Ceisteanna ó Cheannairí - Leaders' Questions

I do not think the Government should underestimate the level of public anger at the spectacular cost overrun in the development of the national children's hospital. We learned today from The Irish Times that senior officials from the HSE and the Department of Health discussed potential cost overruns almost a year before the date on which the Minister, Deputy Harris, says he was informed of rising costs, in August 2018. The bottom line is that we need to know where was the political oversight of this project. This is the Government's flagship capital project. It is the largest ever project in the history of the Department of Health and the HSE. Are we really being asked to believe that the Minister, Deputy Harris, was not kept informed that costs were rising dramatically? What information was flowing to the Minister in respect of this project between the autumn of 2017 and the autumn of 2018, when he acknowledges that he learned of the issue? If he did not know, why did he not ask? Why was he not insisting on regular updates from his own officials who were directly involved in the process?

We are told that the Minister became aware of the significance of the issue, if not the final figure, in late August 2018, yet this information was not passed to the Minister for Finance until 9 November 2018. This is a scenario that I just cannot get my head around. The Minister for Finance, namely, the person in charge of the purse strings of the State, as part of a collective Cabinet decision signed off in April 2017 on a project at a cost of €983 million. We are being led to believe that the next he heard of any change was in November 2018, over a year and a half later, when he was given the news that the direct build cost of this hospital had increased by €450 million, on top of the other costs involved, bringing the overall bill to €1.7 billion. This begs the obvious question as to what supervision did the Minister, Deputy Donohoe, and his Department of Public Expenditure and Reform have over this massive capital project. In the meantime, a budget was being negotiated between September and mid-October. Expenditure allocations for 2019 were agreed and published on budget day. Allocations for current and capital spending were published without this massive overrun being factored in, despite at least one Cabinet Minister being aware of it. Throughout September and early October, there was intense engagement between officials from the Department of Health and the Department of Public Expenditure and Reform and directly between the two Ministers, Deputies Harris and Donohoe. Not only were they discussing the budget for the Department of Health for 2019, both current and capital; they were also discussing the massive overrun on the current side in the Department of Health in 2018 which, as we know, ended up at €655 million. I cannot envisage a scenario in any company in this country where a senior manager in charge of a capital project, on becoming aware of a massive overrun, would not inform the finance director of the company.

We need to know the consequences for other projects. This will go far beyond some projects being delayed by a few weeks or months. The €100 million that has to be found this year is only the beginning. Multiples of that will have to be found over the next four years. I ask the Minister to inform the House of those consequences and to tell us when we will know the facts. What is being done to reduce the cost of this project now? What does this say about the competence and capacity of the Government to deliver on other major capital projects, not least the national broadband plan, for which half a million homes and businesses are waiting?

I thank the Deputy for the question. This hospital will be delivered and is being built at the moment. The children's hospital is an incredibly important project for this country as we all know.

It is a hole in the ground.

It is going to stand the test of time in terms of the families and children it will help up and down the country. Yesterday, the Taoiseach spoke to the many benefits it will bring in terms of services and emergency services it will provide. I think we all agree it is an important project that must be delivered.

It is in the wrong place, though.

Of course people are angry with what they have heard now about the inflation in the costs for the delivery of this project-----

The Government was warned.

-----and the additional €319 million in capital costs that are going into this project since the original outline for phase 2 was provided in 2017. The Government is angry too-----

What about the sick children?

It is angry a year and a half later.

I would not put those people building a house.

-----and that is why we are taking action to get to the bottom of this problem.

If only it was in charge, it could have done something.

Anger will not build a hospital.

A Cheann Comhairle, could the Minister be allowed to answer the question?

In December of last year, an important decision was brought to Cabinet on the future of this project. Essentially, three options were available. One was to pause the project, meaning even further delay to a project which has been discussed for decades and which the Government is now implementing. The second option was to go out and re-tender the project, again meaning more delay and an even greater cost. The third option was to proceed with this project and pursue this hospital. That was the right decision to make.

Carry on regardless.

If other people would have taken a different decision and put the future of this hospital in jeopardy, I would like to hear that. We believe it was the right decision to pursue this hospital-----

The Minister for Health called it the least worst option.

