National Children's Hospital Costs: Statements

In recent weeks there has been significant debate and discussion about the development of the new national children’s hospital and the increase in the cost of the project. These statements provide another opportunity to discuss the issue following the publication last week of the report of the independent review of the escalation in the national children’s hospital costs. Last week we had a good, lengthy discussion, with questions and answers, at the Joint Committee on Health. With the Minister for Public Expenditure and Reform, Deputy Donohoe, I will revert to the Government with proposals to respond to the PricewaterhouseCoopers report and implement the recommendations within one month.

I reiterate the extreme disappointment and deep unhappiness the Government and I, as well as all those involved in the project, feel at the cost escalation over that originally committed to by the Government in 2017. That is why on 18 December, at the same time as the Government approved the construction investment to allow phase B of the hospital to be constructed, the Government also approved the commissioning of an independent review of the cost of the capital project. As Deputies will be aware, the independent, comprehensive review process was carried out to examine the contributory factors and associated responsibilities in order that any potential weakness would be identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds. The terms of reference also required the review to address major residual risks, control and oversight issues and bring greater oversight of performance and value for money. It was also required to develop recommendations which might identify any area of potential cost savings or reductions consistent with the applicable contractual undertakings and the delivery of the project.

The report on the review process was considered by the Government last week, on 9 April, and published that day. I was always clear that it would inform the next steps by decision makers, including the Government. The Government noted the findings made in the report and, as I stated, the Minister for Public Expenditure and Reform and I will revert to it in one month with an outline of our plan for implementation of the recommendations made in the report.

Our two Departments have begun work on this, giving detailed consideration to the findings and recommendations and how best to move forward to ensure, as was the ultimate purpose of the review, and it bears repeating, that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of this much-needed project and the effective management of public funds.

The Government is committed to ensuring the successful completion of this project and let there be no doubt about this. While the views that we all share regarding the cost of this project are legitimate, I know that none of us forgets that the purpose of the project is to deliver transformational change to the delivery of healthcare for children in Ireland. I have said many times before, and I reiterate here again today, that the children and young people of Ireland have been waiting far too long for a modern healthcare facility, and this new children's hospital project will transform the delivery of children's healthcare in our country.

The new children's hospital project will be a game changer in the delivery of services for children. The successful delivery of that game changer is why we need to be very careful in our consideration of the specific and significant recommendations of the PwC report. In all, there are 11 recommendations, of which nine are directly linked to the new children's hospital project and the management and mitigation of the residual risk of potential further cost escalation. The other two are relevant to the delivery of major capital projects generally in Ireland and, as such, come under the remit of the Minister for Public Expenditure and Reform. The Minister for Public Expenditure and Reform, Deputy Donohoe, and I will revert to Government in May to outline our implementation plan for the recommendations contained in the report. I do not intend to comment in detail on our response to the report in advance of completion of these deliberations.

On the report's recommendations, the first nine recommendations of the report, namely, those relating to this project, identify steps to be taken by all stakeholders in the project relating to project delivery, control and assurance. These range from a review and, if necessary a revision, of the scope and responsibilities of the advisory firms that constitute the design team to reflect their future roles in the performance monitoring of contractors, to strengthening the capacity and capability of the National Paediatric Hospital Development Board executive, and right through to putting in place a scrutiny process that includes all levels of the governance structures to review all proposals that are focused on reducing the gross maximum price.

As I have said, the Department is working on this implementation plan, mindful there is not a moment to lose in ensuring that any deficiencies are addressed, including, where necessary, developing and implementing more robust project control and project assurance plans appropriate for a project of this national importance right throughout the remaining construction programme. In doing so, consideration will need to be given to the report's warning of potential loss of corporate knowledge. This is appropriate, now that the focus is on maintaining corporate knowledge and expertise and on strengthening and supporting the project by building further capacity and capability. The recently appointed chair of the National Paediatric Hospital Development Board is very mindful of this and will work with the Department, the HSE and the Department of Public Expenditure and Reform to ensure that the board and the executive are supported while also challenged in their statutory role to deliver the new children's hospital project.

The terms of reference for the independent review required the report to be completed by 29 March. This was extended by a week to enable fact checking to be completed. As Deputies are aware, the independent report concluded that taking any alternative course of action other than continuing with this project would, in all likelihood, have resulted in significant delay and increased costs and the possibility that the hospital would not be built. I was given advice by some in the House to take an alternative course of action, and the PwC report has found the correct judgment call was made at that stage to proceed with completion of the project.

This debate would not be complete without a reminder of the significant progress that has been made on the project. This progress was noted in the report of the independent review. After false starts and failures to build the hospital over many years, as referred to in the PwC report, the completion of enabling and underground works has been dealt with, amid difficult issues such as planning, and the project is now in the major construction phase. Considerable work has already been undertaken on the project, with Phase B above ground works under way at the St James's Hospital site. Works at the urgent care centre at Connolly Hospital are on target for practical completion of the building this month, with works at Tallaght Hospital urgent care centre under way, with a target handover date of July 2020. The facilities at Tallaght and Connolly hospitals, both of which will be open by next year, will see 33,000 additional children's outpatient appointments carried out. This will have a major impact on access to healthcare for children. Many Deputies in the House highlight all too often the fact we have long outpatient waiting lists. A total of 33,000 more children's outpatient appointments will take place between Connolly and Tallaght hospitals, both of which will be open by the middle of next year. However, it is imperative that lessons are learned from this project to date, for the completion of the project itself and for other capital projects in the State. This will be addressed by the Government in our response next month.

We have an unprecedented opportunity to deliver a very positive change in healthcare for Ireland's children and young people. While we must and will learn from the issues that have arisen in the project thus far, the priority is and continues to be delivering on the vision to improve services for the children and young people of Ireland. The establishment of Children's Health Ireland by legislation passed by the House at the end of last year was a major milestone and historic, and will further assist the ongoing operational integration of the three hospitals in advance of the opening of the new children's hospital and the outpatient and urgent care centres. The outpatient and urgent care centre at Connolly Hospital will start delivering improvements to healthcare for children this year, providing expanded outpatient and urgent care services in modern facilities under the responsibility of Children's Health Ireland. I have said many times, and reiterate here again, that children have been waiting far too long for this facility and the hospital project will transform the delivery of their healthcare. The capital investment will be underpinned and complemented by a new model of care for the delivery of service to children.

I invite Members to go to the St James's Hospital site, or to the Connolly Hospital campus, to see the progress that has been made. Since that invitation was issued at the time of the cost escalation controversy, very few Members have visited this site, met the project team and viewed the project. I suggest it is well worth doing. When they do, they will see that the project is finally, undeniably a reality and is a vital opportunity for children's health. Lessons must be learned and will be learned. The recommendations of the PwC report are accepted by the Government. The Minister, Deputy Donohoe, and I will put in place an implementation plan and we will report to the Government next month. At that stage, I will be very happy to have further debates in the appropriate fora.

