National Children's Hospital: Motion [Private Members]

I move:

“That Dáil Éireann:

notes:

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

— the current cost of the construction of the National Children’s Hospital stands at €1.433 billion and rising;

— that this represents the most dramatic, fluid and unprecedented cost escalation level for any single health related project in the history of the State;

— that this escalation in costs is likely to be ongoing and represents significant challenges in the capacity to deliver urgently needed local health related or capital spending projects;

— that the urgent clinical necessity of co-locating a maternity hospital with the National Children’s Hospital is now seriously compromised if not fatally undermined due to site capacity issues;

— that fire safety and structural viability related concerns have been flagged around the decision to construct approximately 1,000 underground car parking spaces directly under the National Children’s Hospital;

— that the independent review of 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

— the decision by Government and the Health Service Executive (HSE) to commission a review by PricewaterhouseCoopers to establish the sequence of events in relation to the cost increases experienced by the project, establish what was known, when and by whom, and the reporting of relevant information from the project team to the relevant oversight and governance bodies including the National Paediatric Hospital Development Board and also its committees, the HSE and the Department of Health; and

calls on the Government to:

— immediately suspend construction of the National Children’s Hospital at the St James’s Hospital site pending the outcome of a time-limited independent investigation to assess the viability, cost and efficacy of re-tendering the project and transferring its location to a greenfield site with the capacity to include the co-location of a maternity hospital; and

— utilise any site preparation work already started at St. James’s Hospital to develop a satellite children’s urgent care centre, further adult services or any other services deemed most appropriate in the event that a recommendation for relocation is made following the outcome of the independent investigation.”

I would like to acknowledge the work of our Whip, Deputy Mattie McGrath, and the staff in his office in preparing this motion. This is not our first time coming before this House to speak about the national children's hospital and our concerns about it. Our views are very heartfelt, sincere and factual. We were bitterly disappointed in March 2017, a month before the Government signed the dreaded contract that led to the situation in which we now find ourselves, with a massive overrun that has the potential to detrimentally affect many health projects throughout the country. I will make no apology for saying that in County Kerry we want a new community hospital to be built in Killarney. I am sincerely very worried that this massive overrun will affect the budget for that project. I am very concerned to ensure that more beds are made available in University Hospital Kerry in Tralee. We want to keep that hospital open. We do not want it to be made into a second-class hospital or downgraded to a glorified community hospital. I was dealing with situations there today. They are absolutely crying out for more beds in University Hospital Kerry.

This massive budgetary overrun was caused by the Government's mistake in locating the national children's hospital in the wrong place. It is costing multiples of what it would if it was located in the right place. We told the Government that it was wrong in March 2017. It was wrong then, and it is wrong now. If the Government starts out wrong, it finishes wrong.

That is exactly what the Department of Health and the Government have done. It is a shame, at a time when we want to nourish and protect. It is very wrong to have this debate without talking about the children. This is a children's hospital. We want a hospital for our sick children. This could help the children of today or our grandchildren tomorrow. We want a proper hospital for them, but we want it to be in an accessible place. We want it to be in a place where gardaí will not be brought to their knees by trying to provide escorts for ambulances bringing patients to essential services. We want it to be in a place where helicopters can bring sick children and their families in urgent situations. The Government has made an unmitigated mess of it.

As a result of this massive mistake, the Government has endangered other projects. I am only outlining the needs of County Kerry. I refer to other hospitals, such as Dingle Community Hospital, Kenmare Community Hospital and Caherciveen Community Hospital. There is a massive need for capital infrastructure investment in those hospitals. Instead, we are going to have Ministers and Department officials coming before us week in, week out. When we make the case for these projects we will be told that funds are not available because of the massive overrun in the national children's hospital, caused by the Minister of State and the Government putting it in the wrong place.

I hate personalising this, but the Minister of State, Deputy Jim Daly, is the only one here. Looking around, the Government is a fairly sad-looking crowd tonight. This is a very important Private Members' motion into which an awful lot of work was put. Look at this pitiful sight. No man or woman would sit alongside the Minister of State to support him. That is wrong. Where is the Minister himself? Where is the Minister for Health, the man who is overseeing this shambles? The Minister of State knows that I mean no disrespect whatsoever to him. They are hanging him out tonight, leaving him sitting there on his own to take this motion. That is deeply wrong and unfair. If I was in the Minister of State's shoes I would ask the Chief Whip, the Taoiseach and the Minister for Health where the hell they were on the night a Private Members' motion on this very important subject came before the Dáil. They have all abandoned him, like rats jumping off a ship. They would not sit there with the Minister of State and at least support him.

God damn it, that is a disgrace in this day and age. The Irish public, looking at this debate tonight, sees that a Minister of State has been left sitting on his own with no-one in the world to support him. Not one person is here to support him in this Chamber. That is wrong. If I was in the Minister of State's shoes they would not do it to me, because I would not let them get away with it. I certainly would not take that cheek from them. It shows total disregard and disrespect to our Whip, Deputy Mattie McGrath, and to us as a group of elected representatives who brought this to the floor of the House. It is wrong and it is a disgrace. The Minister of State should have words with them about it.

It saddens me greatly to be standing up here tonight and that the Rural Independent Group and I have again had to put forward a motion on the national children's hospital. The knowledge of the enormous cost overruns of the national children's hospital, and that people up and down the country will suffer in order to make up the €100 million funding gap, saddens me for sure. What saddens me more is that all this could have been avoided.

The Rural Independent Group and I stood in this very Chamber almost two years ago on 29 March 2017 and put forward a motion on the national children's hospital. Two years ago we could see that the national children's hospital should not go ahead on the proposed site. As part of the statement that I made two years ago I quoted an email from a parent:

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

It looks to me as if the Government agrees, because the senior Minister is not here tonight to discuss this. As Deputy Michael Healy-Rae said, the Government benches are empty. This is the most shocking scandal in recent years and bar the Minister of State, the members of the Government do not have the dignity or respect to turn up here and discuss it.

I want answers from this Government. When the Rural Independent Group and I raised our concerns two years ago, why did it not listen to us? Why were we ignored? What is going on in this State? What kind of pathology does this show? The way the Government is treating the people is appalling. Scandalously, projects will be destroyed by this. Why did the Government refuse to listen to parents who opposed placing the hospital on this site from the very beginning? This Government also ignored a petition of 60,000 signatures opposing St. James's Hospital campus as the site for the national children's hospital. I want to know why this Government thought it was above everyone else. I need to understand how a Government could completely ignore the valid concerns of Members like the Rural Independent Group and myself, the parents of the children who will be using the hospital and the views of the public.

It galls me that until recently the Minister for Health was still insisting that the hospital represented value for money. Where in the name of God is the value for money for the people throughout the country who will have to suffer the budget cuts caused by these hospital overruns? Many projects are gone. We know they are, but that is being hidden. We are being codded. One example is the Sandycove primary school project. Parents are waiting for a primary school down there. They have been promised it several times. Now they have been given another cod of a promise and it has been put off until 2022. This is a joke. All these projects are being delayed and it will cost this country seriously. The incompetence of this Government is frightening. One only has to look at the recklessness of infrastructure spending reflected in budget overruns on previous projects. I refer to the Luas, the early days of the road programme, the maternity and children's hospital and the likely final cost of the national broadband plan. Now we do not even know if that project will happen. This is probably going to result in the Government pulling the national rural broadband plan.

These have all seen major overruns. On top of this, we know that 15 of the major school building projects completed since 2010 ended up costing more than the agreed tender price. This is not acceptable. Our health service is on its knees. It shocked me to the core to find out that each year, 370 people in Cork alone unnecessarily go permanently and irreversibly blind due to lack of treatment. The South Infirmary Victoria University Hospital in Cork was promised a new ophthalmology unit in 2007. Can this Government give me assurances that this unit will go ahead? Where will the money for it be found now? Alternatively, will we Independent Members continue to clean up the Government's mess and take patients to the North of Ireland to be looked after?

We have a health service with very frustrated staff.

The nurses have criticised the unreasonable contract offered by the Government after the recent strike. I fully support the nurses and I am appalled that this Government could treat its nurses in such a shocking manner. Ambulance personnel who are members of the Psychiatric Nurses Association of Ireland, PNA, are still protesting for their rights and I stand strong beside them. The PNA will be protesting outside Dáil Éireann on Wednesday, 27 March. It is time this Government listened to the request of the PNA and gave its members a resolution.

Members should consider Vera Twomey's battle. I am trying to point out the utter incompetence on the part of the Minister for Health. It is time for the Government to listen but as we have said time and again already this evening, there is no one there to listen. To get medicinal cannabis, Vera Twomey's family and other families must fly regularly to Holland to bring home the medicine to save their children, while this Government lies idly by. It does not care. It does not worry about the people who are seeking that. There is a mechanism through which people can find some resolution. This Government has a Bill before it. It will not pass the Bill or allow this medication to be brought home and administered through pharmacies to save the parents distress.

The incompetence of the Government is nothing short of appalling. We only have to look across the floor of the House. We are faced with an appalling situation and nobody cares. That is the bottom line. That is what the people throughout west Cork and the rest of the country believe; nobody cares.

I am delighted to speak on this motion. Two years ago, I spoke on another motion calling on the Government to change its mind on the decision to locate the national children’s hospital on the St. James’s Hospital site. At that time, there were dark mutterings about the soaring costs, which at that stage were predicted to pass the €1 billion mark in total. Today, that seems like a bargain price.

I wish to lend my full support to this motion calling for the halting of construction pending an investigation into the possibility of retendering the project and moving it to a more suitable greenfield site. The main reason is that I am firmly of the belief that the Connolly Hospital site in Blanchardstown is the best place for a national children’s hospital, but it could also make financial sense. It has been suggested by people who are experts in the building and running of healthcare facilities, including the likes of Dr. Jimmy Sheehan, that switching to a greenfield site such as that at Connolly Hospital would be hundreds of millions of euro cheaper than sticking with the St. James’s Hospital site.

We have available two major reports, going back years, which stated that building this much-needed facility on a greenfield site would be 25% less expensive than building it on a brownfield site in a built-up urban area. The costs of the current project seem to be rising every day and I note, too, that the final bill for the external review of the cost overruns on the national children’s hospital looks likely to exceed more than €500,000.