-----to bring about the many benefits that it will deliver for the next 100 years in this country. Now that we are proceeding with the hospital and have the size of the cost overrun in front of us, we need to establish and get to the bottom of how this occurred.

The Government was warned.

Is anybody in charge?

Was it avoidable? Was there negligence? How do we prevent it from happening again? Can we make cost savings now? That is the process that is under way with the work PwC will do.

The Government has real-time information.

The terms of reference of that review have now been published and we have to get into the process. Alongside that, representatives of both the Departments of Public Expenditure and Reform and Health appeared before Oireachtas committees last week. The Minister, Deputy Donohoe, was in committee yesterday and the Minister, Deputy Harris, is in committee today. The Taoiseach has taken questions on this. The chairperson of the board has resigned to protect the integrity of the process and has been replaced. Now we proceed with the PwC process to get answers to those questions that are very important.

Papering over the cracks.

We are committed to delivering this hospital because it is so important for families and children up and down the country.

It is in the wrong place.

Whatever the cost.

It is not the Minister paying for it.

We want to get to the bottom of exactly what happened here in respect of how these costs inflated over time, who knew what and when they knew it, and what happened as a result. The terms of reference for the PwC report and the work it will do between now and the end of March will bring us back those answers and details. Then we can make decisions as to what happens next.

What about the site? Do they mention the site in the terms of reference?

We know a lot of the costs and what has happened there. What we need to understand is why and, on the admittance of some of the people involved in the project, why some of the early warning systems did not work.

The Government was warned in this House.

Early warning systems.

These are the questions that need to be answered so that we can then have a detailed discussion on where we go from here.

Before we proceed, I wish to bring to Deputies' attention that the people who elected them and me are sitting in their homes watching this carry-on. The issue is of enormous importance but they would expect to see us conduct our debates in an appropriate and effective manner. Will Deputies please stop heckling the Minister? If there is continued heckling, I will be forced to suspend the House. We ask a question and must at least allow it to be answered. I ask Deputies to stick to the times allocated, please.

The Minister has not dealt with the elephant in the room, which is the lack of any political oversight over the single largest capital project in the history of the Department of Health and the HSE. Why is it that officials representing the Minister, Deputy Harris, knew for up to a year that the cost of this project was spiralling through the roof before it was even brought to his attention? That is what we are led to believe. Why is it that the Minister for Health himself, on learning that this was a major issue in late August 2018, allowed a budget to be brought into the House and prepared against a backdrop of not knowing that this was going to manifest itself by way of hundreds of millions of euro of an overrun? We have a Minister for Public Expenditure and Reform who was represented on the board but who also happened not to be told. The Minister, Deputy Harris, says his officials told the officials in the Department of Public Expenditure and Reform in October yet the Minister, Deputy Donohoe, was not told. Does anyone talk to anyone in this Government? This is all over the place and meanwhile, there is no certainty that the costs associated with the project will not climb further and further. What reassurance can the Minister give to the House and to the people that the costs are going to be reined in and that efforts will be made to reduce the cost of delivering this project?

He cannot give any reassurance.

When will we have clarity on the consequences for other projects in health, education and transport throughout the country that depend on capital funding? When will we have that clarity?

I thank the Deputy for his follow-on question. The political oversight here is clear. It is not correct to state that officials knew that costs were spiralling out of control for a year before this. The issue of the costs in 2017 - the increase in costs of approximately €60 million to €62 million - is a separate issue to what we are dealing with here. We must be very clear to separate these issues in order that we can actually understand what has happened here and what led to the decision the Cabinet had to take in December of last year.

The Minister, Deputy Harris, did not inform the House.

As soon as the Minister, Deputy Harris, was informed at the end of August or beginning of September that there was the potential for a significant overrun here compared with the outline figure in 2017, intensive work was done, while the gross maximum price, GMP, process was happening, to crystallise what those costs might be before the process came to an end. When that information was understood at the beginning of November, it was given to the Minister, Deputy Harris, who immediately made sure that the Department of Public Expenditure and Reform was informed. From then until December, when the Cabinet made its decision, work had to be done to make sure we knew exactly what had happened in terms of the scale of the costs and how it would be managed by future budgets. The issue was brought to the Cabinet in December for decision as to where to go from there. The decision was taken to proceed with the hospital and to then have an intensive investigation into how this happened

The hospital is in the wrong place.

