Ceisteanna ó Cheannairí - Leaders' Questions

There are two further serious reports in the news media today on the continuing saga of the national children's hospital. There is one in the Irish Examiner which is headlined "Secret plan to manage hospital fallout [...]" and another in The Irish Times which is headlined "Children's hospital overrun would have happened regardless [...]". The articles reference a confidential report which the HSE prepared having been asked to do so by the Department of Health. The minutes of the meeting of the joint construction and finance sub-committee of the National Paediatric Hospital Development Board on 30 August are particularly revealing because they show that there was significant unease and concern about escalating costs. They also reveal that there were significant efforts to keep the news under wraps, including the signing by approximately 25 members of confidentiality clauses. The meeting took place three days after the Minister for Health ad been told about a potential overspend of €391 million. One wonders whether this overall secrecy fed into the misleading of the Dáil in the answer Deputy Cowen received to his parliamentary question which, as we now know, was not correct.

The articles also describe a meeting that was held with a public relations agency to discuss the communications fall-out from the overspend. They state the meeting with Q4PR examined two scenarios: awarding the phase B contract to BAM or not awarding it to BAM and going with plan B. The minutes show that Mr. John Pollack noted that a paper had been issued and that Anne Butler agreed on some actions that were required. That level of engagement with a public relations company in deciding whether the contract was to be awarded to BAM or whether the project was to be retendered as plan B was quite extraordinary. Two issues emerge, one of which relates to the secrecy. One of the 25 people is the top procurement officer in the Civil Service. There is a code, under which he is obliged to report to the Minister, particularly where there are serious weaknesses in controls that have not been addressed, despite having been drawn to the attention of the board or the chairperson. There is an obligation, particularly in a non-commercial State body, to provide that material for the Minister of the day.

The main message emanating from this seems to be that the Government's focus was on controlling the message, not the cost. Whatever else it did, it would control the message around the overspend. There was no real focus on getting the costs down. It is quite extraordinary. On looking at all the photographs and videos on the national children's hospital, the Government was good on the hard hats and the yellow vests. It was good on the videos, YouTube, you name it; there was no lack of communication around this hospital right from the get-go. It was all about getting the project started. It was even started without the detailed design being worked out. Get boots on the ground, get it working from the public relations perspective. That rendered the Taoiseach very vulnerable when it came to costs and taking a hard line on cost management and control. Is it still the Government's position that the chief procurement officer did not discuss or alert senior officials in the Department of Public Expenditure and Reform to this overrun until November, notwithstanding what was going on around August? Can the Taoiseach rule out that the confidentiality around this was not a factor in the Minister misleading the Dáil last September? Will he confirm that all documentation and reports pertaining to this issue will be made public once and for all and that this drip feed of information is stopped?

I understand the minutes to which the Deputy refers are either minutes from committees that met at official level or minutes of the National Paediatric Hospital Development Board, many of which were made available to the Committee of Public Accounts and other committees many weeks ago. The National Paediatric Hospital Development Board is an agency that was established by the Oireachtas, empowered and given the statutory responsibility to design, build and equip the children's hospital. There are no politicians on that board or any of those committees and there are no political advisers on any of them. Once again this sounds like one of Deputy Martin's conspiracy theories. There are no politicians or political advisers on this board or any of those committees. If the National Paediatric Hospital Development Board had a PR or communications plan to explain the increased costs of the children's hospital, it did not do a very good job of it, quite frankly. I think we would all agree on that, given that it was not explained or communicated very well either to the Government or to the public thereafter.

The Taoiseach would know about that.

Blame someone else.

I understand that one of the reports from the meetings indicates that the increased costs were inevitable. That is yet to be determined. The PwC report currently under way may well answer that question. I think it is probable that what has happened here is that the cost of building this project, this massive hospital, this very complex development, was underestimated. This is not a case of taxpayers' money being wasted.

So it is not the contractor's fault now.

In fact, the vast majority of the money has not even been spent. Less than 20% of the project cost has been spent so far. This is a case of the real cost of the project being underestimated. We have seen examples of that in the past with other major structural projects, although not in the past decade.

In respect of Mr. Paul Quinn, he was appointed by the Minister for Health to the National Paediatric Hospital Development Board. He does not represent either the Department of Public Expenditure and Reform or the Office of Government Procurement on that board. He was appointed because of his procurement expertise.

