executive officer of St. James's Hospital and the Master of the Coombe and we expressed our shared commitment and desire to move forward. I have asked that a design team be put in place to move ahead with the project brief for that maternity hospital.

Recently I had the opportunity to visit the site at St. James's to see the clearance works that began last summer and will be completed in the next few weeks. When one sees the site cleared one appreciates the area available for the children's hospital and the proposed maternity hospital. It is exciting to finally see visible progress being made on this project. The hospital has been designed to meet the demands of projected child population growth. Beyond the current building footprint, a further 20% expansion capacity has been identified as part of the planning process.

I know there are some people who continue to advocate for a greenfield site as a means of building a cheaper hospital more speedily. However, I assure them that building on this campus is the right decision. Reviews since 2006 have affirmed and reaffirmed the importance of co-location of the children's hospital with a major adult academic teaching hospital. We have a well advanced plan for the St. James's site. There is no plan to build anywhere else. That would mean starting from scratch. The Government supports the need to develop this hospital as quickly as possible and that is what we have been working towards.

There has been much speculation about the cost of building this hospital. A total of €650 million of Exchequer funding was approved in 2014 but this was always - as anyone in Cabinet at the time would say and I was not there - for the core construction of the new children's hospital and the core construction of two satellite centres, when construction inflation was running at 3%. Construction inflation is now running at over 9%. The pricing proposed by the tenderers in the recently concluded tendering process for the main construction works took account of that higher figure, as well as the extended project timeline. The core construction costs at that time did not include other services we are providing including commercial spaces, higher education facilities, the Children's Research and Innovation Centre and equipment. The final project brief is now with the Department and I intend to go to Government on this shortly. As Deputy Harty said, when this brief and the Government's decision can be published people will see the true figures and the rationale behind them.

I know the project has the support of many Members of the House and many members of the public who share the desire to improve health outcomes for children and they want to see this hospital built as soon as possible. The decision to create a new children's hospital was taken by Government over ten years ago. I want us to get on with it but I also want us to make sure we engage with and address the genuine views and concerns of parents and other organisations as we work together to deliver world class paediatric facilities.

Deputy Billy Kelleher

I welcome the opportunity to speak on this issue. This debate is important because much concern has been expressed not just in recent weeks but over a long time about the development of a children's hospital, on whatever site. I am here long enough to remember the debate even prior to the Mater Hospital being identified as the site. People with eminent views and experience of paediatric care said at that time that other sites should be considered. However, a decision was made to locate the hospital at the Mater Hospital site, and we know the results of that in the context of the planning decision by An Bord Pleanála to reject it on foot of the mass of the site and of the proposed hospital. The issue of site selection was revisited and eventually in 2012 the Government decided to locate it at St. James's Hospital on foot of thorough investigations of various sites. The Dolphin report did not make a 100% recommendation of any one site. However, there is no doubt in the context of clinical expertise and clinical outcomes that taking account of the clinical provision in St. James's Hospital was a key determining factor in locating the children's hospital on that campus.

Of course, there have been concerns about accessibility, parking and accommodation for families. I am not an expert in choosing the location of, designing or assessing the best clinical expertise for a children's hospital. I have to defer to the experts. However, having questioned many involved in the process and reading much of the documentation I have come to the view that St. James's is as good a site as we can find. That is determined not just by me or anyone in this Chamber; it was determined by the fact that An Bord Pleanála granted planning permission for that site and took into account many of the concerns being expressed by others who held a contrary view, for example, on parking. A total of 1,000 places is proposed for the St. James's children's hospital campus. Of those, 675 will be ringfenced for families and patients. Therefore, there is an acknowledgement that parking is a critical component in ensuring ease of accessibility and that there is no pressure on parents or siblings to find parking. Many people who contacted me had very difficult experiences finding parking in Temple Street or elsewhere when bringing their children to Dublin. Another issue regarding accessibility is traffic. The inspector's report is clear that the James Connolly Memorial Hospital site was not necessarily the best and most accessible when taking into account the numbers who would use the campus and the dependence on car transport only to access it, as opposed to the availability of proper public transport services to the St. James's Hospital site. All of these issues must be taken into account.

I do not question the bona fides of anybody inside or outside this House who has expressed a contrary view and has campaigned passionately for the same outcomes as I speak for, namely, that we develop a world class health care facility for the children of this country. No parents of children who have been to hospital question the commitment or expertise of the staff but everybody questions the physical environment in which that health care is provided. The Minister referred to the crumbling façade of Temple Street which is a 19th century building. Our Lady's Hospital in Crumlin was built in the 1950s. We have to be conscious of the need to develop a world class facility. We must also take into account not just the building but what is inside the building in terms of attracting the best clinicians and medical professionals in the world to practice in the children's hospital. Having read much of the documentation and having listened to people with clinical experience and managerial and administrative experience in children's hospitals I believe co-location broadens the ability to attract world class clinicians to the children's hospital because in sub-specialities there is often a crossover and the seamless transfer from paediatric to adolescent to adult care has also been mentioned in much of the documentation. People have also expressed the view that we have stand alone world class children's hospitals being developed and there is no doubt about that. Some do stand alone, but they do so very often in close proximity to adult teaching hospitals.

For those who have concerns we need to make our point through action, through foundations and through concrete and steel and thereafter through clinicians. We should start building it, mindful that it is a huge undertaking which stretches the financial capacity of the State. This is a flagship development of a new era of an expanding economy and ability to fund infrastructural projects. We do not want to see runaway escalating costs. It is imperative to rein in construction costs and that there is a robust tendering process throughout from initial construction, through kit-out, etc.

This is an exceptionally exciting time. That is evident from older documentation I have read, such as the Dolphin report. It was also evident from recent presentations in the AV room at which people explained the St. James's site and outlined what is going to happen there. There is a lot of excitement and optimism among the paediatric clinical community. They are optimistic about the environment in which they will be providing care to the children who need it most.

When one talks to parents, one hears that they have slept on chairs in crowded wards where children are in close proximity to each other, not taking into account what is required in a modern children's hospital with stand-alone individual suites. One hears that we have provided care which, but for the commitment of the clinicians, nursing staff and other health care professionals, would have led to the collapse of the system. We have lacked a world-class infrastructural development. We must welcome, therefore, the 375 individual suites where there will be bed capacity for a parent or a sibling to stay with a child for a number of nights. The Ronald McDonald development also allows families to stay for longer periods. We must ensure that there is a holistic approach to the health of the child, that there is a nice ambience and that it is a suitable environment for a family to stay in while a child is being treated.

The transfer of children to the hospital is an issue which needs clarity. Of the children currently attending Dublin children's hospitals, 70% are from Dublin, Wicklow, Kildare and Meath. We should not consider the possibility that large numbers of children will be transported late at night in the backs of cars to the children's hospital. That is not what happens. If it is happening, it is for the wrong reasons. If it is the case, we are failing in our care systems in the rest of the country. Commitments must be made. If we are to develop a world-class children's hospital in Dublin, we must remain conscious of the satellite requirements in Galway, Sligo, Cork and elsewhere. We cannot have a situation where children have to be transferred urgently to the children's hospital without being able to avail of any support or triaging in their home areas. It is critically important that we do not concentrate everything in the children's hospital to the detriment of services elsewhere in the country. The Minister stated that construction of the two satellite outpatient centres will soon begin in Tallaght and Connolly hospitals.

The Minister must accept that there is huge pressure on systems throughout the country. I said in November 2012 that I was concerned that a national children's hospital, regardless of its location, could take all the resources from elsewhere. I am still concerned about that. Regardless of whether it is located on the St. James's site or at Connolly Hospital, the fact that the new facility is being built in Dublin could lead to there not being capacity in the rest of the country. The 30% of children who currently travel to Dublin for treatment would still have to do so because the necessary capacity, clinical experience and supports would not be available across the rest of the country. Planning a flagship hospital must also take account of the many areas of the country that are a long way geographically from its location.

