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Dáil Éireann debate -
Thursday, 24 Oct 2019

Vol. 988 No. 5

National Children's Hospital: Statements

I welcome the opportunity to share with the House the progress being made on the new children's hospital project. As Deputies will be aware, this project is the largest capital investment project ever undertaken in healthcare in Ireland. It includes a state-of-the-art hospital being developed on the campus shared with St. James's and the two associated outpatient and urgent care centres on the campuses shared with Connolly and Tallaght hospitals. This project is now in the major construction phase.

This year saw: the opening of the outpatient and urgent care centre at Connolly Hospital, Blanchardstown, on 31 July; the commencement of work on the centre in Tallaght, scheduled to open next year; and continued work on the new children's hospital, which is scheduled for completion in 2022. The provision of the additional services at Connolly has already shown the impact that the overall project will deliver, with more than 1,122 children presenting to the urgent care centre and 744 consultant-led outpatient attendances since it was opened. Once fully operational, this new facility will provide for 17,000 outpatient appointment attendances annually. This will contribute to significant reductions in general paediatric outpatient department waiting times for our children.

Much discussion has taken place on the cost of delivering this project. Last December, I advised Government of an escalated cost for the new children's hospital capital project, with a final figure of €1.433 billion, €450 million more than had been advised to Government in April 2017. I reiterate that this figure remains unchanged, despite accusations to the contrary. The capital build cost of the project is €1.433 billion. This includes all of the capital cost for the main hospital at the St. James's Hospital campus, which will house the school and third level educational spaces, the two outpatient departments and urgent care centres at Connolly and Tallaght, equipment for the three sites and the construction of the car park and retail spaces. No further increases to this figure have been put to, or agreed to by, the Government.

References have also been made to a figure of €1.7 billion, a figure I would like to clarify. This figure includes additional investment from other sources associated with the broader programme required, which is outside of the €1.433 billion capital costs. This includes investment in information and communications technology, ICT, with the new hospital planned as Ireland's first digital hospital. It also includes the comprehensive children's hospital integration project, the €40 million wasted on the former Mater site project and the planned construction of the children's research and innovation centre, which is to be funded through philanthropic funding.

Notwithstanding this investment from additional sources, the reported €450 million increase in December was very significant and warranted a comprehensive and independent review. PwC carried out this review earlier this year and I thank it for the thorough job it did. The review set out to examine the contributory factors and associated responsibilities so that any potential weaknesses could be identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds. Based on the recommendations in the report, my Department and the Department of Public Expenditure and Reform have been developing an implementation plan, which my colleague, the Minister for Public Expenditure and Reform, and I will submit to Government shortly.

Deputies will be aware from the PwC report that there are residual risks in respect of costs. This is not new information; it is included in the PwC report. These costs are not included in the guaranteed maximum price. As the chairman of the National Paediatric Hospital Development Board pointed out to the Oireachtas Joint Committee on Health last June, it is likely that some of those risks will materialise. The most significant of them relates to general construction industry inflation, which is running at higher levels than included in the contract and which is outside the control of the board. Another area that may add to costs is that of claims being submitted to the board by the main contractor. The contractor is entitled to submit claims that it feels are appropriate, and it is likely that such claims will continue to be put forward for the remainder of the project, as they would in respect of any construction project. These are commercially sensitive interactions between the contractor and the board and may be the subject of a dispute resolution process. As such, I am not in a position to comment any further on them. However, I assure the House that a robust process to assess these claims is set out in the construction contract, with all claims independently assessed and determined by the employer's representative, and that there is an additional dispute management process in place. I remind colleagues that when, in the past, people talked about figures that had been put forward for claims, the board had great success in significantly reducing costs through the engagement process.

There has been coverage and commentary in recent days about the resignation of one member of the board in July this year. Under the legislation establishing the board, a board member may resign at any time they choose by letter addressed to me. As Minister for Health, the only role I play in respect of such casual vacancies is to appoint a replacement. Given the range of boards for which I am responsible and the number of members on these boards, which is approximately 800, I do not, as a matter of course, issue statements when board members resign. Currently there are a number of vacancies on the National Paediatric Hospital Development Board and there is an active campaign being undertaken through the Public Appointments Service to fill them. This is very clear to see as these vacancies are advertised through the Public Appointments Service. My Department agreed, with the chairman of the board, the specific qualifications and expertise being sought in respect of any new board members. When I receive nominations from this process, I will make the appropriate appointments.

With regard to the particular individual to whom reference has been made, I would point out that this person indicated in his letter of resignation that it had been an honour and a privilege to work on such a critical project and wished us every success in its delivery. I thanked that person for his contribution.

The work the board has done over the past few years has been critically important in advancing the new children's hospital project. The Government is grateful for the time, expertise and priority that individual members have given to help advance this hugely important development. I will conclude by reiterating the importance of this project for Government. The new children's hospital project, which has been much talked about, is now finally being delivered. It is a landmark project for Ireland and is a priority capital project for the Government. It will transform how care is delivered to 25% of our country's population and will reform the Irish health service.

We have heard in recent days that the cost of the national children's hospital is likely to be even higher. We have also learnt that the State's chief procurement officer has resigned from the hospital's development board. On Tuesday, the Taoiseach said the following in that regard: "it happened in July 2019 and is not news and certainly not new news", "His decision on this is a matter for himself", and "I do not know the reasons for it". The position of the Taoiseach and the Minister for Health is that the State's chief procurement officer was on the board in a personal capacity and that his resignation from the board is a personal matter. Fianna Fáil and I find this an extraordinary position for the Government to take.

Fine Gael told the Irish people that the children's hospital would cost €650 million. Then it was €1.4 billion. It then turned out another €300 million had not been added in, so it was €1.7 billion. Many people have asked how any Government could be so reckless with the taxes people work so hard to pay. The Government's response was extraordinary. It blamed inflation, contractors, and managers and then claimed that there was no overspend but rather that some other people had underestimated the cost at the start. It then claimed that finding the additional money needed for the building would not impact on other healthcare services and claimed that it was still getting the hospital built at a reasonable price. The response from the Government this week has been equally extraordinary and, I must say, equally insulting to many people. As before, it is case of hands off, nothing to see here. Not only is Government not on top of the detail of this resignation, it has not even bothered to find out why it happened. This is how one loses financial control of big capital projects and of public healthcare.

The Irish Fiscal Advisory Council recently published analysis of healthcare overspending going back many years. It found that from 2005 to 2010, the six years of the HSE for which Fianna Fáil was in government, the overspend each year was €0. Over a six-year period, the cumulative overspend for the HSE on healthcare was €0. It was €500 million in 2016, €200 million in 2017, €650 million in 2018, and it is set to be approximately €350 million this year. This comes to a total of approximately €1.7 billion in just four years. In parallel, over the same period, the cost of the children's hospital has increased by €1 billion so far, although it will probably cost several hundred million euro, more based on the bits and pieces we are finding out.

