Joint Committee on Health debate -
Wednesday, 25 Oct 2017

General Scheme of Children's Health Bill 2017: Discussion

Chairman

The purpose of this morning's meeting is to undertake pre-legislative scrutiny of the general scheme of the children's health Bill 2017 with officials from the Department of Health and officers from the Children's Hospital Group. On behalf of the committee, I would like to welcome from the Department of Health, Ms Fionnuala Duffy and Ms Siobhán Kennan, and from the Children's Hospital Group, Eilísh Hardiman, chief executive officer, and Valerie Plant, chief financial officer.

I draw the attention of witnesses to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. I also wish to advise witnesses that any opening statements they make to the committee may be published on the committee's website after this meeting. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

I call on Ms Fionnuala Duffy to make her opening statement.

Ms Fionnuala Duffy

Thank you. Good morning, Chairman and committee members. I am head of the acute hospitals policy unit in the Department of Health, with overall responsibility for the children’s hospital project. I am joined by my colleague, Ms Siobhán Kennan, assistant principal officer in the same unit. I thank the committee for giving us the opportunity to come here this morning to talk about the children’s health Bill 2017, concerning Phoenix Children's Health. The Bill is listed in the Government's legislative programme for publication this session as a priority for the Department. Accordingly, the agreement by this committee to prioritise scrutiny of the heads is very much appreciated.

As members all know, the development of the new children’s hospital is an extraordinary opportunity to transform paediatric services in Ireland. It is essential that the children's hospitals come together operationally well in advance of the move to the new facilities in order to ensure their effective functioning as a single entity, and to support the clinical, operational and cultural integration programme.

The children’s health Bill 2017 provides for the creation of a new entity that will be responsible for the operation of the new children’s main hospital and two paediatric outpatient departments, OPDs, and urgent care centres at Tallaght and Connolly Hospitals. The establishment of such an entity through legislation has the support of the three hospitals - Our Lady’s Children’s Hospital, Crumlin, Temple Street Children's University Hospital and the paediatric services in Tallaght. The development of the draft legislation has benefitted enormously from the close engagement of the three hospital boards with the Department through the legal entity committee of the Children’s Hospital Group board.

As the Minister advised the committee at its meeting last week, the new hospital will be completed by the middle of 2022. The paediatric OPD and urgent care centre at Connolly will open in 2019 followed by the second centre at Tallaght in 2020. The new body will run the services on the existing sites at Tallaght, Temple Street and Crumlin until the services can be provided from the new hospital and from the two OPD urgent care centres currently being developed.

It is essential that we have the right structure and approach in place to integrate the existing services over the next few years and to prepare for the delivery of the best possible paediatric health care in the new facilities.

On 26 July 2017, the Government approved the drafting of a Bill based on the general scheme we are discussing today. The legislation will provide for the establishment of a new entity to run the children’s hospital, to take on a leadership role nationally in regard to paediatric health care and to play a central role in the national roll-out of a new model of paediatric and neonatology services. Its functions will allow it to deliver on its remit for education and research, commensurate with its status as the national leading body in children’s health care.

It is appropriate in drafting the scheme that we are establishing a distinct body with appropriate governance. The new entity will be managed and overseen by a competency-based board of 12 members, appointed by the Minister for Health. The board will have sufficient autonomy to make the decisions required to effectively manage the operation of the hospital. This, for example, will extend to managing property, entering into contractual arrangements, accepting gifts and engaging in philanthropy.

In regard to accountability, the legislation provides for a requirement for ministerial approval in consideration of borrowing and a mechanism for intervention in the case of failure on the part of the board. This safeguard is considered to be essential, given that this is the national tertiary paediatric hospital and the delivery of a safe, quality service must be assured.

As the existing hospitals will no longer provide services after the new facilities become operational, the legislation also provides for the transfer of all staff, data, assets, rights and liabilities to the new body such as are appropriate for transfer. The Bill is included with the priority legislation for publication this session in the Government's legislative programme for autumn 2017. While we are working on the basis of enactment by the end of the first quarter of 2018, allowing for a reasonable timetable for publication and a smooth passage of the Bill through the Oireachtas, it is acknowledged that we are working to a tight timescale.

In addition to the legislation's enactment, there are due diligence and merger processes to be concluded before commencement by ministerial order. A significant programme of due diligence is under way as part of the overall pre-commencement analysis and review work being undertaken as part of the children’s hospital programme. The outcome of this work will be known and agreed before the legislation's commencement. We are anxious to have the body in place as soon as possible to lead the necessary preparations, including advance planning for the OPD and urgent care centres, and we were advised by the group CEO last week that the hospitals will be prepared for commencement by mid-2018. However, the Department, in conjunction with the HSE, will undertake an options appraisal of the pros and cons of commencement taking place during the financial year 2018 to inform the final decision on commencement timing.

This legislation also provides for certain amendments to the National Paediatric Hospital Development Board establishment order. Those include that members of the board shall be appointed from among persons who have the experience and expertise in regard to matters connected with the functions of the board, rather than through the processes of nomination of bodies. The scheme provides the legal mechanism for the dissolution of that board in due course.

Provision is also being made for the option for the Minister for Health to make an order giving the National Paediatric Hospital Development Board responsibility for the planning, design, building, furnishing and equipping of the new maternity hospital that will be located with the new children’s hospital on the St. James’s Hospital campus. It is considered prudent to allow for this provision in this general scheme, pending a final decision as to whether this function will be given to the development board.

Since the Government decision approving the drafting of legislation based on the general scheme, the Office of the Parliamentary Counsel has been drafting the legislation. It will conclude its drafting following the receipt of the report of this committee to allow for publication of the Bill by the year's end.

I thank the Chairman and committee members. We will be happy to take any follow up questions.

Chairman

I thank Ms Duffy. I now invite Ms Eilísh Hardiman to make her opening statement.