A helipad has been proposed for the hospital. Sikorsky helicopters cannot currently land on elevated helipads. What is being done to ensure that the vast majority of helicopters which transfer patients in this country will be licensed to land on the helipad at St. James's? As the Minister knows, these are the helicopters capable of carrying patients for long distances and during the hours of darkness. However, they are not licensed to land on elevated helipads and will have to land at the Royal Hospital, Kilmainham. How many people are expected to transferred to the hospital by helicopter per year? If facilities in Cork, Limerick, Galway and elsewhere are downgraded, more patients may need to be transferred to the national children's hospital because the capacity of the regions to triage and cater for children in their own area will have been undermined. We have limited resources. Those resources must not all go to one place if that would mean downgrades elsewhere.

Reference has been made to the land available at St. James's. It is important to acknowledge that much of the 14 acres will be taken up by the children's hospital. There is a four-acre site which will be available for the maternity facility when it moves from the Coombe. We need to follow through on promises about tertiary hospitals, tertiary care and trilocation. If trilocation is the ultimate goal, we should also expedite the movement of the Coombe facility to the site. To do otherwise would undermine the reason for locating the children's hospital on the St. James's site.

A huge number of students will be coming to St. James's, not only to the children's hospital but also to the adult teaching hospital, which already has many students. We must be conscious of the implications for public transport of such a large number of people working and studying on the site, many of whom will be travelling there on a daily basis. Public transport is a critically important component in that area. For that reason, the St. James's site is important as well.

When we consider how to assess a nation, it is often on the basis of how it cares for its elderly and how it embraces its young that it is judged. It is now time to build this hospital. Issues have been raised about the location in terms of ensuring that parents and siblings have access to accommodation, that there are car-parking facilities, that long-term accommodation is available, that there is a holistic approach to the child's care and health, that it has a nice ambience, etc. While there are concerns about the cost of construction, when the St. James's facility is built, it will be world-class in nature and will benefit the children of this country for many years to come. I hope it will get speedy support from Government, all requisite funding, and that construction can commence so that it can begin its future as a world class health centre for children.

Deputy Louise O'Reilly

I am sharing time with Deputy Cullinane. I thank the Deputies from the Rural Independent Group for bringing this motion forward and giving us the opportunity to discuss the national children's hospital. This discussion is needed.

Sinn Féin is not in a position to support this motion. While we agree with much of what is contained in it, we cannot support it in its entirety. That is the reason we have tabled an amendment for which I seek support. Our amendment seeks to address the concerns raised by the campaign groups and the parents of sick children and seeks to put vital information into the public domain, which should address the concerns that have been raised. I note the Minister has started to put some of that information into the public domain but there can be no disputing the fact that the people who hold the view that this is the wrong site do so very sincerely and they need and deserve to have their concerns addressed. This debate should give us an opportunity to do that.

I believe that the concerns expressed by the groups are well-founded in many respects and they need to be addressed. The Government has insisted it is confident that St. James's Hospital is the best site for the new children's hospital and it is up to the Minister and the Government to prove that. That is why we are calling on the Minister to provide evidence of the Government's repeated claims of improved clinical outcomes resulting from adult co-location and specifically from co-location with St. James's Hospital. If he is saying that this is the best site, he should not just try to convince us but should convince those people who are opposed to it. He should talk to them and show them the evidence he has that has convinced him that it is the right site. He should share that information with them.

There is a frightening lack of information in the public domain about the planned workload for the paediatric satellite hospitals in Tallaght and Connolly hospitals. That has to be rectified, and I note some information was provided by the Minister. Parents need to know where they will be bringing their sick children and the services they can expect. That is what we expect from the Minister and the Government this evening and throughout the duration of this project. We want information about the new hospital because if reports in the media are to be believed, we are about to spend a phenomenal amount of money and therefore we need to know we will get the best outcome for that money when we spend it.

There is not a Deputy in this House who wants anything less than a world class hospital for our children but it needs to be accessible. We need to hear from the Minister that he has heard and understood the concerns about traffic congestion and the problems with access, and that he has confidence that this new hospital will be available and accessible for those who need it. We need to know that there will be adequate parking. We need to know that staff, sick children and their families will be able to access this hospital easily. I am sure the Minister knows that access on public transport is not an option, either for families with seriously ill children or for staff working anti-social hours. They cannot rely on public transport when they finish work potentially in the early hours of the morning.

We want the Minister to reassure us. We want him to tell us that he has a plan and that he has confidence that the scenario outlined in graphic detail by groups which are not convinced that this is the right site will not happen. We want him to tell us that this is the right site and demonstrate that he has enough information and evidence to stand behind it and support it.

I want to use my remaining minute to raise once again the issue of palliative care for children outside the Pale. It is all very well for us to be here discussing this new hospital but we need to remember also that there will be children discharged from this hospital, wherever and whenever it is built, who will be going home to die, and there is no home support for many of them. The only support they have is that which they get from their families or from charities, and that is not good enough. While we acknowledge that the new hospital will be a vital asset for children and their families, we cannot lose sight of those who will not get better in hospital. Those children and their families need and deserve every bit as much attention as the children who will get better in the new hospital.

Deputy David Cullinane

In the first instance, I commend the rural Deputies on tabling this motion. As other speakers said, it has given us the opportunity to have this important debate.

I want to acknowledge the Minister's contribution and the commitments contained therein, some of which I welcome. I fully understand that where the hospital is located is important. It is important to me, the Minister and every Deputy in this House. It is important also to those people who disagree with the location of the site. People are entitled to their opinions and as has been said, people have deeply held views on a range of different locations, not just the Connolly Hospital site. Views on multiple sites were put to all Members of this House over many years and all of those are deeply held views. I have two young boys who live in Kilkenny so I would want to make sure that if my children were sick they would have access to the best possible services.

While site and location is important, what is also important is the type of hospital we get, the services that hospital will provide, the cost to the Exchequer and whether the money can and will be provided. We were sold the current site, and I am prepared to support the current site, on the basis that there would be trilocation. There were many hours of debate over many years in different sectoral committees, especially in the health committee. The Minister will be aware that Deputy Caoimhghín Ó Caoláin, who was our previous health spokesperson, spent many hours in many sittings of that hearing examining all the different options. Eventually, we decided that we just needed to get this hospital built, but not at any cost. It has to be built based on international best practice, what is best for children and what is best for everybody involved. Trilocation in terms of paediatric, adult and maternity services is vital.

I need to be reassured by the Minister that the maternity services will be located on this site because that is what I am hearing from those who are the strongest opponents of this. Some of them disagree fundamentally with the site. There are others who say they have their disagreements but we need to be absolutely reassured that the trilocation will go ahead, that the planning application will be lodged and that there will not be a fudge where we are told it will happen and then it does not happen. That absolute commitment has to be given to us in good faith, in deed and in practice.

With regard to the costs, this hospital needs to be built. If there is an overrun, so be it, but the Minister has a responsibility to make sure that there is good spend of taxpayers' money. Why has it taken so long for the memorandum the Minister talks about to be brought to Cabinet? With respect to all of us, there has been a good deal of media speculation about that. Some of it may be helpful while some may be unhelpful but it is known that the costs have overrun significantly. Any time we table parliamentary questions or write to the Minister, the reply is about the memorandum that will be brought to Cabinet. When will it be brought to Cabinet? Why is it taking so long to be brought to Cabinet? When it is brought to Cabinet, will the Minister inform Deputies in this House of the true cost in the first instance? Importantly, whatever the costs, will he inform us that the money will be available to make sure this hospital is built, and I do not mean partially but in its entirety? That means trilocation, which has to happen.