I am deeply concerned about how the cost overruns will not only cost the taxpayer more but also threaten to have a serious impact on other developments within our health system and elsewhere in State spending. They have cast a long shadow of uncertainty over the timely development of other services and capital projects such as the building of a new emergency department at University Hospital Galway, a facility that is badly needed and already long overdue. Any delay would be a shocking disappointment to the more than 60,000 people who come to the existing unit every week seeking treatment in a cramped and outdated emergency department that is universally accepted as being not fit for purpose. It would be a kick in the teeth for the doctors, nurses and all the other staff who have put up with working in those unacceptable conditions for far too long. Those are the kind of conditions that are leading to nursing staff shortages because they are leaving in their droves to work in far superior conditions abroad.

Apart from the potential cost savings, which are considerable, I have long been of the view that the St. James’s site is the wrong location for a new national children’s hospital. It is important to remember that it is a national children’s hospital and not just for Dublin. Some of the sickest children in the country will be treated in the hospital and we have to think of the accessibility for them and their families. The Connolly Hospital site is located just off the M50, which makes it much more accessible for everyone coming from outside Dublin, allowing for faster access without running the risk of getting stuck in city centre traffic. In an emergency situation, the difference could be crucial for a seriously ill child being brought by ambulance or by car. Families under enormous stress could do without the hassle of extra traffic when they are coming to and from visiting their sick child.

Another drawback of the current development is the fact that the larger Coast Guard helicopters cannot land there. The Sikorsky S-92 search and rescue fleet is not licensed to land on rooftop helipads, which is what is proposed now. They would have to land in the Royal Hospital Kilmainham and transfer by ambulance from there, which is hardly an ideal situation with a very sick child and potentially heavy traffic on the roads.

The work already done on the current development will not have gone to waste. St. James's Hospital will make good use of the underground car parking, which will prove inadequate to meet demand. The site should become the location for a satellite children’s urgent care centre, switching the current idea of the main hospital being at St. James’s with a satellite at Connolly Hospital. The extra space would also allow for the expansion of adult facilities at St. James's Hospital.

Once this project is built, there will be little room for further outward expansion at the St. James's location, which is a much more cramped site than the 145 acres available at Connolly Hospital, and the potential that offers for more pleasing surroundings for the young patients to look out on.

I urge the Government to see the sense in this argument and call a halt to building work while a speedy and time-limited independent investigation is carried out into the viability of moving the project to a more suitable location.

I thank the Rural Independent Group for giving me time. This is the fifth time I have raised the national children's hospital in this House. I have asked many questions. I have got very few answers. I have put down many written questions to which I got a couple of answers, not many. It is a bit like trying to unravel the secret of Fatima. It is absolute nonsense that there is no transparency around what happened.

I have concentrated mostly on the form of contract, which was a joke and is the reason the Government has the overruns, but no one seemed to be interested in the contract. Moreover, the Government does not seem to be interested in giving answers on it. In one of the replies I received, I was told that stage 1, the below-ground stage, was a detailed design, and so it should have been. That was fine. In the second one we were told it was based on a remeasurable bill of quantities priced at the preliminary design tender rates. That is nonsense. One cannot do that. Who was responsible for that? Who made that decision? Will anyone be held to account for it? Did McCann FitzGerald advise the Government on it? Was it somebody else on the board who decided it? That question has to be answered by somebody.

Why was phase 1 not a stand-alone construct in order that BAM would not have the Government over a barrel for the second phase? Why will no one answer that question? I do not understand it. Doing the bill of quantities for phase 2, which is all the work above ground - the main work - and not doing it on a detailed design was madness. There is no logic to it and no one is telling me the reason.

The reply referred to a preliminary design. Was that initial design and feasibility or the developed design? It certainly was not a detailed design but there are no answers on that either. The numbers keep going up so the Government has no control over them. That is because of the format it has invented and come along with and no one has been held to account for it. It is absolute nonsense.

The Secretary General of the Department of Public Expenditure and Reform appeared before the Committee of Public Accounts last week. He said the bill of quantities was 95% sorted. It was not 95% sorted. He actually said in response to Deputy Jonathan O'Brien that "the complexity of the project meant that it was not possible to set out a detailed design". That is rubbish. He also stated: "The second issue is that we were given commitments relating to the approximate bill of quantities". By whom were the commitments given and what kind of commitments were they? Will anyone be held accountable for that? Was there a public benchmarking analysis prior to the tenders going out? I have asked that question a couple of times and no one has answered it. I do not understand why no one is answering any questions.

I would like to have 20 minutes to contribute. I have asked whether PwC was independent. How did it get the job? How was it procured? One should see the answers I received on this point. One answer, and one could not make this up, stated that prior to commencement - this is the Government talking - of the review, assurances were sought and received from PwC in relation to potential conflicts of interest. That is like asking the fox if the chickens will be all right with him tonight. If PwC was asked about a potential conflict of interest, there should have been a conflicts procedure process internally in PwC. How did it determine that it did not have a conflict of interest? Did it tell the Government? Can we see the minutes of that meeting? How did PwC give assurances to the State that it did not have a conflict of interest because it had a conflict of interest? It partially designed the contract we are debating.

Another response I got on the lack of independence of PwC stated that in January 2017, following a competitive tendering process, PwC was awarded a contract for external consultancy services in support of the HSE's programme for health service improvements. It further stated that the contract provides recounting for expertise to be drawn on as required.

This is a construction project. What, in God's name, do accountants know about construction? They did not have to be given this work. This was done on a framework agreement. PricewaterhouseCoopers, PwC, was drawn out of a framework agreement which had been put in place in 2017 and was not fit for purpose in this case. This is about construction and what BAM got up to with the increase in prices. It is about how the contract was done and how it was not done. It is about construction. PwC are accountants. It is a different area. It was providing money for friends that saw PwC get the job. This is nonsense.

There are many points I want to cover. Can we please get some answers? Why does the Government not have a go at being transparent about what really happened? Nobody is telling us what happened or answering the questions I put to them over the past three weeks. I am getting no answers. It is all being hidden under the covers. We are talking about half a billion euro of taxpayers' money being wasted. The Government does not have a clue where this will end up because of the form of contract it used. It has done it all wrong. Are McCann FitzGerald going to be held to account?

I understand the Minister of State, Deputy Jim Daly, may be moving an amendment. There is no issue if he is not. The Minister of State has ten minutes.

I welcome the opportunity today to address the House on the new children's hospital project. I cannot accept the Deputy's motion and I am moving the Government's countermotion on the development of the new children's hospital.

The Minister of State is moving an amendment.

I apologise.

He does not know what he is doing and nor does the Government. It is shameful, a farce.

I move amendment No. 1:

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

“notes:

— the 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 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;

— the Government’s decision to re-develop the Coombe Women and Infants Hospital on the St. James’s campus in the context of achieving tri-location 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 children’s hospital and maternity hospital, and the incorporation into the design of the 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, part of the Fire Safety Certificate granted by Dublin City Council for the hospital, will be provided for 1,000 cars, including 675 dedicated to patients and families and 31 drop-off emergency spaces;

— the Government’s decision to develop satellite centres on the campuses of Tallaght University Hospital and Connolly Hospital, and that they 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 site and the satellite centres at Tallaght and Connolly Hospitals;

— the vision of the new 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;

— the enactment of the Children’s Health Bill in 2018, and the establishment of Children’s Health Ireland as a statutory body to take over the services provided by the three existing Dublin paediatric hospitals, and run the new children’s hospital, outpatient and urgent care centres; and

— 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;

acknowledges:

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

— the considerable increase in capital project costs over and above that notified to the Government in 2017, to a capital cost of €1.433 billion;

— the decision taken by the Government to proceed with the project, and the significant financial commitments given by the Government to complete the construction of the hospital and associated outpatient and urgent care centres;

— the commissioning of an independent review of the escalation in cost to identify the contributory factors and associated responsibilities so that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds, and to develop recommendations, if possible, which may identify any areas of potential cost savings or reductions;

— the significant progress made in the development of the new hospital at the St. James’s Hospital campus, and works relating to the Tallaght University Hospital and Connolly Hospital outpatient and urgent care centres, with the latter scheduled to open in July 2019; and

— the Government’s investment plans as outlined in Project Ireland 2040 and the National Development Plan 2018-2027, which provides for a substantially increased capital funding commitment of €10.9 billion for the public health service, which includes the substantial capital investment in 2019 of €642 million which will, in addition to the new children’s hospital, and the urgent care centres at Connolly and Tallaght Hospitals, continue significant capital investment in the health services;

and supports:

— the Government’s priority to develop and deliver the new hospital on the St. James’s campus and centres at Connolly and Tallaght Hospitals to support best clinical outcomes for children and young people in Ireland; and

— the proposals recently announced by the Minister for Public Expenditure and Reform on a revised approach to major capital projects.”

In recent weeks, there has been much debate and discussion on the development of the new children’s hospital and the increase in the cost of the project. When Government approved the construction investment decision in April 2017, the capital cost for the delivery of the hospital build project, following the evaluation of main construction tenders and selection of preferred contractors, was €983 million, of which €916 million was to be met by the Exchequer. In December 2018, my colleague, the Minister for Health advised Government that the overall cost to complete the project was €1,433 million, €450 million more than advised to Government in April 2017. Some €319 million of the additional cost relates to construction costs, and the balance of €131 million, which includes €50 million in VAT, relates to costs associated with staff, consultants, planning, design team fees, risk, contingency and equipment.

Both as a member of Government and as an individual, I find the cost escalation of this project from what the Government originally committed to in 2017 deeply disappointing. The Government wants to get to the bottom of the major and sudden cost escalation associated with the finalisation of the guaranteed maximum price, GMP, in November 2018 and the lack of timely warning that the capital budget was under such pressure. That is why, on 18 December, at the same time as the Government approved the construction investment to allow the phase B above ground works of the hospital to be instructed, it also approved the commissioning of an independent review of the escalation in cost. This independent comprehensive review process is under way and will examine the contributory factors and associated responsibilities so that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds.

The review’s terms of reference also require the development of recommendations which may identify any areas of potential cost savings or reductions which are consistent with the applicable contractual undertakings and the delivery of the project. It is also required to address major residual risks, control and oversight issues and bring greater oversight of performance and value for money. The Department of Health, the HSE and the National Paediatric Hospital Development Board are fully committed to collaborating with the review and implementing any recommendations arising. The report from this review process is expected to be completed by the end of March.

