Blog 21_ Waiting Patiently
"I have a relative languishing on a hospital waiting list for hip surgery", says one voter. "I'm pleased to see you stress the importance of speeding up delivery of the Elective Hospitals, but how long will that take and how much will they cost?"
I understand the frustration - into the eighth year since they were agreed on by all parties and very little progress. The questioner is right to enquire about the timeline, but also about the cost, given how bad the state has become recently at delivery and cost management of big projects.
Other big projects underway wouldn't inspire confidence.
The proposal to pipe water from the Shannon at Parteen basin up to Peamount in Dublin was originally estimated to cost between EUR 800 million and EUR 1.4 billion. By 2020, this was upgraded to between EUR 1.9 billion and EUR 2.4 billion. However, the latest projections are in the range EUR 4.6 billion to EUR 6 billion, with the possibility that it could run as high as EUR 10 billion, in a worse case scenario. Even at that, Dublin won't see the first litre of water from the Shannon before 2030, if indeed the project ever goes ahead.
The National Children's Hospital will be one of the most expensive hospitals in the world, costing EUR 2.2 billion at least, without taking into account a large number of disputed claims, yet to be decided. It was first proposed in 1993 and it is still unclear when exactly it will open, so, way over budget and behind on delivery. Large numbers of design changes during works were blamed by builders for the delay, but it took so long to construct, that children's medicine and so the requirements, had changed in the meantime.
The tragedy is that we were once able to manage these projects. Building work started on Tallaght University Hospital in 1993 and it opened on time in 1998 within budget. Somehow, in the meantime, we have lost the skill-set needed to achieve this.
Based on the most recent Slaintcare Progress Report, given all the hoops the elective hospital projects still have to jump through, I seriously doubt if construction will start before 2030 and expect that the final cost will dwarf the initial estimate.
Furthermore, if policy changes elsewhere take a huge bite out of Irish tax receipts from the activities of the multinational sector here, as could happen in the years ahead, then, at this rate, the elective hospitals may never be built.
Here's what I would do to fix this problem:
1. Scrap the remaining stages of the Government's Infrastructure Guidelines for the elective hospitals. Government approval, in principle, has already been given to the project. I understand the need for these guidelines in general but the bigger risk here is that these long overdue and much needed hospitals, if delayed further, will never be built. Final cabinet sign-off required before the construction contract is placed.
2. Build each hospital in phases and equip, staff and open each hospital once the building work finishes on phase one. Use modular construction as far as possible.
3. Skip the design phase by buying in the design of a world-leading elective hospital and simply use that, for example, the Wyvern Hospital in Sydney Australia. Building work commenced on Wyvern in March 2022 and phase 1 opened for service in December 2024. Total time taken to build, equip, staff and open the hospital was 2 years and 9 months. It cost less than EUR 60 million and includes 85 beds, 8 operating theatres with 150 staff. Further phases to follow.
4. No design changes permitted after construction begins.
5. I would start with the Dublin Elective but only because if we locate it at Connolly Hospital in Blanchardstown (one of the Dublin options), we get access to a large green field site which will speed up construction. Quickly move on to Galway and Cork hospitals.
6. Work on Manpower Planning, IT system and Procurement to run in parallel with construction.
7. Quarterly project meeting to be chaired by Minister of State. Ex officio members to include Dept and HSE nominees, RIAI president (or nominee), EI president (or nominee) and SCSI president (or nominee).
8. Target to commence construction January 2026. First Hospital opens December 2028. All three up and running before the next General Election in November 2029.