The Government is breaking new records in healthcare all the time. It is spending a record €17 billion this year on health, which is up a record €3.5 billion in the past three years. A record 80,000 women are waiting for their CervicalCheck results. This figure has increased since the free test was stopped in December. A record 101,000 men, women and children are now waiting more than a year and a half to see a consultant. This figure has gone up from just 13,000 three years ago, a jump of 800%. A record 500,000 people are waiting for an outpatient appointment with a consultant. A record number of children are waiting for special needs help, mental health support and life-saving operations. It has never been harder for people in Ireland to access healthcare than it is today. At the same time, clinicians have never been so demoralised. A record number of doctors are leaving Ireland. Ireland has the record as having the lowest level of consultants per capita anywhere in Europe. This year, we have seen a record number of clinicians going on strike.

All of this is happening in spite of vast spending increases, which suggests clearly that taxpayers' money, that is, public money, is being badly managed. Nowhere is this more evident than with the national children's hospital. It is one of the most important capital projects ever undertaken by the State and on this we can all agree. Just three years ago, we were promised by the then Minister, Deputy Varadkar, that the all-in cost would be €650 million. Then we were told it would be €1 billion. Now we are told it is €1.7 billion. Per room, it will be the most expensive hospital built anywhere in the world. It will be twice as expensive per room as the two most expensive hospitals ever built and four times more expensive per room than the children's hospital in Liverpool completed a few years ago and the newly planned children's hospital in Belfast.

The Government states it accepts responsibility, but when pressed the Taoiseach conceded that the only real responsibility his Government took on was not communicating the situation better. First it was the fault of inflation, then it was the fault of contractors, and then it was the fault of agents of the State. Now it is the fault of quantity surveyors for underestimating the costs. The Government has gone so far as to tell us and the people that €1.7 billion is, in fact, a reasonable price for the hospital. At the same time, paediatric consultants who hope to work in the national children's hospital are telling me their budgets are being squeezed. These are the very budgets that will provide what is needed, which are the actual services in the national children's hospital.

Now we have the PwC report at a cost of more than €500,000. It was meant to identify cost savings but it has not done so. In fact, it excluded 85% of the cost base because it stated it is already contracted, with a "sure what can you do" approach. It made no effort to outline options for redesign, of which there are many.

Let us remember that the national children's hospital has been designed as a huge, curved, glass building. It is about as expensive a design as one can think of. There is a reason why none of us live in curved glass doughnut houses. They are incredibly expensive to build and are a very poor use of space, which was critical on the St. James's Hospital site. The design of the building, not the project itself, has become a vanity project for the Government. It is a vanity for which the Irish people and sick children will pay dearly.

The PwC report was meant to identify individuals and individual companies but it did not. This is in spite of an assurance from the Taoiseach that the terms of reference would be changed - which they were - to allow for exactly this sort of identification. The PwC report was supposed to analyse the cost and timing implications of moving sites but it did not. A few days ago I asked the Minister for Health to clarify this. The Dáil had voted overwhelmingly for this analysis to be included in the PwC report and the Minister said he would revert to us on whether the will of the Dáil was passed on to PwC. In reality, most of what is in the PwC report is already covered in the Mazars report, which was available last September and which cost approximately one tenth of what the PwC report will end up costing.

This is not to say that the PwC report is useless; it is not. We have learned something very useful from the PwC report, namely, that the risk of the price going up from €1.7 billion is very real. This is important because it flies directly in the face of what we were told at the Oireachtas Joint Committee on Health, where we were assured that the great advantage of the two-stage process was that it gave the State a so-called guaranteed maximum price. We were told that the financial liability now rested with the contractor. The PwC report states that this is, essentially, complete nonsense. It blows that argument completely out of the water. PwC have identified numerous ways in which the State still holds liability and numerous ways in which the costs can rise very considerably, perhaps to the tune of hundreds of millions of euro. To its credit, the PwC report also provides a useful list of recommendations for controlling and mitigating further potential cost escalations.

There is, however, a problem. At the committee the HSE told us it had no reason to express any deal of no confidence in the National Paediatric Hospital Development Board. The HSE said it had no reason not to have confidence in the board but the Department said that if it was starting the process again, it would proceed as it did the last time and use the two-stage process again. The Government has admitted to no mistakes other than poor communications. This does not sound like a group of stakeholders who have learned serious lessons. That, unfortunately, makes it much less likely that this same group of people will do anything better than they have done up to this point.

I will conclude on a related note. We were all told that the most important condition for the national children's hospital was that it was co-located with a maternity hospital, which was to be the Coombe Hospital. The then Minister for Health, Deputy Varadkar, told us that the planning and design for the national children's hospital and the moving of the Coombe Hospital to the St. James's site would happen at the same time. He did nothing about the Coombe Hospital and it did not happen. Just a few weeks ago I received a reply to a parliamentary question I had asked the Minister for Health, Deputy Harris. I had asked at what stage was the project to move the Coombe Hospital. The Minister said that it had not started and that the planning and design phase for moving the Coombe had not begun. Last week at the committee I asked what funding the Government had allocated in this entire calendar year to get that process under way. The answer I got was zero euro. This is what we now know. We were told that planning and design for moving the Coombe to the St. James’s site would happen at the same time as the children's hospital. We have now found out that the earliest the Government is considering starting the planning and design will be 2020 because no money has been allocated for this year. We can be absolutely sure that the financial mismanagement and cost overrun at the national children's hospital will do two things. It will soak up money that could and should have been used to move the Coombe onto the site and it will terrify anybody thinking of building a second new hospital on the St. James’s site.

I imagine that most or all Members of the House have listened to women's testimony on national radio recently of their stories of childbirth and reproductive health. Enormous credit must go to many of our clinicians for their fantastic services but we have all heard what has happened to woman after woman after woman. We are also all aware of the completely unacceptable circumstances and buildings in which the maternity hospitals, women and their new babies find themselves. Women’s reproductive health should be one of the absolute top priorities for this and any future Government. Yet here we are with one of the most critical projects in women's reproductive health - the movement and upgrade of the Coombe to the St. James's site - and nothing has happened.

The Minister for Health has, unfortunately, left the Chamber so I will direct my questions to the Minister of State, Deputy John Paul Phelan, who might pass them on to the Minister. Will the Minister commit to allocating new funding immediately to start the process of moving the Coombe to the St. James's site? Will the Minister ask PwC to come back with more creative ideas around reducing the costs? Will the Minister undertake to pursue those individuals and companies found negligent to date in the building of the national children's hospital?

Deputies O'Reilly and Jonathan O'Brien will share their time.

The Minister has stepped out of the Chamber but he will be back for the question-and-answer section.

I welcome that the PwC report was published in a timely fashion. This is important because it gave us all an opportunity to have the report and to be able to go through it forensically - especially those of us on the Committee of Public Accounts, who will be dealing with the National Paediatric Hospital Development Board in the next weeks.