The human cost of these overruns cannot be overstated. I will now read out testimony I received today from one of our doctors, a consultant ophthalmologist.

From the way she was led into the room, to the searching look as she moved her head to see me in a small residual island of sight, I knew from the outset that whatever I could have done for her in the past, it was already too late. This is endstage glaucoma. Let's call her Brigid. Referred from another regional centre, Brigid told me about the heartbreaking wait for a review appointment for over 2 years for a disease that she knew she had, a disease she knew was progressing. She told me about her many calls to request appointments, being told repeatedly that the hospital would contact her. But the hospital never did. She described how she felt abandoned, waiting daily for a letter in the post, forgotten. She told me about the lonely hours at night, living alone in darkness unable any more to watch TV, read the headlines or get around her house, concerned that if a letter came now that she might miss it. She told about how she can no longer leave the house alone to shop; about how the light is fading and how she has an ominous sense that it will soon go out. She is correct. I could have saved her from that. So could others had she been reviewed in time. Now all I can do is delay it a little.

The doctor went on to explain that she meets another Brigid every month and stated that the "reason we are now seeing blind in one or both eyes is that the between visit interval is now 4 to 6 times higher than recommended". Why is this happening? It is because there is not the money to hire the ophthalmologists to treat women such as Brigid and men. It is also happening because, despite massive increases in healthcare spending and Ireland having one of the biggest healthcare budgets on Earth, somehow the money is not available. Why is that? It is because of the overruns and overspends.

When the State's chief procurement officer resigns from the development board of the national children's hospital it is relevant and it is news. Understanding why he resigned is relevant. Getting his insight into how to stop the costs escalating further is also relevant.

Last week, the State's chief procurement officer resigned from the development board of the national children's hospital. It is being reported that he resigned over the spiralling costs of the project. That is what is being reported but it does not necessarily mean that it is the case. We do, however, need to get to the bottom of why he resigned. It is a big deal and it does matter. We deserve to know exactly the reasons or motivation behind that resignation.

The cost of construction for the project has increased from an initial budget of €650 million to almost €2 billion today. The figures keep going up and up and taxpayers are the ones who will have to foot the bill. This is a staggering increase of costs in such a short period. It shows that the entire design of this process was fatally flawed from the start. Last January, an Taoiseach had the gall to blame the cost overrun at the national children's hospital on sprinklers. It would be laughable were it not so serious.

The PwC report into the cost overrun at the national children's hospital is lengthy, detailed and comprehensive. It clearly shows that this process was flawed and hamstrung from the beginning. It shows mistakes and failures at every turn. It illustrates how the Government pursued a risky and untested two-stage procurement strategy. This strategy was known to have grave risks of cost escalation. The purpose of the strategy it seems was to get the project finished quickly to provide a photo opportunity for the Government. The report highlights significant issues with governance and oversight and it points to the serious matter of non-compliance with the public spending code. That alone required immediate Government investigation, but of course nothing has been, or will be, done - not by this Government in any event.

The Government has proven time and time again to be unable to navigate this project and is responsible for what may turn out to be a €1.35 billion cost overrun. Can one imagine how that money might be spent in providing home care packages to people or for the many capital projects in acute hospitals up and down the State that are in a queue and need to be funded? Yet, there is a €1.35 billion overrun in respect of this single project.

It is incredible that PwC was able to conclude that 65% of the overrun was a result of "underestimation" and issues that it stated "should have been identified". It did not have to be this way. This is purely down to bad project design, a desire for speed, and an horrendous lack of proper oversight. The Committee of Public Accounts has examined this a number of times and had accounting officers and officials before the committee, including the individual we mentioned earlier who has resigned since. The committee shines a light on public procurement because we believe that it is important to make sure we look at where lessons can be learned and savings made.

Health plans across the State were put under review because of the rising cost of the national children's hospital. The Minister would reject that any project was cancelled or faced with delays, but the facts say something else. I commended him on the approach he took with Oireachtas Members from the south east and Waterford regarding a number of health projects, one of which relates to the second catheter lab. We had a meeting more than a year ago when this project was signed off. It took four months for the HSE estates department to issue the approval letter for the regional HSE estates department to progress the project. When I challenged the head of the HSE estates department at the committee, he stated that it was because the organisation was looking at all of the projects in the context of the overspend on the national children's hospital. There is an example of one project that faced some delay of a couple of months.

Overruns on this scale are not victimless. Huge amounts of money are involved. I appeal to the Minister to learn the lessons. We all want this project to proceed and for the hospital to be built. That is a given. It needs to be done for children across the State. The days of looking at what the alternatives could have been and should have been are well past. We need this project delivered as quickly as possible. We need to learn very serious lessons about how we do public procurement when it comes to projects of this scale. The State cannot afford to see a project like this happen again with such significant cost overruns and the consequences this has for citizens.

There is no doubt that the spiralling cost of the national children's hospital is an example of the Government's laissez-faire attitude to large-scale capital projects and by far the most disastrous. It has obviously had an effect on other capital projects. The project I care about most is the 96-bed hospital in my constituency, University Hospital Limerick, UHL, which continues to be the most consistently overcrowded facility in the country.

The cost of building the new children's hospital on the site of St. James's Hospital in Dublin has increased from €987 million in 2017 to more than €1.4 billion. While the Minister has indicated that he does not believe it, the total bill will certainly be more than €1.7 billion. There are many people who believe it will not stop at €2 billion when it is completed, including IT commissioning and fitting out. The Minister stated: "No further increases to this figure have been put to, or agreed to by, Government." I accept that no further increases to the figure may be agreed by the Government now, but the question is whether there will be further increases in the future. That is really what we need to know.

I do not know if Ministers for Health and Finance were completely asleep at the wheel as these costs escalated. The Minister for Finance's chief procurement officer was sitting on the National Paediatric Hospital Development Board. Did he just ignore all the alarm bells? Amazingly, despite weekly meetings with his Minister, did he never hint at an overrun on the project? Now we know that Paul Quinn, the State's chief procurement officer, which is a role tasked with securing value-for-money reforms in the use of private contractors by public bodies, who sat on the children's hospital board because of his expertise and was the chair of its finance subcommittee, has resigned in recent weeks. The board minutes from a meeting on 7 August noted the senior civil servant's resignation from the hospital board. Mr. Quinn is the latest senior figure to step aside from the board. Other previous resignations included the chairman of the board, Tom Costello, and the project director, John Pollock. According to the Comptroller and Auditor General, as a senior civil servant, Mr. Quinn is obliged to pass on concerns about the rising costs of the project to the relevant Government Minister, if he felt the hospital board was not addressing them. The Comptroller and Auditor General stated that Mr. Quinn was bound by a circular stating that information should be presented to the Minister where there are serious weaknesses in controls that have not been addressed, or where there is a risk of reputational damage to the body. This appears to have never gotten through to the Minister.