That process began in January in the committee and it continues today; the Minister, Deputy Harris, is now appearing before the committee. PwC is carrying out a report that will get those answers. We will work with the report and those answers and will take further decisions based on what that brings us.

The Government is wasting more money on that report.

The budget in October was based on fraud. It was basically fraudulent.

Yesterday, nurses and midwives who are members of the Irish Nurses and Midwives Organisation, INMO, engaged in a 24-hour stoppage due to the complete failure of the Government and the Minister for Health to address the recruitment and retention crisis now gripping our health service. This afternoon will see hundreds of general practitioners, GPs, protesting outside the gates of Leinster House due to the lack of investment in primary care and the Government's failure to reverse past cuts to GP fees. The Psychiatric Nurses Association is today stepping up its industrial action through an overtime ban in advance of a three-day strike by those nurses next week. At the same time, we have the worst hospital waiting lists in Europe and last month, more than 10,000 patients spent time on trolleys in hospitals right across this State. To top it all off, we have the national children's hospital fiasco; a project that is now €450 million over budget.

This all adds up to a health system in a state of absolute and utter chaos. The situation in respect of the national children's hospital has descended into the realm of farce. This morning we learned from The Irish Times that senior officials from the HSE and the Department of Health who sat on the steering group for the hospital were flagging the soaring costs in respect of the children's hospital from October 2017 and almost every month after that. The Minister still maintains he was not informed or made aware of the costs overrun until August 2018. That time lapse does not sound credible but even if we do take the Minister, Deputy Harris, at face value, that does not explain why it took until November for the Minister to bring it to the attention of the Minister for Public Expenditure and Reform, Deputy Donohoe. Not once was the issue of an overrun mentioned and even in November, he did not personally tell the Minister of the €500 million overrun in that area. Can that be explained to us? The Minister, Deputy Harris, did not open his mouth about this project's cost overrun of €500 million for three months. It is utter madness, and shows the dysfunctionality in those Departments and at the heart of the Government.

The Taoiseach tweeted this morning: "We can get this project back on track." While we know that the Taoiseach is very much a man of spin rather than substance, what does that tweet mean? Is he suggesting that the figure he announced when he was Minister for Health, that of €637 million, would represent the project getting back on track? Alternatively, does he mean the figure of €982 million we were expected to believe would be the cost of this hospital or is it the €1.43 billion that is now suggested? Will that figure increase further? Is he suggesting that we are going to rein back costs on this project? The public does not have confidence in the Minister or the Government in this area and there must be accountability.

Any of the myriad of issues I raised at the beginning is bad enough in itself but combined, they are an illustration that there is something seriously and fundamentally wrong when it comes to health. The fact is there is incompetence and dysfunction at the top of the health service. It is crying out for direction and leadership and has been for many years. When will the penny drop with the Government that the Minister for Health is simply not up to the job?

It is true to say that we face many challenges in our health sector today but we have a fantastic health service. It is fantastic because of the people, doctors and nurses up and down the country who work on it.

They are all on strike.

The first issue the Deputy raised was that of the strike action happening at the moment. It is a very serious disruption for patients up and down the country. Tomorrow will see the second full-day strike of this week. Psychiatric nurses are also reducing their hours, and there is also an issue about GPs. We know that nurses are not taking this position lightly because we know how much they care about the patients they look after. In situations such as Storm Emma, we saw that they went above and beyond the call of duty to look after their patients. However, the Government does not take its position lightly either. We have to think about the potential outcomes that might arise if this cannot be resolved in an appropriate way. Contingencies have been put in place, which is important for people in the health system today. We have to think about how we can catch up on time that has been lost but we have done that before. We must bear in mind our responsibility to the public finances. We cannot jeopardise the current public service pay agreement. We cannot risk other strikes in other parts of the public sector and cannot endanger the important agreement we have at present, which is essential to the security of our public finances. It is true to say that it is important in the context of Brexit being on the near horizon; we are still working on contingency plans to deal with that issue. The belief of the Government is that we can find a resolution to this issue. It is very important that we do so quickly because of the escalation in action that is happening over the course of this week.