I only have a couple of minutes so I want to focus on just one area, which is the narrative the Minister is now putting out that he has been vindicated in the decision to go ahead with the construction of the national children's hospital. The Minister fails to actually explain to people that the whole point of the two-stage process was that if we were not happy with the guaranteed minimum price process there was an option to pull out and re-tender. There was a difficulty, however, in that by the time of the decision and by the time the Minister, the Department and the Cabinet had all of that information, that option was no longer an option. I do not believe it is fair for the Minister to say he has been vindicated in the decision to go ahead. He left it so late that he had no option but to go ahead. This is an important point.

I shall now turn to the issue of the steering committee and the project programme committee that were put in to oversee the development board. The PwC report was very critical of the powers of those two groups. The steering group was made up of Department of Health and HSE officials. Among some issues outlined by the report was the point that it was a pretty toothless oversight process. The group could only deal with information that was given to it. There was also a lot of criticism of the board itself. This is a challenge for the Minister. We have a report that is very critical of the role of the board. The Minister has said he will strengthen the board but unfortunately, there is no legislation to allow this unless the Minister removes members of the board. This is contrary to what the Minister said at the health committee last week when he told us he does have the power to put additional members on to the board. I checked the statutory instruments and this is not the case. The maximum number of people on the board is set out in legislation. For the Minister to do what he proposes, and to bring in some expertise to the board, he needs to remove some board members. I do not know when the Minister proposes to do this.

I will put that question to him later. The report, which cost more than €500,000 or €4,500 per page, is a costly report. Much of the information contained in it was contained in the Mazars report. The only good thing to come out of it, in addition to what we already knew, is the recommendations, which the Government says it needs time to review but is committed to implementing in full. That remains to be seen. I hope that the Minister will be in the Chamber for the questions and answers session.

The debacle and scandal of the cost overrun at the new national children’s hospital will not and cannot end with the PwC report. Holding up this report and claiming it absolves the board or the Government of blame is not just dishonest, it is intellectually lazy. The Minister said in his contribution that we must learn from the issues that were raised. We will be paying for these issues. The word "issues" is a bit of an understatement. There are very serious concerns that have been raised and this report does not in any way, shape or form vindicate the Minister, the Government or the board.

The report lists a litany of failures which were the direct result of Government policy or Government decisions. The insertion of two boards above the National Paediatric Hospital Development Board, the decision to use of a two-stage procurement strategy, bad governance and senseless political decisions need to be taken to task. I note that Deputy Donnelly said recently on, I think, Newstalk that he and his colleagues do not have confidence in the Minister for Health, Deputy Harris. Somebody should telephone Alanis Morissette because it is ironic that it is because of Deputy Donnelly and his colleagues the Minister remains in his job.

The PwC report is detailed. It collates a lot of information which we had not been able to access over a number of weeks as the story was breaking. The report reinforces Sinn Féin’s analysis of the failures which led to the cost overrun, most notably the disastrous nature of the procurement strategy, the breakdown and lack of communication from the board, and the complete absence of oversight at ministerial level. It documents a litany of damning failures from the development board to the Minister's office. At its core, the report shows that this process has been flawed and hamstrung from the beginning. It shows mistakes and failures at every turn of the project and illustrates how the Government pursued a risky and untested two-stage procurement strategy which was known to have grave risks of cost escalation, with its single advantage being a somewhat quicker finish. I have referenced many times that his was done so that it could be a Fine Gael Minister cutting the ribbon. It certainly was not done for reasons of good governance or best practice. The two-stage procurement strategy, we can all agree, has abjectly failed. The only thing that it had going for it was that it might result in a quicker finish of the project, but of course it did not.

The report highlights significant issues with governance and oversight and points to the serious matter of non-compliance with the public service spending code which requires immediate Government investigation and action. It outlines how the people tasked by the State with delivering the project could not even deliver value engineering. The report states that inquiries into the value engineering programme revealed considerable challenges in securing savings, and there were instances in which costs actually increased. It goes on to say that adjustments to the design of air handling units was made to reduce cost and this led to the addition of new items for which the rates in the contractual bill of quantities did not apply, exposing the package to current rates, and that the overall impact in this instance was a 27% increase in price. One could not make this up. If it was not so serious, it would be comical. In the midst of all of this and the escalating overspend, the Minister reappointed the entire board. Without any review of the performance of the board, he reappointed it for another term, which was and is a vote of confidence in the board for a job well done. All the while, this project was haemorrhaging money.

While there is much information in the report, it raises a lot of questions about the future of the project and the ability of the development board alongside the Minister for Health, Deputy Harris, to navigate the project through future risks and deliver it within the current expected budget of €1.7 billion. It is my belief that we will be looking at €1.7 billion in the rearview mirror very soon. Unfortunately, these players have all proved to be unable to navigate the risk on this project and they are responsible for the cost overrun. We need to be clear that this is a cost overrun. Nobody buys the underestimation argument which the Government likes to spin. As I have said previously, I have a turbo-charged washing machine at home that could not spin this as a cost underestimation. It is a cost overrun and the public know that. Nobody is fooled by the underestimation argument. The future delivery of this project within the new parameters needs the oversight and guidance of a Minister who is competent and capable of managing risk. Will the Government give a commitment that it is confident that it, the Minister and the board can manage the challenges in this project and ensure the project costs will not exceed €1.7 billion and further threaten public finances? That is the question on everybody's lips. The answer continually is that nothing will be delayed and that the cost will be reprofiled, which I will place alongside underestimation. We are told noting will be delayed, stopped, halted or impacted by this massive cost overrun but other projects will be impacted. The Government needs to he honest with people and tell them and us where the axe will fall and what projects will be impacted, because the additional money cannot be picked out of the sky.

To continue with this debate is pointless because the Minister is not here. I have good time for the Minister of State, Deputy Phelan, but his responsibilities lie in a different Department. The Minister should be here listening to this debate on the largest overspend on a capital project in the history of this State. Should we continue or wait for the Minister to return?

The Deputy should proceed.

Should the Minister be here?

It is not for me to comment.

I note the Minister has arrived in the Chamber.

I am glad Deputy Kelly could join us. He missed my opening statement.

Deputy Kelly, without interruption.

I thank the Minister for being here. We have been around the houses on this issue for a long time. The real issue is the economic competence of the Government. It is obvious from what has happened in regard to the national broadband plan that it cannot manage big projects. The Minister, Deputy Harris, cannot stand over this overspend. In fairness, I do not expect him to do so because it massive.