If he had moved to another role in another Department or another employment outside the public sector, he would have continued to be on the board and that is still the case.

What civil servant is governed by that?

Ministerial directives do not count.

Members of the National Paediatric Hospital Development Board, in line with the code of practice for the governance of State bodies and the board's own code of governance which is published on its website, have a duty to the board in the first instance, a responsibility to act collectively in decision-making and communication and an obligation to observe its confidentiality arrangements.

The Comptroller and Auditor General.

The Deputy can print out from its website page 51 of the code of conduct for board members of the National Paediatric Hospital Development Board. Point 15 is on confidentiality. Reports, documents and briefings-----

Put aside by the ministerial directive.

A Cheann Comhairle, it is a recurring feature that when Opposition Members put out a yarn and-----

The Taoiseach has spun a fair few. He is doing his damnedest to put them out now.

Expensive yarn, is it?

There is loose-lips Leo again. His yarns come at a billion a piece.

It is a recurrent feature that the Opposition puts out a yarn, perpetuates it for days in the media and, when they are about to be found out, they shout us down, but I will come back on a supplementary.

The Taoiseach is correct that politicians were not on the National Paediatric Hospital Development Board or on the sub-committees. However, they were in all the photographs, the videos and every communication presentation for this hospital. This was the centrepiece of the national development plan, and therein lies the problem. The Taoiseach's said to hell with the costs-----

He is still saying it.

-----and let us get the good story out and get it out fast. When the Taoiseach is talking about yarns, the biggest yarn we heard in the last three years was in 2016 when the Taoiseach, who was Minister for Health at the time, said that the hospital would cost €650 all in.

It is now €1.7 billion and climbing. The Taoiseach should not talk to anybody in here about yarns. People are quite frankly fed up with yarns, public relations and spin. They want substance, facts and precision.

The Taoiseach made reference to Mr. Paul Quinn, the chief procurement officer. The Taoiseach's defence or response is simply not tenable. It drives a coach and four through circular 12/2010, the protocol for civil servants nominated to the boards of non-commercial State bodies. It reads: "Where there is a significant public policy issue at stake or a disagreement within the board on a major public policy issue, the civil servant should request the Chairman to notify the [relevant] Minister or, failing that, notify the Minister himself-herself." There are serious weaknesses in controls that have not been addressed, despite them having been drawn to the attention of the board or chairperson. We are talking about a €391 million overspend which the Government was alerted to last August. It is the Government's position that the chief procurement officer, who is a civil servant, with loyalty to the Government, the State and the taxpayer, was prevented somehow from telling his line Minister, who is responsible for the overall expenditure of the State, the facts around the alarming growth in expenditure for this project. I do not believe that is a tenable response.

It is a yarn and it is Deputy Martin's spin. It is yet another conspiracy theory from the leader of Fianna Fáil. Roughly this time last year the Government published and approved Project Ireland 2040, which is a €116 billion, ten year capital development plan.

The Taoiseach is a spinning machine.

Does the Deputy think that if we knew this time last year that the project was going to cost €1.4 billion we would not have accounted for it?

It is €1.4 billion out of €116 billion, and represents a little over 1% of the total cost of that project.

(Interruptions)

Of course, if we had known that this project was going to cost more we would have accounted for it, and accounted for it a year ago.

That is what the Taoiseach has done.

We told you this would happen two years ago.

Members of the National Paediatric Hospital Development Board, in line with the code of practice for the governance of State bodies and the board's own code of governance, available on its website, has a duty to the board in the first instance, a responsibility to act collectively in decision making-----

Carry on regardless. Keep spinning.

Where did that tablet of stone come from?

-----and communication, and an obligation to observe its confidentiality arrangements.

There is a quote on the record.

(Interruptions).

Mr. Quinn serves on the board in a personal capacity. Circular 12/2010, which deals with the protocol for civil servants nominations to the boards of non-commercial State bodies applies to civil servants serving on state boards, as comprehended from the code of practice for State bodies in section 3.4. The circular sets out the process by which a civil servant may bring the concerns to the attention of the relevant Minister, who in this case would have been the Minister for Health.

The Taoiseach is in a hole; he should stop digging.