I commend the rural Deputies who tabled this motion. They have genuine concerns. They have given expression to many of the concerns relayed to me. I have met many parents and campaigners on this issue. I have been honest with them that I will support the current site, not because I am not listening to what they have to say. I have listened to all of the views and having listened to all of the views I am firmly of the opinion that this hospital needs to be built quickly. I am somewhat but not fully reassured that the commitments that have been given on trilocation will be delivered. I am not sure whether the Minister will have a chance to speak again but that is the core issue for me. If that commitment is given, I am sufficiently reassured that this project should go ahead as quickly as possible.

Deputy Brendan Ryan

I thank the Rural Independents Group for submitting this motion on the new national children's hospital. The new hospital promises to be an exciting development in the area of modem paediatric medicine. It is beyond time that children in this country had access to a modern state-of-the-art centre of excellence for their care. I know that everyone on both sides of the location argument shares that view. When brought to completion, these facilities will revolutionise paediatric care in Ireland.

It makes sense to trilocate an adult hospital, a maternity hospital and a new national children's hospital on one central site. It provides a one-stop facility for areas of medicine that are intrinsically linked. I note Deputy Mattie McGrath's objection to the idea of trilocation. In his e-mail to Members today, he argued that it would be hugely disruptive, costly and unlikely to ever happen. Perhaps he could elaborate in an evidence-based manner on why he feels this way. The key factor should be that any proposal is clinically sound. Even if we were not talking about the site at St. James's, trilocation makes sense from the point of view of having diagnostics, early interventions and access to highly-respected medical professionals in the one domain. I find it difficult to oppose a concept that would allow for the best possible patient outcome along with an efficient use of resources. When implemented, the new plan would also cater for satellite units at both Connolly Hospital in Blanchardstown and Tallaght Hospital.

While the Labour Party sympathises with some of the arguments made, particularly in respect of the costs, abandoning the new hospital and starting afresh could set back progress in this area for many years. Our children have waited long enough. If the Government was to change its mind on the location, and technically it has not made a final decision, we would risk eroding public confidence in the project as a whole. We cannot afford to leave another generation of children behind because of indecision on the part of this House. We are at a key juncture and it is important to note that were we to abandon the choice of St James's, we have no guarantee of a site thereafter. The planning process is lengthy and the idea of turning around would serve to leave another generation of children behind.

In saying that, it is also fair to point out that this plan is not perfect nor should it be portrayed as such. Every potential site has its positives and negatives. I attended two recent presentations in the AV room in Leinster house in respect of the proposed location for the national children's hospital. The first had highly reputable speakers who argued convincingly against the St James's location. As a result, when the second presentation took place last week to outline the proposal for St James's, I felt compelled to go along in order to hear how the proponents of the St. James's site could possibly convince us how such a "totally unsuitable" site could be the right one but they did just that and I was impressed with what I heard. Dr. Peter Greally, consultant respiratory paediatrician, Dr. Sean Walsh, consultant in paediatric emergency medicine, Dr. Adrienne Foran, consultant neonatologist, Dr. Ciara Martin, consultant in paediatric emergency medicine, Professor Owen Smith, professor of paediatrics and adolescent medicine, Dr. Sharon Sheehan, Master of the Coombe Women and Infants University Hospital, Dr. Emma Curtis, consultant paediatrician, and Professor AIf Nicholson, consultant paediatrician at Temple Street Children's University Hospital, explained to us and convinced me and others in the audience why they believe that the campus at St. James's is indeed the best location for the new children's hospital. I have received many e-mails in recent days urging me to vote for this motion this evening and strongly suggesting that St. James's is the wrong location. One such e-mail suggested that nobody "apart from a few crackpots" believes that St James's is the right location. The people I have just referenced are not crackpots. They are highly-respected professionals in this field. The point I am making is that there are experts on both sides of the location argument who argue trenchantly and very convincingly in favour of their point of view. At a meeting of the Joint Committee on Health and Children in 2015, the former Senator, Professor John Crown, stated:

My position in the debate on the location of the national children's hospital continues to be that it was nearly impossible to obtain a medical opinion on the location of the hospital that was not, in some sense, biased by institutional loyalty on the part of the person making the statement. I do not propose to debate the issue again.

He also stated, "at the time, I argued that we should all support locating the hospital at one site and that once a site had been chosen, we should all shut up and get on with it." In my view this is exactly the point we have now reached with the national children hospital. I think that is where we are now. I have a bit more to say but it is a good point at which to stop. It is now time to get on with it in the interests of children. Let us stick with the decision and get the project done.

Deputy Michael Fitzmaurice

I thank the Deputy for sharing time. I welcome this motion from the Rural Independent Group. Everyone in the House agrees that we need a world-class hospital for children. What should we build the hospital for? Should we build it to cater for all of Ireland or part of it? A few things emerged from the Minister's speech. He spoke about inflation. I come from the building sector and have spoken to subcontractors around Dublin. I can tell the Minister there is no such thing as 9% inflation in the building sector. Consultants are telling the Government that. They are increasing prices and the Government is listening but the reality is totally different.

There is a myth to the effect that what amounts almost to a cult wants it to be moved to Connolly Hospital. I am not in a cult. I am making my own decision. I am not a clinician but I am giving my view. I worked on the extension to St. James's Hospital in 1997 or 1998. It was the greatest bottleneck site I ever worked on in Dublin. We are being contacted by nurses who have to travel from a distance and who cannot get into the hospital with their cars. They are being told that they must be in at 6.30 a.m. This is due to preparatory work happening on the site at the moment. A considerable amount of such work needs to be carried out.

The Minister said that the hospital will cater for all of Ireland. The reality is that in rural parts of Ireland, there is no helicopter at night. No Sikorsky helicopter, about which we heard earlier, will land in the west of the country. This is in the programme for Government but, one year on, it has not been looked at. We do not have the facilities. I have listened to mothers. I heard a gasp from the Public Gallery earlier when it was said that nobody is putting children into the backs of cars. A mother in Roscommon, Galway or Westmeath who is in a desperate state and has to wait 35 minutes for an ambulance will put her child in the back of her car and drive like hell. In fairness, she will reach the M50 quickly enough but it takes as long to go from Glenamaddy in Galway to the M50 as it takes to go from the M50 to the St. James's site on any given day. These are the things that need to be looked at. This is the anxiety felt by some people around the country.

I was not involved in politics when they spoke about the Mater Hospital site. Politicians said that it was the greatest site ever and that we had to go with it. Everyone was agreed on it but when it was turned down, they said there was a better site down the road. No site is 100% perfect. The figures I have heard are astronomical. A greenfield site is far cheaper to buy and nobody can dispute that. The Minister spoke about the Dáil vote in 2012. The previous Government had a majority of over 100. There is a minority Government in place at present and if Deputies want to stand up for what they believe in, they should do so.

An Ceann Comhairle

It is really gratifying to see the Public Gallery full and all those present are heartily welcome. However, they must remain quiet.

Deputy Ruth Coppinger

Solidarity welcomes the opportunity to discuss the delivery of the new children's hospital and how best to deliver quality health care for children. We have serious misgivings about the cost of the new hospital. As the motion outlines, there has been an increase in the cost from €404 million in 2012 to approximately €1 billion in 2017. We are told that much of the added cost is due to inflation but it also results from the problems of building a hospital in the city centre, with all the ancillary costs relating to the relocation of existing pipes and infrastructure, difficulties regarding access and the logistics of building within a crowded site for construction traffic. The general guideline for building hospitals is that the cost should be approximately €1 million per bed. This would include the cost of equipment. The new children's hospital would have 473 beds for patients and family accommodation space for 53 persons. This shows how expensive it is at almost €1 billion. It seems that this will be one of the most expensive hospitals ever built. I understand that only one other hospital - located in Australia - is more expensive but this hospital has a far higher degree of technology and automation, even down to the distribution of meals.