The Government’s investment plans, as outlined in Project Ireland 2040 and the National Development Plan 2018-2027, which provides for a substantially increased capital funding commitment of €10.9 billion for the public health service, includes a substantial capital investment of €642 million in 2019. This will continue significant capital investment in the health services, in addition to the new children’s hospital and urgent care centres at Connolly and Tallaght hospitals. The Revised Estimates adopted by Government for 2019 provide for the costs arising this year in this priority project. The costs in future years will inform future capital expenditure plans.

The location of the hospital has been the source of much commentary for many years. Let me be clear that we are building the main children’s hospital on the St. James’s Hospital campus. The hospital is under construction, as anybody who visits the site can see. A fully aligned, 57-month programme has been agreed with the main hospital construction to be completed by July 2022 followed by a period of commissioning and staff familiarisation before services transfer. We are also building an outpatient and urgent care centre on the grounds of Tallaght Hospital and an outpatient and urgent care centre on the grounds of Connolly Hospital. Works at Connolly Hospital are on target for practical completion of the building in the spring, with the opening scheduled for July. The outpatient and urgent care centre at Connolly Hospital will start delivering improvements to healthcare for children this year, under the responsibility of Children’s Health Ireland. Works at Tallaght Hospital are under way, with a target handover date of July 2020.

The Government decision in 2012 to locate the hospital on St. James’s Hospital campus was clinically led and made in the best interests of children. Dáil Éireann endorsed this decision in November 2012 on foot of a Government motion. The site at St. James’s Hospital campus was chosen due to the co-location benefits which ensure access to adult specialists for children and young people with conditions that are more common in adults. The joint management of these conditions by adult specialists and paediatricians can provide better quality clinical care, for example, in cancer care for adolescents and young adults. Practising clinicians have expressed their full support for the St. James’s site, recognising the clinical benefits of co-location. By bringing together the full spectrum of subspecialties in paediatrics and neonatology on a single campus, supported by adult services subspecialties, a degree of scale and critical mass can be attained that will support better outcomes from the most complex treatment and care for the sickest children and young people of Ireland.

I also want to be very clear, and assuage any concerns there may be in this regard, that there is capacity on the site to accommodate a maternity hospital. This was recognised in the planning application and subsequent planning approval given for the site. A site for the proposed maternity hospital is identified in the site master plan for the St. James's campus and the new children's hospital design has incorporated the required operational links with both maternity and adult hospitals. Indeed, it was announced in June 2015 that the Coombe Women and Infants University Hospital will relocate in time to the St. James's campus, achieving tri-location of adult, paediatric and maternity services. The national maternity strategy, published in January 2016, reaffirms the delivery of trilocated maternity services on the campus with the new children's hospital and St. James's Hospital. Ultimately, tri-location 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 Hospital. The new children’s hospital has been designed to meet projected child population growth and unmet clinical need which will result in a facility that can provide for a very significant expansion in the delivery of healthcare.

Reference has been made to car parking. The design of the hospital has recognised the need of most parents to access the hospital by car and 675 spaces have been provided for families based on current and projected future demand. A further 325 spaces have been provided for staff, giving 1,000 spaces in total, which is three times the current number of parking spaces at existing paediatric hospitals. This safe, underground parking system will also allow families to reserve spaces ahead of arrival at the hospital. There is some concern regarding the underground nature of the car park and its particular application to this project. As we all know, underground car parks are commonplace. I am happy to confirm that the fire safety certificate granted by Dublin City Council for the new children’s hospital covers the car park.

It is important that we do not forget the purpose of this project is to deliver transformational change to the delivery of healthcare for children in Ireland. The desire of all political parties, groups and Members to improve and prioritise medical outcomes for the nation’s sickest children is evident. We know that the children and young people of Ireland have been waiting far too long for a modern healthcare facility. With the development of the new children’s hospital and the two outpatient and urgent care centres at Tallaght and Connolly hospitals, we are replacing outdated hospital buildings with modern and appropriate infrastructure, including fit for purpose, single en suite rooms for every child designed to best serve the needs of our children and their families and the staff who care for them.

The centres will expand outpatient and urgent care capacity and provide services in modern facilities. Overall, the three new sites will significantly increase capacity across all types of care, including increases of 16% in inpatient capacity, 7% in emergency department attendances, 26% in day case capacity and 47% in outpatient capacity levels. These are significant figures indicating the scope of improvement that children and their parents will experience.

This new children’s hospital project will transform the delivery of children's healthcare in Ireland. The capital investment will be underpinned and complemented by a new model of care for the delivery of service to children. The establishment of Children's Health Ireland by legislation passed by this House at the end of last year was a major milestone in the new children’s hospital project and will further assist the ongoing operational integration of the three hospitals in advance of the opening of the new children’s hospital and outpatient and urgent care centres. The new hospital will have a leadership role nationally in the implementation of the national model of care for paediatrics and neonatology, working closely with paediatric service providers in other hospitals across the country, in the primary care service and in the community.

I firmly believe that this hospital is the right hospital on the right site and is being built for the right reasons. The Government considered three options, namely, to pause the project, to retender and delay it or to proceed with it. We made the decision to proceed. I invite Deputies to join me in ensuring that, while recognising and meeting legitimate concerns, we get on with delivering this vital project.

We were told in 2016 that the national children's hospital would cost €650 million. We were told in 2017 that the total cost would be €980 million, an increase of approximately 50%. We were told in 2018 the cost would, in fact, be €1.4 billion, another 50% increase in costs. There is also an additional €300 million required for IT and opening the hospital. This brings us to €1.7 billion so far. This is well over two and a half times more than the €650 million we were told about in 2016. It is like people being told in 2016 they could have a house built for them for €250,000 and in 2018 being told it will no longer cost €250,000 but €650,000. This is the scale of the increase the Irish people have been told about.

At €1.7 billion, the Irish people are paying several times more per bed than the most expensive hospitals anywhere in the world. The two most expensive hospitals ever built, in Adelaide and Stockholm, came in at €1.8 million and €1.6 million per hospital bed. The national children's hospital is coming in at €3.6 million per hospital bed, more than twice that of the most expensive hospitals ever built. Some in government state this comparison is not fair and that we must compare the national children's hospital with other children's hospitals, so I did this. Four years ago, the Alder Hey Children's Hospital was finished in Liverpool.

I ask Deputies to stop talking.

At 309 beds and a cost of €270 million the English people will be paying one quarter the amount per bed.

I ask the Deputies to leave the Chamber if they want to have a chat. We are trying to have a debate.

You are grand, Deputy. Work away.

It is not good enough.

I told the Deputy he is fine.

Everything said here is through the Chair and there should be silence for any Deputy.

At 309 beds and €270 million, the Irish people will pay four times more per bed than was paid in England just a few years ago. By any measure this is an outrageous overspend. It is an insult to every taxpayer and citizen. It is an insult to every doctor and nurse working in outdated facilities or understaffed teams. It is an insult to the more than 500,000 people waiting to see a consultant. It is an insult to every child waiting for surgery or a wheelchair or special needs support. It is an insult to every young person desperately waiting for access to child and adolescent mental health services. The Government's response has not been to put up its hands and state it got it badly wrong and will do everything it can to fix it; the Government's response has been to deny and defend.

In September 2017, the Minister for Health was told he was already looking at an overrun of €61 million. I will put this in context. In recent days, Deputy Michael McGrath obtained figures from the HSE that looked at overruns of health projects of more than €10 million. The combined overrun in the past decade was €30 million. In September 2017, the Minister, Deputy Harris, was told he was already looking at an overrun of €61 million, more than twice the combined overrun for the entire capital spend in health over a decade but, having been told this, in the subsequent year he never once asked for an update. At the same time, he was trying to get his head around a €700 million overrun on the current expenditure side but never once asked whether the €61 million overrun on the children's hospital had increased or reduced. Finally, a year later, he was told it had increased from €61 million to approximately €400 million and they would get back to him with an exact figure soon enough. What did he do? He withheld the information from the House, for which he has apologised, he withheld the information from the Taoiseach and he withheld the information from the Minister for Finance, in spite of a PR firm being hired to come up with communication strategies for the overspend. We are now told that even if the Minister had told the Taoiseach, the Dáil and the Minister for Finance he was looking at the overspend of approximately €400 million it would not have affected the health budget for 2019. We are being told this at the same time as the health budget for 2019 is being changed because of the overrun.

We were told originally that the massive overrun was due to inflation but then we got documents to show this was not true. An attempt was made in the Chamber to shift the blame to unnamed contractors for lowballing but that strategy very quickly failed also. Now we are told that the mistakes were made by what the Taoiseach has described as agents of the State but even these mysterious agents of the State did not let the costs out of control. All they are guilty of is underestimating the cost at the start.

We were told that €650 million was a reasonable price to pay. We are told today that €1.7 billion is a reasonable price to pay for the same hospital. We were told by the Minister for Health that the only scandal regarding this would have been a decision to cancel the project. No - a €1 billion additional spend on the same hospital is a scandal. Recently, when the Taoiseach was pressed on what mistakes his Government actually made, he said he did not think that if it had been monitoring it any more closely that somehow it could have made it cheaper to build but, perhaps, in terms of the timing of communications that it could have made the public and media aware sooner. In this entire debacle the only blame the Taoiseach is willing to accept for his Government is that perhaps it should have told us all about it a little bit quicker. That is it. That is all it is willing to accept. Every expert I have spoken to about this has said that major construction projects routinely run over and are routinely brought back into budget. That is how the world works; it is just not how the national children's hospital works.

We were told that serious efforts were made to reduce the costs but then we were given more than 100 documents, and these documents do not show any serious effort to reduce the costs. In fact, it was Fianna Fáil that asked for the PwC terms of reference to change to include looking at ways to reduce the costs. The Government's terms of reference did not even ask PwC to do this.