As others have indicated, the real issue now is that this project is affecting so many projects across the country. HSE managers are openly telling Deputies that their local projects such as nursing homes and primary care centres cannot proceed because there is no money in the kitty. In many cases, the HSE is just profiling the spend and pushing it out by years in order to hide the fact that it is not happening. At a national level the progress being made on a range of projects shows there is no funding available. Despite the situation with overcrowding at UHL, there does not appear to be any real provision for the proposed new 96-bed block in the hospital, which we absolutely need.

I hope the Minister can reassure me in respect of that matter when he replies. The other hospitals in the mid-west are trying to pick up the slack, but there is simply not enough capacity to do so. We need to know also when the scanner will be rented or delivered. I hope the Minister has some news on that. There is no provision for proper capital spending on the national maternity strategy and that affects the hospital in Limerick and the three hospitals in Dublin. It is, again, a very sad state of affairs in Limerick when the HSE cannot find €1 million for the design of the new maternity hospital.

What is of great concern is the design of the new children's hospital. Are there new issues with the design and with health and safety in the hospital? I quoted the Minister's comments to the effect that no further increases had been agreed by Government. Can he confirm that these issues in respect of design and health and safety do not arise? We need to have full confidence that additional costs are not coming, yet again, on the children's hospital because of mismanagement. If there are, I hope the Minister will tell us.

I pressed for this debate at the Business Committee because the massive overruns relating to the national children's hospital, involving hundreds of millions of euro of public money, and the resignation of the chief procurement officer from the National Paediatric Hospital Development Board are examples of the substantial and important issues which have been overshadowed by the Dáil voting scandal. The latter involves many aspects, of course, and has, critically, called into question for many the integrity and credibility of the voting system and the House. While that needs to be investigated in and of itself, an unfortunate consequence is the overshadowing of the issues regarding the national children's hospital, which would otherwise have been at the top of the news agenda. They are issues of enormous national importance. The country has been scandalised by the level of the overruns which have seen the initial cost estimate of €500 million increase to €766 million, then to €983 million and on to €1.4 billion. There is now of a figure of €1.7 billion and suggestions that the cost will rise above €2 billion. This involves hundreds of millions of euro that could have been allocated to other things and overruns which may affect other vital health capital projects. Deputy Bríd Smith tells me that there are serious questions over primary care centres in her area in Drimnagh. While she is not certain about the centre's fate, it seems to no longer be on the capital programme on which it formerly appeared. She has asked questions but I do not know about it for certain. The point remains, however, that this is a great deal of money and people have been scandalised by it. Against that background, I find the response of the Taoiseach and the Minister on the resignation of the chief procurement officer incredible.

The chief procurement officer, Mr. Quinn, was appointed by the Minister in 2013. It was a Government appointment and he was presumably given the position because of expertise in the area of public procurement. He was put in charge of the largest capital project in the history of the State and that project then spiralled out of control as a result of underestimates. We have had a damning report from PwC on how badly the project has been mishandled, how gross were the underestimates and how there was a failure to anticipate higher demands from contractors and so on. Against that background and rumours that the Taoiseach is briefing the Leader of the Opposition about possible further overruns because of further demands from contractors that could push it well above the already shocking current figure, the Minister says the resignation of the chief procurement officer is not a matter for comment. I find it unbelievable he does not think that this is news or that the Taoiseach could say it is a private matter and that it is nothing to do with him, so why on earth would he make a statement. That stretches credibility. Does the Minister accept that most people looking on and seeking transparency, clarity, answers and accountability with regard to the scandal involving this project will consider it odd that there has been yet another resignation of a key civil servant? He was not only responsible for public procurement on this project but was in charge of public procurement more generally, including €9 billion worth of procurement projects in the year he was appointed. Yet, there are no questions and no comment from the Minister and we are told this is not a subject of interest. It is, in fact, a subject of huge interest for the public and the Minister's answer is, frankly, unacceptable. The Taoiseach's approach is not acceptable. There must be a full explanation as to whether the resignation was linked to the continuing and likely increase in the cost overruns relating to the national children's hospital, which is already a major national scandal.

I was scathing earlier this year when it emerged that the cost of the building of the children's hospital had escalated from €987 million in 2017 to €1.4 billion. I called for building to stop and for an investigation into the overrun. We know now that the total bill is expected to be more than €1.7 billion when other costs are included for the total cost has yet to be finalised. The cost will then go to arbitration to be haggled over, as happens in all building projects. Any differences will go to arbitration to haggled over and we will probably never know the actual final cost of the hospital.

Paul Quinn was the State's chief procurement officer, in which role he was tasked with securing value for money and reforms in the use of private contractors by public bodies. He sat on the board of the children's hospital and was chair of its finance sub-committee. The board met on 7 August and noted Mr. Quinn's resignation from the hospital board. Mr. Quinn is the latest senior figure to step down from the board. Previous resignations to hit the hospital project include that of the chairman of the board, Mr. Tom Costello, and of project director, Mr. John Pollock. The officials in charge of the project came under sustained political criticism over the failure to flag the serious cost increases. According to the Comptroller and Auditor General, Mr. Quinn was obliged as a senior civil servant to pass on to the relevant Minister any concerns he might have had about the rising cost of the project if he felt the hospital board was not addressing them. The question is whether Mr. Quinn passed on any reports to the Minister or his Department on cost overruns or questions regarding the running of the hospital project. The Comptroller and Auditor General, Mr. Seamus McCarthy, told the Committee of Public Accounts that Mr. Quinn was bound by a circular which states that information should be presented to a Minister where there are serious weaknesses in controls or a risk of reputational damage to the body concerned.

In the context of the cost of the project, it was interesting that the Taoiseach and the Minister chose not to launch the HSE's €2.1 billion three-year capital plan at the site of the new national children's hospital. The cost of building the children's hospital at St. James's has jumped from €900 million to €1.7 billion and continues to hang as a millstone around the Government's neck. It took the Minister nine months into the capital plan period to agree a capital plan that we are told is proofed against cost overruns at the children's hospital site. The Taoiseach proclaimed proudly at the launch of the capital plan that none of the hundreds of other capital projects, large or small, will be cancelled because of the problems of the children's hospital. He said that if delays occur, it will not be because of the children's hospital and that anyone who said otherwise by claiming projects would be cut was scandalmongering and telling fake and made-up stories. That is strange because it was the HSE which earlier warned that it would be impossible to deliver investments in healthcare because of the budget overrun in the children's hospital project. The Minister told colleagues last December that spending on a number of major projects could be halted or significantly curtailed for four to five years on foot of the same issue.

I do not remember that.

The Minister did that. It is public.

The Government line is that the Minister for Public Expenditure and Reform, Deputy Donohoe, found an additional €200 million this summer which will be used to fund the children's hospital and broadband projects. However, the children's hospital needs more than an additional €100 million a year for four years, and it is far from clear from where the deficit is to be made up. The capital plan, which lacks detail and uses woolly language with the word "progress" appearing about 25 times in relation to the project, does not provide the answer.

