I move amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
— 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;
— 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;
— 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, Deputy Harris, 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 trilocation 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.