Paul Hosford: Lessons learned? Children's Hospital shows Government needs extra tuition

After 18 years and €2.4bn, we may get our new Children's Hospital. Paul Hosford wonders if there have been any lessons learned from the process

The overall cost of constructing the new Children's Hospital has risen to over €2.24bn. Picture: Colin Keegan, Collins Dublin

Lessons learned, what a wonderful phrase.

It can sometimes seem that Irish society and the body politic is always learning some lesson or another, usually about a failure of the State. This week, it was, perhaps, a lesson in cost overrun? A lesson in public procurement, maybe? A lesson in...something that costs €2.24bn, anyway. 

On Tuesday, Health Minister Stephen Donnelly informed his Cabinet colleagues that the overall cost of constructing the new Children's Hospital had risen, bringing the total to over €2.24bn. 

But that's okay, because €2.24bn is the max that will be paid, the Taoiseach Leo Varadkar would tell the Dáil. Which, you've got to admit, is some hard bargaining; in the end the project will only cost €1.7bn above its original budget and will arrive some 18 years after work began on the project.

The Government said that the approved increase in the capital budget "will address areas identified in the 2019 report, the New Children’s Hospital Independent Review of Escalation in Costs, carried out by PwC".

The report said that the new children's hospital "was unique in scope, scale, and complexity in comparison to any other health infrastructure project in Ireland's history and was explicit in stating that the project's complexity should not be understated". However, it said that the idea of going back to the market for a builder was "unrealistic".

"However, it identified a series of weaknesses in terms of set-up, planning, budget, execution, and governance that have since been addressed.

It is a red herring to suggest that those who criticise the spiralling costs of something don't agree with its necessity in the first place and there is even a possibility that this hospital will be worth every cent that's come from the taxpayer's pocket, given what will undoubtedly occur there. Photo: NCH

"The report considered the alternative option of re-tendering the works. It concluded that this was an unrealistic fall-back option and would have increased costs further and would have likely resulted in no hospital being built."

The opening of the hospital next year will finally bring to a close one of the most long-running and vexed developments, which started back in 2007 when then-Health Minister Mary Harney established a board to develop a new national paediatric hospital, though development was delayed by the small matter of a global economic crash. 

In 2015, having failed to get planning permission on the site of the Mater Hospital in Dublin, a new application was made for a facility on the St James’s Hospital campus in Dublin 8. The ambitious plan, launched by Mr Varadkar when he was Health Minister, was set to cost €650m and open in 2020. 

This deadline quickly moved when construction firm — BAM — was actually appointed the following year and a new target of substantial completion in August 2022 was announced.

While the timeframe is one thing, costs started becoming a factor in 2017 as it is revealed that the cost of construction will reach €1.43bn, with an additional €300m for other works. When the PWC reports landed in 2019, Mr Varadkar called them "grim reading", before four months of shutdowns were caused by covid-19 in 2020.

But aside from the time and cost and disruption to the part of Dublin due to be home to the hospital, Sinn Féin leader Mary Lou McDonald spelled out the impact of the hospital's delays in the Dáil on Tuesday as she excoriated the Government's handling of the hospital.

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"As this fiasco goes from bad to worse, children are waiting longer than ever for care," she said. "Eight out of 10 children are waiting longer than the Sláintecare target for an orthopaedic appointment. Parents of children with scoliosis and spina bifida are at their wits' end as their children wait in agony for life-changing and lifesaving treatment. 

"The promise that Simon Harris made in 2017 that no child would wait any longer than four months for their procedure rings as hollow as the Taoiseach's own promise that short of an asteroid hitting the planet, this hospital would be built and complete by 2020."

At a media tour in late 2022, then-Taoiseach Micheál Martin said that all-important phrase that “lessons have to be learned” but pointed to the benefits that will come when the hospital becomes operational — early next year being the guide date.

It is that tone which has been largely struck by Cabinet members this week. At a private meeting of Fine Gael TDs and senators, the Taoiseach reportedly said that he was "confident" that the hospital will come in within the spending envelope and said that it was possible for people to be "tied up in knots" on the cost, but that the benefits of the hospital should be focused on.

He told the Dáil in response to Ms McDonald that the facility will be the country's first digital public hospital, with 300 individual rooms for every child that needs to be admitted and space for their parents to sleep in the room beside them.

"It will have more theatres, more scanners and facilities we could not even imagine now, compared to what we have at the moment," he added.

But nobody is anti-hospital. Nobody is pro-children being ill. It is a red herring to suggest that those who criticise the spiralling costs of something don't agree with its necessity in the first place and there is even a possibility that this hospital will be worth every cent that's come from the taxpayer's pocket, given what will undoubtedly occur there.

But, at the same time, it is not sacrilege to ask what lessons have been learned and when others will be.