Change the Government

The children’s hospital project lurches along in a financial shambles – all predictable, and predicted, by us – yet continually dismissed by the Fine Gael government in a web of untruths and obfuscation. The Taoiseach , Leo Varadkar, yesterday, 23 Jan 2020 (The Hard Shoulder, Newstalk 106) said that ” in recent months no one was calling for a re-tendering or a pause in the project”. Let us remind him of the following:-

June 2016 -Connolly for Kids Hospital(C4KH) umbrella group (which included among others the Jack and Jill Foundation, NCHA, the ExtraSpecial Kids group, patient advocates, Mr. Jimmy Sheehan ) delivered a letter at the gate of Government buildings to the then Taoiseach , Enda Kenny, signed by over 60,000 citizens asking that the choice of site for the hospital be reviewed. No answer was received – request ignored.

(access the letter on our blog -5th Sept. 2016)

February 2017 – C4KH wrote to every member of the Cabinet (copied to all TDs and Senators) with concerns including the possible awarding of a construction contract to BAM. That, too, was ignored and the contract awarded to BAM, April 2017

(Access the Letter to Cabinet on our blog – 9th Feb 2019)

October 2017 – C4KH requested and obtained a hearing before the Oireachtas Health Committee. The Committee invited the NPHDB to also attend. Again, our concerns were ignored by the Minister for Health

(read our submissions and comments on Home page

18th December 2018 – the Cabinet approved the awarding of Phase B(the overground build) of the construction contract to BAM, the day before the Oireachtas went into the Christmas recess . The contract was “instructed” to BAM on 8th January 2019 while the Oireachtas was still on recess, thus effectively scuppering the possibility of any democratic debate on the awarding, re-tendering or pausing of the contract without incurring financial penalty.

March 2019 – The Rural Independent group in the Dáil tabled a motion to — “.. immediately suspend construction of the National Children’s Hospital at the St James’s Hospital site pending the outcome of a time-limited independent investigation to assess the viability, cost and efficacy of re-tendering the project and transferring its location to a greenfield site with the capacity to include the co-location of a maternity hospital..”. This was defeated, as Amendment 3 by Fianna Fáil – which omitted the re-tendering or pausing of the project – proposed instead to “… include in the [then on-going] PwC report, in light of the massive cost overruns at the current site, an analysis of the total costs and delays associated with moving the site…” was passed. (Tá,112; Níl, 18; Staon, 3)

Cynically, Fine Gael and the Minister for Health who had voted ‘Tá’ then proceeded to ignore their own vote. The PwC report was published and contained no analysis of the delay or cost of moving the site.

And the Taoiseach is still suggesting that concerned citizens might continue to call on the Government for a project pause or re-tendering of the site?? To what purpose – to again and again plead for our children – just for their cause to continue to be treated with disdain??

We say- CHANGE THE GOVERNMENT. You have failed the children of Ireland.

Urgent Care-an untested model

Two Children’s Urgent Care Centres (UCCs) are planned for Dublin. They are not Emergency Departments (EDs). Serious questions remain about the “stand alone” children’s UCC on the grounds of Connolly Hospital in Blanchardstown – its safety, its appropriateness and its operational cost.

Run by Children’s Health Ireland(CHI) and independent of the adjacent adult hospital it is based on no clear model. Though presented to An Bord Pleanála (ABP) in 2015 as a model, the PANDA unit in the Royal Salford Hospital in England is not comparable – the PANDA unit beside an adult Emergency Department in an adult hospital, accepts all levels of clinical acuity, is continuously open and has a maximum 23 hour stay. The only other models presented to ABP were American and are in essence out -of -hours evening and weekend services open when family primary care paediatricians (equivalent to Irish General practitioners) are off duty.

Due to open in 2020, the UCC currently being built at Tallaght hospital will replace that hospital’s 24 hour Children’s Emergency Department. Depriving the Tallaght catchment area of a 24 hour children’s ED can scarcely be described as a better local service.

The only external review of the New Children’s Hospital project ever commissioned, The National Paediatric Hospital Independent Review, 2011 ( , recommended (p12) that “there should be consideration of extending the UCC to a 24 hour service with an appropriate number (between 6 to 8) of 23-hour short stay beds”.

A 24 hour service is not planned for Dublin’s Children’s UCCs.

Staffing the CHI Emergency Department at St. James (due to open 2023) and the two UCCs at Connolly and Tallaght with Paediatric Emergency Medicine consultants present on all shifts would require a complement of approximately 40 consultants and a new consultants contract. Further diagnostic support services hours throughout opening hours would also be required at all 3 sites.

Operating the current proposed model must, if nothing else, be urgently and accurately costed.

Compare NCH with the new Belfast Children’s Hospital

€350 million for 53,878 sq m new Children’s hospital in Belfast – with construction to start 2020 in Belfast on a brownfield site beside the Maternity Hospital. Planning permission has been granted April 2019.

€1.09 billion construction cost for the 119,163 sqm new Children’s Hospital in Dublin with other building costs bringing the building cost to €1.43 billion and with costs of Children’s Health Ireland giving a total cost of €1.733 billion.