While the new National Children’s Hospital will be modern, I do not believe it is gong to be that modern.

The Director General of the HSE Tony O’Brien told the Dáil Committee on the Future of Healthcare that there is not even a sufficient budget for the relocation of the hospital to the St. James’s Hospital site. My colleague Deputy Mick Barry was very concerned about this when it was raised at that Dáil committee last month. It would appear there is an insufficient budget in place not only for the new children’s hospital but also for important projects such as nursing homes, the transfer of the National Maternity Hospital to the St. Vincent’s site and the move of the Central Mental Hospital to Portrane. This is a very serious situation. Not having a sufficient budget for health is a political decision. I know that many of the parents listening and watching the debate today are aware of the Oxfam report on Opening the Vaults, published this week. In this State 16 of the top 20 European banks operating here have an effective tax rate of 6% on their profits. Barclays, Royal Bank of Scotland and Crédit Agricole have an effective rate of 2% on profits they shifted here and yet the State does not have the money to build the National Children's Hospital. It is well known that now the Government is trying its best to not take €13 billion from Apple.

I will turn to the matter of the site location. In 2012 the Labour-Fine Gael Government made a decision to take the proposed children's hospital away from the Mater Hospital site and all of the controversies there. That Government decided not to locate it on a greenfield site but to locate the children’s hospital at St. James’s Hospital. That decision was the wrong decision. It was discussed at Fingal County Council when Connolly Hospital made a bid for the original proposal. This is going back many years. The spiralling of the costs has now reopened the debate around the location of the hospital and whether it is now viable to revise the decision to locate the hospital at St. James’s. Some people have estimated a saving of €200 million if the building was done on a greenfield site. I have been contacted by large numbers of parents in the past few days who are wondering if it is not too late to build the hospital at Connolly and the two satellite centres at St. James’s and at Tallaght. The Solidarity Deputies will be voting for the motion because it calls on the Government at least to reconsider the location and to justify why a relocation is not to take place.

Access to St. James’s Hospital remains an issue. Obviously, the rural group of Deputies has raised this concern because it is to be a national hospital and proximity to the M50 is very important. I represent Fingal and the population there has doubled since 1991. It has the youngest population in the State and in western Europe. Given that the population there is almost 300,000, the idea that we would not have a children's hospital or a maternity hospital in Fingal is just incredible. The population there has risen from 152,000 to 296,000. The youngest population in the State does not have access to a hospital that it needs. When our children are ill we must bring them to Children's University Hospital, Temple Street and women must travel to give birth. The census figures from 2016 said that the rise in population has almost been entirely due to the natural rate of increase, namely the number of births and that there is a baby boom. This additional point is actually a huge issue for people within County Dublin as well as for people outside of Dublin.

I worked in St. James's Hospital for four years in the 1990s. I cannot understand the original decision, having seen how crowded it is and how busy is that part of the city. Many ambulance drivers consider St. James’s Hospital to be one of the most difficult hospitals to access. There are local problems that need to be resolved also with transport and local infrastructure. Adding a new children's hospital and maternity hospital to the site would seem to be far too crowded. The proposed hospital will be for children right across the whole State. It will be important that parents are not caught up in traffic as they enter Dublin. Crucially, there is a need to have clear and rapid access for ambulances travelling to and from the children’s hospital. This would be best served by a location outside of the city centre and outside such a crowded site. If the hospital was located at Connolly Hospital there would also have to be work done on improving public transport and access but I believe it could be done more easily in that location. Connolly Hospital caters for every road traffic accident that occurs on the M50. Every single accident goes to Connolly Hospital because of its proximity to the M50. There is a reason why this site would be more accessible.

With regard to the Rotunda Hospital relocation, the new children’s hospital should be located alongside a maternity hospital. The original debate focused on the bi-location being with an adult hospital but a maternity hospital is more important. The motion before the House makes the point about a maternity service being corridor-linked to the new children’s hospital. This would mean newborns with particular difficulties could be aided quickly without recourse to an ambulance. The supporters of the St. James’s site mention the co-location with the Coombe Women and Infants University Hospital that is due to happen. There is a difficulty with this, however, and it again shows why there may be problems with the St. James’s site. The Rotunda Hospital is due to move to Connolly Hospital and it will move into a greenfield site. Clearly, the problems with the cost of building that we are experiencing now is highly likely to happen all over again when building commences on the Coombe relocation. The potential locations for the Coombe Hospital on the St. James’s site would involve demolition of existing buildings and the relocation of existing services in St. James’s Hospital.

I shall conclude. I am sure that many people have seen the harrowing account given by parents on the "Claire Byrne Live" programme on Monday night. The piece was about the lack of transplants available for children in the State. I believe that since the programme aired announcements in that regard were made yesterday. The idea is outrageous that transplants could not be done for children in Ireland. The operations are not necessarily the most complex. They can be done and we have the skills to carry them out. I hope the parents will get some solace that by bringing their stories out it may have led to this decision, although it really should not have come to this.

Deputy Joan Collins

I first want to state that I am not a clinical or medical professional, I am not a planner and I do not have a young family or children. I live in the area where Our Lady's Hospital for Sick Children is located in Crumlin. I have worked with many families in respect of the crises they have met in that hospital year in and year out on issues such as scoliosis, the minding of children and access to their children while they are in hospital. In the absence of a top class children's hospital in the State the Crumlin Hospital had to be developed and a large amount of money has gone in to the Crumlin Hospital over the last number of years.

I have met with the national paediatric hospital development board. They explained quite clearly why the St. James's site, which provides co-location with an adult hospital, provides absolutely the best way to give the greatest care to our children. These are children who have not had the greatest of care over the last 20 or 30 years in the State.

I can understand why people are questioning the project. Too many times in this country we have seen decisions made, such as the Mater Hospital plan, which then fall apart through objections around suitability and other areas of concern. People have a right to question things as they develop over time and I support people having that right. We have accepted too much bad planning for there to be no questioning of plans. I support people being able to question it. The arguments made by the national paediatric hospital development board were sensible. The information came from consultants at Tallaght and the Coombe hospitals and from Galway and across the water. They said that this was the best way to do it. The Coombe Hospital had indicated in 2015 that it would relocate to St. James's Hospital, and there was room for that, and this made the decision even more important from a medical perspective.

A number of people have already said there are pros and cons to every site, but the public transport access to this site is going to be important, especially when the Luas lines join up. People will be able to travel right across the city. I know the emergency transport access must be dealt with and I would like to see more development of explanations around how that will be resolved. The worst nightmare for a family would be if they were caught up somewhere and they could not get access to the services they need. This must be dealt with through the national paediatric hospital development board and through the Minister.

There are serious questions about money. It is a problem with this country in general. While I am not comparing the children's hospital with a football stadium, I was talking to somebody only yesterday who said that the Aviva in Dublin was built at a cost of about €480 million while Juventus football ground was built at the same time for about €140 million. With every project, we hear there is a cap on the cost, yet by the time it is actually built we are well above that. We have to examine how we deal with this issue of agreed costs versus the costs we end up with. I would like to hear more from the Minister on that matter.

Although I will not be supporting the motion, I take on board many of the points made in the Sinn Féin amendment. Very reasonable points are being made there about reporting back to the Dáil every quarter about what is happening. I question the estimated cost of €1.1 billion. I do not know how much it is going to cost as we have not got that figure yet. When the figure is brought out, I will comment on it. The Minister should now move very quickly. The decamping has happened, the site has been cleared and we should be moving much more quickly now.