The process applies where a civil servant has concerns that a serious issue-----

Leave him at it, he is going well.

-----is not being addressed to his or her satisfaction by the board or the board chairman. I understand that Mr. Quinn was and is satisfied that the cost issues-----

The Taoiseach has picked up the wrong sheet.

-----which developed over the summer and autumn of 2018, were being appropriately addressed by the board, and the chairman communicated both to the HSE and the Department of Health in a timely fashion, through the Government's arrangements, established by the Department of Health as the accountable Department for the project. Under circular 12/2010, Mr. Quinn would have had to advise the Minister, Deputy Harris, if he felt that serious matters were not being addressed by the board, and communicated through the Minister's Department. However, Mr. Quinn felt that the matters being dealt with were being communicated. The various minutes of the board and the governance meetings bare that out. Therefore, he discharged his responsibilities under the circular.

The Taoiseach's time is up.

It does not matter.

Give the Taoiseach more time; he was doing well.

Under the watch of the Taoiseach, the Minister, Deputy Harris, has led our health service into a state of absolute crisis. In recent weeks, nurses and midwives were forced to engage in strike action because their legitimate and correct concerns in respect of the recruitment and retention crisis were ignored by the Taoiseach and his Government. GPs have protested outside Leinster House at the Government's failure to invest adequately in primary care. Hospital waiting lists have continued to grow, and last week reached new record levels, with more than 523,000 patients now waiting for an outpatient consultation and over 72,000 waiting for an inpatient procedure.

That is absolutely scandalous. The trolley crisis continues unabated. Today there are 512 patients on trolleys in hospitals throughout the State. Despite this, only half of the additional beds promised in the HSE's winter plan have been opened, which is absolute madness. Last week we learned that women who had availed of a smear test following the CervicalCheck scandal last year were waiting up to six months to get the test results. To top it all off, we have the calamity surrounding the cost overrun – I heard the Taoiseach today spinning it as a cost underestimation - on the national children's hospital project. It is going to have a serious knock-on effect in the delivery of other health projects throughout the State. For example, in Limerick the provision of a new 60-bed ward block at University Hospital Limerick is the latest project to face the axe, despite the fact that University Hospital Limerick is consistently one of the hospitals worst affected by overcrowding in the State. This is a serious blow to people across the mid-west region and, quite frankly, unforgivable.

In that regard, I acknowledge the announcement this morning by the Chairman of the Oireachtas Joint Committee on Health, An Teachta Harty, that he would support Sinn Féin's motion of no confidencein the Minister for Health tomorrow evening. That is significant and I am sure An Teachta Harty has not taken the decision lightly. I am sure he has arrived at the conclusion, with the rest of us, that something has to be done because we cannot tolerate the health service in this crisis. The Taoiseach's friends in Fianna Fáil who, as he says, spin yarns may well be prepared to stand aside, allow the status quo to prevail and allow an incompetent Minister to remain in office, but we will not. Deputy Micheál Martin and Fianna Fáil will have the opportunity to put up or shut up tomorrow evening in that regard.

Deputy McDonald might do the latter.

In the meantime, it is incumbent on the Taoiseach to make clear which specific projects are being axed as a result of the overrun on the national children's hospital project in the health service and elsewhere, including flood defences. Across the State people have a right to receive accurate information from the Taoiseach.

I actually made it clear last Tuesday in the Chamber. I appreciate that the Deputy was not here and that she was otherwise occupied, perhaps in Northern Ireland or London – I am unsure. I outlined in detail exactly which projects would be affected. In the health service there is none. Of the €100 million that has to be found within other parts of the capital budget, €24 million will come from the Department of Health. The Department of Health has a fund of €94 million for minor capital repairs, equipment and replacement. That budget has been reduced to €70 million, which is still represents an increase on the budget last year. Therefore, it does not affect any of the individual new builds or new healthcare projects. I am happy to reiterate that point today, but I do not think for one second, a Cheann Comhairle, that that will stop Deputies from all over the country from trying to claim every project is being delayed or axed, as the Deputy says.

The Minister for Transport, Tourism and Sport, Deputy Ross, told me otherwise.

Even when they know that it is not true, it is smart cynical politics to make such a false claim. Therefore, they will make them all over the country on all sorts of project. Projects are delayed for all sorts of reason.

