Sunday 21 July 2019

Health warning: Could hospital fiasco finish Varadkar?

The National Children's Hospital is the Taoiseach's signature project with its robots, electronic patient systems and rainbow roof garden. But as costs spiral out of control, will it damage him politically? Kim Bielenberg reports

Taoiseach Leo Varadkar. Photo: Steve Humphreys
Taoiseach Leo Varadkar. Photo: Steve Humphreys
Kim Bielenberg

Kim Bielenberg

The Taoiseach Leo Varadkar once said that his favourite name for a children's hospital was the Starship.

He would have loved to attach that title to his gleaming new National Children's Hospital, but sadly there is already a hospital by that name in New Zealand.

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The new National Children's Hospital may not have a stellar title, but the Taoiseach will be able to boast that the cost of his most-treasured and beloved project will be astronomical.

That is if and when it is finally completed some time in the next decade.

If the shiny new health facility does eventually rise above the skyline next to St James's Hospital, it will be a project that will have been more than half a century in the making.

Anthony Staines, professor of Health Systems at Dublin City University, told Review that the first plan to bring the children's hospitals of Dublin together was first mooted as long ago as 1962.

At that time it was suggested that the united hospital would be in Crumlin. Now it will be the grandchildren of the kids from that era who will be the first patients at the new facility.

Another elaborate plan from the Bertie Ahern Celtic Tiger era to put a vast spaceship-like children's hospital in Dublin's north inner city was jettisoned after planning permission was refused.

That abandoned plan has cost the State €40m.

The Taoiseach can at least boast that his elephantine project has started, so he might as well just finish it.

The oval-shaped hospital with its elaborate rainbow roof garden reminiscent of the hanging gardens of Babylon, en-suite rooms, electronic patient records and cute robots was supposed to be the jewel in the crown of the reign of King Leo.

Even though the St James's Hospital site was chosen during the time of Varadkar's predecessor as Minister for Health, James Reilly, Leo took credit for the project when he was campaigning to be leader of Fine Gael.

And when, as Taoiseach, he set up a Strategic Communications Unit, a short-lived quango that was meant to deliver good news about the Government, promoting the hospital was going to be a major part of its work.

As Minister for Health back in April 2016, Varadkar was naturally proud of the project when it received planning permission.

He hailed the breakthrough as "fantastic news for all youngsters across the country".

"It will produce a state-of-the-art hospital of which everyone can be proud," the minister said.

Children would be able to stay in single en-suite rooms with a spare bed for a parent. They would be able to play games, watch films and order their meals on their bedside "patient portal".

In the new children's hospital, some of the work would be done by robots.

Food, bedding, waste and equipment would be transported around the hospital by "Automatic Guided Vehicles", which would give the new facility a touch of Star Wars atmosphere. They would be programmed to move through the corridors like a self-driven trolley.

Futuristic facility

The new hospital is destined to finally bring Irish hospitals into the digital age with electronic records of patients.

Rather than filling out endless forms repetitively in the primitive paper information systems still prevalent in our healthcare system, patients will have a single electronic record, accessible to nurses and doctors.

Information about a patient will be collected once, entered once, and it will be available throughout the whole of the hospital.

Booking in patients through apps, hospital planners hope to prevent a deluge of patients all arriving at the same time for an outpatients' clinic.

Patients will be advised by digital notification to go to waiting areas just before staff are ready to see them.

Back in 2016, Leo promised that "short of an asteroid hitting the planet", this futuristic facility bringing together three old children's hospitals under one roof would be ready by 2020.

Perhaps he could foresee that by then, he would be Taoiseach, preparing for his first general election, and the hi-tech paradise would lead him to the sunny uplands of a Fine Gael victory.

In the spring of 2016, with planning permission granted, it was envisaged that the hospital would cost €650m, but there were fears at the time that the cost could possibly escalate to €700m.

But almost three years on, with the project well under way, the costs have spiralled relentlessly upwards. When the tendering process was done, the cost rose to €983m by 2017.

As recently as September of last year, the Government was still saying that the hospital would cost €983m. But behind the scenes, it became apparent that the costs were rocketing ever upwards. Within a matter of months, they were estimated to have gone up to €1.4bn, with an extra €300m added on for equipment and the integration of the three old hospitals.

Questioned at the committee, the deputy director general of the HSE, Dean Sullivan, described the signals that there were pressures on the potential cost of the hospital as "noise in the system".

One health official told me that he had heard rumours that the cost would be over €1.4bn by March of last year.

Few would now bet that the eventual cost will not top €2bn.

Having been Leo Varadkar's pet project, it is in danger of turning into a millstone around his neck that could destroy Fine Gael's reputation for fiscal prudence.

The other crowd, Fianna Fáil, were supposed to be the shower that engaged in the sort of wild and reckless spending that caused the crash. Now his government are being blamed for being asleep at the wheel.

