National Children's Hospital: Statements

I welcome the Minister of State. There is a 45-minute time limit on the debate. The contributions of group spokespersons are not to exceed six minutes each.

I am taking this matter on behalf of the Minister for Health who cannot be here.

I thank Senators for raising this matter and I am pleased to take the opportunity to update the Seanad on the new children’s hospital. I emphasise that the project to develop the new children’s hospital is an extraordinary opportunity to enhance paediatric services for children. The planned accommodation will include facilities for inpatients, day care patients, outpatients as well as operating theatres and emergency care services. There will be 380 inpatient single en suite rooms, of which 60 will be critical care beds, 93 day care beds and 20 operating theatres. Outpatient and urgent care facilities will also be provided at two satellite centres on the campuses of Tallaght and Connolly hospitals, providing local access for families. As more than simply hospital facilities, the new children’s hospital and satellite centres will be research intensive academic health care institutions.

The granting of planning permission in April 2016 for the hospital, satellite centres and related buildings was a huge and very welcome milestone for the project. An internationally recognised design team, supported by an experienced national paediatric hospital development board and project team, is in place to drive the new children's hospital project and ensure it is delivered in accordance with national policy on optimal design and value for money. The sum of €650 million for the hospital relates to Exchequer funding approved in 2014 for the core construction of the new children’s hospital, together with the two satellite centres. This funding was approved following a cost estimate that commenced in 2013 and which was completed in early 2014.

At the time, construction inflation was estimated at 3%. The tender process for the core construction elements for the new children's hospital and satellite centres at Connolly Hospital and Tallaght Hospital has recently been completed. The pricing proposed by the tenderers took account of construction inflation which is now running at higher than 9%, the extended project timeline which is now scheduled to be completed in 2021, and the final market cost of the build. Local and international companies participated in the tender process and more than 35 people participated in review panels for the tenders. The tenders were reviewed and measured against a number of technical and financial criteria and were independently peer-reviewed by construction experts with extensive experience of projects of this size and complexity. I understand it was a highly competitive process. Following its conclusion, a company has been notified that it is the preferred bidder.

While there has been much media speculation about the cost of building the hospital, I am informed that the final proposed cost is actually within 5% of projections and that the successful party was the one with the most competitive tender. The Department is aware from the national paediatric hospital development board that the tendered construction costs per bed suggested in recent media commentary are not accurate and do not resemble the actual tender costs. Furthermore, it has been previously stated the construction tender does not include equipment, which will be funded through annual operational expenditure, or ICT costs. These elements of the project were always to be funded and procured separately. Funding for educational facilities and commercial elements such as retail and car parking were also separately identified from the core construction costs for the new children's hospital.

The new children's hospital and satellite centre programme is made up of three interrelated elements, namely, the building, the ICT infrastructure and the operational integration. It includes the change management needed in order for the three existing hospitals to become one and the actions required ensure the smooth, safe and efficient transition to the satellite centres and new children's hospital. Work is ongoing to finalise the heads of Bill to merge the three existing children's hospitals into one entity to further facilitate this service integration.

This complex programme of work is set out in the definitive business case for the new hospital. Now that the construction tenders have been completed, the capital costs put forward in the preferred tenders have been incorporated into the definitive business case. This was recently submitted to the HSE for final review after which it will be considered by the Department of Health.

The Minister intends to bring the definitive business case to the Government in the coming weeks for decision.

We need to remind ourselves that in the past decade a clear case for the development of a new children's hospital has been discussed. The Government decision in 2012 to locate the hospital on the campus of St. James's Hospital was made in the best interests of children from a clinical perspective. Independent reviews since 2006 have reaffirmed the importance of co-location of the paediatric hospital with a major adult academic teaching hospital. St. James's Hospital has the broadest range of national specialties of all acute hospitals, in addition to a strong and well established research and education infrastructure. This makes it the hospital that best meets the criteria to enable the children's hospital achieve our vision of excellence in modern paediatric practice.

As announced in June 2015, the Coombe Women and Infants University Hospital will in time relocate to the St. James's Hospital campus, achieving tri-location of adult, paediatric and maternity services. Tri-location has benefits for children, adolescents, newborns and mothers. In all cases, the benefits of tri-location are maximised where the adult hospital provides the broadest possible range of clinical sub-specialties and expertise, which are readily accessible for paediatric and maternity patients on the shared campus. We have an opportunity to deliver a considerable positive change in health care for Ireland's children and young people and the priority must be to advance the project as soon as possible.

