If planning, funding and expert advice are not to blame for the national children’s hospital project, why have things gone so badly?
IT WOULD be hard to find a single project that better illustrates the mess that has been made of our society in recent years than our failure to advance plans for a national children’s hospital. And, like the rest of our troubles, what is no one individual’s fault is yet a problem for all of us.
By the same yardstick, it will be the measure of our recovery if a solution to the current impasse can be found.
Despite universal agreement on the need for a new state-of-the-art facility to treat sick children, we have spent six years and €30 million and got just about nowhere. Political strokes, vested interests and an aversion to compromise have all played their part in the delays suffered by the project.
Following An Bord Pleanála’s rejection of the plans for the hospital on the Mater site, it would be easy to blame the planning process for the manner in which it has foundered. In fact, the project was fast-tracked under procedures designed to speed up the delivery of strategic infrastructure. The board, in stating that the plans represented an overdevelopment of the site, was merely stating the obvious – as anyone who has seen the photomontages of a monolithic hulk towering over central Dublin can attest.
Neither can the setbacks be blamed on an absence of expert advice. The report by McKinsey consultants that kick-started the selection process in 2006 looked at children’s hospitals in 15 countries, including world leaders in Canada, the US and Scandinavia. Other reports followed, notably the design brief in 2009 and last year’s review by the incoming Government.
THE OTHER factor that cannot be blamed for the latest setback is money. Ironically, this was the greatest concern surrounding a project that was originally projected to cost €500 million, now carries a €650 million price tag, and will probably cost even more. This is because the imminent sale of the National Lottery will deliver a large proportion of the funds needed to pay for the capital costs of the project – provided this money is not diverted elsewhere.
So if planning, funding and expert advice are not to blame, why have things gone so badly? The answer to this question goes back to the start of the development, when decisions were made before sufficient agreement was reached in the medical community and the Mater site’s suitability for such a big project was properly tested.
The decision was, as former hospital development board chairman Philip Lynch so pithily said, “a political decision, a northside job”. The State’s biggest construction project landed in taoiseach Bertie Ahern’s backyard, and no one was one bit surprised.
Ironically, the initial arguments about the site had little to do with the welfare of children. What about the parking, asked the critics, even though the Mater is a stone’s throw from O’Connell Street and cheek by jowl with a stop on the proposed Metro (a project since mothballed). There was more than a touch of snobbery about the moans of well-heeled critics at the prospect of having to drive across the Liffey for medical treatment for their children. There was also a dog-in-the-manger attitude from elements of the existing children’s hospitals to any move that would probably alter the existing power structures in their institutions.
Even as the State’s finances were collapsing, the project continued to grow. The McKinsey report defined co-location as the siting of a children’s hospital with an adult hospital, but as the years passed, further co-location with a maternity hospital was seen as essential. So much so that this week Minister and GP Leo Varadkar turned the original proposal on its head and claimed co-location with a maternity hospital was the primary link needed.
Make no mistake about it, the Mater site is not perfect, mostly because it is tight. Yet there was little recognition of the imperfections of other potential sites. Equally, there was little recognition of the calculus that, as time went on, the Mater was the only hope of building a children’s hospital in this generation. Back in the Celtic Tiger era, resources seemed unlimited and developers were queuing up to offer sites; today, we’re broke, and most of the developers are too.
Despite the new economic reality, the project team went for broke. As the planning inspector explained, they took one element of local planning rules, which allow for a building of “exceptional height”, and applied it to the entire site. The result was a 164m-long behemoth rising 74m in a low-rise inner-city area. Liberty Hall is under 60m high.
THE NEED for a hospital is as pressing as ever. Last year, more than 24,000 children were waiting for outpatient appointments at the existing three hospitals and 1,000 had been waiting for more than a year. Last month, overcrowding in some hospitals led to scores of children spending more than 24 hours on trolleys.
Minister for Health James Reilly inherited the problems when he was appointed last March. The economic crisis has caused carnage on the Government’s list of capital projects, but the national children’s hospital, which was promised in the programme for government, has survived.
Reilly took advice and decided to go ahead with the Mater site. Having nailed his colours to the mast, this week’s rejection of the plans by the board is extremely embarrassing, and sources say the Minister was “seething” at the decision. The discussion on what to do now has been farmed out to another committee, but will ultimately be a political decision.
Already voices are saying the hospital should be built elsewhere; there are calls for changes to the planning system, as if that were the problem; others are saying the size of the proposed hospital cannot be reduced, wherever it goes. Yet the Minister must be aware that the only hope of having a new children’s hospital built in time for the anniversary of the 1916 Rising – and one he can see from the podium outside the GPO – lies in submitting a scaled-down version of the project on the Mater site to An Bord Pleanála.