It is essential that the national children's hospital be co-located with a maternity hospital. We were told the Coombe Women's and Infants University Hospital would move to the St. James's Hospital site but a few weeks ago, in response to a parliamentary question, we were told the project to move the Coombe hospital is at an early stage and has yet to progress to planning and design phases. The St. James's Hospital site was chosen seven years ago but basic planning and design to move the Coombe hospital to the St James's Hospital site has not even started. We were told a workforce planning exercise would be done to ensure the new children's hospital would be fully staffed but the reality is it is struggling to find staff even for the satellite centres.

We have now reached a point, it is fair to say, that when it comes to the children's hospital nobody believes a single word the Government says. Here is what we do know. The clinicians at the three children's hospitals are doing everything they can to provide the highest possible quality of care but those facilities are no longer fit for purpose. They do not have the diagnostics, equipment or space.

That is putting significant pressure on sick children, their families and the clinicians. We know these children urgently need a new hospital. If the children's hospital opens as planned - the opening has been delayed until 2023 - it will have taken 11 years from the St. James's site being chosen and 17 years from the Government decision to build a new children's hospital.

We know that there are material risks to moving the site. There are very strong reasons for choosing the Connolly site over the St. James's one, but there are very serious timing risks involved in any contemplation of moving the site. We also know that there was and continues to be a lack of consensus among clinicians and other stakeholders with regard to the choice of the current site. All Members are acutely aware of the genuine anger and real fear felt by many parents of sick children regarding the potential access difficulties and other issues associated with the current site.

In that light, Fianna Fáil has tabled an amendment to the motion which calls on the Government to ensure that the ongoing PwC report includes an extensive value engineering analysis to identify options for reducing the cost overrun, to produce urgently a costed and timetabled plan for the delivery of the new Coombe hospital on the existing site, to redesign the process for public procurement such that it does not take 17 years to build a hospital, to include in the PwC report, in light of the massive cost overruns, an analysis of the total costs and potential time implications of moving from St. James's to the Connolly site, and to act on the chronic clinical recruitment and retention issues being experienced such that when the hospital opens, it will have the doctors, nurses and other wonderful healthcare staff it needs.

It is highly unlikely that moving the site would be the right thing to do for sick children. There are significant cost implications and, more seriously, significant time implications. The project could be delayed for another ten years. I hope to God it will not be, but that is a real risk. On balance, moving the hospital at this point is not the right thing to do. The wrong site may have been chosen at the start. However, there are eminent clinicians and parents of very sick children who passionately believe that building the hospital at St. James's is still the right thing to do. If for no reason other than to respect those doctors, nurses, parents and children, Fianna Fáil believes the PwC report should run the rule over the cost and timing implications and that it is critical that the Government gets to grips with getting the cost back down and the maternity hospital constructed and ensuring we can fill it with the best doctors, nurses and healthcare professionals possible.

I welcome the opportunity to contribute on the motion regarding the national children's hospital. We must start on the basis of the information recently provided to the Committee of Public Accounts which set out an estimated cost on that date of €1.7 billion. Nobody believes that will be the final figure because, as has been pointed out, there is an agreement in the contract such that if construction inflation exceeds 4%, the additional cost will form part of the overall bill for the project. The sum of €1.7 billion is the baseline figure as of the date it was announced. Based on the contract signed by the Government, it is unavoidable that the cost will escalate significantly. I am quite satisfied that the Government has no idea where the final cost will end up.

It is interesting that the response of the Government on this matter at the beginning of the year was to invite PwC to examine the issue and review the cost escalation. To me, that was a public relations stunt. Aspects of the original draft terms of reference for the review were pathetic but have been improved as a result of the contribution of Fianna Fáil. Far more importantly, however, the final National Paediatric Hospital Development Board report on preliminary observations on the construction capital cost escalation of the national children's hospital was issued on 17 December 2018 by Mazars. I have the report in front of me. Within six weeks of it being issued, the Government decided, hey presto, it would appoint PwC to examine the cost escalation issue. That was a farcical decision. The Government had possession of the Mazars report which states that on the basis of the detail outlined in the report, it is clear that a number of capital projects, fundamental systems and checks and balances failed to protect the board from a large and sudden increase in costs of construction. It concludes that the costs estimation procedures used to produce the original capital budget did not serve their intended purpose and further states that the ongoing cost management systems failed to capture properly a significant element of the capital budget implications of the developing design. The Government knew all of that at Christmas. What did it do in the new year? It decided to order a further report. The Mazars report was on the Minister's desk. I do not know why he needed a new one.

The PwC report is geared financially to look at the costs and the re-engineering of the construction costs. The construction costs of the project as presented to the Committee of Public Accounts account for €1.4 billion of the €1.7 billion total, meaning that over one third of the costs relate to ICT, fit-out, equipment and electronic equipment, not construction. Such costs will not be incurred for several years, bearing in mind that the hospital is not scheduled to open until 2023. In light of the level of cost escalation, I do not understand how anyone could think that there will be no further cost increases between now and the hospital becoming operational in 2023. Anyone who thinks the final cost will come in even close to the current figure must be living in Disneyland. Not only will the final cost exceed €2 billion, it will be closer to €2.7 billion than €1.7 billion. If any current Deputies are still Members of the House when the hospital opens, they will find that I may be understating the situation.

We are in this mess because the Government wanted a PR photocall of construction commencing on the site. The project was in gestation for such a long period, with the Government having failed to secure permission on the Mater site, that a decision was made to get the contractor on site irrespective of the debate over the best location. Was there a design for the hospital? No. Did that matter to the Government? No. It decided to get the contractor on site to do the groundworks and to discuss the design of the hospital thereafter. Has anyone ever decided to put a contractor on site to build a house before the house has been designed? This must rank as the most serious incidence of commercial incompetence by any Government. What happened is extraordinary.

Thereafter, the Government decided on a two-stage contract, thinking that when stage 1 was completed, it would have the option to keep BAM on site, retender phase 2 or suspend the project. The Minister, Deputy Harris, admitted that suspending the project was not a real option, while retendering would have delayed the project. It would have been bad PR for the Government if BAM had to leave the site not having won the tender for phase 2 and it might have delayed the project by a few months. That PR situation was unacceptable to the Government. The Government entered into the contract looking for good PR. However, it locked itself into dealing with BAM. The contract is so bad from the Government's point of view that it provided that BAM was to be compensated for each day of on-site delay resulting from a Government delay in making a decision on moving to phase 2. This problem began and ended with PR and politics overruling all commercial sense regarding how a contract should be dealt with.

As Deputy Donnelly stated, when contracts are for five, ten or 15 years, there should be a root-and-branch assessment every couple of years of whether the project is progressing as originally planned or whether requirements have changed. That must be undertaken as part of good governance. Obviously, there has been significant change to the hospital design since work began, leading to substantial cost increases. Are those design changes in line with current EU procurement rules? That question has not been asked until now. I would like it to be answered.

This leads on to a bigger issue. The Government announced projected capital spending of €140 billion under the national framework for capital investment and the national development plan. Assuming a final cost for the children's hospital of €2.8 billion, it will account for approximately 2% of the overall figure, leaving 98% to go.

The Government has shown it was incompetent with the first major project and there is no reason to believe it is learning lessons because it is clear it is not. It is ploughing ahead, regardless of the cost. There is a need for overall Government control of such a project. I, therefore, call for the establishment of a national capital projects management agency that would do something in line with what the NTMA did with the national debt a number of years ago. We set up a dedicated Government agency to handle it.

Let me refer to the farcical comment that the national children's hospital will be the best in the world. The best hospital in the world means the hospital that has the best doctors and nurses and provides the best medical care. A hospital is not deemed to be the best in the world based only on the design of the roof. The quality will be achieved through the provision of medical care, not by construction and design.

Many unanswered questions remain. I do not even believe all of the questions about this project have been asked to date, but we do know that the information on it is being drip-fed, which is regrettable. It has caused more confusion and public unease and certainly eroded the confidence some have in the ability of the State to manage major capital projects.

Let me begin at the start. We know that the two-stage procurement process for the project was a risk. We know this because a report on it outlined both the advantages and the disadvantages of a two-stage process, involving phases A and B. The report sets out clearly that one of the disadvantages is that not tying down the costs could lead to cost overruns. That is what transpired. Why did it transpire? I do not believe we have the complete answer to that question yet, but we certainly know some of the reasons. We know that the bill of quantities was so far out that it obviously contributed.

Deputy Wallace asked who signed off on the process. That question has not been answered as of yet, but we are aware that the Government contracts committee which granted the derogation to the National Paediatric Hospital Development Board did not sign off on it. It only stated the derogation could be taken up by the development board if it so wished. We are aware that the Department of Health did not sign off on the two-stage procurement process because it told us that it did not. We are aware that the Department of Public Expenditure and Reform did not sign off on it because it has told us that it did not. We are also aware that the Minister for Health and the Ministers responsible for both finance and public expenditure and reform did not sign off on it because they have told us they did not. That leaves only one element - the development board. Its representatives are to appear before the Committee of Public Accounts in two or three weeks' time when we will ask them whether they signed off on it. If they say they did not, we will have a major issue because nobody will have signed off on it. I am just presuming the board signed off on it because everyone else says they did not. It is simple to answer the question as to who signed off on the two-stage process. Surely it is not a State secret and somebody in the Department knows. Instead of coming to Oireachtas committees, whether they pertain to finance, health or public accounts, and saying who did not sign off on it, we should be told who did. That is the first issue.

The information coming out of the Department and the HSE is being drip fed. It is just creating conspiracy theories in some places, but it is certainly not a good PR exercise on the part of the Government when it cannot even state who signed off on the very process that probably led to the cost overruns. It needs to be honest about the information it is giving. I say this knowing that nobody is a liar in this place. I presume the Minister of State knows the cost of the PwC report. We have been told it was €450,000. At every opportunity to ask questions, including during Leaders' Questions and at committees, we were told that the cost of the report was €450,000. That is not factually true. The cost will be nearly €600,000. The Government knows it and I know it, but nobody is saying it publicly. Today I received from the HSE an answer to a parliamentary question on the cost of the report. I had asked on numerous occasions what the cost was. I asked whether it was €450,000 and set in stone. I was told that it was and that it was the maximum and great value for money. The answer I received today was that the cost was €450,000, plus VAT of 23%, which amounts to another €103,000, plus expenses. Therefore, the cost is €450,000, plus VAT, plus expenses. We cannot yet quantify the expenses because we do not know what they are. There is a cost overrun associated with the report on cost overruns. How ridiculous are we becoming? The Government knows this. It is just not being honest in the information it is giving the people. I ask it to stop trying to spin figures and stories and be honest with the people.