Ms Eilísh Hardiman

Thank you. Good morning Chairman and committee members. I am chief executive of the Children's Hospital Group. I thank the committee for the invitation here this morning to represent the group for the first stage of the legislative process on the Children’s Health Bill 2017. I would like to introduce my colleague, Ms Valerie Plant, chief financial officer at the Children’s Hospital Group, and I would like to acknowledge the presence of representatives of the four boards involved in developing this general scheme. We are joined by Dr. Jim Browne, who is the chair of the Children’s Hospital Group Board; Mr. Turlough O’Sullivan, vice chair of Our Lady’s Children’s Hospital, Crumlin; Mr. Derek McGrath, board member of Temple Street Children’s University Hospital; and Ms Catherine Guy, board member of the Children’s Hospital Group Board.

Mr. Liam Dowdall, chair of Tallaght Hospital, unfortunately, had to send his apologies. The presence of these representatives demonstrates that the commitment of these four boards to the vision for children’s health is truly commendable. It clearly demonstrates the agreement of the four boards to voluntarily transition to a new stand-alone children’s hospital and to a single legal structure to govern and manage paediatric services in Dublin, as the central hub of a clinical network for paediatric services in Ireland. The Children’s Hospital Group is working with colleagues in the three children’s hospitals, the HSE and the Department of Health to achieve an ambitious transformation programme for acute paediatric services - one that will be equipped to serve the needs of children and young people in Ireland today and for generations to come.

Central to this work is the implementation of a new national model of care for paediatric health services in Ireland. This will have at its centre a new children’s hospital in Dublin providing tertiary and quaternary care and two paediatric outpatient and urgent care centres located on the campuses of Tallaght and Connolly Hospitals. The new children’s hospital, currently under construction, will bring the three children’s hospitals together under one roof and, before this, into a single legal entity. The network approach being planned will deliver care seamlessly across a network of services, working closely with our colleagues in the other hospital groups and community health care organisations, as envisaged in the Sláintecare report.

Paediatric services in Dublin are currently provided by three separate voluntary hospitals, namely, Our Lady’s Children’s Hospital, Crumlin, Temple Street Children’s University Hospital and the National Children’s Hospital at Tallaght Hospital.

In parallel with the physical building of the new children’s hospital and two paediatric outpatient and urgent care centres, an ambitious integration programme is under way to ensure that all staff and all clinical services are successfully brought together, operating as one ahead of the physical move into the new buildings. Our integration programme is focused on our people, on valuing and aligning our different cultures, integrating our IT systems and standardising clinical and operational protocols, staff recruitment and training. It touches all parts of the operations of the hospitals and all parts of service delivery. It has at its centre the health, safety and well-being of children and young people and valuing our staff. The programme of integration is being undertaken while we continue to deliver care and services in three very busy acute hospitals. This programme for change takes years to implement and, therefore, will be enabled greatly by the early enactment of the children’s health Bill 2017.

The three children’s hospitals have long established histories, with between 60 and 196 years of delivery of services to children, young people and their families. The success of our integration will require a continued commitment to planning and implementation to ensure that the reconfiguration of services is undertaken in the right way, within the right timeframe and in the interests of the patients we serve. To support this integration work from a legal and governance perspective, the three children's hospitals and their boards have voluntarily agreed to come together as part of a new single entity. This new single entity on commencement will take over the governance and management of services currently provided by these three hospitals, and the rights and liabilities of the three hospitals will transfer into it.

The Children’s Hospital Group Board has a new vastly experienced board. Included in the papers submitted to the committee is the actual board membership and the members' competencies. That needs to be put on a statutory footing as soon as possible to enable and facilitate the scale of work that will be required and to allow clear governance of the new services planned to open in 2019 at Connolly Hospital. It is critically important that Ireland’s new paediatric services are being delivered under the right governance structures, built on the vast experience of the existing boards in their governance of services. It is imperative that the planning of integration work is undertaken by the appropriate legal structure. This will give impetus to our work, provide protection and assurance to our staff and patients and will act as a catalyst for progress to our continued programme of integration. Importantly, it also provides assurances for staff that their terms and conditions will remain the same as they transfer. We are satisfied that the model proposed in the general scheme provides the best support for a new legal entity in light of the significant change management process that we are undertaking.

As members will know, we announced the new name for children’s health services on Monday last, Phoenix Children’s Health. It is a particularly fitting name given that the mythical figure of the phoenix represents opportunity, transformation, and regeneration. We are entering into an extraordinary period of change in children’s health care. I know that the committee will agree with me that it is long overdue. The legislation will play a critical role in supporting us in the three hospitals and the Children's Hospital Group in providing the single entity required to support our staff delivering paediatric services as we work to deliver the vision for children’s health care. I thank the committee and I am happy to take any questions from committee members.

Chairman

I thank Ms Hardiman. We will now open the meeting to our members. I will bank questions in groups of three. The three first speakers are Deputy Margaret Murphy O'Mahony, Deputy Louise O'Reilly and Senator Colm Burke.

Deputy Margaret Murphy O'Mahony

Thank you, Chair. The witnesses are all very welcome. It is the first time we have had a full panel of females, which is great to see. The best of luck to all the witnesses in their roles. I am concerned about the employees when the hospitals come together. Obviously, the contracts they will have are going to be very different. Do the witnesses envisage that there will be a problem with this? I also note that the Bill states that existing employees will be placed on the voluntary hospitals superannuation scheme. Will this be comparable to what they are on at the moment?

Chairman

Thank you, Deputy Murphy. I call Deputy O'Reilly.

Deputy Louise O'Reilly

Thank you very much, Chairman. The Deputy is right, it is refreshing to see an all-female panel. I do not think anyone would see anything wrong with that, because very often we do sit in front of all-male panels. That is no disrespect to those men, who I am sure all work very hard, but it is a refreshing change. The witnesses are all very welcome.

I have a number of questions. The first that comes to mind relates to sprinklers. I know that was not specifically addressed in the opening statements, but it would be remiss of us to pretend people were not discussing it outside this room, because they were. I am willing to be corrected on this, but it appeared that there was an argument involving a compromise on health and safety so this would be a good opportunity to make a statement that health and safety will always win out over aesthetics. We need to be very clear on that.

