Oireachtas Covid Committee, 19th May 2020

Deputy Duncan Smith : “With regard to more complex sites, such as the National Children’s Hospital, how does Mr. Parlon estimate costs might shift on projects of that size and complexity? It has been well-documented that the cost of that project has increased from €400 million to €1.7 billion. A higher figure of €2.4 billion has been suggested. There is great concern about the cost of this project. ”

Mr. Parlon, Director General, Construction Industry Federation:

“Some sites are obviously more complex. The Deputy referred to one of them..The industry has suggested the extra cost to complete such projects while the very strict regime[safety measures against Covid-19] is in place could be as much as 40%.”

NCHA says – COCOON THE SITE. Do not resume construction now. Let the Minister for Health, Children’s Health Ireland Board, the NPHDB, BAM, Advocacy groups review their positions. The whole project should be reviewed – its cost, its value for money, its definitive business case, its adherence to the Public Spending Code. There are better ways to protect and promote our children’s health in these straitened times.

NCHA says – COCOON THE SITE – Let the Minister for Health, the NPHDB and BAM review their positions during a Covid pause. The whole project and its cost, its definitive business case, its adherence to the Public Spending Code, its relevance to children’s health require objective reassessment.

General Election 2020 : We demand answers from Fine Gael before the Election.Fine Gael claims that clinical considerations were paramount in choosing St James’s. Is Fine Gael trustworthy? The New Children’s Hospital Alliance(NCHA) has TWO Questions arising from the interview recorded below. The public deserves answers to them both from Senator James Reilly, FG,  running in the Dublin North constituency and from the Taoiseach Leo Varadkar running in the Dublin West constituency.

Question 1

You claim an Expert Group of both National and International People  advised you that St James’s was the right site for the new children’s hospital – Who was that group?  Name it, publish its report.

Question 2

Could you name even one  clinical condition or one of the ‘Super Specialists’ you claim are in St. James’s and whose presence on a shared site is required to prevent children having to go abroad for treatment?

Thank you.

Interview: Newstalk 106,  Moncrieff Show, 23^rd June 2016. 

[ This interview was the only time the public was informed by any politician as to why St. James’s was chosen by the Cabinet on the 8th November 2012 for the site of the new National Children’s Hospital when Senator Reilly was Minister for Health]

Sean Moncrieff:   Senator James Reilly is still with us, we have been talking obviously about the Health Service. And we’ve had a few texts in here on a kind of similar theme. Please ask Senator Reilly why he chose the Wrong Site at St James’s for the Children’s Hospital? Blanchardstown is more accessible, faster, cheaper and has the Rotunda going there. No one can explain this Medical Speciality Reason either, can he?

Senator James Reilly (Fine Gael):   First of all I didn’t choose the Wrong Site. I chose the Right Site. As advised by an Expert Group of both National and International People .

I will actually explain what the primary concern here was. We have a small population, North and South, for some of the more rare conditions. What we wanted to achieve was an economy of scale here, where we would have sufficient numbers to deal with some of the rarest of problems, which currently require our children to go abroad for treatment.

Now if you’re ill with a condition as an Adult, it’s distressing. But when you’re a Child, it’s particularly distressing, and you want your family around you. So the more people, more children we can treat in this country, that was the goal. So the, being able to bring the Experts, the Super Specialists, who deal with Adults and Children, for these very rare conditions, was a primary concern, and the Primary Clinical Driver. 

Em certainly, you know, the arguments made around access, and at a Greenfield Site. I mean you might as well go to a Greenfield Site, no disrespect to James Connolly. Because you know, James Connolly it’s an excellent Hospital, but it’s a Model 3 Hospital, it doesn’t have the Super Specialists in there. The bulk of them are in St James’s. The site is plenty big enough, plenty big enough.

And it has excellent transport connectivity. Now people talk about a sick child, you’re not going to use public transport. That is never the case anyway, because a sick child is always brought in by an Ambulance or parents in a hurry. But the main traffic in any large Hospital like that, is Staff. And the fact that Staff can get in and out in a way that doesn’t cause all sorts of traffic problems, because the infrastructure is there, is a huge consideration.

We went through this back and forth and back and forth. And at the end of the day, I am from Fingal, and Blanchardstown is in Fingal, so I mean you know Fingal would have been attractive to me. The Mater was attractive to me. But at the end of the day, the best, the best decision, on the best of advice was St James’s.

And I believe now what we have to do is, and I know there’s a petition out there with 60,000 people saying, you know, move it. Let’s please not revisit this. There are children who are in trouble today. This hospital needs to be built as quickly as possible, not delayed by another two years of wrangling.

The decision is made. The money is there. Let’s built it as quick as we can. So that we can truly say that those dark days, and how we treated children in the past, and God knows they were dark, are done. END.

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, 23 Jan 2020 (The Hard Shoulder, Newstalk 106) said that ” there’s nobody now saying they can build it any cheaper, certainly not at that site and nobody any more[is] calling for it to be re-tendered or paused “.

Let us skip the repeated concerns (2008-2015) that we – The New Children’s Hospital Alliance (NCHA) – spoke about again and again- in the media, to the NPH Independent Review (2011), to An Bord Pleanála (2011), the Dolphin Group (2012), An Bord Pleanála (2015) -about the falseness of the clinical argument in favour of the unsuitable city centre St.James’s site, its cost and the absence of the essential co-located, co-built Maternity. Let us remind the Taoiseach – just since 2016 – 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, Mr. Jimmy Sheehan, patient advocates, concerned citizens) 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 and that the Connolly hospital campus in Blanchardstown be again considered . No answer was received – request ignored.

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

13 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 which had just announced (3rd Feb 2017)that it was the preferred bidder. That, despite no value for money or spending code standards applied or business case made. The cabinet, 26th April 2017 approved the awarding of the contract to BAM. The C4KH letter was ignored.

(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/dismissed by the Minister for Health.

(read our submissions, and our comments on the disinformation in the NPHDB presentation – Home page www.connollyforkidshospital.com

December 2018/January 2019 -The cabinet decided on 18th December 2018, despite the known massive increase in project cost, to award Phase B (the overground build) of the construction contract to BAM. The Oireachtas Christmas recess started December 20th. The contract was instructed to BAM on 8th January 2019 during the Oireachtas recess – thus preventing any democratic debate by Dáil members of the possibility of withdrawing, re-tendering or pausing the contract without financial penalty being incurred by the State, an option that was in the original contract (governing Phase A and Phase B) signed in August 2017.

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 [6 weeks] 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 and proposed instead just 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, including the Minister for Finance 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 any potential delay or of the cost of moving the site.

And now, January 2020, is the Taoiseach suggesting that if citizens care they should still 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 our expertise and message to be treated with disdain??

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

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 (https://health.gov.ie/wp-content/uploads/2014//NPH_NACHRI_CHIEF_Review.pdf) , 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.

€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

Fine Gael is expert at producing ‘False Facts’ or ‘Strategic Misrepresentation’ which Stephen Kinsella notes (Sunday Business Post, May 19th, 2019) is just academic-speak for lying about potential costs and benefits of a megaproject. Read their l**s about the children’s hospital in the document linked above.

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.

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.

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 National Paediatric Hospital 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 [ABP 23/02/2012] and the Dolphin group was established to review potential sites for the NPH.

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.