Another matter causes me great concern and I have raised it before. It is disgraceful that eight private outpatient consultant rooms will be part of the overall cost. The Government has stated that it is in the consultants' contracts that they must be put in place but this is against the backdrop of Sláintecare, which is supposed to provide public healthcare for everybody.

The children's health group which will run the hospital announced that the proposal is for consultants to pay a fee for the use of the rooms and other operational costs. Is this the case? Will they pay for the labs and to access diagnostic facilities? Will that be transparent and out in the open so that people can see exactly how much it costs and how much consultants are paid?

The resignation of the chief state procurement officer, Mr. Paul Quinn, from the board of the national children's hospital is just one more in a long line of incidents that have raised questions about the integrity and credibility of the entire oversight process related to this project. It is well known that myself and my colleagues in the Rural Independent Group put two motions before the House to have this project halted and immediately reassessed. Unfortunately, both efforts were rejected by the House as a result of the confidence and supply agreement.

I am not sure what the Deputy means. We are here. Gabh mo leithscéal. That is why it is galling to listen now to the concern that has suddenly developed around this process. We had two chances to stop the madness at the national children's hospital and we chose not to. The Taoiseach said on Tuesday that the Board of the NCH and the entire process is subject to sufficient levels of oversight. That comment is almost comical. What planet is he on? Who believes him? Nobody. We saw the farce around the PwC report in April. That review of the escalation in costs associated with the national children's hospital project demonstrated a glaring political unwillingness to pursue any kind of meaningful accountability. In fact, that report, like the site of the national children's hospital itself, will prove to be nothing more than a black hole into which we have poured significant amounts of public money for no good purpose.

The PwC report was clear the nine organisations interviewed during the process did not include Connolly for Kids or any of the senior clinicians who have campaigned and forensically deconstructed the arguments for St. James's for years. There was not a single interview with any of the tens of thousands of families affected. It is shameful.

What is most revealing is that in its recommendations, PwC states: "We have considered and agree with recommendations made by Mazars in their reports relating to cost escalation and governance" and that the recommendations in the PwC report do not replace them. Effectively we paid out €600,000 plus to find out what we already knew. This is scandalous. It will go down as one of the worst parts of the Minister’s legacy. I have said before that he is the worst Minister for Health ever in this country. He should hang his head in shame. I believe from media reports the Minister is chomping at the bit to have an election because he wants to get out of his position so quickly: he wants to run away and leave the mess.

Dr. Jimmy Sheehan and Dr. Finn Breathnach, Dr. Róisín Healy, and John Irwin and the Jack and Jill Foundation, ambulance drivers, nurses and families have all warned the Minister about this site.

I have a new grandchild, Cathal, born last week, thanks be to God. The greatest shame for rural politicians, and it is why we tabled this motion, is that none of our grandchildren will ever get into that hospital because they cannot access it. They will not be able to get near it. There is no helipad. It is a crying shame. Dr. Finn Breathnach and Dr. Jimmy Sheehan said they would build the hospital for €1 billion, and had a greenfield site of 100 acres. It would have had three helipads, a lake and an ambience in which children could recover. This is a kip inside the centre of a city which has no room for it. It will never come out of the black hole and will probably never finish. The Minster thinks he can run, but he cannot hide because the people of Wicklow know all about him and they will be waiting for him. This election is imminent. They will give the Minister his answer. He is not accountable to anyone. He can laugh all he wants, but this is a travesty for the sickest of children and the families who are so desperate for care for their little loved ones. He treats them like this with a vanity project which has gone through three Ministers for Health, Senator James Reilly, the Taoiseach, Deputy Varadkar, and the Minister himself. They all say it is a wonderful project but there have been comparisons made with hospitals all over the world. It is five times as dear as anything that has been built and is in the wrong place and it will never be right. It cannot be accessed by car, by bus or ambulance, getting stuck in narrow streets. The houses around the site are all damaged and undermined. Local people are horrified with the project and the disruption. The real crime is that there is no helipad. Imagine that in this day and age, yet they say it is the most modern hospital of all time. It is a vanity project and a disgrace. The people who I represent in Tipperary will never use it because they cannot get into it. They need it badly but they will not be able to access it because of the lack of a helipad. It has a small helipad for a small helicopter on the side of a third floor building where, when there is a windy day, one cannot get near it. Imagine the noise and the disruption to sick patients from the sound of a helicopter landing outside the window. It is a disgrace and a travesty. This is a rotten legacy which the Minister will have to his name. How he will be proud of it, I do not know, but the people of Wicklow will give him his answer when they get to him very soon.

The ongoing debacle around the national children's hospital would make one despair. It is not only the children's hospital. One must despair at the State's ability to deliver a major infrastructure project some way on budget and on time. Successive Governments have failed to do that and to have basic respect for public money down through the years. When the Office of Government Procurement was established and a head was appointed, people thought this would make a difference but it has not. Over recent years, people on this side of the House tried to get the Minister and his colleagues to focus on the shambles that the children's hospital was becoming in relation to the cost overruns and the delays. On an ongoing basis the Minister and the Taoiseach put forward the rationale for a modern new children's hospital. No one is disputing that. Everyone agrees that we desperately need a modern children's hospital that can meet the needs of children living in Ireland. There was a lack of honesty around the failure to address the issue and to contain costs. The Irish Fiscal Advisory Council, IFAC, has been very vocal on this. It has drawn attention to the standout issue, the national broadband plan. Second only to that is the national children's hospital where the overrun was estimated at €983 million last year. That represented a 94% cost overrun. IFAC has been very clear on the reasons for these overruns. It said that they displayed: "weak leadership by planners who lack experience in large projects, which can lead to major changes throughout the project cycle". We saw how this happened with the children's hospital. I agree that Dr. Jimmy Sheehan was very clear about the right kind of approach that must be taken where the full specification needs to be agreed and nailed down at the beginning. Unfortunately that was not the approach taken. There was a rush to deliver the project by this Government and therefore, adequate attention or care was not paid to ensure that the initial specification was got right.

IFAC also referred to "conflicts of interest in decision making by different stakeholders in the public and private domains". I also agree with that. It said there was a failure by Government to recognise that it is not playing around with some sort of slush fund: it is public money that the Government is spending on the public's behalf.

The Minister has a duty to ensure the money is spent properly. There seems to be a cavalier approach to public money and there was nonsense spoken to the effect that this would not have an impact on other projects. Of course, it is having and will in future have a major impact on public projects. There is currently a cost overrun of €500 million and the likelihood is that this will double. We are now looking at a position where essential funding that was supposed to be provided for other capital projects will simply not be available.

The other point I will make relates to Mr. Paul Quinn, the head of the Office of Government Procurement. I raised this in February and at the time the Taoiseach misled the House. I made that very clear at the time. He said Mr. Quinn could not divulge the issues associated with the ballooning cost of the children's hospital because he was bound by-----

-----the legal responsibilities-----

I said it at the time and I am saying it again.