Why else would they be delayed?

Sometimes it is because they do not yet have planning permission from the county council.

Which projects are being delayed?

Sometimes it is because there are objections or they are being appealed to An Bord Pleanála. Sometimes there are changes in design or they go to tender. Sometimes the tenders come back higher than what was budgeted for.

(Interruptions).

In Limerick in recent years there has been considerable investment – massive investment - by the Government in the particular hospital referenced. A new state-of-the-art emergency department and a new Leben building which includes cystic fibrosis, stroke and many other facilities are in place. In fact, 17 beds were added in the past year.

It is philanthropy on the CF side.

The new 60-bed ward block has not been axed. Planning permission was secured only in October or November.

There is a tendering process which I understand may be complete, but it may not be.

That project will proceed to construction this year.

It is the Taoiseach himself who is spinning the yarns but he is not on his own. I understand the Minister for Health is attempting to spin a line that there is nothing to see here and that the cost overruns, or the cost underestimations, as the Taoiseach put them, were really no big deal. He seems to imagine that there is a magic money tree somewhere from which he can draw resources.

She must know it very well.

He seems to be in line-----

She can dish it out but she cannot take it.

The Members on the Fine Gael benches need to accept that any claims they may have made to fiscal prudence, to minding the house and to watching the taxpayers' purse have been well and truly blown out of the water at this stage. Can the Taoiseach guarantee that the 60-bed modular ward for Limerick will be delivered on time? Can he give us a precise timeline because the view among people in Limerick is that this project has been axed, or certainly that they will not see delivery on time.

We do not seem to do precise timelines around here very well.

I think-----

I am afraid the Ceann Comhairle might save that remark for his Fianna Fáil colleagues as well.

It applies to all.

He might look towards them also.

I do not think the Deputy heard my answer last Tuesday or my answer five or six minutes ago. I have already answered a question on Limerick. I understand this is now part of Sinn Fein's spin all over the country. I am advised that Deputy McDonald was on local radio in Wexford last week, claiming that the Enniscorthy flood relief scheme was also delayed because of the children's hospital. This, of course, not the case and the scheme is on schedule and the project has been allocated €40 million plus. I turned the sod on the new runway at Dublin Airport last week and I will turn the sod at the N4 in Sligo this week.

Turn the sod on children's hospital and turn that key.

What is happening here, and I am going to call it out again, is pure cynical spin from members of the Opposition. They are going around the country and whatever the project is and whatever the reason for the delay is, they are pinning it on the children's hospital's, even when they know it is not true. When one tries to call them out on it, they shout one down because they do not want their lies exposed.

I remind the Members again that there are thousands of citizens in their places of work or in their homes looking at the proceedings here-----

There will be disappointed with what they see.

-----and they certainly will not be impressed by the heckling and the antics on all sides of the House. I call Deputy Coppinger.

Nine months ago the country voted en masse to repeal the eighth amendment and to allow abortion rights. It was a truly historic referendum. The central message was clear that people with a crisis pregnancy should be cared for in Ireland and should not be forced abroad and that people should be able to make these decisions freely without barrier or obstruction. In the last 24 hours we have heard that women may face intimidation from anti-choice zealots in hospitals, clinics and car parks. The Taoiseach needs to give the date for urgent safety-zone legislation.

We are also hearing of women struggling to get access and who are left outside of the law. I want to ask the Taoiseach about women with tragic foetal diagnoses, people who had such an impact during the referendum. There are worrying signs that the very women whose stories resonated throughout the country are still being forced abroad. A number of women have contacted my office and three of them have had to go to England for terminations for medical reasons. In the latest case, a woman - let us call her Mary - contacted me. She had a scan in Portiuncula Hospital and the obstetrician told her that there was a muchal translucency with fluid around the neck of 8 to 9 mm and possible Edwards syndrome. She was told there was only 15% chance of delivery and the baby might live an hour or so.