Ms Hardiman referred to the name of the hospital. I thought it was a bit premature to name what is effectively a building site at this stage, but I would also be interested to know how that name was arrived at. My colleague, Deputy Aengus Ó Snodaigh, submitted to successive Ministers for Health what I, and others, would deem to be an eminently appropriate name. That is not for consideration here today, but the witnesses might outline the process.

With regard to the terms and conditions of staff, it is of course impossible to transfer people on the same terms and conditions, because one of those terms or conditions specifies where they work and that is clearly going to change. The witnesses might outline for us what negotiations have taken place. There is only one other person in the room who would have more experience of negotiating for staff and their terms and conditions of employment than me. I had some experience of transfers. I know that it can be incredibly difficult, and that the thing to do is to start as early as possible. I would question the use of the phrase "in accordance with their existing pay and conditions", and I would substitute "on terms and conditions no less favourable". That actually covers what would be captured in a collective agreement, and is a term that would have been used.

Also in regard to staff, there is a mix of privatised and directly employed staff in all the hospitals. I have some knowledge of some of them and zero knowledge of others, but regarding terms and conditions, how is that distinction going to be incorporated? For example, cleaning services in one hospital may be outsourced while in another cleaning staff are directly employed. Again, my preference is for directly employed staff, and I would like to see that incorporated into the legislation if possible.

There is a reference in head 10 to land, property, gifts and borrowing. Under that head, could the issue of car parking be addressed? We understand that there is going to be substantial car parking, and God knows we have had enough discussion about where it is going to be and how it is going to be organised. The next question is whether the hospital is going to run it or whether it is envisaged as a very lucrative source of income for a private entity. The committee will know my feelings on that.

With regard to the make-up of the board, there are 12 board members. It would strike me as sensible to have an uneven number in the case of a dispute.

I would also be interested to know, given the conversation we have just had, if there would be any objection to the legislation mandating a minimum 50% female and 50% male membership, if we could designate it in that way. I note that the board is not doing too badly with the current ratio of 41% female membership, which is certainly better than the ratio here. Perhaps we should not be pointing any fingers. Would the witness have any objection to that?

On head 16, conditions of office of membership of the board, will a briefing be provided to the other members of the board and the Oireachtas where a member is removed? I refer to where a Minister would exercise his or her power to remove a member of the board. How is that going to be communicated to the community in general as well as the board members? Would the witness envisage that a briefing would also be given to us?

With regard to the hospital lands and what is laid out in sections 31, 32, 40, 48 and 55, perhaps this is not a question the witness can answer, but is it envisaged that the lands will remain in use by the health service?

Head 8 refers to the pursuit of fundraising activities. That issue has had more than its fair share of controversy so perhaps the witness might outline what exactly is envisaged by that and how it is going to work. In other entities it worked as a mechanism to enhance wages. However, that invited much criticism. Perhaps the witness might outline how that is going to work.

Chairman

Thank you, Deputy O'Reilly. I call Senator Colm Burke.

Senator Colm Burke

I thank the witnesses very much for being here this morning and their work on this project to date. I have two concerns. One is the transition period leading into when the hospital is built. Is there going to be a period of time when staff coming from a number of different locations will transfer to work for a period of time with colleagues from another facility? Is that planned for so that people can become aware of practices and procedures in one place? The witness mentioned bringing many different work practices together. There has to be a lead-in to that. I know it is some time away yet but it is something that needs to be looked into.

The other issue I have relates to management, which I raised here last week. I referred to one hospital facility where there were ten managers in 18 years. We are talking about independence. In regard to the management structure, what level of independence is it envisaged that the board would have? We already have difficulties in the recruitment of medical consultants. However, we also have a difficulty in getting management in and staying in place. What level of independence will the board have? Will it be able to agree salary scales above the HSE guidelines? This going to be a huge project to manage and someone with very good managerial skills will be needed. I am not saying such people are not already in place. However, it is fine to get people but the issue then is to hold on to them. What level of independence will the board have in regard to negotiating pay and conditions in order to get the best person in to do the job? It is something that needs to be looked at now. Will the board have to stay within all the HSE guidelines? Will there be discretion in regard to what agreement the board can arrive at?

Chairman

Thank you, Senator Burke. Perhaps Ms Duffy might like to address those questions.

Ms Fionnuala Duffy

I thank the Chairman. In response to Deputy O'Reilly, I will start by addressing the safety concerns. The safety of patients, staff, visitors and everybody attending these facilities is of paramount importance too all those involved in this project. I would like to assure the Deputy that the development board had fire sprinklers in place. There may have been a perception that no fire sprinklers were in place. That was not the case. The provisions incorporated into the design exceeded all current national regulations in regard to safety. However, An Bord Pleanála's report was received yesterday. It is being reviewed. It does put some additional conditions around putting additional sprinkler systems in. The development board will, of course, comply with everything that An Bord Pleanála has recommended to it.

Deputy Louise O'Reilly

Would the witness accept it was not exactly confidence building to learn that the recommendations were being challenged in any way? I do not think there was a perception that there were no sprinklers. I think there was a perception that the sprinklers were inadequate. I fully appreciate that they conformed to national standards. However, the development board appeared to be attempting to fight the imposition of additional health and safety measures. Much of this came to us via the media, so this may be a good opportunity to clear that up. Clearly, recommendations were put in place and that was appealed. That was an attempt to fight additional health and safety measures and it did not fill the public with confidence.

Ms Fionnuala Duffy

There was a statutory process in regard to four of the conditions that were associated with the fire certificate. That is part of a normal statutory process. An Bord Pleanála has made its decision and all parties will abide by that.

Deputy Murphy O'Mahony and Senator Colm Burke referred to employee transfers. Obviously, a smooth transfer of staff is important to this project. It is one of the reasons we need to embark on this very early on. We have a multiannual transfer programme to make sure it is smooth. Negotiations have already started with staff and perhaps Ms Hardiman may elaborate on that. It is important to us that there is a smooth transfer of staff and that there are plenty of opportunities for staff to integrate and to have a virtual single hospital across the city well in advance of the move to the new facilities. There are moves afoot to have that rotation and learning from each other and standardisation in practices. It is a crucial part of integration that brings benefits and opportunities for staff. Ms Hardiman might also elaborate on the details of discussions under way in that area.