I welcome the Minister's point about the move in respect of the maternity hospital and the talks he has had on that issue. That, too, should be moved more quickly as regards planning and so on.

Deputy Maureen O'Sullivan

Part of the history of this project involves the Mater site in Dublin Central. There was a lot of speculation as to why that site was even considered in the first place. In that instance, I do think the right decision was made. I did not feel it was a suitable site. I admit that, if we were starting today, my own preference would be for a greenfield site out in Blanchardstown or Tallaght. However, we have to accept the reality of where we are now. Planning permission has been granted for this site at St. James's. Like others, I think that there would not be 100% agreement, no matter what site was chosen. I am sure there are some now who would like to go back to the Mater site.

What is important, and is covered in both the motion and the amendment, is the commitment to develop a world-class national children's hospital. It is quite incredible to think of the years that have been spent and wasted and the cost to date in getting to this point. Even considering looking at another location now would delay the project further.

I attended the presentations for both locations, St. James's and Connolly in Blanchardstown, and there were compelling arguments from both groups. The more recent presentation was from the St. James's location. One of the arguments that struck me was that Great Ormond Street Hospital in London stayed with its city centre location. They went through all of the issues, such as accommodation, services, trilocation, parking, future expansion, etc. There was argument and counter-argument. There was also the point that there were international and national reports in favour of the St. James's site, which was disputed. What exactly, then, is the truth?

Deputy Harty outlined very valid questions on the extent of the costs. We need to know exactly how much it is going to cost to build and also to fit out the hospital. Why does it cost us so much to build here compared with countries similar to ours, whether it is public transport, a stadium, a hospital or infrastructure? We need a cost-benefit analysis of all the aspects, as well as a timeframe in respect of the hospital and the trilocation issue.

It is really good that the Rural Independent Group Deputies have used their Private Members' time to raise this so that we can get these issues aired. We cannot afford any further delay. The planning permission has been granted for St. James's and the other centres at Blanchardstown and Tallaght.

Deputy Catherine Murphy

From the outset, this issue was fraught with difficulties and competing demands. The Mater site was rejected on planning grounds and the new site selection process commenced. I must say I was more than surprised when St. James's was selected, but that is what happened. The background has been the many years over which families have waited for and have outgrown a world-class children's hospital that can provide all the clinical necessities required of a multidisciplinary centre of excellence. This has been and should be the paramount consideration in all of our discussions.

We understand that there are serious and legitimate concerns regarding the decision that was made on the St. James's site. However, we also understand that considerable time and resources have been expended to date on the site, and to stop it now would represent a significant setback for this project. The reality is that if the St. James's site does not go ahead, children who are now seriously ill will be adults before a decision is made on an alternative. There seems to be some unfortunate misconception that it is a case of simply swapping St. James's for Connolly, but of course that is not the case. Even if the matter were opened up again, there would have to be a site selection process along with a number of other processes, such as design process, planning application, funding process, tendering process, award of tender and building process. They would all have to be gone through again.

We think it is now vital that assurances be given not only that this hospital can be built, and the financial implications must be specified to us, but, more importantly, that it can be run. Will the resources and the staff to equip the second most expensive hospital in the world be available? When Beaumont Hospital was built it was, I think, ten years vacant before it was actually occupied. There can be no point in having a world-class building if wards are closed because of a shortage of nurses or if the funding is insufficient to purchase diagnostic machinery. We need to have those assurances.

The concerns that have been raised regarding the St. James's site must be addressed to give people some comfort that this decision has a legitimate basis and a realistic prospect of being successful. One of the significant concerns for families from throughout the country, including those I know of in counties Wicklow, Kildare and Meath, is that they will be required to bypass hospitals like Tallaght and Blanchardstown, which will be downgraded to minor cases only, and travel instead all the way into the city centre and into an area that is already a traffic blackspot. Assurances must be given that hospitals like Tallaght will be upgraded to deal with emergency cases, without children having to be transported from Tallaght to the city centre.

There are also concerns about the helipad at the St. James's site and whether it will be able to accommodate the Coast Guard helicopter. If it is not, it would appear that critically ill children would be required to be landed at one site and transported to St. James's. That is not acceptable and I would like to hear the Minister's views on it.

During the discussions on site selection, it was accepted that co-location with a maternity hospital was one of the key criteria. However, it appears there are no plans at this stage for such a move. Anyone who has tried to get from Cork Street, where the Coombe Women and Infants University Hospital is located, to the main entrance of St. James's Hospital during rush hour will know that, even though it is a very short distance, it is a significant problem. Furthermore, not every sick child will be born in the Coombe. The transfer of children from other maternity hospitals must also be considered, although the specialty will be at that particular hospital.

We are loath to set back the process, which has already progressed to a significant point in the development of a much-needed new children's hospital. For that reason we cannot support this motion but will look at the amendments. It does not mean that we do not share the significant concerns which have been outlined frequently, particularly by parents of children who are very ill and require this hospital more than those who are looking at it in a purely academic sense.

We really have to be certain that this hospital can be built. We have to be sure that the money is there to build it. We have to be sure that the money is there to run it. We have to be given assurances about the outer hospitals and the emergency cover. We also have to be given some reassurance about access to the hospital which is, from a traffic point of view, in a far from ideal location.

An Ceann Comhairle

I call Deputy Noel Grealish, who is sharing time with Deputies Michael Collins and Danny Healy-Rae.

Deputy Noel Grealish

I thank my colleagues in the Rural Independent Group for putting forward this motion. When I was first elected to the Dáil in 2002, a major topic of debate in the House was the need for a new national children’s hospital. Here we are in 2017, 15 years later, and still there is little to show for all the talk and debate in the interim. Instead, Ireland is on the brink of creating a world record for all the wrong reasons, that is, the most expensive children's hospital to be built anywhere in the world. The cost of the project just a few short years ago, in 2012, was predicted to be €404 million, but it has now soared to more than €1 billion and is rising.

The reason we have put this motion before the House is that we do not believe the St. James’s Hospital site is a suitable one for a development of this scale. We seriously question much of the Government's justification for continuing to insist that the new hospital be built at this location. While I and my group fully support the provision of a new national children's hospital, we have to get this right. It is a €1 billion-plus investment and even that price tag looks likely to continue to increase.

One of the considerations in deciding where the new children's hospital should be built was whether it should be co-located with a maternity hospital or with an adult hospital. I feel that, in deciding to build on the same campus as the adult hospital at St. James's, the wrong decision was made. Connolly Hospital in Blanchardstown offers a much better option for several reasons. When we are planning developments of this scale, we should think of the needs of the whole country, not just Dublin. Blanchardstown would be a much more accessible location for people coming into the city to visit their sick children as it is located just off the M50, as opposed to a journey through congested traffic into the city centre, with a nightmare of limited parking to be faced at the other end. Another big plus is the fact that the new Rotunda maternity hospital is to be built in the coming years next to the Connolly Hospital complex, and the proximity of a full-scale children's hospital next door would surely help to improve outcomes in cases of post-natal problems among vulnerable babies. A third consideration on a long list of reasons the current decision is the wrong one is the fact it would cost much less to build on a greenfield site next to Connolly Hospital than in the built-up urban setting currently being promoted.

The current estimate of the cost of building a national children's hospital at the St. James's site is in the region of €1.1 billion whereas I have seen estimates for building the same facility at Connolly Hospital being put at 25% less. That is a saving of more than €250 million that could be put towards other vital services and capital projects that are badly needed within our health system or towards the provision of life-saving and life-changing drugs that are the centre of so much debate in Ireland at the moment. I urge the Government to have another look at the facts and, indeed, the figures and to make the right decision for the future of the country and its children.