On the issue of the children's hospital, between the end of August or the beginning of September, when the Minister for Health, Deputy Harris, was made aware that there was the potential for significant overrun with the capital costs of this project and November, when the figures finally crystalised, he was getting to the facts of the matter. He was not working on innuendo or what he might believe but sought to understand the scale of the problem. When he understood the scale of the problem, the situation was relayed on the same day to Cabinet colleagues, including the Minister for Public Expenditure and Reform. Work then began on what decision had to be made, how it would be made, and what the consequences of the decision might be. Since that decision was taken by Cabinet in December, we have discussed this issue publically. There has been full transparency and accountability around that, but there is also a process in place, including the work of the Joint Committee on Health, where the Minister is answering questions by Deputy Pearse Doherty's colleagues on this topic in detail. The process also includes the PwC report, the terms of reference for which were published yesterday evening. The process seeks to get very detailed answers about what kind of oversight was happening, who knew what and when they knew it, whether proper procedures were observed-----

The Minister has just said the Government is on top of everything. Why do we need a report?

-----what we have learned from all of that and what we can do to try to save costs now, given what has happened in the past couple of months.

The Minister has mentioned the Government's responsibility to the public finances. Where was its responsibility or that of the Minister when it came to the overrun on the national children's hospital, running to €500 million of taxpayers' money? Where was the responsibility of the Minister for Public Expenditure and Reform when it came to one of those major capital projects that has now been beset by massive overruns? The Minister has spoken about the Government's responsibility when it comes to nurses but when it comes to a capital project such as this, it is clear that both Ministers were out of their depth, asleep at the wheel and kept in the dark by senior officials within their own Departments.

We learned in The Irish Times that the assistant Secretary General told the board in May that it had to go to the Government. It is incredible that the assistant secretary general would not have told his own Minister that there was a serious overrun. It is worse that the Minister, Deputy Harris, did not once, over August, September or October, a time when he was in direct negotiations with the Minister for Finance around a Supplementary Estimate for the Department of Health worth hundreds of millions of euro and a budget for 2019, tell the Minister for Finance that there was an overrun on this project. This Minister is out of his depth and not just on this issue. It is the fact that he has forced tens of thousands of nurses to take to the streets. It is the fact that people cannot go to their GPs today because they are on strike and are protesting outside these gates. It is the fact that people cannot get beds in our hospitals. It is the fact that we have hundreds of thousands of people-----

It is a fact that the Deputy is over time.

-----on hospital waiting lists. When will the penny drop? This is complete incompetence at ministerial level and departmental level. There is clearly serious dysfunction at the heart of Government and at the heart of these two Departments.

I thank the Deputy for his follow-up question. At the time in question, the GMP process was still under way, so the full facts of the matter were not established.

The responsibility of the Minister when he was informed that there was going to be the potential for this significant over-run - it was only in the August-September period last year - was to establish the full facts.

He never told the Minister for Public Expenditure and Reform. Is that it?

The idea was to have an interrogation of the process that was being finalised in the gross maximum price process. When he had the information, he brought it to the Minister and the relevant Department. The Taoiseach was then informed. A detailed memorandum was prepared for the Cabinet, on which we would then have had to make a serious decision. At the same time, the public was informed of that decision and we have since been having a public and transparent debate and bringing as much information to light as we can. Again, the Minister for Health was before the Joint Committee on Health this morning answering many of these questions, but we also have a PwC process and the terms of reference for that process.

I know that those in Sinn Féin struggle sometimes with the idea of due process and getting to the actual facts before they pull the trigger.

Fine Gael struggles with accountability.

As the Sinn Féin leader likes to say, the dogs in the street know. Ministers have been hung based on what the dogs in the street did or did not know before. We will follow due process, get the answers and act on the correct information.

What about the site? Can we get accountability on it?

Fine Gael has been in charge of the Department of Health since March 2011. We have come out of the austerity years and are now, I hope, in a position where we can bring the health system forward. Funding for the Department of Health and the HSE has grown from €14.2 billion in 2011 to €17 billion this year. As others have made clear, the Government has serious questions to answer about how there was an explosion in costs for the national children's hospital. It has serious questions to answer about how other hospital investments will be delayed or perhaps cancelled throughout the country as a result. It also has to fix the terrible problems stemming from the CervicalCheck scandal, not least the waiting times for checks to be processed that are inexcusably long.