In terms of the land, Ms Hardiman might confirm the ownership and the future ownership of the land and what will transfer and what is appropriate there.

With reference to gender balance on the board, as a State board there is a process in place to appoint members to the board. We will, of course, adhere to the guidelines for appointments to State boards. Gender balance is a key component in consideration of applications and in putting forward nominations to the Minister for appointment. That is an important consideration for us.

Deputy Louise O'Reilly

I asked a specific question on whether any of the witnesses would object to a mandatory 50% gender balance, if it was put into the legislation.

Ms Fionnuala Duffy

That is something we would have to consider in terms of the discussions on the drafting.

In regard to fundraising, there is a significant philanthropy programme planned for this hospital that is of a scale that is a little different from what traditional fundraising might be. Ms Hardiman might explore that further for the committee. On car parking, there have been protracted discussions around adequacy. That has been addressed in many fora to date. Perhaps Ms Hardiman might discuss what is envisaged in terms of the running of the car park and how that might be an integral part of the hospital overall.

We have had many recruitment challenges overall in the health sector. We are hopeful that these new facilities, both the urgent care centres out in Connolly and Tallaght and the main hospital, will be like a magnet to attract hospital staff, both clinicians and non-clinicians, because it will be a very exciting place to work. In regard to terms and conditions, there is a provision currently in the draft scheme that the terms and conditions will require the consent of the Minister for Health and the Minister for Public Expenditure and Reform.

There will not be complete freedom in regard to terms and conditions for attracting employees. This board will run its recruitment processes like any section 38 agency. I think they are the main questions. I am not sure if I missed anything from the members.

Chairman

Was there a question on the name?

Ms Eilísh Hardiman

I thank the Chairman. I would like to add to some of the responses to questions. The plan for pensions is that staff are transferring so pension rights are protected. I can give that assurance. From an employment perspective, we see the vast majority of staff still working in their existing locations until we do the reconfiguration. That will be planned with staff.

Staff engagement is very important and we have two approaches to that. We totally recognise the well-established mechanisms that are in place for major change management and the importance of engagement and involvement of staff in shaping where they are going to be. We have set up a formal engagement framework process with all the official trade unions that have negotiating rights. We have brought it through the national structures. We have had very good engagements from all the representative bodies where we have agreed the steering group terms of reference and the structure of how we are going to proceed. We have had our first meeting and a second meeting is happening before the end of the year. There is a requirement for specific work groups that relate to issues specific to particular members of staff and that is what is envisaged. Our employee relations lead is starting to acknowledge the work that needs to undertaken on this. That is the formal side and we recognise that getting that started early is very important for the next four to five years ahead.

On the other side, and in regard to the Bill we are talking about today, the vast majority of staff will not feel any different in their daily operational work of looking after children and their families in their hospitals. It is very important that staff feel they have a way of inputting in terms of shaping the future of this service. Staff members are engaging in a programme called On the Move Together. Staff can get their voices heard about shaping how it is we are going to shape the service into the future. We have had roadshows in the three children's hospitals and 700 staff turned up to those roadshows. Many of the staff have put their names forward to be part of this programme. The children's hospitals staff are very committed to the delivery of services for children's health, so I am not surprised that many want to be part of shaping our future together.

In regard to the name, we had an extensive process that took about nine months. We did some research into this. In my previous role of CEO of Tallaght Hospital, I changed the name there. I certainly did not want Our Lady's Children's Hospital, Crumlin, Temple Street University Children's Hospital and the National Children's Hospital at Rialto. The primary concern of members of the public is that they get the care and the treatment wherever they go. Everybody understands that.

The name of the organisation is really important to staff. We undertook roadshows around the three children's hospitals and we invited staff to put forward suggestions for a name. We also went to the regional units because they are part of a network. It is not just a hospital that we are naming. We had about 1,000 submissions and 300 names came out of that process. We set up a steering group that was representative of the staff and parents, which was very important. We went through a process of focus groups that involved more members of staff and more parents. We did market research with the public and, most importantly, the Youth Advisory Council, which the committee has heard me talk about before, and which has an extensive history of using our services. They helped us to come up with a name which really was to work on several levels. It is not just a building. People see that services are not about buildings anymore. Services are about a network that is broader and can reach even into the home. It needed to work at its location in Rialto. If we followed the example of Beaumont, for instance, we would have called the hospital Rialto. That would not work, however, with Rialto at Connolly and Rialto at Tallaght. It needed to work in multiple locations.

We tried to reflect its mythical character. Phoenix stands for inspiration, hope, transformation, growth and this constant sense of renewal that we think really reflects the aspiration of our staff in what they try to do everyday with the children and the families we serve. Another element of it was that it was easy to pronounce. We had a speech and language therapist on our selection committee and she was very clear that some names are difficult for small children to pronounce. It had to go through that linguistics test. It is also easy to translate into Irish. It is féinics and it is pronounced the same way linguistically. As our vision for the service is an all-island network, it needed to work for all our colleagues on the whole of the island, including our colleagues in Northern Ireland. It had many tests and it was robustly challenged.

Hence, we see the name very much as a unifying name. Phoenix Children's Health is the name of the network. Phoenix Children's at Tallaght is the outpatient and urgent care centre, Phoenix Children's at Connolly is the one at Connolly and Phoenix Children's Hospital Ireland is the hospital as part of that network. That was the process behind it. I hope that helps the committee understand it. I know submissions were made and those names were considered as part of this process. However, for all the reasons I have outlined, some of the names put forward were ruled out, including the names Deputy Ó Snodaigh put forward.

On the terms and conditions, the majority of staff are going to continue to work where they are at the moment. We are assuring staff they will have no less favourable pay and conditions. We are conscious that we have to go through a process over the next four years to get to a single hospital. There are differences in staff salary scales; we understand that. It is a process of going through that over the next four years.