Deputy Michael Collins

I am happy to be in the House to debate this very important issue of the location of the national children's hospital. Let me begin by quoting an e-mail I received this morning. It states:

St. James's is wrong for children. St. James's is wrong for families. St. James's is utterly wrong.

Since coming into office last year, I have been receiving correspondence from parents, doctors, children's organisations and parent support groups which are vehemently opposed to the proposed location of the new children's hospital at St. James's. These individuals are concerned exclusively with the well-being of the children of Ireland and they have no ulterior motives. They have been giving up and continue to give up their free time to fight for what they believe is right, and this must be commended and acknowledged by the Minister. Why would these people be giving up their free time and energy to fight for something unless they really believed in it?

Last June, a petition of 60,000 signatures opposing the St. James's campus as the site for the national children’s hospital was delivered to An Taoiseach. A Red C national survey around the same time recorded 73% opposition to the St. James's site. Reports from staff, patients and ambulance drivers have repeatedly reported that traffic and parking problems are a nightmare at St. James's Hospital. The St. James's site is impossible to get access to, especially at rush hour. With an additional 4,000 vehicular movements per day associated with the children's hospital, this already major problem of access to the St. James's site will become even worse, and it will no doubt result in a serious negative impact on the functioning of the adult hospital. Due to the restricted nature of the site, parking provision for the children's hospital is dramatically lower than that of international comparator hospitals. It will have fewer parking spaces per bed than were available at Crumlin in 2010 and, overall, only 8% of staff in both the children's and the adult hospitals will have access to parking. This will not bode well for retaining staff. Helicopter access is also impacted as there is no space at St. James's for the Coast Guard air and sea rescue helicopter to land.

It must be noted there is no benefit in co-locating with an adult hospital as paediatrics and adult medicine are two different specialties. However, co-locating with a maternity hospital is non-negotiable, according to the experts, and not having a maternity hospital co-located will result in the avoidable death and disability of sick children. There is no site for a maternity hospital at St. James’s.

It has been stated repeatedly that it would cost more to change the site at this point but this is false. The fact is that to change the site at this point to Connolly Hospital would represent a saving of at least €250 million for the taxpayer according to the international independent review of 2011 and the Dolphin review of 2012. Building the children's hospital at St. James's will result in poorer clinical outcomes for children, lack of adequate expansion space, staffing concerns, restricted parking and access for ambulances, helicopters, patients and their families, lack of a supportive natural environment and poor value for money. I am pleading with Deputies to support this motion and to address the concerns of our citizens. Once again, I repeat that St. James's is wrong for children. St. James's is wrong for families. St. James's is utterly wrong.

I thank Deputy Mattie McGrath, who has soldiered in this great cause with his staff, Tríona and Maureen. He is trying to keep the truth alive on this issue. I know for a fact that if this is not changed, it will lead to tribunals down the road.

Deputy Danny Healy-Rae

I welcome the opportunity to speak on this very important motion. I welcome all the people in the Visitors Gallery who have given so much time to this very important matter.

We all want a proper children's hospital for all of Ireland. I was very disappointed when I read in the Minister's speech that this hospital is to serve the greater Dublin area, Meath, Kildare and Wicklow.

Deputy Simon Harris

That is not what I said.

Deputy Danny Healy-Rae

The people in Kerry and west Cork are also entitled to the best care, as well as the places mentioned in the Minister's speech. Parents will inevitably have to bring children from faraway places like Valentia, Slea Head, Ballybunion, Lauragh, Cahermore, the area west of Castletownbere, Sneem and many other places. Nine out of every ten children will have to come in by the M50. Of course, there will be problems for doctors, nurses and staff getting to work and parking at St. James's. From what we can see, there was no proper consultation with the ambulance services.

The situation with the helicopters was mentioned. The biggest and best helicopters should be able to land at St. James's but that will not be the case. I was in Lissivigeen the other evening, where there was a car crash and the patient was to be taken to Cork but, because of the wind, the helicopter had to take him to Limerick instead. We can imagine how, all along the west coast, which is windy nearly all the time, the largest helicopter would be needed to pick up child patients to bring them to Dublin but that helicopter will not be able to land. Will there have to be a transfer and where will the helicopter land with the patient?

We were told first that the hospital was to cost €400 million and it is now €1.2 billion. The reason for the increase is not the reason which was given, namely, the increase in interest rates. I believe the cost only became apparent when the construction companies were asked to tender to build the building. When they worked out their prices, they had to take into account the access constraints, such as the trouble to get materials in and out, the problems for lorries trying to bring in ready-mix and traffic management, which will be a savage problem. Opening times will be restricted because of the residential properties such as houses and flats all around the site. A contractor will not be able to start work at a time he would like. He cannot start at 6 o'clock in the morning and stay working until 8 o'clock in the evening because he will not be allowed to do so.

People locally will not let that happen because it will keep children and elderly people awake.

With regard to the timescale, I believe that it will take much longer and cost much more than what has even been suggested today. The site will prove to be the most difficult in terms of access and in terms of the hours that the builders will actually be allowed to work. If the building did not start for three more years on the greenfield site, I believe it would still be finished before St. James's, if that is where the hospital will end up being built.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I thank Members for raising this matter and for their considered contributions. It is clear from the debate that this House shares a commitment and determination, as does the Government, to ensure that the children in Ireland and of Ireland and their families can access world-class health services as soon as possible.

I am sad to say that I myself am sick to the stomach of trying to understand this, which is a real issue for me, because we are back here again in the Dáil Chamber talking about the location and site of the new national children's hospital. In 2005, as Lord Mayor of the city, I visited the Mater site. It was clear to me then that it would not be built there. Here we are again 12 years down the road. Finally, we have planning permission and a decision from the independent An Bord Pleanála to build on this site but there are still challenges in the Chamber this evening that are all about the site and not about the sick children. There was plenty of opportunity during the oral hearing and during An Bord Pleanála's process to submit any difficulties that people had. Unfortunately, a lot of the Members who are speaking today did not even bother to do that. I do not know where they are coming from now. That are all of a sudden jumping on the bandwagon and scaremongering people, particularly families who have very sick children around the site in Dublin South Central-----

(Interruptions).

An Ceann Comhairle

I ask the people in the Public Gallery to remain quiet.

Deputy Catherine Byrne

I will respond to one or two of the issues relating to parking, a matter which has been raised by a lot of people. Contrary to what has been said, there will be 675 spaces provided for families based on the current project's future demands. There will be 325 spaces for staff. That is a total of 1,000 spaces, three times the current number of parking spaces for the existing paediatric hospitals as they are. I will talk a little bit about public transport as well. Contrary to some of the comments about access to the new national children's hospital, the Luas is on its doorstep and the 123 bus route passes by it. The 40, 13 and 68 bus routes all go back and forth from the north side of the city and are located in and around the St. James's Street area. It is two stops from Heuston Station on the Luas as well. There is a lot of significant transport in the local area to bring people to and from the hospital. Some people mentioned that people go to hospitals by car, which they do. They did that in Crumlin for years. Let us look at the problem the people in Crumlin have had down through the years in not being able to access or park outside their own houses or having to go three streets down to find a space when they come home from work in the evening. This is going to be a really positive approach by which there will actually be parking spaces for people who are bringing sick children to the hospital. There will be spaces that people will be able to book in advance.

Regarding the bed capacity, there will be 473 beds in single rooms with en suites for families in areas. I spent quite a considerable number of years travelling back and forward to Crumlin hospital with my own children and grandchildren when they were sick. The hospital's rooms and suites have not changed dramatically at all. As we all know, many of them are probably the same as they were when they were built in 1956. Many of them do not facilitate parents to actually sleep within the room with their child. That is going to completely change under the whole structure of the new national children's hospital for parents, whereby they will be able to sleep in the room with their very sick children and have en suites as well, instead of having to run out to go home and come back in to stay with their children, sleeping most nights on a chair outside. There are a lot of things that are positive about building a new national children's hospital. The most positive thing is that it will be for all of the sick children of Ireland and not just a particular cohort of people.