The Taoiseach misled the House about the role of the-----

-----but if you said it at the time you were out of order, and you are still out of order. Please do not repeat it.

Excuse me. The Taoiseach stated here that the head of the Office of Government Procurement-----

I am sorry, Deputy, but if you want to use the rest of your time repeating your mistake-----

Allow me to say what the Taoiseach said. He said he had a fiduciary-----

You said now in your speech-----

Could the clock be stopped, please?

-----that the Taoiseach misled the House. It is a serious allegation and you will have to come back to it again.

It is the second time I have made it. He said Mr. Quinn had a fiduciary responsibility and his responsibility was to the board. That is not true. It would be true in respect of a commercial board but this is not a company; it is a development board. In that respect the Taoiseach was not right.

We know that under the terms of the operation of the head of the Office of Government Procurement-----

-----Mr. Quinn had a responsibility to tell the Minister present as the Minister in the parent Department. The Minister for Finance confirmed that he did tell the Minister but he chose not to share that information with anybody else-----

No, he did not.

Thank you, Deputy. I am sorry but the Deputy's time has expired.

That is not true.

-----just as the Taoiseach chose not to disclose-----

You obviously do not have any respect for the Chair or the House.

In a secret arrangement with the leader of Fianna Fáil-----

-----to inform him of-----

The Taoiseach is answerable to this House-----

The Deputy is out of order.

You are out of order and not for the first time. Please resume your seat as you are out of order.

He has completely disregarded the responsibility-----

-----of the Taoiseach to ensure this House-----

I will suspend the House if the Deputy continues in that vein.

-----can be made aware-----

You clearly have no respect for anybody else or their time.

-----of what his civil servants-----

Do not suspend the House.

Deputy, that will be recorded in your next intervention.

-----want to shut me up-----

If you want to talk about this all night, I am quite happy to entertain you but your behaviour is appalling.

-----about the reality of the Taoiseach misleading the House-----

Your behaviour and lack of respect for the other Members in the House is appalling.

-----you are not doing your job as Acting Chairman.

We will now go to questions and answers before the Minister gets five minutes to wrap up. Each group has five minutes for questions and answers.

I will share time with Deputy Curran.

Is it five minutes for questions and answers?

I have three related questions. Does the Minister agree with the Taoiseach's statement here on Tuesday that the resignation of the State's chief procurement officer from the development board of the national children's hospital is a private matter, not news and not relevant to the Government or the Minister? Has the Minister made any attempt to speak with the State's chief procurement officer about his resignation? Has he gained any insight that would be relevant to controlling costs from that?

The letter from the Taoiseach to Micheál Deputy Martin, which, for the information of Deputy Shortall, was not part of a secret arrangement but rather in response to an oral question in the House-----

It went to the Deputy's leader.

It states that the guaranteed maximum price does not provide a contractual ceiling and significant residual risks remain of further cost. Nobody knows what the final cost escalation will be but does the Minister have a total amount that he believes this could rise to?

I will be as brief as I can. I thank Deputy Donnelly. We have spoken much about votes this week and people are forgetting what they voted for in this House. We passed the Children's Health Act 2018, which gave new powers in how this board is appointed. It set new criteria for how the board should be appointed and we have appointed a new chairman of the board, Mr. Fred Barry. Mr. Quinn is spoken about in this House and there are statements made about him that are not very fair. He served for six years. The chairman went into a new board and looked at how to augment the skill set, considering how the project was transitioning from a build project to commissioning and opening facilities. A number of members of the board decided that now was the time for them to step down. There was no secrecy around this and it was advertised on the Public Appointments Service website, in line with the legislation for which Members voted that dealt with how those appointments would be made. Deputy Boyd Barrett seemed to suggest Mr. Quinn was the chief procurement officer for the project but that is not the case.

I am reluctant to cut across the Minister but we are going to run out of time. The specific question was whether the Minister agrees with the Taoiseach's comment in the Dáil on the resignation.

Of course I agree with the Taoiseach and he is entirely correct that a number of members of the board decided they had done a significant stint. I believe they have done the State some service but most of the Members here wanted to sack the entire board. The PwC report found it would not have been the right course of action.

The Minister reappointed them last year.

I did. We will get to Deputy Shortall's questions in a moment.

I want to bring in Deputy Curran.

Again, I appreciate time is tight.

I will stay here.

We are not going anywhere. I want to bring in Deputy Curran.

I can stay here all night.

I appreciate it is tight.

This is Fianna Fáil's time.

I know it is very important but Deputy Curran is important as well and he is entitled to his time.

The Deputies can get the answers to the two questions after he uses his time.

I am more than happy to stay longer.

With the greatest respect, how we use our time is not a decision for the Chair. It is a decision for us.

If the Deputy wishes to take the entirety of the time allocation, that is fine. I do not mind.

There is clearly quite a degree of concern about the cost overruns and there is not agreement on what the figure might be now or in future. In previous replies, the Taoiseach and the Minister have indicated that this would be a relatively small amount in any given year and it can be factored into calculations. They have spoken about re-profiling other projects. Sometimes it sounds as if that would be without consequence.

I will put it as follows. At Rowlagh in north Clondalkin, a primary care centre was announced by a former Minister, Senator Reilly, in 2012. It was supposed to open in 2016 and it eventually received planning permission in 2018 but it has not gone to tender or construction as we speak. Is it one of the projects that will be delayed and re-profiled as a result of the cost overruns at the new national children's hospital? Will the Minister outline all the other projects directly affected and delayed?

There are 46 seconds left before we roll into somebody else's time.

That is okay and I do not wish to be disorderly but we need to give each other a little bit of an opportunity to ask and answer the questions for the people watching these proceedings. I will be guided by the Chair.

I would like to answer the Deputy's serious and important questions. I will revert directly to the Deputy about Rowlagh primary care centre as I do not have information to hand.

On the Deputy's substantive point, no projects will be delayed as a result of this because of the decision we took in the summer economic statement to allocate a reserve for the funding for both the national broadband plan and the additional costs required for the children's hospital.

The letter to Deputy Micheál Martin simply restated the comments made by Mr. Fred Barry before the Oireachtas health committee on 12 June. I have long quotes that I could read from him but he listed those residual risks. It might suit people to suggest this is new information but it is not. The residual risks were always there and they were outlined transparently to the Oireachtas health committee on 12 June.

The Sinn Féin group has five minutes as well.

The Acting Chairman should mellow or relax. He should take a deep breath. I have no problem putting my questions and I will use my five minutes as best I can. I thank the Acting Chairman for his guidance.

Will the Minister inform the House as to whether there have been any additional costs aside from those of which we have already been informed by the Minister? Will he give the updated figure on the estimated overall cost? A number of Deputies mentioned there may be new design issues, which have been put in the public domain. Will the Minister inform the House if there are new design issues of which Members have not been made aware that may complicate the progression of the project?