On the mixture of privatised and public staff, as part of the due diligence on what we call the pre-commencement analysis and review, we have taken cognisance of all those contractual arrangements. The vast majority of them are similar across the hospitals and we do not see it as an issue. However, we need to look at contemporary ways of working into the future. As always, we will comply with the guidance around employment negotiations and other agreements that have been put in place. We are more similar at the moment than we are dissimilar on getting to the new hospital.

Deputy Louise O'Reilly

On privatisation, and if we just take cleaning staff as an example, off the top of my head I can give two examples - one where they are directly employed and one where they are not. Is it open to the witness at this stage to state a preference? I understand it will be negotiated and I genuinely wish every person well. I have been there and I understand that it is going to be very tough. There are people who are concerned about outsourcing and the impact it has on the quality of service. In cleaning services, catering services or in any of the ancillary services in a hospital, how will they be managed? Perhaps that level of detail has not been reached yet, but the simplest thing to do would be to say that everyone will be directly employed.

Ms Eilísh Hardiman

I do not think I can give the Deputy a straight answer like that. What I will say is that we have carefully taken into account how it has worked within the existing hospitals. We have a mixed model and that has stood to us because the HIQA reports on the three children's hospitals have demonstrated in particular areas that direct employment has worked really well while in other areas outsourcing has been beneficial. We will take the experience of the children's hospitals going forward. However, we have a mixed model at the moment across the hospitals. I, more than likely, see that continuing because of the benefits demonstrated. I am talking specifically about cleaning here.

In other areas there are structures that we will go through and that we know are well-established industrial relations processes. Of course, we will recognise those mechanisms in any of the proposals that we put forward.

On the question on land, to be clear, the heads talk about the transfer of assets. The only land owned by the three children's hospitals is in Our Lady's Children's Hospital, Crumlin. The others are not owned and, therefore, will not be transferring. The proposal is that Our Lady's Children's Hospital, Crumlin will be transferred to the Children's Hospital Group. We have started formal discussions on that with the HSE to see potential future use but I assure the committee that we will be using it for the next five years so we do not need to have it all concluded. It is important to note that the objective of that board is for the benefits to be for children's health. I want to be clear that it is not that we are running services on these hospitals because we need all the services to be consolidated but that is one of the conditions we would like to see honoured in those discussions.

There is very clear guidance in the health system around car parking. It is not core business to us. We do not have it in Temple Street, so it is only in Tallaght and Our Lady's Children's Hospital, Crumlin. It is managed by a car parking company. One of the things we are working through is the funding of that. I might ask the chief financial officer to talk about that.

I have dealt with the issue of the lands. To be very clear, the children's hospitals have a good record on fundraising and have very well-established foundations that successfully fundraise for both the existing hospitals and our very important research agenda and patient comforts programme. We have had a very positive meeting with the three foundations only two weeks ago who came to say that like us, they will merge into one foundation, which is a very positive development. We welcome that. We are working closely with them in establishing the future philanthropy and fundraising activity for the new children's hospital.

I totally support what Senator Colm Burke said regarding the transition period that is required for the amount of change we need to achieve. As we are opening up the new facilities, the first of which is the Phoenix Children's Hospital in St. James's Hospital in 2019, there is an element of rotating staff within those services because not all services are there so it is predominantly our emergency department, general paediatrics and trauma orthopaedics. That is a key element of success whereby the people who are delivering services know each other when they go into the facilities and understand their processes. Part of the reason it is so important to start the integration programme so early is so we standardise as many of those processes as possible so that people are not doing things differently when they come together in the facilities.

I concur with the point made about sustainable management. In large projects, the moving on of senior staff is seen as a big risk. We are on an infectious albeit challenging programme. It is really important that we attract the best people to deliver on this. We have experienced some challenges about some posts. That is the reality. We are working as much as possible with the Department and others to come up with sustainable solutions to ensure we get good management in place. We have made some progress relating to that to identify the specific skillset that is required to deliver a programme of this nature. My colleague has answered the question relating to pay, conditions and the autonomy of the board.

Chairman

I will now bring in two other members.

Ms Valerie Plant

I want to respond about car parking. There is no doubt that the car park at the hospital is a valuable asset with the potential to generate significant operating revenues for the hospital. It is not funded by the Exchequer. It is not a core part of the hospital delivery facility. Its construction is costed at €44 million by the development board. As it is not funded by the Exchequer, the funds for that construction need to come either from funds raised by the hospital or a tender from a private investor or operator. We are in an options appraisal process to assess what way we can extract the maximum benefit for the services from the car parks, be it through raising funds, a significant amount of funds must be raised by the group, or by tendering to an operator for the operation of the car park over a period.

Ms Fionnuala Duffy

Could I return to a point raised by Deputy O'Reilly regarding gender balance? As members will have seen, the administrative board of the Children's Hospital Group is very much a competency-based board and that is the approach we use to populate the board. If we stipulate 50:50 gender balance in legislation, it could be restrictive in terms of making sure we have people with the actual competencies rather than being solely mindful of gender balance to achieve a 50:50 balance. That would be a consideration for us.

Senator Colm Burke

Could I ask a question on salaries? If funding is made available for research, will the board have discretion to give a supplementary salary to an employee in that situation? Is that envisaged because of additional work taken on board by the people working within the system? Is that envisaged if the money is coming in through philanthropy or research funding rather than the State or the people receiving the service?

Ms Eilísh Hardiman

The history of this issue has caused lots of problems because of how it might have been used.

Senator Colm Burke

That was because it was kept under the radar whereas-----

Ms Eilísh Hardiman

There are formal allowances that are recognised so there are processes. My experience has involved us being open and honest about it and disclosing it because there are people who carry out additional duties above and beyond what is their normal work and we need to take that into account. One of the things the board is planning to put in place is a sub-committee of the board that would look at remuneration so we are clear we have recognised that while adhering to public pay and policy. We recognise that an institution of this size and nature will have unique elements that might not be around the rest of the system. While it is not relevant to the legislation, the board has already agreed to establish one of those sub-committees that would look at remuneration so that we have good governance in respect of the decisions we make.