I thank the Minister of State, Deputy Catherine Byrne, for attending. It is disappointing that the Minister for Health, Deputy Simon Harris, has not come to this House to clarify the comment made by the HSE's director general, Mr. Tony O'Brien, at the meeting of the Committee on the Future of Healthcare yesterday. Given that it fell to Mr. O'Brien to tell members of the committee that this project was in jeopardy, it is not surprising that the Minister has not attended and has instead sent his Minister of State to provide clarity on the matter. Notwithstanding my disappointment that the Minister has not attended the House, I welcome the Minister of State to represent the Government. I hope she will provide a clear and transparent account of the status of the project given the comments made by Mr. O'Brien yesterday. I acknowledge she understands the need to provide clarity not only to every family whose children required hospital services but also to those living in the locality of St James's Hospital. Residents in the Rialto area deserve to be kept up to speed on the status of the project.

I would like the Minister of State to clarify whether the statement made at the health committee yesterday by Mr. O'Brien, namely, that the HSE cannot afford to progress this matter, is accurate. If so, what exactly does it mean? Does it mean the entire proposal to build the hospital at the St. James's Hospital site is to be shelved? Why did it require a HSE official to deliver that news yesterday to an Oireachtas committee? Why did the Minister not deliver the news if the hospital project was in jeopardy? Could the Minister set out how much taxpayers' money has been invested in developing proposals for the St. James's Hospital site to date? I will be getting my colleague to ask a parliamentary question to obtain this information in due course.

Questions need to be asked of the Department of Health and the HSE about why the State is facing a bill of an additional €300 million for the much needed national children's hospital. It is extraordinary how the reported costs have increased by 50% in one year. Over five years ago, Fianna Fáil welcomed the decision on the new national paediatric hospital and it urged the Government to expedite the design, planning and development process. We consistently maintained that a new hospital for children and maternity care was essential to bring about world class health care and the best possible outcomes for our children. Unlike others, we had never sought to score political points on issues as serious as these.

The reports of late have indicated that the minimum cost of the new hospital will now reach more than €1 billion. It may reach as much as €1.2 billion, with other ancillary costs not included. That is a significant proportion of the HSE's capital budget. The money needs to be spent, but what about the additional acute hospital beds that are needed throughout the country and the other capital projects? Ireland needs a children's hospital. We cannot have circumstances, nearly 100 years after the foundation of the State, in which the most sick children are being treated in the most substandard facilities or not treated at all, as we have seen in the "RDTE Investigates" programme. I really would like an answer to the four questions I have asked as a matter of priority.

I am disappointed that the Minister for Health, Deputy Simon Harris, is not present to hear these very important statements on the future health of the children of the nation and the biggest health project undertaken in the history of the State. I am aware of the presence of the Minister of State, Deputy Catherine Byrne, who represents Dublin South-Central. I have been a representative in that area. The project would have a direct impact on my village, Rialto. Rialto and the surrounding areas have endured almost a year of enabling works, which have tested our limits. We were waiting and believed the project would go ahead, but it is now in abeyance and we are not really too sure what is going on. I mean no disrespect to the Minister of State, but I believe the Minister should be here and have some regard for the Senators who are demanding a fit-for-purpose state-of-the-art health facility for children.

We need a new hospital and need to build it without delay. It is quite clear from the programme broadcast on Monday night that children languishing on the waiting list for necessary treatments are suffering inexcusably. We are neglecting them while they lie in pain. The issue is one of capacity. We have all agreed on this and, therefore, the last things we need at this stage are political games that prevent construction. As no project can remain outside oversight, however, we have deep reservations about the recently reported outlandish increase in the cost of construction of the hospital. The initial estimate was approximately €600 million and it rose to an estimated €1 billion, if not more. Can the Minister of State account for this increase and explain whether there was a significant underestimation? To what can the substantial increase be attributed? Since it was first mooted in 2012 that the new hospital would be at St. James's Hospital, the estimated cost has increased by over €500 million. The cost has doubled and it does not cover the enabling costs I have talked about or the planning costs, including the cost of the failed Mater Hospital project, amounting to €30 million or €40 million. The planning cost for the St. James's Hospital project has amounted to €40 million so far. Enabling costs amount to €80 million. There is a doubling of the cost to the public purse. The reported cost per bed of €1.9 million seems quite extravagant. Perhaps the Minister of State might address that issue in her response.

I spent over a year of my life planning for and involved in this project, including in my capacity as a representative at the oral hearings of An Bord Pleanála in Kilmainham each day in December 2015.