I want to focus on the Government's record in managing negotiations. The Irish Nurses and Midwives Organisation is on strike. Those involved will be going on strike for a third day tomorrow. Where is the Government's ability to handle this situation? Why can it not sit down and engage in a serious process of negotiations well in advance of an actual strike? After nearly eight years in the Department of Health, I would have thought Fine Gael would have developed working relationships with all the major stakeholders, yet it seems years have slipped by and it has been unable to get to grips with these issues. We are now hearing concerns about the awareness of cost over-runs for the national children's hospital dating back to August 2017, one year before the Minister for Health was informed, apparently, and 15 months before the Minister for Public Expenditure and Reform was informed. It is his job, as set up by statute, to monitor public expenditure. The notion that the Minister for Health would know that he had to get all of the facts and that it took him three months to tell the Minister whose job it was to mind the money that there was a problem is startling.

The Government has been negotiating a new contract with general practitioners for at least four years with no outcome. In order for the programme for Government commitments to roll out more primary care centres to be achieved, we need to have the GP contract agreed to. In order for the Government's own commitments to provide free GP care for all children and young people under 18 years to be realised, we need to have the new GP contract agreed to. The latest report is that the Minister for Health began a new round of negotiations with the Irish Medical Organisation in October last year. I have two direct and simple questions for the Minister for Housing, Planning and Local Government. What progress has been achieved in the negotiations on the new GP contract? When, in his estimate, will the GP contract be signed off on and delivered in order that the programme for Government commitment signed off on by the Government will be brought to fruition?

It is important to acknowledge the increase in spending that has happened in the health service in recent years. The increase in spending has happened because we place such a priority on improving the health benefits and results for people going into the health system. Of course, we have challenges in the health system - every country does - because of the types of service we are trying to deliver. Over the course of that period we have increased the budget and seen more doctors, nurses, healthcare centres, as well as community supports and improvements in health outcomes, but challenges still remain.

Action is under way by the INMO. The mechanisms of the State are in place - the Workplace Relations Commission and the Labour Court. Both the Minister for Public Expenditure and Reform, Deputy Donohoe, and the Minister for Health, Deputy Harris, have said they are open to the engagements that could happen through that process as it comes to a resolution. However, this has to happen within the parameters of the public service pay agreement. This is because the agreement has been agreed to across the public sector and that is what we are working towards in getting public sector workers back to the position where they were before the crisis happened in their pay and benefits. That was an important negotiation and it has been agreed to. We want to and have to continue with it. We have a responsibility beyond the nurses. It applies to them, of course, but it goes beyond them to all public sector workers and the wider economy in terms of the public finances.

Deputy Howlin referred to the GP contract. An important engagement between the State and the IMO resumed in October, as the Deputy said, and there were intensive engagements at the time, especially in the weeks leading up to Christmas. Some progress was made, but there are outstanding issues. We need to ensure that, as we benefit patients, we also provide value for money for the taxpayer. The State's negotiating team is keen to bring a renewed focus to the engagement with the IMO in the coming weeks in an effort to bring matters to a conclusion. We believe we can bring matters to a conclusion because it is so important in terms of what we want to deliver through GPs. The ability to deliver the service through them and do so in a cost-effective way not only for the taxpayer but also in such a way as to avoid adding a financial burden to the individual, family or parent who wants to bring a child to the GP is crucial. We need to find money through savings in other parts of the healthcare sector because we are doing it with GPs.

These are only generalisations.

We recognise the important role GPs play in communities up and down the country. We are now involved in an engagement with them. People are engaging on behalf of the State to come to a conclusion as quickly as possible.

What is the point in vastly increasing the health budget if the Government is so spendthrift that it has no control over the escalating costs? A total of €500 million can go without being noticed. It seems that industrial relations and Fine Gael do not work well together. I again ask the Minister my questions, specifically about the GP contract. The doctors are outside. It is the next national crisis. There are vacancies in GP practices in every county. I can list the areas in my county of Wexford where we cannot get GPs to take up contracts. This is going to be crippling for the health service, unless we get a contract in place. Four years of negotiations should bear fruit, rather than the generalisms the Minister has provided for the House today. I will repeat my question. When does he expect a concrete result from the ongoing negotiations on a new GP contract? When will the Government be in a position to deliver on the programme for Government commitments to roll out GP services?