The project to develop the new children’s hospital at St. James's is an extraordinary opportunity to enhance the health service for children in this country. The new children’s hospital will be a world-class facility to care for all of our children and young people from all over Ireland who are in need of specialised and complex care. The hospital will have two satellite centres, as the Minister has previously said, at Connolly in Blanchardstown and at Tallaght hospital campus. It will also be the local children’s hospital for children and young people in the greater Dublin area of Dublin, Wicklow, Kildare and parts of Meath. It will provide secondary health services for children, both emergency and planned. The majority of these patients may not have to stay in the hospital for treatment of their ailments and could be discharged on the same day.

It is also important to emphasis the future benefits for children across the country. The new children’s hospital is only one element, albeit a crucially important one, of the implementation of the national model of care for paediatrics and neonatology. The model advocates a hub-and-spoke model for paediatric services, facilitating delivery of the majority of care for children locally. The new children’s hospital will have a central role in this model of care. The new children’s hospital and its satellite centres in Tallaght and Connolly will work with the regional paediatric units in Limerick, Cork and Galway and in the 13 local paediatric units to deliver this new model of care. This will see children receive the right care at the right time in the right location and, where possible, close to home. Doctors and child health professionals fully accept that this is best practice. The hospital will provide specialist tertiary services for children from all over Ireland. The specialists in the new children’s hospital will provide outreach clinics in regional centres and engage in shared care arrangements with local paediatricians in regional paediatric units, thereby bringing their expertise closer to the patient with the aim of ensuring that children are able to access the right care in the right place at the right time.

For those who do not know the site in St. James's Hospital and do not know the surrounding areas, the new children’s hospital is one of the most exciting projects to take place in the Dublin 8 area for a long time. It will be a game changer for the area and will be a catalyst for employment in the community. There are significant economic and social benefits to gain from the new children’s hospital development for the community in Dublin 8, both during the construction phase and afterwards when the hospital is operational. The new children’s hospital is one of the first projects of this scale in Ireland to include social clauses as part of its construction contacts, committing to providing job opportunities for local people.

Acting Chairman (Deputy Eugene Murphy)

Is the Minister of State sharing time with Deputy D'Arcy?

Deputy Catherine Byrne

Yes, he will have a few minutes.

Acting Chairman (Deputy Eugene Murphy)

That is okay. Sorry for the interruption.

Deputy Catherine Byrne

I wish to emphasise the work that is being done on the ground by the project team, particularly in the community and in schools, to encourage young people who may not have even considered an employment role in a hospital on a health care basis, whether doctors, nurses or any other type of carer, and who will now have the opportunity to be employed locally. I believe that is a real positive for the south inner city. Through many years, it has had many problems in trying to develop its own skills in that area.

I want to commend the hospital being built on the St. James's site. It was not my decision or a political decision. It was a decision taken by An Bord Pleanála, which is an independent-----

(Interruptions).

Acting Chairman (Deputy Eugene Murphy)

The Ceann Comhairle asked before not to interrupt when a Member is speaking. We are delighted to have people in the Public Gallery, but I cannot allow them to interrupt. I ask them to adhere to the rules. That is all I ask.

Deputy Catherine Byrne

I will repeat that. It was not my decision where the hospital is built. In 2012, the Dáil voted for this site as well. I want to make it very clear that it was An Bord Pleanála, at the end of the day, that made the decision on the development and planning on the site and passed the planning application. I would like people to remember that An Bord Pleanála is an independent body that facilitates planning applications and makes decisions on the grounds of the material provided and adhered to during the planning stage.

Deputy Michael D'Arcy

I speak as a parent who has visited Crumlin hospital with children and family members and Temple Street hospital with family members. We have got to get this hospital built. There were several sites in Dublin city. The Mater site was ruled out by An Bord Pleanála. Subsequent to that, when St. Vincent's University Hospital did not apply or request to be considered as a site, there were two sites left, namely, the St. James's and Connolly sites. An independent objective decision was made by people who have knowledge and experience in this space.

They decided on the site at St. James's Hospital. It is now time to get this hospital built. For too long families have had to bring children to facilities that are substandard. I have friends who have had to sleep underneath the beds their children were in. Those days have to come to an end. I look forward to when the hospital is built. It will be a world centre of international expertise, knowledge and ability.

One point that has been completely ignored in all of this is the establishment of the paediatric outreach centres. The days of every child coming to one centre have to end. The facilities need not all be on one campus or site. We have the best clinicians in the world. Those clinicians can run outreach clinics throughout the country, including in Cork or Galway. There will be 13 centres in all. That will be of real benefit. It means not all children have to come to Dublin city. Clinicians can go to the centres throughout the country and provide knowledge and expertise.

This has been going on for 30 years. It is time to bring it to an end. It is a little late for the motion at this stage because work has started. An Bord Pleanála made the decision on the site at the Mater hospital some years ago. It was excluded. Now, we have time to start building. If there are infrastructural problems with regard to car parking and access, they can be overcome.

Acting Chairman (Deputy Eugene Murphy)

The final speaker is Deputy Mattie McGrath. The Deputy has ten minutes.

Deputy Mattie McGrath

I thank everyone who has contributed tonight. I thank all Members for giving their honest and frank assessment.

I am disappointed with the Minister of State, Deputy Catherine Byrne. She came to the Chamber tonight but did not answer the questions we had asked about the helicopter and parking that is worse than the parking at the hospital in Crumlin.

People have asked why stand-alone children's hospitals continue to be built. Examples include the hospital in Melbourne and Alder Hey Children's Hospital. Where is the evidence? Why did the Minister of State not refer to these, rather than taunting us and accusing us of being reckless and whatever?

Deputy D'Arcy should note what we have said. The Rural Independent Group honestly put down this motion in good faith because we believe the current site is the wrong site. We want to see a world-class children's hospital built as soon as possible as well. We are entitled to it. I have heard all the talk about the unanimous decision and the great majority following the vote in 2012. I was here. The Minister of State and the Minister voted for it. They cannot wash their hands of it like Pontius Pilate. What Deputy Michael Ring is doing with the post offices is becoming contagious. The Minister was in the Chamber at the time. Fine Gael voted for it with its big bulldozer majority at the time. The Minister was then a backbencher. The Minister of State voted for it as well. Fine Gael had a majority. Let us consider where it got them. It nearly got them demoralised because the people did not agree with any of the actions that Fine Gael took. Mr. Hogan – Big Phil – and the others bullied everyone. They are paying the price for it and will continue to pay the price for it.

I wish to record the points made by the Government in favour of the current site. As part of the consultation exercise, the Dolphin review group identified St. James's Hospital as the most suitable adult partner for the new children's hospital from a clinical and research perspective. This is rather misleading. No report ever recommended the site at St. James's Hospital. There is no such claim in the Dolphin report. That is a fact.

The Government took the view that a planning application to place the children's hospital at Connolly Hospital might prove difficult due to lack of transportation capacity at the N3-M50 junction. That is wrong. The truth is Connolly Hospital has dedicated slip access off the M50-N3 interchange. Bus services are available on site. There are no parking restrictions. It is within walking distance from Castleknock train station, which is on the Dublin-Sligo main rail line. There is a helicopter pad at ground level that can take any helicopter. There could be world-class helicopters if the Government decided to put up the money to pay for them, rather than having a volunteer group trying to fund helicopters throughout the country. We support that group as well.