With regard to the cost overrun, I agree with Deputy Fleming that we do not know the final cost of the hospital project. Deputy Kelly was the first member of the Committee of Public Accounts to state publicly it would not stop at €1.7 billion and he has been proved right. Deputy Fleming has also been proved right, with everyone else who said the cost would not be €1.7 billion. The only people who are saying it will be €1.7 billion are members of the Government. They need to start being honest in the information they are giving. It is in the contract that if construction inflation exceeds 4%, the contractor can look for additional moneys. Construction inflation in the Dublin area is around 11% or 12%, which is 8% above the rate set out in the contract. That will be next year, but there is also the following year and the year after that. Therefore, there is no way the Government can state the cost of the project will not exceed €2 billion. In fairness, there is no way I can say it will not exceed €2 billion, but the reality is that no one knows what the final cost will be. I do not know whether the PwC report will address that issue. It will examine the cost overruns, what caused them and how we might be able to reduce them. As I stated, we have to await the outcome of the report.

We already have a report, the Mazars report, from the end of last year. It considered the cost overruns and went into some detail on the issue. There are many questions to be answered and we have not yet had some of the main players before any of the Oireachtas committees to allow us to question them. We need to ask about the role played by the Office of Government Procurement, people sitting on boards not being responsible or being responsible to the board and about collective decision-making. Ludicrously, the minutes of meetings of the development board involving the Department of Health and the HSE refer to cost overruns, but the Minister did not know about it. Not only that, they decided at the very same meeting, when talking about cost overruns, to write to ask him whether there was any chance he could reappoint all of them. He said "not a bother", that he would reappoint all of them. I asked him in a parliamentary question whether, prior to reappointing all of the said individuals, he had asked for a report with an update on the development of the national children's hospital.

Did he ask for any analysis of their performances as board members? Did he ask any questions at all? He did not even speak to them. He just wrote back and reappointed them, which is not good enough. The new chair of the National Paediatric Hospital Development Board will be before the Joint Committee on Health in the morning. We will ask him some questions. I hope he is more open than other members of the board in that regard. I also hope he is more open than the Department and the Government in answering questions, because they have answered very few questions that have been factually correct and they have no one to blame but themselves. They are responsible for the cock-up.

On a night where we have seen complete chaos in Britain in respect of how an omnishambles can be created, by comparison, this is similarly an omnishambles, which has been going on for a period. The idea of building a children's hospital has been mooted for decades. The process can be traced back to 1993 when the Royal College of Physicians of Ireland made its recommendation; that was 26 years ago. No one could stand over what has happened regarding the hospital. It is a collective mess and a complete and utter mess as regards decision-making, Government handling and the processes and structures that were put in place. I have spoken on the issue in the House and in committees numerous times. The situation is bizarre. It will provide a case study for business students in years to come. The bottom line is that the cost will not stop at €2 billion. My colleague on the Committee of Public Accounts, Deputy Jonathan O’Brien, said this before me, as did the Chairman of the committee, and they are deadly accurate. The cost will be closer to well over €2 billion than it will be to €1.7 billion because there will be 4% inflation and more on top of that. There are so many holes in the process, such as how we ended up in a two-stage process in the first place. I was quoted earlier and I do not wish to repeat what has been said but I have always asked that question. It was virgin territory. The question is: why now and why this? Who made the decision? Who calculated that it was the right decision to make? After all this time, we still do not know.

When we consider the events over the past year or so, it gets even more bizarre. I wish to focus on that because it goes to the essence of a Government that is in control and knows what it is doing. There are cost overruns but they have been outsourced to the board. That board has another layer on top of it because there were concerns about overruns. That board then has another layer on top of it again because there were concerns about overruns. Now there are three boards for the one project, yet this was the right thing to do and it was right to have a two-stage process. Those involved were so confident about it that nine months ago that three boards were put in place to report to one another, yet still during all of this process when overruns started to materialise at a substantial rate last summer, the Minister for Health only found out at the end of the summer and the Minister for Public Expenditure and Reform, unbelievably, despite one of his most senior officials sitting on the board, did not find out until 9 November. I have said previously in the House that that is not credible. That is substantiated by the evidence given to the Committee of Public Accounts last week by the Secretary General of the Department. That is not credible. As a former Minister, I know there are officials in the Department of Public Expenditure and Reform who would fight someone for a fiver. That is their job. Is it credible that the project escalated from €61 million to €271 million to €400 million, to God knows where it is going, and that nobody said anything? Is it possible that during the budget process, the Estimates process and the confidence and supply agreement negotiations, not one individual in the entire Department ever said there was a problem?

According to the Constitution and how we must behave in this House regarding Estimates, the process must be truthful. There were major cost overruns, which was known since the middle of last summer. Letters were sent by the constructor to the Department which ended up with the Minister at the end of August. The budgetary process had begun and it was concluded in October. The Estimates process comes after that. They were revised in December. None of that was taken into account and yet we had the embarrassing situation where the Government had to come in recently to revise the Estimates. However, we were told not to lose sleep over it because, as we found out last week, it will only cost €100 million in 2019. I am sorry, but it will be a lot more than €100 million. We do not know what the figure is, but hundreds of millions of euro that will have to be found.

I wish to ask a few questions in the short time available. Why was the PwC report not commissioned by the Government? How many people know that is the case? The report was commissioned by the HSE. Why is there such a distinction? This is not a Government report. How many times have we inside in this theatre asked questions of the Minister for Health to be told that it is a matter for the HSE and he has no function whatsoever in regard to it? Where does that leave us as regards the report, which bizarrely should probably look similar to what Mazars said in the first place, with a few add-ons? Specifically, I would like to know where it leaves us, given the fact that the HSE has commissioned the report rather than the Department. Is this a buffer zone? Why was it necessary? The Minister should explain the need for the HSE to commission the report as opposed to the Department. It has been repeatedly said that we do not know who signed off on the two-stage process. I do not know what will be the difference between the report done by Mazars and that done by PwC. The Minister had it all in front of him. He was able to hire PR firms to spin matters. He knew it would be a big mess all along. The issues relate to how we got here and I have touched on a flavour of them.

I was a member of the Government that signed off on building the children's hospital. It was the right decision. I would not have been part of a Government that made such a decision if I knew it would end up with the current scale of costs. As everyone knows, money was very tight, and there is no way we would have been in a position to make a decision based on the current costs. That is why this is a case study, and it must be analysed as to how in the name of God we got to the bad situation that we are in. Throwing good money after bad is not something I can support. However, the process that has been gone through with PwC justifies and shows comparatively that we must continue on this route while learning about cost savings we can make, as opposed to moving to any other site.

Earlier I read some documentation dating back to when I was a councillor in the area of St. James’s Hospital, which is in my constituency. Along with Councillor Tina McVeigh, I made a lengthy objection to An Bord Pleanála on the location of the children's hospital. We did not believe the site was the correct one for the hospital as the scale and the impact was too big for the location and the character and size of the area. Despite all the positive comments about public transport in and out of the hospital, it is quite a difficult area to reach, with bottlenecks on the South Circular Road, James's Street and around Ceannt Fort beside it. One of the measures Councillor Tina McVeigh did manage to retrieve from the process was the establishment of a residents monitoring committee. She told me earlier that the big issue at the moment is the structural impact on the houses in Ceannt Fort where some are showing cracks in the walls.

They rattle and shake during the impact of the construction. There is massive noise, dirt and pollution and the construction traffic is a nightmare. The same will be true for the construction traffic coming down Davitt Road from Drimnagh in the future.

All said and done, An Bord Pleanála passed it and the hospital was to go ahead. As the fellow said, we are where we are and we get to where we are. Much has been said about the mess in which we are. However, I want to draw particular attention to the process of public procurement itself. It has been proved to be entirely flawed not just in the case in the children's hospital but in the case of broadband. In 2013, when the Government, of which Deputy Kelly was a member, and the troika ran the country, it was decided we needed a public procurement officer. Mr. Quinn was appointed as the State's first public procurement officer and is still in place. His aim at the time of his appointment was to save the public purse €500 million. Six years later and one only needs to look at the mess we are in with broadband. In answer to a parliamentary question I tabled, it was stated €18 million was spent on finding out which company could retender for the broadband plan. We are now left with one bidder which is as an entire mess. It looks like the rest of the country will be left in the dark if compared, as the Minister is fond of doing, with the rural electrification process in the 1950s.

What is striking about what is going on with public procurement is that the public procurement officer is also a member of the board of the National Paediatric Hospital Development Board. He, however, failed to tell the Minister for Finance and Public Expenditure and Reform that an overspend had occurred. The Taoiseach stood over that in the House stating that if somebody is on a board, his or her fiduciary and legal responsibilities are to the board and the correct line of accountability is to the chairman of that board, not the line Minister. We now know that this is not the case. It still remains for the Taoiseach to correct the record of the Dáil.

The next biggest farce in all of this is that the investigation into the overruns is being carried out by PwC. There has to be a conflict of interest when PwC has long-standing relationships with the main contractor, BAM, and the HSE. We have tabled an amendment to the motion, which we will be supporting, that there should be a time limit put on an investigation, namely, six weeks. Otherwise we could have an overrun of time as well as of money.

The Government is behaving like Macbeth, the king who was afraid to step back from the blood he was up to his knees in. It is about time the Government pulled out of this and investigated an alternative.

An issue which has not figured in this debate to date is the question of worker exploitation at the national children's hospital project site. This is an issue which must be dealt with and stopped wherever the hospital ends up being built, be the St. James's site, a greenfield site or Connolly hospital. The contractor at the site, BAM, has a network of subcontractors. One of the subcontractors it frequently uses is Kwik Structures. On 7 February 2018, my colleague, Deputy Paul Murphy, told the House that the company was responsible for illegal super-exploitation of construction workers, many of them migrants, at a BAM student accommodation project at Grangegorman and Boland's Mill. He instanced the fact that Kwik Structures was paying significantly below sectoral employment order, SEO, rates, was not providing workers with payslips and had not registered its workers with the construction workers' pension scheme.