Deputy Louise O'Reilly

What Ms Hardiman is effectively saying is that money raised from fundraising can be used to top up the salaries of staff.

Ms Eilísh Hardiman

No, what I am saying is that a process is under way that identifies that remuneration is an important issue. We already know that there are formal allowances within the health system that can be used and that are recognised.

Deputy Louise O'Reilly

We also know there were controversies regarding top ups. It would be helpful if that was ruled out here rather than explicitly ruled in.

Ms Eilísh Hardiman

I am just saying a process is in place whereby the board will take very seriously the issue of remuneration and it will adhere to pay policy. It is recognising the issue whereby if there are any changes, good governance, good decisions and good justification exist. We do not tend to use the funding and foundations for topping up salaries within the children's hospital. Most of that fundraising money is used for patient comforts, research posts, which are very different types of posts, equipment and buildings. That is how we would continue to see that continuing to be used.

Deputy Kate O'Connell

I have a few questions that may not be pertinent to today's discussion. Regarding the naming of the wards, I know the wards in Our Lady's Hospital, Crumlin have religious names. I know because I was on Nazareth ward. Has the hospital group discussed that? What direction is it headed?

I do not know if anybody here has actually parked in Tallaght Hospital multi-storey car park. It is a test of one's driving skills. It is particularly testing if somebody in the car is sick.

I have been in many multi-storey car parks in my life and it is probably the most difficult one to get up. It is very clear when one drives up through it that everybody else has a difficulty because there are metal and paint marks all over the walls. It is not unique to my driving. I have been in Tallaght and in Crumlin a number of times. Parking is the first experience people have whether they are going to see somebody in hospital, which is not as serious, or if they have a sick child in the car. I have read all the documentation. I am in favour of the car being taken from people so they can go in with their child in their arms. Directing people into a very narrow car park is an issue. If it is going to be tendered out to a private company, I hope that will be considered in the process. There should not be an obstacle course before people even get in the door of the hospital. I do not know about other children's hospitals but in Crumlin if one has a child who is an inpatient for a long period of time, there is a voucher system for parking. People present the voucher - a pink or yellow slip - and do not need to pay for their parking. If it is tendered out to a private operator, which has paid for the car park and is getting its money to pay back the bills for building it, will the hospital group be invoiced for parking for the parents of the very sick children? How will it work? Is it something that has been budgeted for?

Will Ronald McDonald House in Crumlin be defunct? All the rooms have pull-out beds. It is fine if people are from Dublin but if they want to wash some clothes for their children or themselves, are there facilities like that for families from outside the greater Dublin area that might not have family in the area? Are there facilities to organise a bit of food, wash clothes out or prepare things for children?

I understand allowances of certain amounts are authorised out of fundraising money. It might be an issue for some people so I want to clarify it in case I misinterpreted the witness. If the hospital group is giving money on a monthly basis to the current children's hospital, many people would be surprised if that was in any way being channelled into salaries. Will the witnesses clarify that in case anything arises in the committee proceedings which is not entirely correct?

Deputy Bernard J. Durkan

I will start with the safety issue. I congratulate all involved in bringing the children's hospital to the level it has arrived at. It is a result of the dedication of everybody, including the Department of Health and the board, that it has been successfully brought to this stage. I offer my good wishes for the rest of it as well.

I will address the question of safety. I am a bit worried that if a safety issue arises in the future, everybody will hark back to the situation that developed in the first place in which somebody decided to water down the safety precautions because they were considered unnecessary and too costly. I would attach a public health warning to that. It is a dangerous route to go. I would err on the side of extra expenditure on safety. Even though it may appear to be duplication, it is hugely important. It is hugely important to have public confidence in what is taking place and the reasons for it taking place. Short-changing for the want of a number of sprinklers does not add up to me. I do not support that notion.

The other issue is the car parking. Car parking is of huge interest to two groups of people - the patients, who are the most important people of all, and the staff. I have had some discussions with some of the witnesses previously about this. From the point of view of both patients and staff, it is of critical importance that the car parking be convenient and that it involves the least possible walking time in the open air. Great effort should be made to ensure it is close to the hospital buildings and that there is not a great distance or that people have to take a bus, which was envisaged. I do not agree with that at all. We should put ourselves in the position of a mother or father of a child who is distressed, distraught and full of anxiety. The last thing they want to do is waste time finding a place to park and maybe finding themselves clamped when they come back to it, as has happened in other hospitals in the past. I ask that that be eliminated as much as possible.

With regard to philanthropy and the extent to which it could play a part, there is great opportunity for philanthropists to become involved in a positive way that is beneficial to the hospital and to health. I urge that those issues be examined carefully with a view to ensuring maximum benefit is achieved without impacting on policy or the running of services and facilities.

I am a bit concerned about the ownership of the assets. If the Department of Health owns the assets it could be a problem at some stage in the future. The ownership of sites is an issue that has raised its head in recent times with regard to the maternity hospital in particular. I ask that, in so far as possible, the determination of ownership of the surrounding land, which could impact on the operation of the facility itself or could restrict or curtail it in some way, is carefully looked at with a view to ensuring no difficulty arises.

The importance of the board goes back to my mantra for many years. So far the development board has done an excellent job. In future, the chief executive and development board will be part of a new board. It is suggested there could be difficulties arising there. One is non-statutory and the other will have to be a statutory body. There may be some difficulty in merging the two together, which might need to be examined, with a view to ensuring there is no clash of interests. We need to ponder that issue for a moment. For the past 20 years or so every issue associated with health has had commentary from the sidelines attended on it. The composition of the boards is of such importance that in order to get the kind of cohesive administration a hospital system needs, there should be representative interests on that board. I am talking about the interests of professional bodies. Professional bodies need to be represented on the board in some way to ensure the only outlet of people who want to oppose everything is to make a commentary from the sidelines, which impact negatively on the operation involved. A whole plethora of health services in this country are being dramatically negatively affected by various negative comments on a daily basis. If I was a health worker, I would not want to be associated with it. It is a huge burden on the dedicated people who go to work in the health system every day, and who work extremely hard and commit a huge number of hours above and beyond the call of duty, to find that at the same time, there is negative off-stage commentary on their performance. We need to deal with that particularly in the children's hospital structures.

