Minister for Health Simon Harris TD today announced that the Government has approved the investment required to enable the National Paediatric Hospital Development Board to instruct the current contractor for Phase B of the works to complete the building of the new children’s hospital on the St James’s Hospital campus and the two Paediatric Outpatients and Urgent Care Centres on the Tallaght and Connolly Hospitals campuses.
In welcoming the Government’s decision today Minister Harris said: “The new children’s hospital and the two outpatients and urgent care centres at Connolly Hospital and Tallaght University Hospital are long awaited and I am very pleased that the construction can continue now without delay. The hospital will facilitate the implementation of a new model of care that will have a profound impact on all paediatric services once the new hospital is open,”
Considerable work has been undertaken on the project since April 2017 when Government gave the green light for the construction of the hospital. Enabling works on the main hospital site are complete and Phase A construction works (substructure works on the main site), which commenced in October 2017, are also now nearing completion. Following today’s decision, the Phase B 7-storey above ground works will begin early next year. Development is also well advanced on the paediatric outpatients and urgent care centres. Works at Connolly are on target for practical completion of the building in Spring 2019 with the opening scheduled for July 2019. Works at Tallaght are underway with a target handover date of July 2020, and the main hospital to be completed in 2022.
Integration of the three existing paediatric hospitals, the opening of the OPD and Urgent Care Centres and the transfer of services to the new hospital facilities represent a highly complex project in its own right. The recent establishment of Children’s Health Ireland under the Children’s Health Act 2018 to run the children’s hospital supports the major programme of work of service and clinical integration, people and change management required to run integrated services on the existing hospitals’ sites and commissioning required to achieve a successful transition to the new facilities when they open.
The Minister also acknowledged that "While I fully support this project, there is no doubt that the additional costs associated with the project are of great concern and we must have assurance that Phase B of the construction project will be delivered within budget and timescale."
Accordingly, Government today also approved the commissioning of an independent review of the escalation in cost in determining the adjusted contract sum, the contributory factors and associated responsibilities so that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds. The National Paediatric Hospital Development Board will be required to provide on-going assurance to the HSE, Department of Health and Government that Phase B of the project is being delivered within budget and timescale.
Notes to the Editor
1. Contract Award Process
It was decided at an early stage that the traditional design and tender method of procurement was not suitable or realistic for a project of this size and complexity. Therefore, the procurement strategy adopted for this project was developed to ensure that the new children’s hospital would be delivered without any further delay, as well as deliver value for money, compliance with public and EU procurement rules, and reduction of risk. Accordingly, the awarding of the contract for the project in 2017 was subject to a two-stage process which allowed early phases of work relating to below ground works to commence in Stage One whilst the detail of Stage Two was being finalised and agreed, resulting in an estimated 24-month saving in total delivery time.
Stage 1 consists of a full tender for the basement substructure Phase A works on the basis of a detail design, with a full bill of quantities and tendering the main above ground Phase B works on a Preliminary 1st stage design, with an approximate and remeasurable bill of quantities reflecting the Preliminary 1st stage design.
Stage 2: While the basement Phase A works are under construction complete the 2nd stage Detail design for the above ground Phase B works with a full bill of quantities priced at the 1st stage Preliminary design tendered rates resulting in a Guaranteed Maximum Price.
Stage 1 allowed a scope refinement and value engineering process, based upon tendered rates, to finalise the contract sum and a Guaranteed Maximum Price. This two-stage process allowed early phases of work to commence whilst the detail on later phases was being finalised and agreed, resulting in an estimated 24-month saving in total delivery time. This approach brings issues on cost to the fore much earlier in the life of the project than is the case where traditional procurement approaches are deployed.
2. Capital costs
Following completion of the two-stage process, the overall project budget total is now €1,433m. This represents €450m more than advised to Government in April 2017. Of this, €319m is construction costs, and the balance of €131m, which includes €50m in VAT, relates to costs associated with staff, consultants, planning, design team fees, risk/contingency, and Management Equipment Service. Independent reviews undertaken under the aegis of the NPHDB and the HSE have confirmed that the two-stage procurement process adopted was appropriate for a project of this scale and complexity, and that the process was correctly followed. Independent reviews on the final construction elements of the project have been benchmarked against similar international projects. The new hospital is at the higher end in cost per sq.m but aligned with similar projects.