Since then, Kwik Structures has moved on site at the national children's hospital project. Has any action been taken on foot of the charges made by Deputy Paul Murphy over a year ago? Is this company now paying employers’ PRSI? Is it providing its workers with payslips? Has it fully declared the income tax on P60s? Does it have offshore accounts to avoid paying tax? Has the Minister looked into this matter over the course of the past year? Does the Minister not want to look under that particular rock as he is afraid of what he might see?

This is an issue which has importance in and of itself. It is also an issue which has a wider importance. The national children's hospital is meant to be the jewel in the crown of €115 billion worth of national development projects. The standards for all projects are meant to be set at this hospital. What is the position regarding worker exploitation? The Government, the Revenue Commissioners and the Department of Employment Affairs and Social Protection are turning a blind eye to it. They are showing a reckless disregard for workers’ rights and a scandalous dereliction of duty in terms of collecting tax revenue for society.

Sections of the media have tried to make out that construction wage costs are a factor in the overruns. They are not. The entry level wage rate for construction workers is €28,000 a year. This is a sector of the economy which has seen record profits, up €1 billion in 2018 from what it was in 2017. The issue is not of workers being paid too much but of worker exploitation and super-exploitation. It is alive and well on the construction site of the children’s hospital. For these reasons, we support the 12% wage claim over three years that the construction unions have submitted. We also support their claim for a one-hour daily travel allowance.

We will be supporting this motion. We think the point raised by Deputy Bríd Smith about the review being time-limited is important. There should be no suspension of employment for any worker in the event of a suspension of the construction. The issues of the cost of the project and the accessibility have to be important factors in that.

I call Deputy Joan Collins who is sharing time with Deputy Clare Daly.

The plan for the children's hospital has been on the agenda since the 1990s when a single tertiary children's hospital for Dublin was proposed by the Royal College of Physicians of Ireland and recommended to be built on an adult hospital site. That was three decades ago and our children are still waiting for a hospital of such a standard. In 2006, the McKinsey report recommended a single national children's hospital into which the three existing children’s hospitals in Dublin would be merged. From that point, the children's hospital became a political football.

The Mater site was pushed by Fianna Fáil and the then Taoiseach, Bertie Ahern, who wanted it in his constituency. In 2012, An Bord Pleanála refused permission for the Mater site and €35 million was written off as a result. After that report, the then Minister for Health, Senator James Reilly, set up the Dolphin report which announced the new site at St. James's Hospital. A planning application was submitted and we know the story from there. Its cost was estimated at €650 million but now has gone up to €1.73 billion.

It is an absolute scandal. The community in which I live, Dublin south-central where the hospital will be located, finds this incredulous. We know damn well that anybody who gets an extension goes to an architect to get a plan and then a price from the builder. Half the price is paid halfway through and only when all the completion snags are finished is the full amount paid. I know the hospital is a much more complex project but we put a board in place to monitor costs. I said recently that the work should have stopped and costs reviewed. A decision to continue or to retender should have taken place then. That has not happened. The Government has continued with its line.

In my dealings with the National Paediatric Hospital Development Board, many questions of concern were raised. Eminent paediatric professionals had come out clearly and stated: "We are unequivocal in our certainty that the campus at St. James’s Hospital is the right location for Ireland’s much-needed and much-wanted new children’s hospital." There are many reasons the campus shared with St. James’s Hospital is the right location for the new children’s hospital, but the primary one is that it has the greatest number of clinical specialties that will best support our teams in the delivery of better services and clinical outcomes for our sickest children and young people. That is the key point why I support this hospital. There are significant concerns in the community. We dealt with those concerns by supporting the residents’ project monitoring committee. I am not a professional paediatrician. However, paediatricians in the three children’s hospitals said this was the best site. I do not support the motion.

I salute Deputy Mattie McGrath and the Rural Independent Group for tabling the motion. A narrative has been put about that the damage has been done, it is an absolute scandal but what can we do? It is too late. The motion before the House this evening puts a lie to that. All the Deputies who stand up and speak of a scandal but who do not support this motion are facilitating a continuation of that scandal. They are equally responsible as the Government if they take that position because it is not too late. It is shocking when one considers all the questions that Deputy Wallace had put down. He is someone with an expertise in building in this area. Not one of those questions has been answered yet. People in the know know that this project was not normal. It was not an unforeseen accident or unfortunate occurrence. Mistakes have been made that need to be analysed and somebody somewhere must be held accountable for that, but we are not doing that. We need to halt these works now. Everyone who does not support that action is facilitating the scandal because it is blindingly obvious that the right thing to do is to stop pouring money down a hole. We do not know what the limit is going to be but we know that it will be well in excess of €2 billion.

Some say that if we do not continue that there will be delays. The Committee of Public Accounts was told that re-tendering would add two years to the project. Deputy Donnelly said that it would be ten years, in his opinion. That is not a substantiated opinion, backed by evidence, mind, just his opinion.

That is why I called for a report.

The Deputy should not interrupt.

Deputy Danny Healy-Rae is one to talk.

This is the absolute nonsense that we have had to put up with on the matter. We want concrete figures and concrete explanations. We do know, however, that the National Paediatric Hospital Development Board has applied to Dublin City Council to stay in its head office for a further five years, that is beyond the proposed completion date, so it expects the project to overrun. A greenfield site at Connolly Hospital is a better bet. We know that issues such as the need to co-locate the maternity hospital would not be facilitated on the James’s Street site. I must appeal to all the parties here. If they do not support the motion, their words are utterly shambolic. We owe it to taxpayers, to our children and to the medical profession to do that.

I compliment Deputy Mattie McGrath and the Rural Independent Group on tabling the motion. I ask how anyone reading the motion could vote against it but it is no more than many things that go on here, unfortunately, the same wagon wheel turns and the same fiasco keeps going.

Are engineers, architects or quantity surveyors working on the PwC report? Generally, accountancy firms do not employ such people. If we wanted this to be done transparently, we would bring people in from outside the country.

We know that the State is not fit to build anything efficiently. It cannot do it. There are a few different types of contracts. There is yellow form, blue form and design and build. Had we a brain in our heads we would go with a design and build process and put the pressure back on the builder. We would look at the different submissions that were made and pick out the best. However, we do not seem to want to do that. We want to keep trying to waste money.

We are building a hospital that cannot land a helicopter and that is not accessible by car. People coming from the countryside cannot get to it. It is not possible to put the maternity unit onto it. What geniuses are persisting with this? A proper external review should be done. I went out to the site with other Deputies. We looked at it. The only thing that has been done is the retaining walls. If the volume of money that I heard had been spent has been spent, someone is on a good old touch. All that is done is the retaining walls and a lock of columns. One could make a car park out of the part that has been done.

I also want to put on the record that I am worried that down the road there will be a problem with getting out water after heavy rainfall. I have a small bit of knowledge about construction and I worry about the systems in place to get the water out.

This is about taxpayers' money. If the Government is genuine about this we should halt the process.

Fairy tales are what come to mind when one hears the Government’s excuses and explanations for the huge overrun at the national children’s hospital. One could not make it up. The last time I spoke here on this, I said that anyone with a whit of common sense would not believe what the Government is saying. That is even more true today than it was then.

At that stage, we were laughably told that the Minister for Health had not told the Minister for Public Expenditure and Reform about the overrun as he had not completed his own investigation. Now we are told that the chief procurement officer, who is a member of the Minister, Deputy Donohoe’s Department, was not acting in that role on the hospital board, if we can believe it, but he had been appointed by the Minister for Health in a personal capacity, and that is why he was not required to report to the Minister for Public Expenditure and Reform. These are fairy tales, more fairy tales and excuses.

Furthermore, when the Committee of Public Accounts called the procurement officer to appear before it, he did not. Why was this? The Secretary General said that he did not pick him on his team. The Secretary General thought that another individual from that section would be more appropriate than the procurement officer. Anyone who believes that will believe anything.

The PwC report is another fairy tale. Deputy Jonathan O’Brien told us that the report, which was supposed to cost €450,000, will now cost €600,000. The biggest fairy tale of all is the actual cost of the national children’s hospital. It started at what was a reasonable enough figure of €650 million. Everyone in this House knows that if this hospital continues, the cost will be in excess of €2 billion. It is much more likely to be €2.5 billion. That is an absolute scandal.

We know now that there was a cover up by the Government. It was ensuring that it was not officially informed of the position because it was preparing for a general election. The Government was afraid that Fianna Fáil would pull out of the confidence and supply agreement and so it wanted a good budget.

We now find ourselves in a position where a considerable number of capital projects around the country will be suspended, delayed or deferred as a result of this huge overrun. Some of those affected in my own constituency include the unit at University Hospital Limerick, which covers the north of County Tipperary, and the 40-bed modular unit at South Tipperary General Hospital in Clonmel, which, even though it will be completed and constructed later this year, is unlikely to open fully.

As I refer to that, I ask that we finally get confirmation of what funding is being made available to South Tipperary General Hospital to open that unit. A number of us have raised it here as a Topical Issue matter and we have not got figures. We raised it in parliamentary questions and we have not got figures. I have written to the Minister and I have not got figures. It is time that we got the figures. How much is provided for equipping and staff the 40-bed modular unit at South Tipperary General Hospital? There is the question of a 100-bed unit for the elderly at Cashel. Will that be delayed?

Of course, there is the shocking situation of mental health services in Tipperary where the 50-bed inpatient psychiatric unit at St. Michael's unit in Clonmel closed in 2012. We now have a situation where there is no inpatient service in the county and the unit in Kilkenny, where south Tipperary patients must go, has been the subject of a court case by HIQA recently. It is shocking. That unit in Clonmel needs to be opened and we can have no deferral, suspension or delay of those projects.

There is no question in my mind but that the site at St. James's was never the right site. I believe the motion is reasonable and that within a reasonable time span, proper investigation should take place, a new greenfield site, which would allow costs savings, should be investigated and the national children's hospital built there.

Deputy Danny Healy-Rae is sharing with Deputies Nolan and Fitzpatrick.

I believe this is the biggest single scandal that ever happened in this country. In March 2017, our group told the Government that this was going to happen. Many of the members of parties, who are jumping up and down now, voted against our motion when we asked that the hospital be moved to some greenfield site. They voted against our motion and now they are jumping up and down as to what happened and why has the cost escalated to such proportions. We clearly identified what was wrong at that time.