The Minister will appoint the members of the board and he needs to take into account the need to accommodate, in so far as possible, diverging views without breaching the cohesiveness of the board's mission. I refer here to the internal views of the board rather than to outside criticism. If this is a groundbreaking exercise then it is of critical importance to the future of both children's health care and general health care in this country. It has been handled extremely effectively and efficiently heretofore, but there will always be criticism and because of the nature of this, there will always be second guesses coming from all over. My advice to the development board, the subsequent board and to everybody associated with these projects is to recognise that there will be a degree of descant commentary at all times, and to try to put in place the structures that will ensure that this does not continue into the future and grow into a virus that cripples the system.

Chairman

Does Deputy O'Reilly have a supplementary question?

Deputy Louise O'Reilly

I do. It concerns the repeated use today of the words "core activities". There appears to be a division among our guests as to what constitute "core" and "non-core" activities. My view is that if nobody is there to open up the doors of the hospital, then any core activity going on within it is somewhat academic. I consider everybody who comes to work on a hospital campus to be "core" and it worries me that there is split opinion among the witnesses as what this does or does not mean. Everybody is involved, be they cleaning the floor, opening the doors, performing operations, providing nursing care or physiotherapy or indeed facilitating the parking of cars and managing access to the site. All this is core and I am disturbed that there is some division over this. I am using the word used by the witnesses, which is not one that I would use. Could they now address this?

Chairman

I have some questions of my own before we go to the answers. According to Ms Duffy's opening statement, the hospital board should be appointed from among persons who have experience and expertise in relation to matters connected with the functions of the board rather than on the nomination of bodies. Perhaps Ms Duffy could explore for us how that will work.

On the issue of cost, are the witnesses happy that the funds will be available to complete the project? There is much controversy over the eventual cost of this project, so perhaps the witnesses might address how the cost projections are going and what the eventual cost may be. Will fundraising and philanthropy moneys be going towards capital or current costs or are they designated for education and research? The Phoenix Children's Health certainly has the potential to become an iconic magnet hospital, not only in the Irish context but in the context of world paediatrics. I hope that comes to pass and education and research will be very important parts of that.

Car parking is a very contentious issue for hospitals around the country. Will the hospital own the car park or benefit from its profits? Could there be a maximum daily or, indeed, monthly rate for the families of children spending prolonged periods in the hospital? Car parking costs can be a huge issue for families, so could this be addressed by minimising that cost?

Ms Fionnuala Duffy

I will start with the issue of safety. I want to reiterate that safety is of paramount concern to all of us on this project. Although the fire safety measures previously proposed already exceeded the standards in health care design, An Bord Pleanála included additional stipulations and these will be absolutely adhered to. We have appropriate governance structures in place for this project and we will make sure that all safety concerns are taken on board as part of our overriding concern for the public.

In response to Deputy Durkan's question, I will clarify the matter of the boards. Two boards are involved here. One we simply call the "building board" or the National Paediatric Development Board, and this is already on a statutory footing. On the service side we currently have the administrative hospital group made up of the three children's hospitals. We are very anxious to put that administrative board on a statutory footing. All of us involved in the project are very clear about the complementary roles of both boards. Our governance structures oversee both the build side and the service integration side of the project and we make sure that both sides work well together, that they do not overlap inappropriately, and that they are clear about their own distinct roles. I am satisfied that our statutory development board and our administrative board are both working well and that the latter will work even better when we put it on a statutory footing.

On the issue of the Minister appointing the board, we had said that the board was to be made of people with experience and expertise. We put a lot of consideration into how it would be appropriate to populate a board with this kind of governance role. Rather than including representatives of various interests, we felt it appropriate to get the right mix of clinical, financial, legal, public sector and significant change management skills, and to bring a group of people together with those skills and competencies. This obviously includes clinical expertise so the voice of the clinical world can indeed be on this group; it is one of the core memberships already envisaged here and it is very important that we have that. On our current board we have clinical representation, not only from our own sector here, but also from the CEO of Great Ormond Street Hospital in London. This brings an international clinical dimension and thinking that will help our learning and improve our services. Also on the board we have a former deputy chief medical officer, CMO, from Northern Ireland who is currently CEO of a trust there. We are trying to bring together the right mix of voices and skills to represent all of the communities at the core of the function of this hospital. We consider this to be very important.

Ms Hardiman might elaborate on the philanthropy issue as well as on how the car parking situation is envisaged. On the issue of assets, this project is funded by the State; the land that the facility will be on is owned by the State and the buildings will be owned by the State. Part of the due diligence pre-commencement work under way is to ensure that there are appropriate lease arrangements in place so that the hospital can function and operate appropriately.

With regard to costs, we had a significant discussion of this back when the Government approved the construction investment decision in April. As we publicly communicated at the time, the overall capital cost of this project amounts to €983 million. A total of €960 million of that will be funded by the Exchequer. We have in place a governance system, a steering group under the chairmanship of the chief operating officer in the HSE and with all the relevant stakeholders around the table, and a board chaired by our own Secretary General. These will ensure that the project will be delivered within the timescale, scope and funding that we have set out for Government. We have very tight control over all of the parameters involved to ensure the project is delivered within the appropriate budget.

The remaining question was more operational and may be best answered by Ms Hardiman.

Ms Eilísh Hardiman

In response to Deputy O'Connell's question about ward names, we have not moved onto that level yet, although we consider it important that the overall name for the hospital be taken into account. From a design perspective, we are just starting to move into the way-finding stage so it is appropriate that our approach be consistent. There is no desire to represent religious connotations because the new hospital is, if anything, a secular hospital that represents both the population it will serve and contemporary approaches to delivering health care.

Having been the CEO in Tallaght Hospital, I could spend much time talking about the car park there. I completely understand that car parking is an issue. I should, of course, say that the Tallaght car park was designed in accordance with the standards at that time.