We need to have the hospital built. The children of the country need it built; it is as simple as that and we must not lose focus. A children's hospital was first proposed back in 1993. Some 24 years later, there still has not been a block laid. Sinn Féin's aim is to have a state-of-the-art facility to provide first-class professional care and deal with the complexity of modern paediatrics. The new children's hospital envisaged was to be open and operational by 2020 but this is now in doubt given Mr. Tony O'Brien's statement on Monday that the HSE cannot afford to build the hospital and that it is not prepared to sign the contract that was awarded to BAM Ireland on Friday last.

I do not believe the Minister of State has answered any of my questions. She needs to repeat the cost and break it down. We need value for money and a cost analysis. We are running away with ourselves. The dogs on the street know we do not need the history of what we need or do not need. We are asking for a breakdown of costs and not a history lesson. We do not need a further delay. It is unsatisfactory that we are at this stage. It is almost like a farce in which a serious matter is taken too lightly.

I thank the Minister of State for coming to the House and giving us an explanation. It is important that the project be prioritised. My colleague referred to the fact that it was first mooted in 1993. Quite good times were experienced for 14 years under Fianna Fáil, but it was interesting that very little progress was made.

In fact, when progress was made the location turned out to be the wrong site. I do not think Fianna Fáil can throw stones when it comes to this matter.

Of course, costs will rise, and have done so, because the building trade has picked up substantially. As I said earlier this morning, the unemployment rate has reduced from 15% to 7.1%. An awful lot of that success is attributable to the huge number of people who are back at work in the construction industry, thus making it more competitive. As a result, contractors are working out the future cost of labour and other items necessary to progress the project. The Minister of State has stated the cost is within 5% of the original estimate and she mentioned construction inflation. This project has been delayed for too long. Therefore, it is important that it goes ahead and is completed at the earliest possible date. Children need the facility. As they receive a fractured service, the State needs this facility. The State also needs other facilities in Dublin such as maternity units. Let us remember that no major hospital facility has been opened in this country since 1998, yet we have gone through a time when the State was flush with money generated from taxation. It appears that we did not invest that money and look at the long-term picture for the health service during this time. It is important that there are no hiccups with this project and that it goes ahead at the earliest date. Yes, there must be full accountability and transparency about cost but the project should not be delayed under any circumstances.

I thank the Minister of State for making herself available for this debate. I remind my colleagues that the Minister had prior long-standing commitments and it was not possible for him to drop them to attend. These facts must be taken on board when a request is made for him to attend. I am sure he would have had no problem attending if he had received 24 hours notice, which would have been this time tomorrow evening. I am not too sure all of my colleagues would put the same time into this debate if he had agreed to attend tomorrow at 6 p.m.

This is not the first time that the Minister of State, Deputy Catherine Byrne, has had to substitute for the Minister for Health for a debate in this House. She is very welcome.

For the sick children of Ireland and their worried parents it is utterly disappointing that the proposed national children's hospital has been plunged back into question and crisis. The amalgamation of the three Dublin hospitals under one roof was first proposed in 1993, as Senator Máire Devine said. The project has been subject to continual delay. It has taken 25 years to get to this point and now with the start line in sight we have been told that the HSE does not have adequate funds to proceed. The longer this project is delayed, the higher the costs. Building inflation has risen from 3%, when the St. James's Hospital site was selected, to 9% now due to improvements in the economy.

Children have waited long enough. They deserve a world class hospital and treatment. Last Monday "RTE Investigates" told the awful stories of children in pain. Their lives will be damaged forever because the State has let them down and it must stop. We need the children's hospital to be provided as soon as possible.

We were all touched by the stories of the children with scoliosis. They have waited months and years for an operation while the theatre that was originally built to treat scoliosis lies more or less idle due to a shortage of theatre nurses. This is not good enough for these children. There has been a great public response to their plight. It is terrible that again it takes a show like "RTE Investigates" to shine a light on these important matters because the data is well known. What will the Minister do to resolve the matter?

On the show we also heard the story of others who have been failed by the health system. On a number of occasions in this House and elsewhere, I have raised the life threatening situation that exists for women in Cork caused by another operating theatre being left idle. Ms Patricia Connolly told her story of waiting for over a year for a gynaecology appointment. She is condemned to a life of pain and must take painkillers. She is one of at least 4,265 women, if not more, who await a gynaecological assessment. We still have not heard from the Minister what he will do to resolve the matter. I want to hear how he will provide a children's hospital and assist others who await vital treatments and interventions.

We are dealing with a runaway train in terms of the cost of the national children's hospital. In reality, construction inflation does not account for the rise in costs that the Minister of State indicated. She said that the cost rose by 9% per year since the project was first announced. To the best of my knowledge, when I was in government we signed off on a project that was valued at about €650 million. Of course, every construction project factors in, to a degree, the anticipated construction inflation. I do not believe construction inflation is the reason for the project to double in cost.