To categorise the additional money that will be spent on the children's hospital as just disappearing without notice is completely incorrect. It is money that is going into a state-of-the-art children's hospital that will stand for more than 100 years.


The Minister for Public Expenditure and Reform was asleep.

It will provide services, including emergency care and support services for families and children up and down the country.


The spend was not known by the Minister and neither was the over-run in 2017. It is incorrect to say it was. As we address these serious issues about which people are angry – we are angry too – it is vital that we get to the actual facts of the matter.

When was it known?

The issue being addressed in respect of 2017 relates to An Bord Pleanála and the additional sprinkler systems that had to be put in place. The cost was to be managed within the existing budget. That is separate from the information brought to the attention of the Minister for Health, Deputy Harris, at the end of August or the beginning of September on the potential for a significant over-run. It was only crystallised at the beginning of November, at which time the other Ministers were then informed of the seriousness of the issue and the Cabinet took its decision in December.

What is the Minister's definition of "significant"? Is it €5 or €5 million?

It was crystallised.

Deputy Howlin asked about the GP contract. Of course, we have to get the facts of the matter. The Deputy should know as a former Minister for Public Expenditure and Reform that we cannot make up figures or pull them out of the air. We have to drill down and get to the actual numbers and then bring them to the Minister and the Cabinet. We need to get to the facts. As I said in my previous answer, intensive engagement began in October and continued right up until the weeks before Christmas. There are a number of outstanding issues. The engagement will resume shortly and we hope conclude shortly thereafter because of the important role GPs are playing in terms of the future delivery of health services.

I suggest there really is something surreal about the way the Minister for Housing, Planning and Local Government is trying to explain away what can best be described as an existential crisis across the public health service. Those in Fine Gael pride themselves on their management skills, efficiency and financial prudence, yet they are trying to justify what has been, in the period Fine Gael has been in office with three different Ministers for Health, namely, James Reilly, Leo Varadkar and Simon Harris, an absolutely extraordinary tale of failure and crisis.

GPs are protesting outside Leinster House as we speak over the crisis in general practice. There is a national nurses' strike and an ambulance strike. There is a persistent and unprecedented trolley crisis and there are hundreds of thousands of people on hospital waiting lists. There is a crisis in our mental health service where the child and adolescent mental health service, CAMHS, is 50% understaffed, there has been the scandal around CervicalCheck, and there are persistent overruns in the health budget running to hundreds of millions of euro. The cherry on top of all of this is the absolute disaster of the national children's hospital. When it was first touted, the national children's hospital was going to cost just over €400 million, but now the bill has reached €1.4 billion or €1.7 billion all in. Even by the Government's estimate, it is a €1 billion increase in the cost of the national children's hospital. Are we seriously supposed to believe the Government when it says that this is not really its fault and it will get to the bottom of the matter, that it is in charge of things?

To add insult to injury, much of this is being batted off to PwC to find answers. This is PwC which worked for BAM, the contractor at the centre of this controversy, auditing its accounts for nine years, for which BAM paid it at least €34 million. BAM is a contractor with a history of massive overruns in Holland, Britain and Ireland. Now the company which audited them are apparently the people who will get to the bottom of the scandal of the national children's hospital. It beggars belief.

Why does the Minister try to explain away this €1 billion cost overrun, that is, €1 billion which will go into the hands of building contractors, but the Government digs in its heels against the nurses and says the nurses will not get a cent? The Government says it is okay, that it can explain away an extra €1 billion to building contractors but it cannot pay the nurses, the people who hold together what is left of the health service. It digs in its heels and refuses to engage with them seriously. The Government has made a mess of the health service under three successive Ministers. Why does the Government not just give it up and accept that it failed?

I thank the Deputy for the question. Of course we have challenges in health, but that is why we are spending more money in health than we ever have.

It is not being spent on health. It is going on the hospital.

Each year we have sought to increase the budget for health, both current and capital funding, and where additional resources have been made available, health has been prioritised. I have been part of the negotiations where we have discussed increases in budgets. The cost overrun here is €450 million above what was profiled in the initial outline in 2017. About €320 million of that is for construction and €50 million is towards VAT. The rest is for equipment leasing, design teams and those types of things. That money must be spent to deliver this hospital.