However, the doctor then said, for whatever reason, that nothing could be done, as she was over 12 weeks. Mary was handed the names of three hospitals in England. By the way, she also said a staff member had treated her like a leper after this point. She later rang the HSE and was directed to University Hospital Galway where, despite a GP telephoning and apparently making an arrangement for a scan, a doctor told her on arrival that there was no one there to see her and that she would not get to the second trimester. At that stage, she and her husband had had enough. They walked out and within hours had made an appointment to travel to England. Of course, it would have been at great expense, in having to have children looked after, making work arrangements etc. Mary said to me: "I would lose my head if I had to continue this pregnancy, but Ireland will do nothing for me."

All of the women who have contacted me have individual stories, but they have one thing in common - last May they voted never knowing that they were going to face this situation but thinking they would be cared for if they did. They have asked me to put some questions to the Taoiseach. Why can a pregnant person in another country sit down with a doctor, get all of the facts and then come to a decision with her family? In this country why is a distinction made between fatal and severe abnormalities that is not made in other countries? One of the women who is a nurse asked who made the decision on what conditions got onto the list of fatal foetal abnormalities-----

-----and why it varied from hospital to hospital. The women also asked why a 28-day rule had been introduced. It is difficult for doctors to live by and was never part of the referendum conversation. Does the Taoiseach agree that conservative Catholic control of hospitals and a very narrow law with criminalisation are having a chilling effect and forcing such women to travel abroad?

Last May the people of Ireland voted in overwhelming numbers to make abortion legal in Ireland in certain circumstances. I believe abortion is very much a private and personal matter. I do not believe any woman decides or chooses to end her pregnancy lightly. No woman seeking this service and no doctor, midwife, nurse or anyone else involved in providing it should be subject to intimidation in any way in the course of going about that work or seeking to avail of what is now a legal health service in Ireland. As Deputies will be aware, the legislation to enact and realise the decision made by the people was passed by the Houses. There are now 274 GPs nationally who have signed up to provide terminations in early pregnancy, while there about ten maternity hospital units which are providing the service. When one considers that roughly between ten and 14 women end their pregnancies in Ireland every day, 274 GPs are there to help them and ten maternity units provide the service. The service will continue to be developed in the months and years ahead.

To answer the Deputy's question about the difference between fatal and severe abnormalities, that was a decision that was discussed in the Oireachtas. As an Oireachtas - the Deputy participated in all of those debates, which is why she should know the answer to her own question - we decided that disability would not be grounds for the termination of a pregnancy but that fatal abnormalities would be. A severe abnormality is very often a disability. That is a decision we made as a House - that we would make that distinction and that disability would not be grounds for a termination after 12 weeks. I do not really want to comment on any individual case. I know that the diagnosis of a fatal foetal abnormality must be a very difficult one for anybody - the mum, the dad and the family - when in a much wanted pregnancy one finds out something has gone wrong. Without knowing the facts of any individual case, it would be inappropriate for me to comment. I am aware that the Deputy raised an individual case here in the past, the facts of which turned out to be different from those that she-----

Yes, as the Deputy laid them out on the floor of the House. That should be borne in mind.

It was reported in The Irish Times that last April at a Fine Gael Party conference Susan and Tim Corcoran had spoken about their struggle with an Edwards syndrome diagnosis.

There is no guarantee they will be able to have an abortion in this country, despite the new law. That is my point. The Taoiseach has not bothered to comment on the problems women are encountering in reality in our hospitals and, I am sure, particularly in rural areas. What we need now is a review of the law sooner rather than later, particularly the 28-day rule that was never part of the national conversation. The Taoiseach is right. Politicians chickened out on what the Citizens’ Assembly recommended, which was severe foetal abnormalities to be considered as well. Those women are paying the price now and it is really not helpful of the Taoiseach to conflate this with disability when he knows these conditions are very complex and interact with one another.

Finally, we need separation of church and State. We need fully secular hospitals where there is not such a culture that sends people on their way but where the Catholic Church no longer has a say in these matters and influences medical staff as well. We need that sooner rather than later. Is the Taoiseach willing to at least review the 28-day rule, which many people cite as being problematic?

As I recollect, there is an inbuilt mechanism within the legislation already for a review.

It is three years though.

That is something that was discussed in this Oireachtas and we decided as an Oireachtas, collectively, that this is when the review would take place. This service is new. It was never going to be a case of being able to start it in one day. Any new medical service, any new public service, has to develop and evolve, and it will develop and evolve. Unfortunately, it may not be up to scratch for some women and patients now but we will see to it that it improves and evolves as it is developed.