I understand from media interviews conducted by the Minister for Public Expenditure and Reform that he and the Minister for Health will have to sign-off on the cost of the project. I appeal to the Minister of State and her colleagues to ensure that every last cent is extracted from this process in terms of savings for the taxpayer.

Where does this project leave other major capital projects that the State willl undertake in the future? For example, the new national forensic mental health hospital in Portrane, the proposed new national maternity hospital that is urgently required, hospital extensions across the country and the €400 million that was allocated by the previous Government for necessary upgrades, extensions and the development of new public nursing homes across that country that everybody is concerned about. Are these projects in jeopardy due to the projected cost overrun in terms of the original budget for the national children's hospital? If so, I call on the Minister for Health to urgently make a statement identifying which projects are in jeopardy, may not proceed and may be in difficulty. We have not taken into account the estimated €350 million that is likely to be owed to hospital consultants. Neither have we taken into account the cost of a pay settlement that may emerge from negotiations between the Department of Health, the HSE and the nursing unions. All of that is before the Public Service Pay Commission reports and the Government engages with the public sector trade unions on escalating the process of public sector pay restoration for those who work in the public health service. We have spent five years ensuring we got a handle on national budgets, learned lessons from the past and controlled expenditure as expertly done by the former Minister for Public Expenditure and Reform, Deputy Brendan Howlin, in recent years and under an awful lot of pressure. Now it seems that money is no object for this Government. It does not appear to be concerned about cost overruns the likes of which pertain, it appears, to the national children's hospital.

I ask the Minister of State to use her good offices to liaise with the Minister for Health, the Minister for Public Expenditure and Reform and her other colleagues to make sure this issue is examined by the Committee on Budgetary Oversight, as suggested by my Labour Party colleague, Deputy Joan Burton. I ask for this to happen because I do not want to see an investigation being carried out by the Comptroller and Auditor General and the Committee of Public Accounts in a number of years time on cost overruns for such a vital project. We need to get a handle on this matter. We need to understand how the project affects other capital projects in the health service that are essential, current expenditure to address waiting lists and other new and future initiatives in which I am sure the Minister of State and her colleagues would like to invest.

We cannot unlearn the lessons of the past. The country got itself into dreadful difficulties that the State and every citizen has paid for time and again because of the profligacy of previous Governments. We got it under control from 2011 to 2016. Learn the lessons from that and ensure public investment in large and essential projects such as this one is done in a transparent way and over which the Government exercises its responsibility and control on behalf of the taxpayer.

I acknowledge the departmental officials behind me.

I thank the Senators for their contributions. I am not here to make a political football out of the new national children's hospital. That is not my way of thinking. I represent the same area as the two Senators, including Senator Ahern. I am replying to-----

I am sorry.

I will reply to what questions I can. If I cannot answer, I will take them with me and consult the Minister.

The Government is firmly behind the building of the new national children's hospital. At no time during the process did I hear objections from any of the area's Deputies.

I will start with Senator Gerald Nash's contribution. He was a Minister of State in the previous Government. I acknowledge the work that was done to restore the economy to its current position. Everyone recognises that we are not out of the woods yet. No one will recklessly spend money that we do not have.

We are not on a runaway train. We are at a critical point with the national children's hospital. The Minister has pointed out that the cost increase is 5% of the overall projected cost. It is important to keep that in mind. Every last cent should be extracted. The people who will pay for the national children's hospital are the taxpayers. Therefore, we do not have the right to exceed limits. There must be limits and we have to adhere to those that are in place. Now that the builder has been appointed, a significant limit has been reached.

I will not read through the Department's speech, but I recognise some of the issues with running the hospital, for example, bed capacity. These are questions for the future.

I acknowledge the comments of Senator Colette Kelleher who has left the Chamber. I hope she will hear this later, but no words of sympathy from me, any other public figure or anyone in the country could sufficiently acknowledge the suffering of the children in the television programme. As public representatives, we have a collective duty to ensure everything is done to help those who are suffering and in distress, young children in particular. I was happy to hear the Minister's commitment yesterday to open the new operating theatre in Crumlin hospital and get it into action as soon as possible. I visited it a while ago and was impressed by the standards. It is important that we keep this matter in focus.