I want to focus on how large projects are being managed. To be fair to the Minister, this goes beyond him. The Department of Public Expenditure and Reform is the real focus of my attention in this regard. How it allowed this to happen is beyond me. That an official of that Department, who is a member of National Paediatric Hospital Development Board, has obligations as a civil servant on that board and has an office close to the offices of the Secretary General and the Minister, did not at any time in over two years, during all the management advisory committee, MAC, meetings or in the context of the work that he does, mention that there was an issue in regard to the children's hospital is, frankly, beyond me. We learned recently that when this became an issue, he was called to attend a meeting in regard to the children's hospital, yet when we put questions to the Minister for Public Expenditure and Reform in regard to this official, he responded that it was not part of his role and that he was on the board in an independent capacity. If he was there in an independent capacity, why was he called to a meeting when this issue came to a head?

He was either there in an independent capacity, or he was not. If he was there, but he was not called to any meetings, he did not participate and he did not tell anyone in the Department of Public Expenditure and Reform before this became a massive political issue, why was he called to a meeting afterwards? The Minister, Deputy Harris, might ask his colleague, the Minister, Deputy Donohoe, to explain. Even though he was separate from all of this, he was called to a meeting after it became a public issue. He had no role, yet he now had a role. That does not make sense to me.

As far as I am concerned, the Department of Public Expenditure and Reform is dysfunctional. Having served previously as a Minister, I know that officials in the Department would argue over €5. The Ministers were in Cabinet at the time so they know what went on. The idea that officials from the Department would not have asked questions is beyond comprehension. I ask the Minister, Deputy Harris, to publish a chronology of the Department of Health's timelines on the decisions on this project. It would be very helpful if a chronology of the decisions that were made in the Department of Health were to be published because it would tell people what happened here. We also need a chronology in respect of the Department of Public Expenditure and Reform.

My concerns are elevated by the fact that this Government, which likes to talk about economic competence, set up three boards. To be fair, they were two boards and a committee. Really, they were three boards. I am not focusing on the Minister when I ask why the Government set up three layers to oversee a project it had no concerns about. Obviously, the Government had concerns about it. Why would it have established a steering committee and another board on top of it unless it had concerns? How in the name of God can it be the case that the most senior procurement officer in the Department of Public Expenditure and Reform knew nothing about this, or did not tell anyone about it? It is beyond comprehension that nobody in any of the three layers said anything about what was happening. Frankly, it is not believable. That is a very big thing to say in this Chamber. It is not credible that nobody in the Department of Public Expenditure and Reform was aware.

I want to be fair to the Minister, Deputy Harris, because my focus here is on the Department of Public Expenditure and Reform. How did the Department fail to answer the emails sent by the Minister and his officials in which they asked questions about this? Can the Minister tell the House why those emails were not answered for months? Is it acceptable, fair or appropriate that one Department can send an email to another Department about the biggest capital project in the history of the State, only to be told that it will be dealt with after the budget or after three months? How it that credible? It was not credible in my time in government, so how is it credible in the Minister's time in government? I ask him to answer those questions.

I remember asking questions at the Joint Committee on Health or the Committee of Public Accounts - I do not know where the questions were asked because I ask so many questions - about how this project got so far. The fourth or fifth recommendation in the report is that there should be a challenging authority. Is that not called the Department of Public Expenditure and Reform? How can a report say that there should be a challenging authority when the Department of Public Expenditure and Reform is looking at this? Is the Department not the challenging authority? This is an absolute joke. Any of the Deputies in this Chamber could have come together to write 90% of this report in five minutes. We all know what happened here. There was not enough oversight and not enough conditions were put on things. How can the Government stand over a report which says that the Department of Public Expenditure and Reform did not do its job? That is what it is saying. This failure happened because there was no challenging authority in government. It can be seen from this project and the broadband project, which are the two largest projects in the State at the moment, that the Department is dysfunctional. Both projects have been dealt with in an absolutely reckless manner. We cannot go on like this.

I want to ask about how the officials in the Department of Health dealt with this matter. Obviously, they had serious concerns. To be fair, they raised them earlier than the Department of Public Expenditure and Reform has acknowledged. On what date did they bring those concerns to the Minister for Health? He has told us the official dates, but surely there must have been some commentary about this project behind the scenes. If there was no such commentary, that is a sign of dysfunctionality in the Department of Health. There were concerns about this project months before the date that has been mentioned by the Minister. To be fair to him, those concerns may not have manifested themselves all the way up the line. On what date did officials in the Department begin to have concerns about this project? Why did those concerns not come up the line? They took an awful long time to come up the line. The Minister should be concerned about this aspect of his Department's handling of the matter.

I will conclude by reiterating the real issues that exist in this regard. The dysfunctionality in the Department of Public Expenditure and Reform is beyond belief and is unacceptable to a massive degree. There are serious issues in the Department of Health. If it were not the case that real concern about this issue had existed for a long time, three boards or layers - for want of a better phrase - would not have been created. Why did this not come to the Minister's attention at an earlier stage? How in God's name was the communication between the Department of Health and the Department of Public Expenditure and Reform not better? It does not make sense. Any time there is a major project like this, the Department of Public Expenditure and Reform should be all over it. The idea that it was not all over this project is not credible. The idea that the State chief procurement officer, who was sitting on the board, did not ask questions about this matter within the Department of Public Expenditure and Reform is not credible.

I have praised the Minister for Health in the past when praise was due to him but I cannot praise him on this occasion. The speech he has read - I do not think he wrote it - is an insult. The Minister has not dealt with any of the issues raised in the report we are discussing, which cost over €500,000, or indeed by PricewaterhouseCoopers in a previous report.

I will come back to the conflict. I suggest that the Minister should read pages 1 to 30 of the Official Report of the meeting of the Committee of Public Accounts on 8 October 2015, which was before my time on the committee. The members of the hospital development board who appeared before the then Chairman of the committee, Deputy McGuinness, pointed out that lessons had been learned. Some €35.5 million had been written off from the previous debacle. Members of the new board, which had been appointed in 2013, told the committee that lessons had been learned. I wish I had time to read all the extraordinary things that were said at the committee, such as the statement: "Unfortunately, we cannot rewrite history, but we have to learn and make sure that in every step we make along the way, in respect of any of perceived weakness in the decision-making processes during the five years, we [will take all] the steps." It goes on and on for 30 pages. The committee was told about the "expertise" of the group board, which was chaired by the then president of NUI Galway. As Deputy Kelly has said, other committees were put in place as well.

The Minister might get an idea of why there is a problem when he hears that the Committee of Public Accounts was told in 2015 that a total of €650 million had been committed, comprising €200 million from the national lottery and €450 million from the Government. In response to a question he was asked, Mr. John Pollock said:

The €650 million is the all-in cost. It includes VAT, inflation, contingency sums and the project cost. There are equipping costs and design fees. There are a whole load of other costs. That is not the construction costs. The construction costs are for both the main children's hospitals [and so on].

It does not really make sense. What I take out of it is that €650 million was the figure. Some Secretary General who appeared before us told us that there will probably be no change out of €2 billion.

Then the Minister made a speech telling us the children deserve a good hospital. We know what children deserve; we do not need to be told. What we want from the Government is an explanation as to how this debacle could have happened.