We clearly asked as well that this children's hospital should be for children from all parts of the country. I spoke to a Deputy from Dublin here the other day and he said that he thought the reason they went for it and why in their opinion it was the right site to use was because the Luas was servicing it. We do not have a Luas out west in Kerry or along the western coast, and we do not have many other modes of transport that the people in Dublin have. Certainly, what we would need, when there is a crisis and when a child needs to be brought up, is to use the largest helicopter which can fight the winds and land at the hospital door but we are told now that this type of helicopter cannot land at this site.

We have the debacle whereby many projects will be delayed, held up and put back. Many years ago, I had a request at the HSE south forum that there would be a community hospital in Killarney. It was progressing away well but now we know it will be deferred. The population of Killarney quadruples in summertime and we need a new community hospital to enhance the services that we could give there.

I am not aiming at the Minister of State, Deputy Canney, but am directing my venom at those who are not here who should be here and that is a scandal as well. They should be sitting here. Certainly, if we were talking about abortion, the Minister, Deputy Harris, would be there. There would be no doubt about it. I suppose that is what happened. The Minister took his eye off the ball because all last year his only concern was abortion and he forgot about the children's hospital. He only left it plough on whatever way it would happen.

In Tralee, we are waiting for extra beds that have been promised but they are not materialising. There are many patients on trolleys in pain, waiting for proper attention. After all their life given to working for this country, it is wrong that so many of them finish up dying on a trolley because we cannot put them into a proper hospital bed in Tralee general hospital.

We have people who need eye treatment and could not manage, except for the number of buses as these days, we again have three buses going up to the North of Ireland. There were three in February, three in January and there will be two more in April so far. The story goes on. We cannot deal with those patients in our own country.

We will see Dingle hospital half opened. As for all the other projects, I mentioned today the Kilcummin sewerage scheme that has been promised to the people for the past 15 years. That has been put back and that is because of this issue. We have the site, with props holding up the sidewalls in the hope they will keep the houses from falling in. That is not right. What we asked for and what we wanted is a greenfield site which would be accessible for all the children of the country.

I am taking someone else's time. I could go on here for a long time.

Deputy Nolan, please.

Gabhaim buíochas leis an Rural Independent Group a chuir an rún tábhachtach os ár gcomhair anocht.

Tá sé an-soiléir go bhfuil fadhbanna ollmhóra, serious concerns about the overspend on construction costs of the new national children's hospital. These costs, as we all know, represent an increase of 300% in the costs since the original tender.

It is shameful that the Minister for Health himself cannot be here tonight. It clearly shows the lack of respect towards rural Deputies in this House. We were elected to this House to represent our parts of this State as well and it is a disgrace that the Minister is not here to hear those concerns. I will be asking the Minister for a direct response because he represents all of the State, not only Dublin.

The public has expressed concern and outrage over the fact that the current cost of construction of the national children's hospital stands at €1.4 billion. This cost is rising and as has been pointed out here tonight, will not stop at €2 billion. The project represents the most dramatic and unprecedented cost escalation level for any single health project in the history of this State. That is some achievement.

The Minister for Health is responsible for that, whether he likes it or not. As has been pointed out here tonight, he took his eye off the ball. He got a fixation and he had an agenda. He wanted to push that agenda and he forgot about every other section in the health service, and we are seeing that day by day.

There are serious concerns over the possibility of not having a maternity hospital co-located with the national children's hospital as the plan now stands. Neither the Minister nor the Government has taken these concerns seriously. It is both unfair and unacceptable that many projects in rural areas will now suffer the consequences brought about by the Government's arrogance and failure to acknowledge that it made serious and unacceptable mistakes in respect of the national children's hospital project at St. James's.

Even at this late stage, I urge the Minister, and, indeed, the Government, to do the decent thing by the taxpayer, who has borne the brunt of this terrible mistake and the reckless and unacceptable choices the Government has made. The Government should do right by the children who need healthcare outside of Dublin. We must ensure that they have accessible healthcare.

An independent investigation to assess the viability and cost of retendering the project and transferring its location to a greenfield site should be carried out. I believe wholeheartedly that it is the fair way to proceed and we should not be proceeding when this has proven to be unsuccessful and detrimental.

This Government has shown itself to be arrogant and has clearly said "Slán" to proper, accessible healthcare for our children living in locations outside Dublin. That is outrageous and clearly shows how out of touch this Government is. It not only lacks common sense but also a vision for the country.

In supporting the motion, I want to raise awareness of a couple of matters that are causing me and my constituents great concern. At a meeting in my constituency office in Dundalk not long ago about restrictions in services offered at our local hospital, Louth County Hospital, one of my constituents asked me why in Ireland we have the most beautiful civic offices and public buildings but some of the worst hospitals. We do not need to build a "design statement" trophy hospital that has caused massive overspending; we need a hospital that delivers the best service with the highest standards of care to sick children that the State can provide. A state-of-the-art postnatal trauma unit, a world-class paediatric oncology unit and a dedicated burns unit are needed, to name but a few. We need a facility where the mother and child can be cared for under the same roof and where family can be accommodated with a little comfort and dignity. We want our children to have treatments in Ireland and not other countries. We need to bring an end to long waiting lists for paediatric treatments.

It is possible to build a world-class facility without overspending and affecting the taxpayer. It is incredibly unwise to build an underground car park beneath the hospital in question and Deputy Mattie McGrath's health and safety concerns should be considered. Why did a portion of Leopardstown racecourse adjacent to a main road, and which is State-owned, not get enough consideration when potential sites were being discussed? This greenfield site is located adjacent to the N11, M50 and the Luas. The roads and infrastructure have been designed to diverge traffic to and from the site in all directions. Not giving this greenfield site proper and serious consideration was at best a major mistake and it now needs to be considered as a matter of priority.

The horse racing and gambling lobby in this country is influential and it may have many friends in this House. However, the welfare of sick children should be prioritised and proper consideration should be given to this site, with its many natural advantages, not least of which is that the State owns it. We call on the Government to immediately suspend construction of the national children's hospital at the St. James's Hospital site, pending the outcome of a time-limited independent investigation. We call on the Government to transfer the location to a greenfield site, which should be the Leopardstown site.

It is clear from the debate that everybody in the House shares a commitment and determination to ensure that the children and young people of Ireland and their families can access world-class health services as soon as possible.

This project presents a once-off opportunity to deliver adult, maternity and paediatric services on a single campus. The benefits of tri-location of a children’s hospital, maternity hospital and adult hospital are well established and this is provided for in the St. James's site master plan. A greenfield site does not give the benefits that tri-location presents. The children’s hospital on this campus will also be a research-intensive academic healthcare institution. The establishment of the children’s research and innovation centre on the St James's campus will help support and embed a culture of research, education and innovation in modern paediatric practice in Ireland.

At an early stage in the procurement process, it was determined that a traditional method of procurement was not suitable or realistic for a project of this size and complexity. The difficulties around adopting a design and build tendering strategy on large public sector projects had already been recognised, and this informed the decision by the National Paediatric Hospital Development Board to adopt a two-stage procurement process. This strategy was intended to deliver key objectives and deliverables for the project in compliance with strict public and EU procurement rules and reduce risk.

The two-stage procurement process has brought issues to the fore. It has allowed claims to be addressed upfront, prior to main construction, rather than as is traditional throughout the project and beyond. It helped reduce the exposure of the project to increasing inflationary pressures in the construction market through procurement at 2016 tender market rates rather than 2018 rates. Finally, it allows a GMP to be determined, with this only adjustable for clearly defined exclusions such as changes in scope, excess national construction tender inflation above 4% post-July 2018 as per the average of three published tender price indices and changes in legislation such as VAT, statutory labour rates or building regulations. This means that other than in respect of these exclusions, any amount in excess of the GMP ceiling cannot be recovered by the contractors. This two-stage approach would also deliver the hospital as soon as possible, mitigating the time lost following the Mater site planning application refusal. This approach allowed early commencement on-site, two years ahead of traditional procurement. Let us make no mistake - considerable work has been undertaken on the project since 2017.

When the Minister for Health was faced with this cost overrun, he had three options. The first was to pause the project and the second was to retender the project. However, the expert advice was that retendering the project would have cost more for the taxpayer above and beyond the significant existing cost and would have increased the time it would take to deliver this project. The third option was to proceed, which is the decision that the Minister and the Government took. The increase in costs for this project was not envisioned and is certainly not welcomed by this Government or me. It is precisely because of this that the Government has commissioned an independent report to examine the project to date and learn from the issues that have arisen in the project thus far. The HSE engaged PwC because a framework agreement is in place and it could be taken in straight away. The Government will carefully review the report of the independent review when is made available.

There is a will to review and act on the lessons learned from this project to date. The Minister for Health has made it clear that his Department will work with all stakeholders to ensure all weaknesses are identified and comprehensively and speedily resolved, and that robust governance and oversight arrangements can be put in place to ensure the completion of this project on time without any further surprises.

Lessons are being acted upon. The Minister for Public Expenditure and Reform has made it clear that the experience of the new children’s hospital cost overrun must be drawn upon and lessons learned. He recently announced that the State is speeding up the reforms to our public procurement process put in train as part of Project Ireland 2040. As part of these reforms, the Government will now no longer pre-commit to major bespoke projects until there is clarity on tendered costs; in the future, the budgets for large bespoke projects will include a significant premium for risks in order that these indicative costs more adequately reflect the holistic total for the entire project over its life cycle.

We must not lose sight of the fact that we must strive to deliver on the promise of improved service delivery to the young people of Ireland and their parents. They matter, their care matters and their needs are a priority that we now have the opportunity to address well. There is a desire in this House to provide for the improvement of services to sick children and their families. There have been serious issues but now that we have a project under way that will truly redefine the standard and quality of care available to the young people of Ireland, we cannot let it be sidetracked or delayed. It is vital that we learn lessons but also that we continue to advance this project without unnecessary delay and build this hospital that is so badly needed for the children of Ireland. It has been eloquently argued by everybody that we have been talking about this since the 1990s. The Minister for Health and this Government remain committed to delivering on the vision to improve services for the children and young people of Ireland and to continue to make progress on the new children’s hospital project on the St. James's campus, and at Tallaght and Connolly hospitals.