I have to take issue with one of the Deputy’s remarks. We did not chicken out.

You did. Fianna Fáil and Fine Gael did.

We made a decision in this Oireachtas that disability and severe disability should not be grounds for terminating a pregnancy. We decided that a woman was free to choose to end her pregnancy for any reason, or none, up to 12 weeks but after that it would have to be because of a risk to her health, a risk to her life or a diagnosis of fatal foetal abnormality. We decided that as a House. If the Deputy wants to reopen the debate about whether disability should be grounds for termination, that is the her choice. It is not that we chickened out. We decided as a House. We said during the referendum campaign when we asked people to vote "Yes", or at least I did, that we would not allow disability to be grounds for terminations after 12 weeks.

With every passing day, the scandal surrounding the development of the national children’s hospital grows deeper. The only thing that is absolutely certain at this point is that all of it could have been avoided.

In 2016, Dr. Jimmy Sheehan, Ireland's leading hospital developer with six decades of experience in delivering world class health projects, in conjunction with Dr. Fin Breathnach, our premier paediatric oncologist, told the Oireachtas health committee that opting for the St. James's site would lead to catastrophic cost overruns. I and my colleagues in the Rural Independent Group presented this information in a Private Members' motion on 29 March 2017, a full month before the Government signed off on the first part of the contract. Unfortunately, the Taoiseach and his Government chose to listen to an inexperienced Minister who did not have six days' work experience in the Department of Health instead of listening to the experience of a professional hospital developer and a medical man of some renown with six decades of experience.

Every concern Dr. Sheehan, the parents and everybody else raised in 2016 has now come to pass. He has been ignored and sidelined, as was the Connolly for Kids campaign, but above all the parents of the most sick children, the Jack and Jill Foundation, Dr. Róisín Healy and many others repeatedly told the Government about inevitable access difficulties to the site. Not only was the Government told but every Member in this House who cared to listen was told. One would think that having accurately predicted both the cost overruns and the lack of capacity at the site, which we visited last week – it is nothing but a big black hole – that Dr. Sheehan and his colleagues would be welcomed with open arms and asked for their advice on how to proceed, especially now that the company, BAM, has offered to withdraw from the project and go back into negotiations, which I welcome, yet that has not happened. The Government seems determined not to learn from past mistakes. If the Taoiseach wants to talk about yarns, that is the yarn that will be told about him.

Two weeks ago, I wrote to the Oireachtas Joint Committee on Health asking it to invite Dr. Sheehan and his colleagues back in to engage with the committee on possible solutions. Now is the opportunity for that. The committee rejected the suggestion, which appalled me, and gave the extraordinary reason that it had already heard what they had to say in 2016, which has now proven to be true, and we are now in a hole.

Can the Taoiseach believe that the committee objected and refused, as if nothing had changed or happened in the meantime? This beggars belief. It is some yarn.

Two years ago, the Connolly for Kids group wrote to the Taoiseach personally, as it had to the previous Taoiseach, Deputy Enda Kenny, and handed in some 60,000 signatures expressing concern but they were not listened to. The group did not even get a reply from the Taoiseach himself and received a one-line reply from former Taoiseach, Deputy Kenny.

I have worked closely with Dr. Sheehan for a number of years on this issue. He is clear that €63 million in cost savings could be made with respect to the proposed underground car park for St. James's alone. This would also avoid what has been described as the bizarre and unnecessarily dangerous decision to build a children’s hospital above an underground car park where the risk of fire could substantially destabilise the structure, with potentially horrific consequences.

The suggested costs of making the national children's hospital at St. James's a digital hospital are €150 million.

The Deputy's time is up.

Dr. Sheehan said it would cost €50 million at the Connolly site. The square metre cost at St. James's quoted by the Minister for Health, Deputy Harris is €8,000 per square metre. Dr. Sheehan and others have said the rate at Connolly would average €4,000 or slightly more per square metre.

Please Deputy, the time is up.

I put it to the Taoiseach that these facts are available to us right now but unfortunately he will not listen and he will have history repeating itself. There is a saying in the east of the country that a person should always be careful of where he or she wears a halo because it is only less than one foot away from the neck. It could slip down and do catastrophic damage to the ego. I ask the Taoiseach to please listen to the experts, the sick children and the parents who know, and to stall the ball and re-evaluate to see where we go.