The Government commissioned PwC to produce a report. Nowhere does the firm tell us it was tasked by the board to produce a review. This came to the fore at a meeting of the Committee of Public Accounts. Before the Minister ever commissioned PwC, PwC gave advice to the board. It is an extraordinary coincidence that, in both cases, it came to the same conclusion that it was not asked for and that was not in the terms of reference. Page 8 states, "At this point, taking any alternative course of action other than continuing would in all likelihood result in significant delay." PwC had already concluded this on behalf of the board, well before the Minister commissioned it for over €500,000. It is extraordinary that this conclusion was not envisaged in the terms of reference. The Minister might comment on this. The terms of reference were very specific. PwC was certainly not asked anywhere in the terms of reference to give the conclusion in question. There is absolutely no evidence for the conclusion.

The findings are damning. We see a steering group and ambiguity regarding its role. We see a public spending code not being complied with. We see there were material errors in the business case and we see many more mistakes. Then we see a board reappointed. The board was reappointed by the current Minister, or some other Minister, when all these problems were evident. What jumps out for me is the insufficient scepticism and challenge from a board regarding the information coming before it.

I have a list of reports received by the Committee of Public Accounts in addition to the one that cost €500,000. The Minister is appearing before us tonight telling us the children deserve a hospital. What children deserve is honesty and accountability in this Dáil so other children, such as those who live in Galway and are dependent on the hospital there, will get a good service and so funding will not be cut.

This is nothing personal. Believe it or not, I do not believe the Minister is the one making these mad decisions so I do not hold him to account. I believe, however, that the Government is behaving recklessly in how it is handling this matter. The refusal to re-tender and address the nature of the contract was a serious mistake, and it will cost us close to €500 million. I can only assume the Government will not re-tender because it does not want the project stalled for a period and because it may look bad. There could be an election campaign, during which the work on the hospital would not be proceeding. The view is that if we keep going and spend hundreds of millions of euro more than we should, the project will at least be running. This is all I can conclude. I have asked umpteen questions in here about this. This is our sixth time talking about this. It is mine anyway. I have got very few answers. I put in freedom of information requests and have tabled written questions but I am getting so little information back. I am aware, however, that there are major problems.

I asked why a crowd of accountants were got to do the work. I would have loved to have got close to €600,000 to produce the report. Those concerned even admit the information is not independently verified. How in God's name can we part with so much money for a report that is not independently verified? I do not understand that. I do not know where to start and I have so little time.

PwC tells us we should not stop as it would not be a good idea. There is no evidence for it. Why was the project not stopped? I have asked why no public benchmarking was done. Nobody is telling me why. I do not understand that. We are told it is clear there are lessons to be learned both in regard to this project and other major projects but the lessons are not being learned. If the Government had learned them, it would be dealing with these issues now. It is said the scope and responsibilities of the advisory firms that constitute the design team should be reviewed to reflect their future roles. The consultants' role is to advise the executive. The executive makes decisions and it can ignore or follow the advice of the consultants. The executive advises the board. The board can then deal with the executive's advice. It can take it on board or ignore it. We are not finding out why, what, where and when.

The report states the understanding of the risk profile associated with the procurement and contracting strategy was poor at all levels of the governance structure. Why? The report does not tell us. Every project has a risk profile. I do not understand what is occurring. Did the legal team get it wrong in advising the executive? Did the executive get it wrong in advising the board? Did the board get it wrong? There are so many questions. I wish to God somebody would answer them. It is heartbreaking. We are told a lack of interest from the market was the primary potential risk to procurement. Why? What was done about it? I do not understand why PwC will not look under the covers and tell us why.

The report states the understanding of the risk profile associated with the procurement strategy was poor at all levels. This is because the risk factors were not considered. If the risk factors were not considered, why not? Is anyone going to tell us why? Is this Government just going to keep on going and pretend it is all grand? This is a disgrace. This is too bad. Hundreds of millions of euro have been spent and the Government is just going to keep going, with no explanations as to what went wrong. No one is being held to account. This is a fucking joke. This is too bad.

Deputy, please. That sort of language is not permitted in the House, as you well know.

We are now moving to the second round, which is questions and answers. I call Deputy Donnelly.

Is it eight minutes for us all?

It is eight minutes each. The Deputy may ask questions and receive answers. It is entirely up to him whether he wishes to ask a question and get an answer.

We might just go back and forth, if the Minister agrees.

Let me start with the Coombe. I acknowledge we are here to talk about the PwC report, to which I will come, but the matter of the Coombe is intrinsically related. The Minister had to leave momentarily when I was asking questions. He told me last week no funding has been allocated this year to even begin the design and planning phase for moving the Coombe to the site of the maternity hospital. I believe he and I agree it is essential. The idea that maternity services co-location is essential was sold to this House. When the Taoiseach, Deputy Leo Varadkar, was the Minister for Health, he gave a commitment indicating the planning and design associated with moving the Coombe and the building of the children's hospital would happen at the same time. If there is no funding available in this year's budget, it means the earliest one could even begin the process is 2020, which is five years after we were told the process was meant to begin.

We obviously have to be very careful about supplementary allocations but I ask the Minister to immediately allocate additional funding so the design and planning for the Coombe can start right now. Fianna Fáil will support him in this. As he knows, the master of the Coombe was before the Committee of Public Accounts and has been speaking publicly. I do not know how accurate or strong some of the comments are but we will assume the master is an expert and has a fair idea of some of the politics. There were some very worrying remarks. For example, he made the point that St. James's is naturally seeking to expand all the time and that it might be looking at the three and a half acres with a view to expanding.

Notwithstanding the project itself, the total disaster that is the financial end of the hospital will greatly concern people in terms of building another hospital there. The current project will suck up capital and healthcare funding that would have been used for that new hospital. We have to get moving on this and do so right now. Will the Minister commit, effectively immediately, to getting new money and getting the design and planning phase going straight away?

Deputy Donnelly has asked an important question. It is something on which we agree. I want to see all our stand-alone maternity hospitals co-located with acute adult hospitals. It is in the national maternity strategy. The hospital that has a large allocation this year is the National Maternity Hospital Holles Street which is moving to St. Vincent's. It is a project dear to both our hearts and those of our constituents.

The point that I was making at the Select Committee on Health last week was that the priority investment this year is to do some upgrading of existing theatres in the Coombe. I will not be partisan on this. I agree with the Deputy that if we can move ahead with some of the provisional design and planning, and perhaps preparatory phases before that, we should do that this year so that we are ready to move.

Let me be clear. The Coombe is moving to St. James's. It needs to for the purpose of tri-location. I do not disagree with Professor Fitzpatrick, the former master of the Coombe, on that. We are going through our capital planning process now so I will not give a commitment on the floor of the Dáil this evening, but I will engage further with the Deputy on this. He has made a valid point that a very small allocation this year is probably all that is required to go forward with design and planning. I will certainly look at that.