One of our jobs in opposition is to scrutinise Government. The Minister must accept that this is reasonable. I am not calling into question the bona fides of the individual, Mr. Quinn, who is obviously a highly competent person - we all accept that. However, the head of the public procurement agency sat on a board and there was a major scandal around the project that the board was there to supervise. Then that person resigned and stepped away from the position. It is reasonable for us to ask why, especially when others in the media and elsewhere are saying that, potentially, he resigned because of continuing cost overruns. Can the Minister inform the House why he resigned? Can the Minister give us an assurance that he did not resign because of any cost overrun issues, any issues relating to the operation of the board, governance or any other issues? It is a serious matter.

Earlier, I mentioned one project in my constituency that I believe was delayed by several months because of indecision as a consequence of the overspend on the national children's hospital. The Government has never conceded this was the case for a range of projects. It would be helpful if the Minister was in a position to outline to the House specifically what projects and services have suffered as a consequence of the overrun and what was undoubtedly a pause by HSE estates in respect of a range of capital projects. This happened because the HSE was trying to figure out which ones to progress and which ones not to progress. By the way, that actually led in turn to the capital plan being published in September or October - nine months into the year. Was the cost overrun the reason the capital plan was delayed?

I thank Deputy Cullinane for his questions and the succinct manner in which he has put them.

Deputy Cullinane asked about the south east. I thank the Deputy for his acknowledgement earlier of how we work well on these issues. We will meet again to progress issues like the catheterization laboratory shortly.

It is fair to say there was a period of uncertainty for the HSE as it waited to see how Government and the Oireachtas responded to the additional costs. We rectified that by providing certainty in the summer economic statement. The statement provided a reserve, as I said to colleagues, for broadband and the children's hospital. That allowed me to publish a plan not only for 2019 but for 2020 and 2021 as well. It has provided certainty of funding that, frankly, the HSE has been lacking for many a year. We should remember there was no HSE capital plan published the previous year. We would need to go back many years to find a three-year horizon published.

I agree it is entirely reasonable to ask the question. I like being asked questions and trying to answer them as well. The point I need to make is that several members of the board have stepped down. I do not think it is unreasonable for someone who has served for five or six years on a board to decide he has done his bit and brought the project to the stage it is at. The Oireachtas has changed the law. With the Children's Health Act 2018, it voted to allow the Minister new powers to appoint people through the Public Appointments Service. We have a new chairman, Fred Barry. The PwC report said we should augment the skills of the board, so let us get on with doing that.

I do not mean this about Deputy Cullinane, but there is great irony in the fact that many Members jumped up and down and shouted for me to sack the entire board. Then, when a member of the board actually steps down, they bemoan the fact. The reality is that I have thanked the board. The PwC report said it would not have been the right thing to clear out the entire board - that is my paraphrasing. I believe it makes sense at this crucial juncture for the chairman to analyse the skill set, as he has done, advertise in the Public Appointment Service and appoint people. That is what we will now do.

There have been no new design issues since the conclusion of the guaranteed maximum price process or, to be entirely accurate, since the conclusion of the GMP process there has been no change to the design intent for the new children's hospital. There have been some minor adjustments, as would be normal practice in a project of this size. The suggestion that since the GMP process there have been significant changes is not helpful when it is raised on behalf of the taxpayer.

Reference was made to additional costs. The cost remains as outlined to this House. As Fred Barry said on 12 June at the Joint Committee on Health, in a project of this size or in any construction project claims come in all the time. They are commercially sensitive and they have to be robustly defended, if appropriate, by the board. They come in on an ongoing basis. As of now, there are no new additional costs.

I wish to follow up on some of the issues raised already. All three Deputies who have asked the Minister questions so far have asked why the chief procurement officer of the Department of Public Expenditure and Reform resigned from the board. The Minister has given us something of an explanation by saying it is perfectly natural for people to resign from boards from time to time. Did the Minister for Health or the Minister for Public Expenditure and Reform ask him why he was resigning? Did he give the Minister for Health a reason? Will there be the appropriate level of expertise? This is important because his expertise was in procurement. Surely, procurement is still part of the necessary skill set on the board.

My next question follows from what Deputy Cullinane said about the design. The Minister said the design has not changed in recent months. Is there any indication that the design may change in the near future? Can the Minister give us an update on the timelines of the project?

Maybe I am better off not asking too many questions. I might get full answers if I do not, so I will leave it at that for now.

I will give Deputy O'Sullivan full answers, as I know them to be the case.

I have not had a conversation with Mr. Quinn. I cannot speak for the Minister for Public Expenditure and Reform. Obviously, he meets his officials regularly. I have no knowledge of any conversations.

It might be helpful.

Deputy O'Sullivan might be able to ask by way of a parliamentary question. I have no knowledge of a conversation. I have not had a conversation.

I will make this point again. It is a straightforward point. Several members of the board have stepped down. This will allow for a regeneration of the board in line with the skill set that the Children's Health Act 2018 envisaged. We only passed the Act at the end of last year. The posts will be advertised through the Public Appointments Service.

I thanked the outgoing members of the board - there were six in total - for the work they did. They gave five or six years to a vast project and that is admirable. I have no doubt all these people, who have a variety of skill sets, did that for good reason. Deputy O'Sullivan was in government - I say this as a good thing - when many of these people were appointed to the board. They are good decent people who did a good job.

I am not aware of any planned design changes. I suppose it is important to add a caveat as I did in my last answer: there can always be minor alterations with a project of this scale. Anyway, there are no design intent changes. Indeed, the National Paediatric Hospital Development Board went to An Bord Pleanála on 23 May 2019 in respect of some minor alterations. The board said on 6 August 2019 that the proposed alterations do not result in material alteration.

Deputy O'Sullivan asked about the timeline. It is still my understanding that the hospital will be finished in 2022 and open in 2023. I understand the Tallaght part will open next year in 2020. Obviously, the Connolly part opened in 2019.

I have some time left unless Deputy O'Sullivan has another question. She may wish to note that I am eager for the Limerick MRI project to happen. Deputy O'Sullivan has raised this with me on several occasions. I have met officials from the National Treatment Purchase Fund, the HSE and my Department to identify how best to do this. I have asked them all to report back to me quickly. I have also asked that they meet Oireachtas Members from the mid-west. I am guessing from Deputy O'Sullivan's question that this has not yet happened. It needs to happen. There is now significant funding, between the €26 million that the HSE has for the winter and the €100 million that the NTPF has now for 2020, to get on and provide a second MRI facility. The view of the hospital management is that this will make a significant difference.

The 96-bed ward block for Limerick is mentioned in our capital plan. I am not saying it will be completed during the duration of the capital plan - it will not. The sequencing is to go ahead with the 60-bed ward block, which we have delivered. I know Deputy O'Sullivan agitated for that. That is well under way and will open next year. The 96 beds are committed to and funded as part of our ten-year capital plan.

I am fairly stunned by the Minister's response.

I am sorry about that.