It is wrong to conflate this with the issue of the nurses for several reasons. It is not true to say that nurses are not getting pay increases under the public service pay agreement. Changes are happening as a result of last year's review into issues around recruitment and retention. The challenges in the public sector go beyond nurses. The public service pay agreement is in place across the unions to ensure that we can restore losses in salary that were inflicted as a result of the crisis in a way that we do not step back into another crisis and have to cut salaries again. We must do everything in a sustainable way.

Let me be clear about the importance of the delivery of this hospital. That will cost money. We will get to the root of how these costs went from the initial outline for phase 2 announced in 2017-----

There are no landing pads. There is no access.

-----and the figures that were brought to the Minister in November and then to the Cabinet for decision in December, and what exactly happened in that process. PwC will work in tandem with the Government in doing that. I say in tandem because the Minister for Health, Deputy Harris, has been at the joint committee all morning answering questions on this. The Minister for Public Expenditure and Reform, Deputy Donohoe, has also taken questions on the matter, as has the Taoiseach in the Dáil. Officials were before joint committees last week where they took questions. A process is in place where questions about what happened are being answered, but we also have to do a deeper dive, and PwC will do that.

Members will have seen the terms of reference of what it has been asked to deliver, which we will have by March, and we will go on from there. It is very important that we get to the facts of the matter. It is very important that we all understand that we need to build this children's hospital-----

It is in the wrong place.

-----and that we are going ahead with this because of the important improvement it will bring to the health system, which needs those improvements in facilities to ensure that when parents have sick children, they are given the most appropriate care possible in the right environment. That is what the children's hospital is about. It will stand there for more than 100 years. It is incredibly important that we get it delivered now and that, in delivering it, using PwC's work, we find cost controls and savings where we can as we go to completion in 2022.

It is a deeper dive down the hole the Government has dug itself.

Who holds the public health service together? It is the nurses and the midwives, the ambulance drivers, and the GPs. The Government will not speak to the INMO about the issues that have brought its members out on strike, it will not recognise the National Association of General Practitioners, NAGP, the representative group of the general practitioners, and it refused to talk to the National Ambulance Service Representative Association, NASRA, branch of the Psychiatric Nurses Association which is involved in an industrial dispute in the ambulance service. It will not speak to them. It will not give a cent to the people who hold the health service together but it will pay €1 billion over and above the original estimate announced by the then Minister, Deputy Reilly, at St. James's which was €485 million. It is now €1.4 billion under this Government's watch, and we will fork it out, and it will probably go higher.

According to a meme I saw recently, the tallest building in the world cost €1.7 billion, which is about the cost of the national children's hospital. It is shocking, but while the Government is willing to give money to these builders, it will not even talk to the people who hold the health service together, the nurses and midwives, GPs and ambulance drivers. It is shocking double standards, typical of Fine Gael. Its last little claim for credibility, that it could manage things in a prudent financial way, has now been exposed. It has made an absolute dog's dinner of this key infrastructural project and no apologising or explaining can justify it.

I thank the Deputy for his supplementary question. There are nurses at work today. I know that the nurses who will strike tomorrow do not take that action lightly, given their commitment to and care for the patients they look after. However, we as a Government must bear in mind the potential consequences were we not to stick to the public service pay agreement. Within that agreement, there will be changes and improvements in conditions and increases in salaries for people in the health sector. Additional increases will kick in from 1 March. It is not true that things are not being done to help improve the position of public sector workers, because they are. That is why we are seeing an increase in the number of people working in the public sector in recent years.

The Deputy referred to figures from six years ago when we first started speaking of this children's hospital. That it was six years speaks to the delay which has taken place and why we do not want to delay further. The economy has radically transformed in the past six years, no thanks to Deputy Boyd Barrett, of course, or any position that he has taken on any budgetary decision that this Government had to make to restore the public finances. In relation to the public service pay agreement we are trying to keep public finances on a sustainable footing, not least because of potential dangers relating to Brexit. In this significant cost overrun, it is important that we get to the actual facts of the matter. The €1 billion overrun is not a fact. The Deputy can jump up and down about it but we need to get to the actual facts, then understand what lessons are to be learned and what decisions the Government can take on accountability and the additional cost savings that can be found between now and the completion of the hospital in 2022.