On accountability, the terms of reference were changed so that PwC could identify individuals and individual companies. When we started finding out about the cost overruns in January, I asked the HSE and the development board if any sanction of any kind has been taken against anybody, individually or commercially. Anyone who has worked in the commercial world around big projects such as this knows that if a project such as this in the commercial world overran like this, pretty much everyone involved would be fired. Contracts would be cancelled and there would probably be court cases. None of that has happened. Will the Minister give a commitment that that will not be dropped and that if companies or individuals are involved, they will be held to account? When the PwC report came out, even though we had a debate in this Chamber about changing the terms of reference to identify individuals or, more importantly, companies - this is not a witch hunt - none of this has happened. Will the Minister commit to moving beyond the report and, while we cannot prejudice the outcomes, if there is negligence, that, at a minimum, companies will be pursued in the contracts they have?

I can commit to that. As I told the Select Committee on Health last week, companies will have contracts with the National Paediatric Hospital Development Board. Whether the Minister is me, Deputy Donnelly or someone else, those contracts will be legally placed with the National Paediatric Hospital Development board and the company. As I told the meeting, I intend to meet the chair of the National Paediatric Hospital Development board as part of our consideration before we go back to Government or the health committee on how best to implement the recommendations. I have very strong views on this. I went as far as I believe is appropriate to do last week without prejudicing the outcome of that. The report does name a couple of individual companies, but it will be a matter for the board and it might require legal advice. I am clear that the terms of reference were changed, and they were changed for a reason. The Deputy asked us to change them and I acknowledge that, so PwC had the ability within the terms of reference to identify roles, stakeholders and people who could be accountable. It chose to do so in some cases. I will speak to the board about what its options might be in this regard.

At the Select Committee on Health I asked the Minister whether an instruction had been given to PwC, further to the Dáil vote, which included that of his own party, that analysis be done of the cost and timing implications of a site move. The Minister said that he did not know whether he had passed that request on to PwC and he said that he would come back on that. Did the Minister do so? If not, will he still consider so doing?

The most disappointing part of the PwC report was its failure to identify any cost savings. It essentially said that 85% was contracted and that was that. That is not a rigorous commercial approach. If this was a private company and it was looking at its own money, it would be much more creative. It would say that 85% was contracted and ask whether it could be renegotiated or recontracted with the same bidders. It would also ask if there was anything that could be done with the very expensive design to get the cost down while protecting the integrity of the project. Is the Minister willing to pursue that further than PwC's conclusions?

I ask for a tiny bit of latitude as I have only 14 seconds available to answer those two questions. I did say that I would come back to the Deputy on the Private Members' motion. I understand that a vote took place on that on 28 March. The Deputy may recall that a Minister of State took the debate for me. The report was due on 29 March and was given a one-week extension for fact checking. Therefore it was not practical to give effect to that. I did outline at the committee my view that this House had given its opinion, not once but twice, on the appropriateness of the site.

On cost saving, I need to be clear that we did ask PwC to identify potential costs. It did say that it was technically possible. I commit to the Deputy that I will discuss this with the board. However, PwC also said that it felt that the board's focus should now be on reducing further residual risks in terms of the costs rising. I will discuss with the board the report's suggestion that it may be technically possible. Neither the Deputy nor I would want to say anything that would undermine the clinical benefits of the project. I accept the Deputy's bona fides on that.

That concludes Fianna Fáil's input. We move to Sinn Féin for questions and answers.

Who will be ultimately responsible for ensuring the implementation of the recommendations? Will it be the Department of Health or will it be cross-departmental?

The recommendations will go across both my Department and the Department of Health. The PwC report has made two particular recommendations that it says my Department should deal with, namely, recommendations Nos. 10 and 11. They refer to the rules relating to future major public spending capital projects. It also makes a recommendation on how Government can continually challenge during the entire duration of a project being delivered as to whether the project is meeting the public spending code. I have responsibly for those and others are specific to the Minister for Health.

At the meeting of the health committee last week, the Minster said he had the power to increase the number of people on the board. I have looked at the legislation and the statutory instrument and that is not my reading. My reading is that it is set at a particular number and, if the Minister wishes to bring new people on board, he would have to remove others. Will the Minister confirm whether this is the case or whether his analysis is correct?

I confirm that Deputy O'Brien's analysis is correct and I apologise for suggesting to the contrary in error last week. I and the Minister, Deputy Donohoe, will bring proposals to Cabinet next month looking at the overall governance structures and how we can strengthen them. I expect there will be changes in those structures. We will take legal advice on whether that will require primary legislation or if there will be scope to do some of that by statutory instrument. However, Deputy O'Brien's interpretation of the statutory instrument is correct.

What is the situation with the oversight bodies and the steering group? Is there scope in the legislation to change the make-up of those oversight bodies or is it the set number for the development board?

The boards and committees to which the Deputy referred are administrative so they were set up by way of a Government decision when we decided to proceed with the main construction works. They can be amended by a similar Government decision.

The 2007 IMF recommendations on major Government projects state there should be quarterly progress reports given to the Department of Public Expenditure and Reform and they should be audited.

I am looking to find out if that was followed. Were there quarterly progress reports given to the Department of Public Expenditure and Reform and were they audited and looked at carefully?

The IMF report, to which the Deputy is referring, the public investment management assessment, PIMA, report, only came in the latter stages in considering the national children's hospital that we are debating. I have not yet got to the place where we are receiving quarterly reports on key projects. What we will have instead on my Department's website is a capital project tracker which will update the House and citizens on where different projects stand in their life-cycle, whether they are at construction, planning or tender stage, indicating, for example, the phase of construction. The tracker is online and available for everybody to see. We hope to launch the tool the week after next and I am aiming to use it as a way of letting people know what is happening on very important projects.

Obviously, there are other recommendations made in the PcW report that, when implemented by the Minister, Deputy Harris, and me, should help to prevent an issue like this from developing again.

As there are no further questions, I will move to Independents4Change.

I have three or four specific questions for the two Ministers. On page 65, the report states: "The Public Spending Code requires that a revised cost effectiveness analysis, cost benefit analysis or re-appraisal be undertaken in the event that serious additional costs arise". There were serious additional costs which were brought to the Government's attention. Who was responsible for not ensuring a cost-effectiveness analysis was undertaken?

To return to maternity maternity, Professor Chris Fitzpatrick was before us and I have a copy of his detailed submission. He made a number of proposals. I refer to two of them - that the overall cost of the project include a maternity hospital and that the current site be independently stress-tested to ensure it can accommodate a maternity hospital.

Are the Ministers aware that PwC advised the national children's hospital board in the autumn of 2017 on decisions to be made, in particular, the options to be taken? Were they aware that it had done so?

