Thursday 19 September 2019

Eilis O'Hanlon: 'You won't get an answer without asking right questions'

The overspend at the National Children's Hospital was caused by a failure to ask questions, and that rot goes deep

LIVING IN HOPE: An aerial view of what the National Children’s Hospital will look like. Eventually...
LIVING IN HOPE: An aerial view of what the National Children’s Hospital will look like. Eventually...

Eilis O'Hanlon

Asked at a Joint Oireachtas Committee on Health sitting a couple of years ago whether European countries should band together and collectively bargain for drugs in the hope of getting lower prices, Minister for Health Simon Harris indicated his support for the proposal, but pointed out that "health is a national competence".

Lamentably, the publication of a review into the massive overspend on the National Children's Hospital (NCH) at St James's suggests that health has become a national incompetence in Ireland instead.

A final figure for the project still cannot be pinned down, but no one now expects to get change from €2bn.

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"It's a genuine horror story," was how Anthony Staines, Professor of Health Systems at DCU's School of Nursing and Human Sciences, described it on Wednesday's Drivetime on RTE Radio 1. "It's a story of really bad governance at every level."

Prof Staines couldn't have been clearer about the problem: "The [National Paediatric Development] Board didn't ask their staff to write questions... the Department [of Health] didn't ask any questions... no one asked why... This is their biggest capital project ever. One would think they would ask questions."

A failure to do so was why costs kept escalating, as everyone belatedly seems to recognise, Opposition TDs not least.

But did they really cover themselves in glory either? The lack of genuine curiosity about how decisions are made and other people's money is spent is not confined to the Government. The rot goes very deep.

Take the Joint Committee on Health itself. Transcripts of its proceedings are freely available on the Oireachtas website, and they make for depressing reading.

Every quarter, the Minister for Health appears at the committee alongside officials from his department and the HSE to update members and answer questions.

Not all ministers submit to these quarterly reviews, so it is a unique opportunity to put Harris's feet to the fire; but reading the transcripts, it is remarkable how infrequently the costs of the NCH project were raised as a concern in the past three years.

This was not only the biggest capital project in health, but the largest in the history of the State, and the lack of oversight was staggering.

To be fair, the committee has plenty of ground to cover, from waiting lists to recruitment of doctors and nurses. Last year was also dominated, understandably, by tragic flaws in the cervical cancer screening programme. Business elsewhere in the Dail also prevents members from being present at every meeting, and there are other committees dealing with public spending and oversight which should arguably have had their eye on the ball better, too.

It remains incredible how easily TDs, with honourable exceptions, allowed themselves to be fobbed off by the Minister for Health.

Labour's Alan Kelly is one of the few to have made efforts early on to pin down the minister on the NCH budget, asking Harris back in February 2017 "how in the name of God we ended up with the costs that have been outlined?"

The interventions of Fianna Fail health spokesman Stephen Donnelly since he joined the committee have also been notably forceful and forensic.

Until recently, though, Harris has largely escaped a rigorous enough grilling as he hid behind soothing waffle about "construction industry inflation" or praised the "very competent bunch of people heading up this project" or said it was "not fair" to question their professionalism.

Fast forward to January of this year, and suddenly members were full of questions as to how the NCH had become the most expensive children's hospital in the world, and why those costs had not been anticipated. By this point, it was clear that the NCH was going to gobble up the capital budget and stop other projects going ahead.

"Did no alarm bells go off?" asked Sinn Fein's Louise O'Reilly. The same question could be asked of TDs since the project was given the final go-ahead in 2016.

The three committee meetings which have been devoted to the NCH overspend this year alone are classic examples of locking the stable door after the horse has bolted.

There were some people asking the right questions. Dr James Sheehan, a co-founder of the Blackrock Clinic, was telling the committee back in September 2016 how St Vincent's Hospital has grown hugely in the 45 years since he first worked there, but that there was no similar room to expand on the St James's site, making the Taoiseach's boast that it would serve the needs of Ireland's children for the next 100 years sound rather hollow.

What's worrying is that so few of the people asking the right questions were elected politicians.

Again, there are exceptions. As early as March 2017, Independent Mattie McGrath and the Rural Independent Group of TDs did bring forward a motion demanding that the Government call a halt to the project due to concerns over rising costs. Why, though, was the Health Committee not pressing the minister harder on the same matter?

It would seem that everyone is now being wise after the fact, while still not asking the right questions.

Last week, the Taoiseach actually said in the Dail that "nobody is suggesting we can build this hospital for less than it's currently costing", even as Fianna Fail's Stephen Donnelly was identifying savings that could be made, such as paring back on the elaborate design of the building.

"There's a reason that we don't see many doughnut-shaped buildings, with curved glass walls and a hole in the middle," Donnelly pointed out. "That's because they're so expensive to construct."

It may be too late now to move to a different site. As the aforementioned Prof Staines pointed out on radio, the Government signed a further massive contract for the project last Christmas Eve. That money, he mourned, is probably unrecoverable.

Even now, Donnelly noted after the publication of the review last week, "the report contains no analysis of the cost and time implications of a different site - something the Dail voted overwhelmingly to have included in the PwC report".

That can't have come as any surprise to diligent members of the Health Committee either.

In the minister's quarterly update on November 10, 2016, Harris declared: "I want to make clear that the cost of transitioning the new children's hospital to another site has not been assessed in any detail as no such project exists."

A different, green-field site may well have ended up costing just as much. It might not even have received planning permission. We'll never know, because, pacified by that answer, as so often, TDs allowed a further two years to pass during which there was plenty of time for such an assessment to be undertaken.

Fatally, they not only seemed to not know what was going on with the project, but they didn't know what they needed to know.

After the recent Ethiopian Airlines disaster, mention was made of a phenomenon known as the "atrophy of vigilance". This describes an organisation's diminished ability over time to accurately calculate risk. Group-think and complacency are some of the reasons, and the Irish political system appears to be badly infected with it.

Right now, it's the National Children's Hospital. In years to come, it will be MetroLink. Within the past few weeks, cuts to the €3bn transport project have already been announced at the same time as those in charge admit they have no idea what the final cost will be.

Politicians will be good at showing sagacity in hindsight, but who was asking awkward questions last spring when the project, the largest capital spend in the history of the State, was signed off?

Those who cannot remember the past are condemned to repeat it. Endlessly.

Sunday Independent

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