The first time that the idea of building a new national children's hospital was mooted in this House was in 1962. In 1993, the Royal College of Physicians, which represents paediatricians, advocated the merger of the three hospitals onto a single site. I was in school at the time and I remember as a medical student-----

It is back to school he needs to go.

-----and as a politician there being endless debates-----

Perhaps to night classes.

-----about where the new hospital should be located. Everyone had a different view, including planning experts, doctors, paediatricians, developers, you name it, on St. James's, the Mater, Tallaght, Beaumont, Blanchardstown, a site not co-located with an adult hospital at Newlands Road and another site by Belcamp near the M1. There was never consensus among doctors, planners or anyone as to where the best site should be. In 2012 the Government took a decision that the site should be Dublin 8 at St. James's Hospital, with satellite centres in Blanchardstown and Tallaght. In doing so the Government listened to the expert group chaired by Dr. Frank Dolphin. On that expert group were planners, developers, paediatricians and people who knew about building hospitals and where they should be located. It was always acknowledged that it would be quicker and cheaper to build it on a greenfield site. Nobody every doubted that. The decision was made in favour of St. James's, on the advice of the expert group chaired by Dr. Frank Dolphin, because of the advantages of co-location with an adult hospital and a maternity hospital. The advantages are that the hospital would be the biggest one in the State with the most advanced specialties and the most advanced opportunities for academic links and clinical research. This is why the decision was made. Yes, it would have been quicker and cheaper to build on a greenfield site - nobody ever argued otherwise - but it would not have been better. When deciding to build a project like this, which will stand the test of time and will still be used by children in 100 and 150 years, one makes the right decision, not the cheapest or quickest decision. This is why that decision was made.

The Taoiseach has said a lot there. We have a chance now to go back, re-evaluate and stall. The St. James's site was once described in a Department of Health briefing note as "the least worst option for delivery of this priority project”. Will the Taoiseach commit to meet Dr. James Sheehan, Dr. Fin Breathnach and others? Will he sit down in a room with them and talk to them at this stage, while BAM has offered the breathing space?

Relocating the children’s hospital is not just about saving hundreds of millions of euro in taxpayers' money. It is first and foremost about saving children’s lives. They must be the most important people of all. One of the most appalling aspects of this entire tragedy is the lack of capacity to develop a co-located maternity hospital. That is now not going to happen. The Taoiseach knows that - if he knew anything about the whole - and if he went back to school he could add up the sums. The maths just do not add up. It will not happen. This is not in keeping with international best practice and it will absolutely result in avoidable deaths in a few babies and significant disability and handicap in many other babies over the decades.

Professor Chris Fitzpatrick, an obstetrician and former master of the Coombe hospital, says maternity services co-location at St. James's Hospital is pie in the sky. Will the Taoiseach listen to him? Will he listen to anyone? There is none so deaf as those who do not want to hear. This is perhaps the most urgent reason to reassess and consider moving to a site which will permit co-location with a maternity hospital, which is vital but it will not happen at St. James's Hospital. I again appeal to the Taoiseach to do the right thing and stop the project until a full re-evaluation is carried out by experts, not PwC, which knows nothing about construction or issues like it. We need outside experts to tell us the very truth about what happened.

I have listened to all of those people. I respect all of them and hold them in the highest regard, whether it is Jimmy Sheehan, Chris Fitzpatrick, Fin Breathnach or Roisin Healy. I was her senior house officer when I worked in the emergency department in Crumlin. I respect them and have listened to and met them.

I did not say the Taoiseach had not.

However, this decision was made in 2012 on foot of expert advice and endorsed by the Dáil. It was made and the hospital project is well under way.

It is a hole in the ground.

Over €250 million has already been invested and the satellite centre at Blanchardstown is almost complete. Children will attend there to receive state-of-the-art, top-class healthcare this year.

There is no helipad and no access from the country.

Construction of the Tallaght satellite centre will start this year and it will be open to children in 2020. In 2022 construction will be completed on the main campus at St. James's Hospital, with the hospital to be commissioned by 2023.

Please, Deputy.

It is already under way and we are not going back.