Selection Process

The site selection process consisted of :

  1. An analysis of the policy framework from McKinsey Management Consultants which recommended that a single tertiary-level paediatric hospital should be developed and sited in Dublin and
  2. The selection of the Mater site, by the HSE, based on a recommendation by a joint HSE/DOHC group.

While we agree with the McKinsey recommendation and endorse fully the development of a single national tertiary-level paediatric hospital, we are most concerned that the site selection process mentioned at (2) above lacked transparency and was superficial in its consideration of alternative site options. It had been argued that co-location of the NPH with an adult acute hospital was a non-negotiable recommendation of McKinsey. While McKinsey recommended co-location as a preferred option, they made the point that “international experience shows that it is important to weigh a decision to co-locate against pragmatic considerations, including space, and quality of access to potential sites….’’

Over 60% of the children and their parents attending the NPH will come from outside the greater Dublin area. Ease of access for these parents, who by virtue of the ill-health of their children have to travel to the hospital by car, should be a major consideration in selecting a suitable site.

It is our considered view that the TCD access study (“Distance and Travel Time Calculations for a Proposed National Paediatric Hospital in Dublin: A Report to the HSE” SAHRU, TCD, March 2006) relied upon by the Joint HSE/DOHC Group was flawed, insofar as it only assessed two city centre sites- St James and Mater hospitals- and then only while assuming free-flow conditions. In our view the access issue needs to be reconsidered in the wider social appraisal of this vital national capital project. Of major concern is the absence of any study of ambulance access times to any site.

We are most concerned that the selection of the Mater site does not appear to have been subject to appropriate appraisal (including Cost Benefit Analysis appraisal) under the Department of Finance’s “Guidelines for the Appraisal and Management of Capital Expenditure Proposals in the Public Sector“.

In this regard we feel that a number of the sites which were put forward for consideration merit urgent appraisal under these guidelines to establish:

  1. If it would be more efficient to build on one of these sites, rather than on the Mater site, i.e. “Could more be achieved for the resources to be invested” (Para 1, page 9 of the guidelines.)
  2. If the location of the NNPH on the Mater site provides value for money, taking account of “Deadweight” (Para 1.2, page 9 of the guidelines)
  3. If private sector options compared with public sector ones might provide better value for money.
  4. If the ongoing current revenue costs generated by building on one site, when compared with other sites, were fully appraised (Para 1, Introduction to the Fundamentals, page 5)
  5. If the relevant access merits of alternative sites were appraised in the context of the very large number of patients and their families who will travel from all around the country for tertiary-level acute paediatric care.

NNPH Project Concerns

It is acknowledged widely that the site at the Mater Campus is deficient in many ways as the site for the NPH. This is borne out by the thousands of concerned citizens who have registered their support for a review of the decision and left their comments on our website.

Serious concerns have been expressed by commentators regarding:

  • the model of care;
  • building configuration of 16 storeys high;
  • cross infection hazards associated with 31 elevators in the building;
  • the quality of the therapeutic environment for very sick children;
  • difficult access to a city centre site for children and their families, and for emergency ambulances in traffic, especially in light of its proximity to Croke Park, with its matches, concerts and conventions and associated traffic/crowd congestion; the NPH will have the only Emergency Department for children in the whole of the Greater Dublin Area.
  • inadequate car-parking spaces for parents, visitors and staff;
  • inadequate space for parental and family accommodation;
  • inadequate space for multiprofessional and multidisciplinary paediatric training and for research facilities;
  • inadequate space for a maternity hospital on-site;
  • no available space for expansion in the future.

More recently, following many protracted meetings with the Development Board, many of the specialist teams from the two major paediatric hospitals have increasing concerns regarding the facilities which will be provided at the NNPH. As a result of major spatial restrictions, the facilities on offer will significantly restrict the services which can be provided on-site to the sickest children in Ireland for decades to come.

Cost Considerations and Concerns

Of further serious concern is the fact that €650 million approx of taxpayers money is being allocated to a significant National Capital Project in the apparent absence of proper and comprehensive appraisal which would appear not to comply with the relevant Department of Finance’s ” Guidelines for the Appraisal and Management of Capital Expenditure Proposals in the Public Sector”. In particular the need to appraise “all realistic ways to achieve all stated objectives should be identified and examined critically when considering project options for the first time” (Appendix 1, page 33)

It is important to draw attention to the estimates of the cost of building hospitals which is taken from the Department of Health and Children Final Report entitled Value for Money and Policy Review of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals, December 2010.

(i)City Centre versus Greenfield construction costs – [See p56 (second paragraph)]

“The Department’s Hospital Planning Office (HPO) previously developed “cost per bed” estimates which were said to assume that the developments were on “green-field” sites with normal ground conditions, ample space for normal development and surface level car parking, reasonable access to nearby services and unhindered site access. The HPO concluded that acute hospitals also vary significantly in “cost per bed” depending on the mix of specialties and teaching requirements and pointed out that inner city locations can also add dramatically to the construction costs.” (Step 6, page 56, 2nd paragraph)

(ii)Capital Costs: Major Teaching Hospitals – (Page 145, Appendix 5 , Worksheet 4) re Construction/ Equiping Cost/Bed -Major Teaching Hospitals 2007 v. 2009

2007 2009
Average Total Cost per Bed €1,000,000 €828,456
Building on average per bed
(70% of total cost)
€700,000 €557,340
Equipping (30% of total cost) €300,000 €271,116


According to this report, the total cost of building and equipping each hospital bed is €828,456 at 2009 prices. On this basis, the projected cost of the NNPH with 445 beds (392 inpatients & 53 day beds) should be €368,663,000. We are told the NNPH project will cost €600,000,000 (plus €50,000,000 ambulatory/UCC at Tallaght) or a €1,348,314 “cost per bed” at the Mater. In this current economic climate, this excess of €519,858 per bed more than the 2010 DOC estimates, is staggering!

In addition we understand the NPH is to be a “paperless hospital” at an additional set-up cost of €150 million approx with annual running costs of €20 million in real paper notes!

It should be obvious to all that serious questions remain over both the selection of the Mater site as the location for the NPH and the unacceptable projected costs associated with that decision. Bland reassurances will not suffice. We believe that now is the time, before demolition works commence or outline planning permission is sought, for the NNPH project to be paused and the whole selection process thoroughly reviewed by a panel of independent national and international experts.

End. [posted October 2010]