I will make a few comments on Senator Máire Devine's contribution. I know of her local work on the ground. I have been involved in many consultative processes - Fatima Mansions, St. Teresa's Gardens, Dolphin House, etc. - and have never seen as much consultation as there has been on the national children's hospital, rightly so. It will serve every sick child in the country and his or her family. The wide consultation process of the past two years was attended by every community group, family, relative of a sick child, neighbourhood and staff member that would be affected by the complex's service and wanted to attend. Like the Senator, I attended a number of the oral hearings over the two weeks-----

-----and sat through many presentations from people for and against the hospital's location. We must stop digging in and I do not mean digging for the hospital. We need to get the hospital built as quickly as possible. There were many public meetings. I attended some at which the F2 Centre and the community were involved. An office was opened to ensure the project team could relay people's concerns on a daily basis. Great work has been done, not only in the community, but where the project team has connected with schools and enticed young people to consider a different future in the health service. That is important for the Dublin 8 area. We all know it like the back of our hands. We have walked the steps of every flat complex and every house. The change in attitudes on doorsteps is significant. A site was chosen in an area that has seen a great deal of deprivation and educational disadvantage for many years. This is an opportunity, not just for all of the country's sick children, but for the Dublin 8 area and the wider inner city, which needs an injection. As public representatives, we would all welcome it.

Regarding Senator Catherine Ardagh's comments, I cannot say more than I already have. The Senator asked about the project office's work with schools and the state of the project in Rialto. The hospital project is going ahead. We are in the process. We have all seen the work that has been done on the ground. It is time that we pull our horns back in, put our hands together on this project and move forward. We should not turn it into a political football. Think of the most important people in all of this - the sick children whom we see on our television screens on a daily basis.

I will not go into why this site was chosen. The Senators know the reason. I do not want to comment on the reasons for yesterday's remarks by the CEO of the HSE. I wish to make a commitment to the Seanad, in particular those Senators who spoke, that I will do everything I can in the Houses and the community to ensure we will have a hospital that will be one of the best in Europe and deal with the most sick children. I have spent time sleeping on the floor in Crumlin hospital with my own children. Last year I spent time there with my ill grandson in a room in which I could not swing my two arms together. We need to focus on building a hospital that is the envy of the world.

When I spent some time in London three years ago, I had reason to visit Guy's Hospital. I was impressed by it and how it was situated in the heart of the community. Developing the national children's hospital will be one of the best things to ever happen to Dublin 8.

I take on board people's concerns about costs. I cannot answer them this evening because the cost details are set out in the business case and will be brought to the Government in the coming weeks. I cannot comment on media reports and speculation on the cost base in advance of that happening. I wish that I could, but I cannot. I am not in a position to do so.

We are all here to ask about the cost. Mr. Tony O'Brien stated he could not sign the contract that was announced last Friday.

Please, Senator.

I have given Senator Máire Devine a detailed-----

No, the Minister of State has given me the history of the projfect.

I know all of it, as does the Minister of State.

With all due respect, the Minister of State is over time.

At the beginning of my contribution, I explained about the costs and how inflation had changed them. As we all know, when we start to make a little money, construction costs increase, but there is a plan and the Senator has to give it time.

They have doubled.

What does the Senator want? Does she want the process to stop now? Does anyone want that to happen?

The cost has doubled. I want to see the cost analysis.

How can the Senator say that when we have not even received the final-----

This is not a free for all. The Minister of State had four minutes to reply, but she has taken seven.

Please conclude as soon as possible. I do not want any interaction. Senators have spoken already.

No, the Minister of State is fine. I just do not want interruptions. I am protecting her.

We have the opportunity of a lifetime to build and have the best national children's hospital in Europe on our doorstep and we should embrace it. I know that cost will be a factor as we go along. I am not here to talk about that matter because the cost details are set out in the business case and that information will be brought to the Government in the coming weeks. That is the only answer I can provide on the issue of costs. If that is not acceptable, we will have to start again. I urge the Senators - we work in the same constituency - to come behind the project and make it work because it will change the face of Dublin 8 for the next century.

I do not think the Minister of State can question our commitment to the hospital.

The statements must conclude. I rarely make a comment, but I represent a very rural area in west Cork where a woman I knew who had two very sick children had to travel two hours to catch the 5 a.m. train to Dublin for treatment in Crumlin. She spent almost a day and a half coming and going; therefore, when I hear people cribbing about where the hospital should be located in Dublin, they should think about those in remote parts of Ireland.

The Cathaoirleach is missing the point.

I am not; I am making my ownt. I am not contradicting the Senator.

This is about a cost analysis.

When is it proposed to sit again?

Tomorrow at 10.30 a.m.

The Seanad adjourned at 7.45 p.m. until 10.30 a.m. on Thursday, 9 February 2017.