The Martin report on the planning aspect of the project lists regional buses stopping at the nearby Blanchardstown shopping centre. Incidentally, that shopping centre has 7,000 parking spaces and separate staff access at the Waterville estate.

The Minister of State should never suggest that we did not visit the site. I call on her to withdraw that comment, as well as the suggestion that we did not have the manners or respect to visit the hospital. We have visited the sites. We have met all the people. They gave up their valuable time. The Minister of State should show some respect to them rather than demonising us.

The Government claims the vast majority, up to 78%, of children currently attending the existing three hospitals for children come from within the greater Dublin area, including Meath, Kildare and Wicklow. The Government claims these children will be served in future by a hospital and by two new paediatric outpatient departments and urgent care centres at Tallaght and Connolly Hospital. The Government claims the staff will be catered for.

We are not anti-social either. I totally resent the Minister of State even suggesting as much. How dare she? She should know better. I am surprised at her because she is not like that normally. Her conscience must be troubling her on this issue.

There has been grossly misleading use of statistics. One claim holds that a total of 66% of children in the greater Dublin area live outside the M50, while a significant proportion of the remaining 33% live inside or close to the M50. In fact, 90% of children in the country live outside the M50. However, the Government wants to forget about us; it is all about Dublin. Postal addresses are not an indicator of frequency or intensity of hospital attendance. Tertiary patients in specialised units are intensive users with longer stays in hospital. Nine out of ten of these patients live outside the M50. The Minister of State and the Minister should put that in their pipes and smoke it. It is not all about the Pale and the mad cow roundabout at the M50. We had mad cow disease some years ago and we had to eliminate it. Now, we have this madness continuing with this Government and this proposal. It seems nothing can stop the Government, not even the cost.

Another claim is that most parents access the hospital car parks and that ample parking has been provided for families based on the current and projected future demand. That is altogether false. People cannot get parking at the moment. Fewer parking spaces per bed are being provided than were available at the hospital in Crumlin in 2010. Parking at Crumlin in 2010 could never have been described as adequate, never mind ample. Why are the nurses fleeing? The proposed children's hospital has the smallest parking allocation of any recently-built children's hospital with only two spaces per bed. The children's hospital in Melbourne opened in 2011. It provides 6.8 spaces per bed. Alder Hey Children's Hospital opened in Liverpool in 2015 with 4.4 spaces per bed. The Government can put any spin on it or hire any spin doctor but it cannot explain that away. We would need days to count up all the misleading information issued. However, we do not have the time. More important, the children do not have the time or energy. The same applies to the parents in the Gallery – I warmly welcome them and thank them for their behaviour this evening. If we change sites now, the hospital can still be built in 2021. That view is held by the only man in the entire saga who has actually built three hospitals on time, Mr. James Sheehan, who is with us this evening.

I appeal to all my colleagues to go back and review the information that has been provided by the Connolly for Kids Hospital Campaign. I appeal to them to think once again about the consequences for generations to come. The parents of affected children are in the Gallery today and I salute them. They will meet the Minister and speak about their fears for St. James's Hospital. They are not anti-social. They hope that the national children's hospital can be built in the right location. It is never too late to do the right thing.

The Minister asked me a question earlier. I would in no way impugn the reputation of the medical people who came in last week. I simply thought what Mr. O'Brien told us was hilarious. By the way, the Minister of State, Deputy Catherine Byrne, never referred to the cost or the questions raised tonight by Deputy Coppinger. Mr. O'Brien said he has no money to build it. The Minister for Health, Deputy Harris, has no money either but it was nice that he got in before the replies. Mr. O'Brien told us that he did not have the money.

We have one week before the next Committee of Public Accounts meeting. I am glad the Committee of Public Accounts Chairman arrived into the Chamber some minutes ago. I have referred this to the Committee of Public Accounts. The committee is going to deal with it too. We have to get the truth, however we get it. People are going to start telling the truth. The total cost of the BAM Ireland contract – I am referring to the preferred bidder - does not include the enabling works or the demolition. It is like a place in Syria at the moment with all the builders have knocked down, including a wonderful and beautiful church. The accommodation works Deputy Danny Healy-Rae referred to are not part of any contract. These are all hidden costs. The Minister said he was down there last week to see the works. They are growing. If we dropped a bomb, we would not knock as much. What is the cost of all this? The Minister should be honest with us and tell us the costs. These works are ongoing and could cost a further €100 million at least.

Deputy Danny Healy-Rae has experience in construction, as does Deputy Fitzmaurice. We always declare it here before we speak. They told the Minister about it. We cannot make a silk purse out of a sow's ear. The Minister should listen. There is insufficient space to work a mini-digger, never mind massive cranes and equipment. Deputy Healy-Rae is right. Builders have to respect the neighbours and work within restricted hours on such sites. However, on a greenfield site, the builders can cordon the site. We would drop the members of the Government up there every so often to allow them to have a look at it and to see the progress. Work on such a site would pass out the progress of the other dastardly site any time.

Where are the costs for upgrading utilities by Dublin City Council in order to provide adequate services? They are not included. Where are the costs for the HSE? The service is currently using the Croppies Acre in front of the National Museum on the quays as a depot. All these costs are hidden. It is misleading. This is more subterfuge from the HSE and the Minister for Health. Where are the costs of the linear park, the only green space in the entire complex? That was a major selling point in the original proposal. Where are the costs for that? Where are the costs of the satellite units at Connolly Hospital and Tallaght hospital, to which the Minister of State referred? This is outrageous. It beggars belief that there can be such deceit perpetrated on the public and on this House. I mean that.

I am not questioning anyone's integrity but the Ministers are being fed information by their officials and by consultants who are being paid to tell them whatever story they want to hear. They more they are paid, the better the answers they will give.

I have a document here that is so sad. I put it together this morning, with help from a sick person. It states:

St. James's is wrong for children. St. James's is wrong for families. St. James's is utterly wrong. The truth has been sent to you [I mean all of the Deputies here and myself], shown to you and said to you. You persist in your privileged safety, buffered from the gritty truth, hoping it will pass. It will not pass. It will not pass. [I know that we are nearly at the Passion of our Lord coming up to Easter week, but this will not pass and it will rest with you for the rest of your lives]. The truth will never pass. It will walk by your side, sit at your dinner table, kiss your children good night. The truth is like now; it cannot but exist at every moment, in every place. You can scorn the past. [We had a debate on Ferns recently. We had Cloyne only last week, we had the Magdalen laundries, the Tuam mother and baby home and we had Grace. What more do we want?] You were not there, any of you, or me. You would have done differently. You would have stood against common thought, common voice and common action or lack thereof. You would have defied your peers, forfeited your future, [ambitions to be Taoiseach and whatever else] risked your reputation in the name of doing right by the vulnerable, voiceless, penniless, pitiful child. Of course you would have. You would have been a revolutionary; of course you would have. Now, some day when someone else has passed, now it is up to you. Now you are there. Now is your turn, a hAirí. To be absent, to be silent, to be unheard is to be that person who didn't speak when the little children suffered. To not admit, to not stand, to not act is to re-fail those children [and the children of these good people in the Gallery who have given of their time] of the past for their suffering. Has nothing changed? St. James's is wrong for children. St. James's is wrong for families. St. James' is utterly wrong, I tell you.

An Leas-Cheann Comhairle

That concludes Private Members' business and our discussion on the national children's hospital. I am now obliged to put amendment No. 2, in the name of the Minister for Health, to the House.

Amendment put.

An Leas-Cheann Comhairle

In accordance with Standing Order 70(2), the division is postponed until the weekly division time on Thursday, 30 March 2017.

Dáil Éireann debate - Wednesday, 29 Mar 2017

National Children's Hospital: Motion [Private Members]

Dáil Éireann debate -
Wednesday, 29 Mar 2017