I will deal with the first question as to whether, at the point at which the revised and additional costs came in for the national children's hospital, we commenced a cost-benefit analysis, as recommended in the report. We did not commence a new business case process, but what we did do - I was heavily involved in it - was sit down to look at the different options which included pausing the project where it stood and beginning the process all over again. They were the subject of much debate. The Minister, Deputy Harris, and I decided - I believe it was the right decision to make - that we would go ahead and complete the project. While it has understandably been the subject of much debate, it is noteworthy that the PwC report referred to the fact that other options available to us would be equally costly and very uncertain. What will happen in the future is, if there are additional costs above and beyond those in a business case on which the Government has signed off-----

I have one minute only.

-----at that point-----

Will the Minister just answer the question?

I am sorry, I just want to finish my answer. At that point, of course, it would be open to the Government-----

I asked the Minister what happened.

-----to look at whether a revised business case was needed.

I will let Deputy Connolly repeat the question.

I did not ask about what would happen in the future; rather, I asked three specific questions and stayed within the time limit. I ask the Ministers not to work down the clock but to answer the three questions asked.

Did the Minister carry out a cost-benefit appraisal?

I answered the question. The Deputy asked me whether we had conducted a revised cost-benefit analysis when the additional information came in. I stated we did not and what we did in its place and why.

I am taking the other two questions the Deputy asked and will be brief because of the time restrictions.

The Deputy asked a question about Professor Chris Fitzpatrick's testimony which I, too, read. He was kind enough to send it to me. I am satisfied that the current site can accommodate the maternity hospital, which was the subject of one of the professor's questions. It has been identified in a site master plan for the St. James's Hospital campus that we have in place. The new national children's hospital design incorporates the required operational links with both maternity and adult hospitals.

Professor Fitzpatrick's second request was that we allocate funding as part of the overall project. That is a decision the Government has not made. We have, obviously, allocated funding in Project Ireland 2040 and the ten-year capital plan for the relocation project, but we currently have no plans to bring forward the capital.

I am satisfied that there is no conflict of interest. The HSE responded, I believe in writing, to the Committee of Public Accounts on this matter last week. I have received reassurances from the HSE that there are no conflicts of interests with regard to the review carried out by PwC. I have been answering this question for a number of weeks.

Did the advisers, McCann FitzGerald, advise the executive or the board? That is my first question.

The report states: "The understanding of the risk profile associated with the procurement and contracting strategy was poor at all levels of the governance structure". Was the risk profile for the particular project misunderstood and, if so, by whom?

I asked previously how it was, in the second stage of the project, the bill of quantities was based on a preliminary design, not a detailed design. That was a recipe for disaster. I would like to know who made that decision.

From what I can see, the national children's hospital project was approached as a medical project, not so much as a construction project. It is both. Why were they not put together? From what I can see, they were not.

The standard forms are fine in terms of construction discipline, but when one standardises a construction project in one form, one has nothing but problems. That is what has happened in this instance. I do not understand it.

It is a fact that the Government does not know where the final price will land because it is not manageable because of the form of contract in place. That is why I am pleading with the Ministers to change it. They do not want the project to be stopped and delayed, but they would save a great deal of money. If PwC states it is not a good idea, can we have the evidence from it to prove that it would not be a good idea because it has not given it to us? There is nothing to back up that statement. If there is, I would like to see it.

Can we see the contract that was executed eventually? Am I entitled to see it? I would love to see it.

The Minister, Deputy Donohoe, might comment.

To the question related to McCann FitzGerald I truthfully do not know the answer, but I will ask that it be found for the Deputy and given to him directly. It is important to say, though, that PwC did not find that the procurement process, in using the good manufacturing practices, GMP, process was flawed. Importantly, what it found was that it had been extremely poorly executed. I take seriously and have acknowledged publicly the Deputy's experience of major building projects, on which I defer to him, but PwC put together a team which included building expertise, as noted in the report. It found that it would be the wrong decision to stop and re-tender. It found that it would end up costing more. The Deputy and I will not agree, but that is what the independent report found.

Perhaps the Minister, Deputy Donohoe, might give the Deputy one minute. I will give the Minister one minute or take two minutes from the time allocated for his concluding remarks, if he wants to respond.

I will respond. PricewaterhouseCoopers, PwC, has published what it has available. It has published its own conclusion. The Minister for Health, Deputy Harris, and I independently reached the same conclusion where, in advance of this matter becoming as difficult and public as it has, we evaluated the different options available to us. We differ from Deputy Wallace because our view is that if the project had gone out to tender there is no guarantee that the costs would have been any lower and this projectwould have taken even more years to complete. We would be in front of the Dáil this evening dealing with a difficulty relating to money that has already been spent with no hospital constructed and no certainty regarding costs in the future. Those were the reasons that we believed this was the right decision to make.

We will move on to the Rural Independent Group and a few questions from Deputy Mattie McGrath.

The PwC report is explicitly clear that-----

Is it possible to see the contract? Can I see the contract?

The Minister will come back to Deputy Wallace.

We will discuss it and revert to Deputy Wallace on that.

That was a good question and I would also like to see the contract.

The PwC report is explicitly clear that, of the nine organisations it interviewed during the process, not one of them included representatives of the Connolly for Kids group, or any of those senior clinicians who have campaigned and forensically deconstructed the arguments for St. James's Hospital for years. PwC did not interview one sick child or a parent of a sick child. Why?

What is most revealing is that PwC, in its recommendation, stated it considered and agreed with recommendations made by Mazars in its reports relating to cost escalation and governance. The recommendations PwC went on to set out were not to replace the recommendations of Mazars. What was the point in throwing good money after bad? We have effectively paid more than €600,000 to find out what we already knew from Mazars.

The PwC report also recommends what it calls ownership as a lesson that should be learned. There has been no ownership whatsoever.

Professor Chris Fitzpatrick was before the Committee of Public Accounts last week and his presentation was absolutely stark and a reminder of the farcical history of this project. He reminded us that, on 7 November 2012, Dr. James Reilly, then Minister for Health, announced that the children's hospital was to be developed on a site in St. James's Hospital. At that time there was no reference to the Coombe Women and Infants University Hospital. It is scary.

We talk about babies in Tuam and Sean Ross Abbey in Tipperary. Professor Fitzpatrick, addressing the committee, referred to the more than 200 critically ill newborn infants who, every year, within hours of birth, are transferred between the Dublin maternity hospitals and the children's hospitals in Crumlin and Temple Street University Hospital for highly specialised emergency interventions. Professor Fiztpatrick went on to say that the mortality in this group of babies ranges between 5% and 18% depending on the complexity of their illness. He further said that this number is set to increase with increased availability of prenatal autonomy scans nationwide and more referrals coming from Northern Ireland. Mothers from around the country are delivered in Dublin to reduce transit times for their babies after delivery and because of the dangers associated with transport after birth. The consequences of delivering without the benefit of a prenatal diagnosis, planned delivery and proximity to tertiary paediatric services are grave.

Professor Fitzpatrick has told the Government that this will happen. I received a reply to a parliamentary question from the Minister.