This project is about more than just building works; it is about the difference we will make to children and young people by implementing a new model of care in a timely fashion. One evident practical benefit is that the outpatient and urgent care centre at Connolly hospital will start delivering improvements to healthcare for children this year under the responsibility of Children's Health Ireland.

We truly are at a period in time when we have an unprecedented opportunity to deliver a hugely positive change in healthcare for Ireland's children and young people. Finally, I invite Members of this House to join with me in ensuring that, while recognising and meeting legitimate concerns, we get on with delivering this vital project.

Regarding Deputy Healy's queries, the HSE is developing its capital plan for 2019, which will be published very shortly. This plan will set out what is happening for 2019.

I am happy to take the opportunity to wind up this evening's debate. Before I do, I thank my colleagues in the Rural Independent Group for agreeing to bring forward this motion and putting so much time, effort and energy into it. I also thank David and Mairéad in my office for working so hard. I also thank Deputies Mick Wallace, Clare Daly, Seamus Healy and Michael Fitzmaurice as well as Deputies Carol Nolan and Peter Fitzpatrick for their support. Finally, and most of all, I want to thank and welcome the families of the sick children who are at the centre of this motion and to welcome very hard-working people from the Connolly for Kids campaign. They must be quite bored and disgusted. While there were four of us here, there were never as many as four Members on the Government side. There were two when the Minister of State, Deputy Canney, came in. There was only one junior Minister. It is an insult that the Minister for Health would not even bother to come in here for this debate tonight. It is a scandal. I am really disappointed in the Minister of State. It is nothing personal but the Government shoved him in here - a newly appointed junior Minister and an Independent Deputy. He came in here and read out that diatribe to us. The Minister of State is a quantity surveyor and a former lecturer in an institute of technology. God help the students if that is the diatribe he expects them to believe and I do not think he does. I am surprised if reading out that diatribe tonight is the price of power. It is unbelievable.

All of us are doing this so that all the children of this island can have access to a hospital that is truly fit for purpose and cherishes all of the children of the nation equally. Where did we hear that before? We heard it in 2016 during the centenary of the 1916 Rising. The Government should be ashamed of itself. In March 2017, when my colleagues and I first put down a motion on this issue, we believed that the evidence was so obvious and clear that anyone who took the time to review it could only be persuaded of the need to locate the national children's hospital at a greenfield site. It is so obvious. Being a quantity surveyor, the Minister of State should know this more than anyone. Unfortunately, as we know, the majority of Members either abstained or voted against us. They sat on their lámha like Fianna Fáil is doing again tonight. Fianna Fáil is so used to doing that, it does not know what else to do. At that time, the Minister of State, Deputy Catherine Byrne, said we were at a point at which a world-class design with child-friendly, high-spec modern interiors and acres of outdoor space had been completed and had received planning permission following a robust planning application. We know now that this was not the case. One could not swing a cat in it never mind see acres of outside space. The roof garden on top of the hospital will be the most polluted site in the city. What we are closer to today is one of the greatest health-related capital infrastructure scandals in the history of the State and the Minister of State will add his name to it for posterity.

I heard no willingness on the part of Government to genuinely engage with even the possibility that this might still be the wrong site and the wrong location. Instead the Government appears to have dug its heels in and decided that no amount of evidence or pleading will work against delivering the project at St. James's. As was noted by other Deputies here tonight and as we noted in 2017, it is a national disgrace that the interests and vanities of medical academics - certain third-level institutions like our neighbours, Trinity College over the road - and political inability to admit a mistake has taken precedence over the pleas of parents of the sickest children. Shame on you. I repeat again that none of the arguments put forward by the Minister has 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 are ashamed to come in here, 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 where the best outcomes can be achieved. That is the excuse they give.

There is another falsehood I want to debunk because we believe and have evidence to support our belief along with doctors who agree with us that the hospital can still 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 where the best clinical outcomes could be achieved with co-location where one has the necessary space. As a quantity surveyor and a former lecturer, the Minister of State should know that above anyone else. I reiterate a saying of Mahatma Gandhi - "it doesn't really matter how fast you're going if you're heading in the wrong direction" and the Government certainly is, as is the Minister of State as a new addition to it. 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 have heard - as have Government members - the ambulance drivers and nurses screaming "how long more to get to this place?" 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. Do people in rural Ireland matter? The Minister of State is from rural Ireland; he should know. What about people from some parts of Dublin, which are as bad as rural Ireland because the traffic is so bad, trying to gain access to the congested St. James's site? I hope and pray that day never comes but I fear it must if we persist in the madness of pursuing the present location of the national children's hospital.

Colleagues here tonight have raised compelling arguments for the suspension of the project pending an independent investigation. Indeed, I cannot see what can possibly be lost by agreeing to such a request. It would be time-limited. I accept Deputy Bríd Smith's amendment. If the Government is worried about losing time then I suggest it thinks about the loss of time from another perspective. What about the loss of time for a parent of a sick or dying child who is stuck in traffic? Just consider that for a moment. They are obviously ashamed to consider it because they did not come into the Chamber. What about the loss of time for a parent who may have to go on and give 24-7 care to a desperately ill child who could not access the location quick enough? What about the loss of time for the children who may never know what it is like to run and play with their friends because they have suffered an irreversible disability or injury due to the lack of co-location with a maternity hospital? That will not happen. We were told by clinical experts that children born with brain difficulties have a maximum of 12 minutes to have an operation.

In light of this, I plead with every Member of the House to support the motion and do the right thing. I ask them to leave aside political loyalties and place their loyalties instead with the families and children who know, far more than most, that continuing at St. James's represents a catastrophic error of judgment. It is unbelievable. Deputy Donnelly mentioned all the people telling him that it is the right place and the right decision and nobody says otherwise. I would ask Deputy Donnelly to examine his conscience. The following groups made up of parents and patients are 100% opposed to the construction of the national children's hospital where it is proposed to be constructed. They are out fund raising every day. I was at a launch for Daffodil Day. We are all fundraising. The Government is squandering money like it was confetti at a wedding. Eight hundred families whose children have scoliosis, groups representing children with complex heart conditions north and south, LauraLynn Children's Hospice, the Extra Special Kids Group, Aoibheann's Pink Tie, the Jack and Jill Children's Foundation and many others are all 100% opposed and Deputy Donnelly is ignoring them because he is giving the Government a free pass. He sheds crocodile tears here like his leader, Deputy Micheál Martin, and says how awful the Government is but he still gives it a pass. Let members of the Government travel all over the world for St. Patrick's Day and do not demand that the Minister comes in tonight. It is an utter disgrace that no senior Minister came in for this debate - only two junior Ministers. If you want a job done, do not bring half a person and half a shovel. The Government has dug a hole and has gone down so far, it can never come out. It will be in hell next and it deserves to go to hell and perish there for this. I should not even be getting angry because I am wasting my breath on the Government.

We have analysis done by experts to rebut the Government and Fianna Fáil's amendments. When Brexit disappears, the Government will need somewhere else to hide. There will be no place to hide. The Government cannot hide from sick children and their families. The rebuttal of the Government's arguments in its amendment was unbelievable. We were told that clinical considerations were paramount in the Government's decision. According to the rebuttal, no study has ever shown that co-location of a children's hospital with an adult hospital provides any advantage whatsoever for the treatment of sick children. This is a fact. The argument that the Government’s decision to redevelop the Coombe Women and Infants University Hospital on the St. James's campus in the context of achieving tri-location of adult, paediatric and maternity services is wrong. According to the rebuttal, the site at St. James’s Hospital is incapable of accommodating the maternity hospital. It is just not going to happen. The former Master of the Coombe Hospital said that. It is just pie in the sky. Regarding the argument about the capacity of the site at St. James's to accommodate the new children's hospital and maternity hospital and the incorporation into the design of the children's hospital of the required operational links with both maternity and adult hospitals on the St. James's Hospital campus, the rebuttal states that if the children's hospital goes ahead on the St. James's site, a full service maternity hospital cannot be accommodated there. If one goes out and takes one look at the site, he or she would know that. If somebody flew over the site on a helicopter, he or she would see it. The rebuttal states that we know this because despite being requested several times by An Bord Pleanála to provide a master plan showing how the maternity hospital would be accommodated, it has never been in a position to do so as the site would have been so overloaded with the children's hospital that not a single additional car parking space could be provided.

Dublin City Council has emphasised time and again that hospitals cannot function without parking spaces. It is just farcical.

I have a letter from Dr. Jimmy Sheehan. I thank him, as well as Dr. Finn Breathnach, Dr. Róisín Healy, Ms Aisling McNiffe and the countless others who have helped us and tried to talk sense. In recent days Dr. Sheehan wrote to every Member, including the Minister of State, Deputy Canney. The letter reads:

There is now an opportunity to consider this option on a greenfield site.

Existing work on the St. James' site can be completed to ground level with the provision of the planned multistorey car park, leaving the site above ground for future expansion of the adult St. James' Hospital, for whatever needs arise [of which there are many at this time].

I have previously stated on the public record at the Health Committee meeting, and repeated publicly on a number of occasions, that I would undertake on a pro bono basis...

The Minister of State knows what on a pro bono basis means. Some colleagues would not know a pro bono basis from a junkie and-----

I thank the Deputy.

I am nearly finished. The letter continues:

...and with no vested interest whatsoever, other that the future care of the children of this nation, to project manage, or help in any other capacity in the provision of the Children's Hospital.

The Government can do it. It is not too late, despite its pig-headed stubbornness. Perhaps when Ministers come back, having donned the shamrock all over the world, they might show vision.

I thank the Deputy.

The vote will not take place for ten days. It is a good job that it will not take place tonight as the Government would lose it abysmally. No senior Minister could come into the House, except two Ministers of State.

Please, Deputy.

It is an insult to the democratic process that no Minister has turned up. I ask every Member to consider this during the St. Patrick's Day holidays and talk to the parents of sick children. They should then come here and do the right thing when we vote on the motion.

Amendment put.

Since a vote has been called, the division is postponed until the weekly division time on Thursday, 28 March 2019, in accordance with the order of the House outlined earlier today.

The Dáil adjourned at 10.05 p.m. until 10.30 a.m. on Wednesday, 13 March 2019.