What credibility will Leo and co be left with if they cannot keep a close eye on costs for a signature project such as this?

Anthony Staines, from DCU, has watched the development of the hospital with mounting alarm.

Professor Staines, who previously worked as a neonatal paediatrician, says: "I am just stunned by the costs - it is almost incomprehensible."

According to Staines, as a general rule of thumb, a fully-equipped hospital costs about €1m to €1.2m per bed. The National Children's hospital has 473 beds, and so will cost €3.6m per bed.

"I knew that the hospital would be high spec, so I would expect a slightly higher cost - and €650m seemed reasonable as a ballpark figure. When it went to €980m, I began to really take notice and now it is €1.7bn for a fully equipped hospital."

Itemising the increased costs, the hospital's development board recently said €90m has been added by the completion date being pushed back nine months. Some €94m was added after a review of the fixtures and fittings needed in over 6,000 rooms.

Contractors needed a further €22m to reflect changes in scope. Proposals from doctors meant the final design was changed, calling for an extra €21m.

Questions will inevitably be asked about the nature of the tender process and how costs were added on, as the project developed.

Professor Staines said he had some experience of hospitals being built for the National Health Service in the UK.

"Those who are planning the hospitals sit the consultants down and ask them what they want - things like where they want their plugs and their taps and sinks. Everything is planned out, end of story.

"If a surgeon suddenly decides at a later stage that they want another sink, they can't have it. It's like if you were building an extension on your house and you suddenly decide that you want another window - it's going to cost you a lot of money."

Knock-on effect

As one former minister put it: "The first rule of cost control is to set out specifically what you are tendering for, and don't move away from it. That didn't seem to happen.

"When you don't quantify the quantity of every component part at the start, it's like signing a blank cheque."

There are now strong fears that the overruns on the hospital will affect other capital projects, including hospitals across the country.

Until now, Varadkar has had a fair wind behind him on economic issues, with unemployment dropping and the economy growing even though the housing shortage has dampened the feeling of recovery for many families.

The Brexit crisis, where he has been seen to "stick it the Brits", may have won him some plaudits, but questions are inevitably being asked whether the Taoiseach and some of his senior ministers pays close enough attention to the nitty gritty of government.

It still has not been fully explained how the costs of a signature project rose by more than €400m in a matter of months without the Health Minister, the Finance Minister and the Taoiseach knowing about it.

One former minister who worked with Varadkar in government told Review: "Leo was a great man for the big announcement, but I am not sure about the follow-up."

Labour leader Brendan Howlin, who served as Minister for Public Expenditure in Enda Kenny's government, echoed these words. He said the rise in costs of the hospital, which happened in a run-up to the budget, simply beggared belief.

When Enda Kenny's government started during the crash, the post of Minister for Public Expenditure serving alongside the Minister for Finance was created to keep a close eye on costs.

But the separate post of Minister for Public Expenditure was abolished by Varadkar when he became Taoiseach and Howlin believes this was a mistake.

With the Troika breathing down their necks, Enda Kenny, Michael Noonan and Howlin had to keep a tight control of costs, but was this tight grip loosened in Varadkar's administration with the economy in recovery?

"Leo was disparaging of the minutiae of management during our time in government where, out of necessity, we had to manage every cent, because we didn't have many cents to manage," said Howlin.

"He was much more interested in the PR than the doing of it, and I'm not sure if Leo is really a details man."

Election backlash

The Taoiseach will be hoping that as with other major pieces of infrastructure such as the Port Tunnel and Terminal 2 at Dublin Airport, the complaints will quickly subside once the project is complete. But this saga is likely to rumble on until the next general election - and the hospital will not be completed by then.

Now that the massive cost overrun has become a matter of controversy, the Fine Gael faithful will be worried that they suffer a backlash during May's local elections.

Barry Cowen, the Fianna Fáil spokesman on public expenditure and reform, warned that the cost overrun was so serious, the Government would "be gone if it weren't for Brexit".

Maura Adshead, associate professor of politics at the University of Limerick, agrees that Brexit appears to be shielding the Government from trouble.

"In normal times it would have huge potential to cause damage to the Government, but we are not in normal times."

Fianna Fáil may be reluctant to knockout Leo while he is holding the Brexit baby, but in the long term, the hospital cost crisis may come back to haunt him.

"It just puts another dent in the Government's reputation after the cervical smear crisis, overruns in the budget - and now we also have the nurses' strike," says Dr Adshead.

By the time the next general election comes around, Brexit will have been resolved - and the judgment of Varadkar's term as Taoiseach on issues such as health and housing could be much harsher than the present polls suggest.

In that case, the Taoiseach may not be in office long enough to preside over the opening of his beloved signature project.


The hospital by numbers


rooms in total


in-patient rooms, each with a bed for a parent


car parking spaces (675 of them for parents)


acres of outdoor space with 14 gardens


operating theatres and procedure rooms.

Indo Review

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