The National Children’s Hospital – progress report

It looks almost finished – and patients might start to arrive some time next year. But what has really been going on with the new hospital in Dublin 8, and why has it taken so long?

The National Children’s Hospital was first proposed in 1993 by the Royal College of Physicians. The planning application to build it was first put forward in 2015.

Now, in May 2024, the building is still not finished. The Government says the first patients might be seen in the hospital in October 2025.

As the timetable got longer and longer, the cost got higher and higher. In 2017 a budget of €983 million was granted for the building process of the hospital. This figure is now at €2.24 billion, and we don’t know if it will go up even further.

The cost of building the hospital and the long delays have been the subject of a lot of controversy and comment. There are some reasonable excuses. First, the plan was to build it at Dublin’s Mater Hospital. But after years or working towards this, planning permission for this location was refused. So the site was moved to St James Hospital, and planning had to start again. Then the Covid pandemic delayed construction for months. But not all the excuses seem like good ones.

For years there have been disputes between the company building the hospital, called BAM, and the group responsible for overseeing the building, called the National Pediatric Hospital Development Board (NPHDB). BAM argue that they are always being asked to add more features to the hospital than they are being paid for. But the NPHDB say that there are things going wrong which are BAM’s fault, such as putting in faulty ceilings into operating theatres, which had to be changed. BAM sued the NPHDB at one point for €20m.

With all the argument and controversy, we shouldn’t forget why this is being built and how important it is. This is the biggest and most complicated health project ever built in Ireland, and maybe that explains why there have been so many problems. It will provide care for some of the sickest children in Ireland. It will replace the current three children’s hospitals in Dublin, Crumlin, Temple Street and Tallaght. It will have 380 inpatient rooms and will include a Children and Adolescent Mental Health unit, 60 critical care beds and 90- beds for day-case operations.

For children spending long periods in hospital, such as those suffering from serious illnesses such as cancer, it will also provide a schooling programme for young children, as well as a third level education centre. So, it seems likely that when it is built, it will provide very much needed services, and will be a hospital the country can be proud of.

So why has it had so many problems before it was built? Firstly, the design itself is very high quality and so it is very costly. The Minister for Health Stephen Donnelly said in February: “This is an expensive hospital, it is an expensive design, it is on an expensive site. It is not the most expensive hospital in the world but there is a lot of money the Irish people are paying.” But according to the Minister, it will be worth it. “What I would say is, if there is a silver lining to that, it is we are getting a huge amount in return for that money in terms of children’s health care. This is going to be transformative.”

But one of the main critics of the cost of the project, Social Democrat TD Roisin Shortall, doesn’t accept the excuses given for the rising costs and delays. “We seem to have a perennial problem in this country in terms of being incapable of major public infrastructure projects. There is absolutely no transparency or clarity about what the final price is likely to be. We need to control prices in relation to projects like this.”

In 2019, a report commissioned by PWC to examine why the cost had been so badly underestimated said it had found a series of weaknesses in terms of set-up, planning, budget, execution and governance. It said most of the cost increases was down to a simple underestimation of the real costs. Other factors like VAT, delays, changes in building regulations which meant plans had to change, were partly responsible too.

It is ironic that the new Taoiseach Simon Harris was Minister for Health when the huge cost rises and delays were happening. Now it is possible – not likely, but just possible – that after all the delays and the controversy, Harris just might be the Taoiseach who gets to make the speech at the new hospital on the day that it finally opens its doors to sick children.