Maybe I am missing something here. Does the Minister recognise that the public are appalled at the level of overruns with the children's hospital, the amount of money involved, the scale of the project and the damning criticism by PwC of the entire process?

Against that background, does the Minister not understand why the public would be even a little concerned that someone who was appointed by the Government, who was the Government chief procurement officer and who was appointed to the board has resigned? The Government's attitude to him seems to be that he was simply appointed and sat on the board for several years when all these overruns arose and now there are suggestions there could be further overruns. The Minister is telling the Leader of the Opposition there might be further overruns but that his resignation is something we should not be concerned about. I find that a highly strange attitude. Does the Minister not understand why not only I but the public might think that is a particularly odd attitude to take given everything that is happening? The Minister is casually saying that this individual was on the board for several years but the Minister did not really know what he was doing and has not really talked to him since he resigned. It seems the Minister is not really that concerned about why he resigned. He seems to be suggesting it is normal for someone to step down. Is this not a little odd given the scale of the project, the importance of his role and the fear that there could be further overruns on this project?

Does the Minister not think there should be a little more interest from the Government in Mr. Quinn's reasons for resigning? Should there not be a little bit more explanation, transparency and accountability? Does the Minister not think that is a reasonable thing to ask?

It is entirely reasonable but just because the Deputy does not like the answer I give does not mean that it is not transparent; it just means that it does not align with his conspiracy theory.

It is not a conspiracy theory.

On the question of the rationale, I will repeat it one more time. The Children's Health Act 2018 sets out a new way for the board of the National Paediatric Hospital Development Board to appoint members. It identifies a skill set that should be used and it says that no longer will appointments be made in the old way. They will now be made through the Public Appointments Service. Deputy Boyd Barrett voted for it and the Bill was passed in this House. We brought in a new chairman, Mr. Fred Barry, who is doing an excellent job. His appointment was widely welcomed and he is widely respected across this House. The PwC report says that we should not throw out the whole board but look at its composition, augment the skill sets and see what skills are needed going forward. The new chairman will obviously also look at the board, talk to board members to determine who wants to stay on and whether anyone feels that he or she has done enough time and provide opportunities to regenerate the board. Approximately six members of the board decided, having done six years on a very intensive project, that they had done their bit, despite Members of the Oireachtas throwing bricks at them and telling them that they should have to resign as members of the board, as many in this House did. They decided that they had done their bit and were going to step down to provide an opportunity, in a new phase of the project, for others to take it to the next level. That is the truth. That is what has actually happened.

The Minister has not answered the question as to why-----

Mr. Quinn made it very clear why he stepped down-----

The Minister said that he had not talked to him.

He stepped down because he had done six years. He and a number of other members decided it was time to allow an opportunity for new people to serve on the board. He sent me a note thanking me, wishing the project success and saying that he was delighted to have been involved in progressing such an important project. He has done the State some service, as have all of the other people involved.

I must point out that there are 53 agencies for which I am responsible and which have 612 board members and 19 other aegis bodies, which have 262 board members. There are almost 900 board members that feed into me but I do not issue a press statement every time there is a change to a board.

On the Deputy Micheál Martin letter, in fairness to the Deputy and to the Taoiseach, this latest conspiracy theory was articulated by Deputy Shortall, who is no longer in the Chamber for the questions, let alone to hear the answers. Deputy Micheál Martin raised an important matter relating to the children's hospital on the floor of this House, as he is entitled to do. The Taoiseach responded, as he is obligated to, outlining what the Chairman, Mr. Barry, said on 12 June regarding residual risk. People accuse me of being asleep at the wheel but unless people were asleep at the committee on 12 June, they would have heard Mr. Barry outline all of the residual risks. There are no new residual risks. Members were all told this but it suits some to keep on returning to the matter and presenting information that has been in the public domain for months as new information. People will see through that.

A person is entitled to resign if he or she wants to and that is fair enough. That is what the Minister is saying but in the period prior to Mr. Quinn's resignation on 7 August, from January of this year, did he raise issues of concern relating to cost controls or governance in the context of procurement? Did such concerns pass the desk of the Minister for Health or the Minister for Finance? If anything did pass the desk of the Minister for Finance, was he obliged to let the Minister of Health know about it?

I find it hard to believe the Taoiseach's assertion that this will not affect any other projects given that the HSE has said that it would be impossible to deliver investments in healthcare because of the budget overruns in the children's hospital. The Minister said the same in a memo last December. Who is telling the truth? Is it the Taoiseach or the Minister and the HSE?

My final question relates to the suggestion that consultants will have to pay a fee for the use of rooms and will have to meet other operational costs relating to laboratories and diagnostic facilities. Will that be the case? If so, will it be transparent? Will consultants have to show what they paid and to whom the fees were paid?

The reporting mechanism for any Minister and a board appointed by a Minister is through the chairman. I had no direct engagement with Mr. Quinn or any conversations with him. Obviously, I know Mr. Quinn having been a Minister of State in the Department of Public Expenditure and Reform in a past life. In terms of this project, any engagement I would have would be through the chairman to me or through the Secretary General to me. I cannot speak for the Minister for Finance, as I said to Deputy Jan O'Sullivan earlier. I do not have any knowledge of that but the Deputy could ask the Minister for Finance that question directly.

In terms of the impact on projects, the Deputy makes a very fair point. Of course if a project costs more money, that money has to be found somewhere but the answer is to be found in the summer economic statement. We took a decision to set aside additional resources so that no project would be delayed or cancelled. That was the rationale behind that decision to reserve €200 million for the broadband plan and the additional costs of the children's hospital. That provided certainty to the health service that allowed us to publish a plan with 250 health projects, of which the children's hospital is only one, albeit a large one. There are 249 other projects in the plan.

The Deputy asked why we did not launch the capital plan at the children's hospital which is in her constituency. She may be familiar with it but I found the question somewhat ironic given that the board of the hospital is fed up inviting Members of the Oireachtas to come and visit the site. I know that the Chairman of the Joint Committee on Health visited. Every member of that committee has been invited but most have decided not to go. I do not think any party leader has visited the site. If Members did visit, they would not be making ridiculous comments like those of Deputy Mattie McGrath, who referred to a black hole. If one visits, one can see the progress that is being made.

On private consultant rooms, I do not wish to scare Deputy Joan Collins but I agree with her on the matter of private practice in public hospitals. The contracts allow that at the moment. These are only rooms though and we must remember that. If we change the contracts and implement the de Buitléir report, which I hope we can do with cross-party support, then these rooms will simply convert to public rooms. They are just rooms. There is no mystery to the rooms. Consultants have a legal entitlement to their contracts but I would like to see those contracts changed and private practice taken out of all medicine. In fact, I cannot think of a worse area in which to see private practice than children's healthcare, where services are provided if a child's parents have the ability to pay for them. I will ask Children's Health Ireland to provide a factual and detailed answer to the Deputy on how this will be tracked so that the costs of laboratories and diagnostics are met. I do not have that information to hand but the intention is that the full costs of the private practice would be met through the consultant, the insurance company or both. I will get a detailed note on that for the Deputy.