The NCH project must be paused and alternative site costed. Fine Gael, Fianna Fáil, Sinn Féin voted 28 March 2019 to cost an alternative site – DO IT NOW

Harris is contradicted

Jonathan Hourihane (Prof of Paediatrics,UCC, and member of the Dolphin Group) on Pat Kenny Show on Newstalk, December 2016 states : “I think that the clinical outcomes for children are dictated by the quality of the medical and other services available to the children within the children’s hospital……. I would agree that there is no strong evidence to show that co-location [with St James’s] improves the clinical outcome, but that’s not what co-location is about.”

Minister Harris at Health Committee , 29th Jan 2019: “We must remember the reason the site was chosen…. We had to build the hospital in the location that would deliver the best medical outcomes”.

More lies from government whose actions have had, to quote Deputy Alan Kelly, catastrophic consequences for the health situation in the country.

Minister Harris should resign.

Medical reasons to co-locate — none

Minister Simon Harris at the Oireachtas Health Committee (29th Jan 2019) said “We must remember the reason the site [St. James’s Hospital] was chosen……We had to build the hospital in the location that would deliver the best medical outcomes… the primary reasoning behind the location of the site must be the clinical outcomes for our children”

One of he saddest thing about this whole fiasco of building at St. James’s is that the Minister is wrong and refuses to admit it. There is no evidence in the medical literature to support the Minister’s contention that a paediatric hospital is dependent on a co-located adult hospital to achieve best medical outcomes for its children.

The “Ideal Site” became available in 2012

In an e-mail, obtained by the New Children’s Hospital Alliance under the Freedom of Information Acts, in which the reviewers are preparing the final version of the International Independent Review (2011), the editor,
Jonathan Erskine, Executive Director, European Health Property Network, comments – “I removed   The ideal location would be located on green space, provide for unfettered access, accommodate research and educational activity, provide sufficient space to ensure the aggregation of all patient care services meeting current and future care requirements, and be tri-located with an adult tertiary care and a maternity facility. We agree that if there was a site and funding for such an aspirational location it would be a magnificent campus. Unfortunately, given the current challenge of funding the one children’s hospital the perfect location is not possible. Consequently the team considered those options that were viable.’
My concern here is that if the above text is included, the response will simply be that there is such an ideal site, and the issue will open up again.
NCHA says – CONNOLLY is that IDEAL LOCATION, that MAGNIFICENT 143 ACRE CAMPUS. It became available in March 2012 , when Taoiseach Leo Varadkar, then Minister for Sports and Tourism, facilitated the offer of an extra 90 acres from Sports Campus Ireland to Connolly hospital after the Mater was refused planning permission and the Dolphin group was established to review potential sites for the NPH.

13 years ago. HSE says Co-location not necessary

HSE website posting, 7th March 2006, headed “HSE Refutes Criticism of Process to Select New Children’s Hospital Site” states: –
“The outcome process has not been predetermined…..It is open and objective to the point where the outcome may even be a decision to locate somewhere other than an existing hospital site.…Any suggestion that this group has prejudged anything is completely misplaced”. The McKinsey had been published 1st Feb 2006, and the Task Group on optimal Location of the New Children’s Hospital was set up in early February 2006.

Letter to Cabinet 13.02.2017 remains unanswered

This letter from Jack and Jill Foundation and the Connolly for Kids Hospital umbrella group was delivered in hard copy to all members of the cabinet, to Opposition Health spokespersons and to the Attorney General on the 13th February 2017. BAM (3rd February 2017)had announced it was the preferred bidder, before the business case was assembled by Ministers Harris and Donohoe and presented to cabinet for approval on the 24th April 2017. The letter, with references and appendices, was again sent to all members of the cabinet by email on the 17th February 2017. The Minister for Health was tasked by the government Chief Whip with replying “directly and with urgency” to the letter . No reply has been received.

Estimated cost per square metre is €8708 (not €6500)

The Oireachtas Public Accounts Committee on the 31st January 2019, and the Health Committee (16th January 2019) were given the breakdown by the NPHDB of the €1.7 billion expected cost (as of January 2019) of completing the project :

Total Construction cost €1,093,800,000, with the non construction costs bringing the total Building cost to €1,433,000,000. Other costs managed by Children’s Health Ireland of €293,000,000 gave a final total cost [as of 31.01.2019] of €1,700,000,000.

Cost per sq metre : This is the construction cost per metre of gross internal area. The Ambulatory /Urgent Care Centres : – €60million (cost of the two AUCCs inc VAT) of the total construction cost . Cost per sqm of AUCCs is €5586.

Main Hospital at St. James’s : – The remaining €1,033,800,000 of the Total Construction Cost is the construction cost of the main hospital. Gross internal area is 119,368sq m. Using figures supplied by the NPHDB as of 16. 01.2019 to the Health Committee and 31.01.2019 to the Public Accounts Committee,the New Children’s Hospital Alliance estimates that the cost per sq m is €8708 (not €6,500 as claimed by the NPHDB). This will further increase if construction inflation rises (as is anticipated) above 4% as from July 2019 . Other costs-VAT, design changes etc which are outwith the GMP (Guaranteed maximum price) are also expected .

It would appear that the NPHDB chose to include the area of the car park as part of the gross internal area, contrary to estimates for international comparator hospitals – thus falsely lowering the cost per sq. metre. The AECOM international comparator hospital document lists the most expensive hospital as being €8000 per msq. The Dublin NCH is the most expensive of all the hospitals studied.