I am aware of that from my previous role and am pleased to offer some assurance to the committee in this regard. There are 675 parking spaces allocated for the new children's hospital, which is three times the number available across the existing hospitals. The allocation is based on a robust identification of the needs of the families who will access the new facility. Some 22 of the places will be outside the emergency department, where it will be possible to drop and run. It is important to note that the planning application that was secured includes a stipulation regarding the car park design. An Bord Pleanála sought to have the size of some of the spaces increased, having listened to the concerns of the people who attended the oral hearing. Many of those attendees have children who come with a lot of equipment, chairs, oxygen and so on, which require adequate space to unload, and, in addition, many of the families require large family vehicles to accommodate all that equipment. As I said, the provision regarding parking is a planning stipulation and whichever car park provider secures the contract will have to adhere to it. Members are correct that the existing hospitals include a derogation in respect of parking charges for hardship cases and where children are in hospital on a long-term basis. For the new hospital, we have identified 100 spaces within the car park which will not be taken into account from a business case perspective. In other words, they will be available to parents at a reduced fee or free of charge, depending on circumstances.

In regard to Ronald McDonald House, we see it as a key partner in delivering our plans for children's health care. Many of the children who require hospital treatment, including those from outside Dublin, have long stays. The best international comparators show that charities such as Ronald McDonald House provide important services to families. As part of the planning permission for the new hospital, we have secured approval for a 53-bedroom building right outside the front door which will be available for use by families. We are working with Ronald McDonald House on how to progress the construction of that building and decide how it will operate. The hospital will comprise all single rooms and we will have fantastic facilities within those rooms, including an appropriate bed for parents to sleep in and an en suite bathroom. We recognise the need for a family lounge within the hospital and we have provided for that. There are an additional 30 beds within that area which will include showers and facilities where parents can work, eat and engage in other normal day-to-day activities. We are aware that some of the parents currently attending their children at Crumlin cannot even get to the Ronald McDonald House facility there.

To clarify, when I answered the question in regard to management and adhering to the pay scales, I was simply pointing out that we are very much working within the process that is there. The practice of using fundraising as a top-up to the funding of staff costs is not reflective of the policy position within the existing hospitals and not something we want to see. There are challenges in this regard, of course, and we need to work within the parameters defined by pay policies. The board will have an opportunity to discuss any specific challenges in respect of staff recruitment with the Minister for Health and the Minister for Finance, as any good board would do in seeking to secure the best people for its service.

Deputy Durkan referred to safety issues, which are a key consideration of our design. Some of the safety issues we face are unique to hospitals. We already have members of staff in our hospitals who have a legal remit to ensure safety parameters are being adhered to, with those staff being answerable to the chief executive officer of the hospital. I assure members that this safety function has been built into the design of the new hospital and there will be members of staff operating those systems when the hospital begins operation. Moreover, we have undertaken a number of external reviews to provide us with assurances around compliance to standards, particularly those standards that are unique to hospital buildings. This helps to ensure the decisions we are making in the design and building process are in accordance with the recognised standards in health care.

I already spoke about car parking facilities and the importance of ensuring that provision meets the requirements of families. Parents manage to get to our existing hospitals, including Temple Street, for example, which is right in the city centre, but when they get there, parking is the challenge. That is why we have made such an issue of it. An Bord Pleanála accepted our proposals in this regard, which were objectively measured on the basis of future use of the hospital.

I agree there is a huge opportunity around philanthropy, but it needs to be managed very well. We have a good basis there with the existing foundations but there is a chance now to lead out on this issue in a way that will ensure we can avail of any opportunities that arise in a manner similar to other international children's hospitals.

On the question of the composition of the hospital board, I take the point that it is important that the voice of staff be heeded. Regarding the competencies of the current board, three of the members have come from health systems, including paediatric health systems, where quality and safety are very much the focus. That is at the core of what we are trying to do from a services perspective. The board is there to provide strategic direction and ensure good governance and oversight. We envisage implementing clinical directorates and chief medical officer posts that will provide very clear clinical leadership and executive leadership of services. Those clinical and executive staff will be in attendance at board meetings and a structure will be in place whereby their voices will be heard and the board will have an opportunity to seek out their views.

Deputy Louise O'Reilly asked about the difference between core and non-core staff. As we know, there are very formal arrangements in place for how one staffs the public sector, and we will be adhering to those requirements. Of course, there is a multiplicity of posts within hospitals which have a big impact in terms of making the services to patients better. People's experience of hospital is reflective of all the staff they meet there, from the first person they meet when they come into the car park to the last person they see before they leave. We will work through the process that is there to ensure the mix is correct. Any challenges that arise are often to do with communications with staff as opposed to their being any reflection of the competencies of core clinical staff.

On fundraising and philanthropy, we have mapped out three potential phases in which we will approach this issue. We absolutely accept that the three current foundations do very good work for the existing hospitals, including in education, research, providing patient comforts and equipment and, in some cases, refurbishing facilities. The board has made a commitment that this will continue while those hospitals still have children being treated. We also will have a philanthropic capital campaign, as any major children's hospital build does, to enable us to seek funding in addition to what is provided by the State. We have agreed that with the merger of the three foundations and the development of a philanthropic capital campaign, our future strategy in this area will predominantly be focused on a concerted effort around research, education, innovation and improving patient comforts. With our beautiful new building in place, we hope to have the facilities and equipment we need to deliver services when we open in 2022.

Finally, on the question of parking fees, the charges levied will be based on the market rate, as reflective of what is being charged in other hospitals in Dublin. It is usual practice to seek to have a consistency in this regard as between the various hospitals. I assure members once again that in hardship cases and where a child is in hospital for a lengthy stay, parents will be able to avail of a derogation, which is to be accommodated by the setting aside of 100 parking spaces for that purpose.

Chairman

On behalf of the committee, I thank the witnesses for providing their expert opinion on the proposed legislation.

The joint committee adjourned at 11 a.m. until 9 a.m. on Wednesday, 8 November 2017.