Does the Deputy have any questions?

I have questions. Have we any regard for the sick babies that we have been told about by the eminent professor?

I received a reply to a parliamentary question from the Minister for Health today which is full of waffle about co-locating. He stated that a site for the proposed maternity hospital is identified in the St. James's site master plan. It is just an identified site. He went on to state that the design of the new children's hospital has incorporated the required operational links with both the maternity and adult hospitals. He also stated that the construction of the new maternity hospital will not commence until the new children's hospital is completed. Where are the sick babies going to go?

An eminent professor who has not got involved in this campaign at all came into a briefing of mine two months ago and said he had to come in and speak out. Deputy Wallace was also there. The professor said that there are only minutes to intervene when babies are born with profound and life-threatening brain damage. He was asked, by Deputy Wallace or somebody else, how many minutes he meant and the professor said a maximum of 12. We need co-location and it is not happening here. The Minister must know that at this stage.

These are the sickest children and their families. The eminent people from the Connolly for Kids group wanted the site outside the city where we had room. The Government got PwC to give it a rubber stamp to cover up its inadequacies. That was all it was. Finding out things that Mazars stated-----

Has the Deputy asked questions?

I have asked questions.

I am nearly finished.

If the Deputy has asked questions-----

I have four questions.

The Deputy has five minutes so I want to give the Minister a few minutes if there are questions to be answered on-----

There are. I have asked-----

I have asked the questions.

The Deputy cannot always be right.

I am not always right.

The Deputy thinks he is always right.

The Deputy thinks that.

That is not fair to me. This is totally ridiculous.

The Deputy comes in here-----

I have questions. Is the Leas-Cheann Comhairle trying to cover for the Minister as well?

The Deputy was not here-----

I was not here because others did not turn up.

The Deputy was not here for his slot.

That was because others did not turn up and was not my fault. I was told 9.20 p.m.

It is a matter for the Deputy to look after his own interests in this House.

I will make a complaint about the Leas-Cheann Comhairle because this is ridiculous. He did it again today. I have asked questions.

The Deputy cannot continue abusing the Chair.

I am not abusing the Chair. The Chair is abusing me.

The Deputy is abusing the Chair.

I told the Deputy he has four minutes to ask questions. The Ministers must be given an opportunity to answer the questions and they will not get one second longer. The Ministers may answer if there are questions to answer.

There are questions to answer.

The Ministers will decide that.

In response to Deputy Mattie McGrath's statement, I make the point that he has a view to which he is perfectly entitled that the hospital should have been built at a different location. The people's representatives in this House have voted on this three times, once in 2012, once in 2016 or 2017, shortly after I was first appointed Minister for Health, and there was another Private Members' motion which was defeated in this House only a few weeks ago. The people's representatives have spoken on this three times so the location will not change. We are building it and getting on with it.

What about the children? What about the maternity hospital?

I agree with Deputy McGrath, and accept his bona fides on the important and sensitive issue of how we look after some of the sickest babies born in our maternity hospitals. As the Deputy knows from the Government's capital plan and national maternity strategy, we have a plan and, indeed, funding in place to co-locate not just one of our standalone maternity hospitals but indeed all four of them. The Coombe will be co-located to St. James's Hospital.

I am talking about St. James's Hospital.

The Minister must be allowed to continue without interruption from anybody.

We will co-locate all four of the maternity hospitals, the Coombe to St. James's, the Rotunda to Connolly Hospital, the National Maternity Hospital to St. Vincent's, where planning permission and funding are in place, and the Limerick Maternity Hospital to University Hospital Limerick.

I did not ask that.

We will be co-locating. The Deputy asked what we are doing for the sickest children and I am telling him clearly that we will be co-locating all of them with acute adult hospitals-----

What has the Minister-----

Deputy Mattie McGrath has been in this House long enough to know to abide by the rules. It is a matter for the Minister to answer, not the Deputy. Deputy McGrath can ask one more question.

What has the Minister to say about Professor Chris Fitzpatrick's profound statements about the serious threat to babies who will be born with a need for immediate intervention? What does he say to that?

The Minister's reply to my parliamentary question tells me that we will not have a co-located maternity hospital which he has promised all the time. Who is codding who? That is another question so there are two of them.

I remind Deputies and the Minister that these are statements on the new children's hospital independent review and let us confine it to that.

I will indeed. I have already stated, in response to Deputy Connolly, that Professor Chris Fitzpatrick has done incredible work for maternity services. He made a number of valid points before the Committee of Public Accounts last week and I agree with him about the importance of moving the Coombe to the St. James's site. That is in our development plan and there is funding in place to do it. It will not come as news to Deputy McGrath, or anyone in this House, that the sequencing of that was always to build the children's hospital before the maternity hospital.

I welcome the report which provides a thorough overview of the escalation of costs in the national children's hospital project. I want, in particular, to focus on recommendations Nos. 10 and 11 which apply to capital projects in general. Recommendation No. 10 states that the rules that govern public sector spending on major capital projects should be strengthened. The standards to which these cases should adhere should be more clearly and robustly defined. This recommendation concerns the strengthening of the rules on spending on major capital projects with clearly defined and enforced standards for business cases. Project Ireland 2040 was launched just over a year ago.

It sets out a €116 billion approach over a decade to bring our investment up to 4% of our national income. Part and parcel of all of this is how we deliver projects. We have a construction sector group, a Project Ireland 2040 board, an investment projects and programmes office and a capital projects tracker to which I referred when replying to Deputy Connolly.

Key to the recommendation in the report is how we can continue to reform our capital management system. Within all of this, we are updating the work we do regarding the earlier scrutiny of projects, early clarity on project roles and responsibilities, the early identification of risks and the early engagement on costs. My Department is conducting a review of how cost estimation and management for capital projects could be reviewed. This is all done with a view to looking at how we can better select, design and deliver major capital projects.

Recommendation 11 refers to a central assurance and challenge function to provide consistent challenge to and review of major projects throughout their life cycle. The update of the public spending code will strengthen the review and approval framework for capital projects by setting standards for the level of information required for sanctioning authorities at each review and approval gateway. In addition, the investment projects and programmes office was established in my Department in July 2018. The purpose of this office is to co-ordinate reporting on Project Ireland 2040. As part of doing this, we now provide a technical quality review of business cases for major projects. This work has begun with regard to roads, rail, communications, energy, tourism and housing projects. Work is also under way to prepare for the implementation of modern processes of building information modelling, BIM. This will establish the appropriate levels of detail for each stage of a project's development from a high level of focus at inception stages through to detailed design information requirements at the pre-tender stage.

I conclude by noting that over recent years, Ireland has made much progress in delivering projects on time and within budget. The recommendations laid out in the report, which I will implement, will strengthen our ability to do that in future. Risks and complexities exist. This was shown in the case of the national children's hospital. We are aware of them and are looking to take better measures in the future to ensure important capital projects are delivered in our country.