I will ask one more question as I have one minute left. In terms of private patients having access to the hospital's laboratory and diagnostic facilities, will that be transparent too?

In my note, I will have to include the answer to that as well. The Deputy wants to know about the use of the rooms as well as the use of the laboratory and diagnostic facilities. I will get her a detailed note on that.

I visited the site and, having done so, my anxiety regarding the premium for building the hospital in that location as opposed to on a greenfield site was heightened. That premium is adding substantially to the cost. The State is locked into a contract and a process which is very difficult to control. The difficulties started with the two-stage procurement process, which was a mistake. The resignations that have taken place this year could not give anybody confidence that there is financial control over this project.

The Minister made reference to residual risk and I would like him to answer my questions on same. If building inflation goes above 4%, there will be an increase in the guaranteed maximum price. It is my understanding that building inflation is now at 10%. If the project goes over time, there will be a considerable addition to the guaranteed price. If there are additional design or planning requirements, these too will increase the price. If there are any unexpected contingencies or claims, they will add to the price, as will any change to any regulation, such as VAT rates. I would like the Minister to respond to those five points. If he does not have the time to do so now, I would like a response in writing. There are five residual risks which will add substantially to the final cost.

Regarding the letter of resignation, I ask the Minister to confirm to whom it was sent. Was it sent to him? Can he tell us what was in the letter of resignation? Finally, what is the estimated total cost overrun above the guaranteed maximum price? Obviously, there is going to be an overrun.

I thank Deputy Harty for his questions. In the House the other day, Deputies were asking about an oversight mechanism for this project which allows Members to keep a close eye on it and to hold people accountable. That mechanism is the Joint Committee on Health, chaired by Deputy Harty. It does a very good job and provides an opportunity to be more expansive. The committee can also invite people before it who are directly involved in the project, as I know it does. In these back-and-forth sessions, it is difficult to get down into the nitty-gritty of many of the questions posed.

The Deputy has his views on the site, which I appreciate.

The Deputy has acknowledged that the PwC report was very clear about proceeding at this stage. I also take comfort in the views of many practising paediatricians about the site.

I will address some of the residual risks and will write to Deputy Harty about the rest. Those risks are exactly the same as those set out by Mr. Barry at the health committee meeting on 12 June - no more and no less. On that occasion Mr. Barry said:

The committee will be very aware that the construction costs of these works, as finally agreed with the main contractor BAM, are considerably higher than the previously estimated costs. [That refers to the GMP] Notwithstanding the difficulties in reaching agreement with BAM, the view of the development board was that it would be better to proceed with BAM rather than stop the project and retender ... We could have retendered the contract, but it would have added years of delay.

He then noted that chapter 6 of the PwC report stated that there are significant residual risks. That claim did not first appear in a letter to Deputy Micheál Martin. Mr. Barry said at that meeting that these residual risks are not included in the guaranteed maximum price, and that it is likely some of those risks will materialise. He specifically referenced general construction industry inflation. He also pointed out that if there is an additional amount due to inflation, it will be determined by a formula based on various construction cost indices as they emerge over the next few years.

The other significant issue regarding residual risk is claims. Concerns about very significant claims are evident in conversations and memoranda to me from around the time of the original cost escalation. The actual amount was significantly reduced as the robust process of interrogating those claims went on. Mr. Barry also said at the health committee that the process of claims coming in is an ongoing one, which I echo today. There is obviously a commercial sensitivity aspect to it as well, but we need to be satisfied that the board is robust and can challenge claims where it is appropriate to do so. I am satisfied that is the case.

Does the Deputy want me to-----

I will ask one more question with the time I have left, as the Minister has not answered the questions I have asked.

What is the estimated increase in the guaranteed maximum price on the five items I mentioned? The Minister has recited what I asked him, but he has not answered the question.

I will endeavour to expand on each of the items about which the Deputy asked. There are no identified costs there, as the agreed cost for this project is still the €1.7 billion the Government approved. No newer additional costs have been presented to either me or the Government. Mr. Barry must continue to monitor these matters, robustly defend claims where it is appropriate to do so, and try to deliver this project in line with the budget.

The Deputy asked about Mr. Quinn's letter. He wrote to me. One cannot resign from the board without writing a letter to the Minister. He said:

Dear Minister Harris, I wish to tender my resignation from the National Paediatric Hospital Development Board with immediate effect. It has been an honour and a privilege to work on this critical project for the children of Ireland since 2013. I wish you and the Department every success in the delivery of the project in the coming years.

This must be seen in the context of a number of members of the board, who were appointed in an individual capacity, deciding they have done their bit as the project is moving on to a new phase. The Public Appointments Service then fills those vacancies. My understanding is that the competition for the vacancies will conclude on 1 November, and I expect to be in a position to fill them shortly thereafter.

The Minister has five minutes to conclude the debate.

I have endeavoured to interact with Deputies' questions. The Oireachtas health committee can continue engaging with the National Paediatric Hospital Development Board, my Department officials and the HSE in order to monitor this project and get the latest up-to-date information. I encourage it to do so. I also encourage people to visit the hospital site. A number of Deputies in the Dublin West constituency, including Deputy Burton, have visited the Connolly site, which is now making a real difference to children's outpatient waiting lists.

We will never regret building this project. I have no doubt about that. However, until it is built and open, it is only right and appropriate that it continues to be scrutinised intensively. After years of people talking, debating and thinking about it, and arguing about the sites, the project is now under way. It makes my blood boil when people refer to black holes, or make comments and then leave the Chamber without actually engaging with the issues. This is far from a black hole. The development of the main hospital is well under way. Lessons should be learned on this project. Neither I nor the Government is suggesting otherwise. The PwC report makes significant recommendations which apply to both this project and all other major capital projects going forward. The Minister for Public Expenditure and Reform and I are finalising our implementation plan for how we respond to this project and others, which we hope to present to the Government shortly.

I thank the board as well as the many hundreds of construction workers working on this project. There are economic benefits involved in the project due to the number being employed. I look forward to the Tallaght part of the hospital opening next year, the project being completed in 2022 and the hospital opening in 2023. I do not know who will be Minister for Health at that time. Whether it is myself, Deputy Donnelly, Deputy Jan O'Sullivan, Deputy Harty or even Deputy Boyd Barrett, he or she will be very proud to be opening this hospital on that occasion.

We will have to keep a few high-vis jackets.

Deputy Shortall said that everyone accepts the rationale for this hospital, but that is not true. Many people in this House argued that we should have paused the project or moved the site. Some people still argue that to this day. The PwC report does not support that argument; it just says to get on with it. Everywhere I go across the country, parents tell me to get on with it and build the bloody thing. They say we have been talking about it for years and that we should get it done, while also keeping a tight eye on the finances. We intend to do both.