3. Scheduled opening of the hospital and Outpatient and Urgent Care Centres
Considerable progress has been made on the project since April 2017. Enabling works on the main hospital site are complete and Phase A construction works (substructure works on the main site), commenced in October 2017 and are also now nearing completion. A fully-aligned construction programme is agreed with main hospital construction to be completed in 2022.
Development is also well advanced on the paediatric outpatients and urgent care centres. Works at Connolly are on target for practical completion of the building in Spring 2019 with the opening scheduled for July 2019. Works at Tallaght are underway with a target handover date of July 2020. These centres will provide urgent and outpatient care to children in the Greater Dublin Area, including Co. Dublin, Wicklow, Meath and Kildare.
4. Capacity and accommodation
The buildings have been designed to ensure that children and young people are treated in the best organised and most clinically suitable setting. The hospital and OPD & Urgent Care Centres are expected to have capacity for:
- · 31,000 Inpatients (16% on current levels)
- · 34,300 Day Case patients (26% on current levels)
- · 276,000 Outpatient attendances (47% on current levels)
- · 129,000 ED attendances (7% on current levels)
In the main hospital at St James’s, there will be 380 single rooms all with en-suite bathrooms and a parent’s bed. There will be 93 daycare bays, 22 operating theatres and procedure rooms, and 122 consulting rooms in total. The rooftop rainbow garden is a central feature of the design and it will provide a secure and sheltered environment adjacent to the wards. The planned accommodation will include facilities for inpatients, day care patients, outpatients, operating theatres and emergency care. The elements of the hospital will include:
- • Outpatients, daycare, theatre, emergency department and critical care units
- • Laboratory, medical imaging and diagnostic services
- • Specialist therapy and play facilities
- • Age-appropriate facilities for children and young people
- • Hospital school
- • Reception, concourse and public realm including retail spaces in the main atrium
- • Operational communication links into the adult hospital and maternity hospital
- • Education, training, research and innovation facilities
- • Underground carparking
Inpatient accommodation (all single rooms, en-suite, in-room parent accommodation)
• 300 generic inpatient rooms
• 60 critical care inpatient rooms incorporating paediatric intensive care/high dependency and neonatology intensive care/high dependency
• 20 child and adolescent mental health beds (incorporating eating disorders and acute Child and Adolescent Mental Health Services (CAMHS))
Day care facilities
- • 61 general medical and surgical day care bays
- • 4 nephrology/urology day care bays
- • 22 haematology/oncology day care bays
- • 6 cardiology day care bays
Operating theatres and procedure rooms
- • 12 general theatres
- • 6 specialist theatres
- • 1 PIR suite
- • 2 endoscopy rooms
- • 1 catheterisation laboratory
Outpatients
- • 110 outpatient consulting/examination rooms at the main hospital
- • 12 outpatient consulting/examination rooms at the Outpatient and Urgent Care centres (six in each)
5. Emergency Facilities
ED and urgent care facilities will be provided at the main hospital, with urgent care facilities at the Outpatient and Urgent Care Centres also. There will be 24 short stay observation beds across the hospital and Outpatient and Urgent Care Centres (6 in each Outpatient and Urgent Care centre and 12 in the main hospital), and 56 assessment bays (10 in each Outpatient and Urgent Care centre, and 36 in the main hospital).
6. Outpatient and Urgent Care Centres at Tallaght and Connolly Hospitals
The Outpatient and Urgent Care Centres will improve geographic access to urgent care for children in the Greater Dublin Area. Consultant-led urgent care, with 4-6-hour observation beds, appropriate diagnostics and secondary outpatient services including rapid access general paediatric clinics as well as child sexual abuse unit examination, observation and therapy rooms will be provided in the Outpatient and Urgent Care Centres. The centre at Connolly will also include two HSE paediatric care primary care dental services operating theatres.
7. Economic and social benefits
There are significant economic and social benefits to be gained from the new children’s hospital development for the Dublin 8 community, both during the construction phase, and afterwards when the hospital is operational. The project’s scale and national importance are being harnessed as a catalyst for regeneration of surrounding neighbourhoods and businesses. A committee of core stakeholders called the Dublin 8 Urban Regeneration Committee was established in June 2017 to explore the commercial opportunities for the Dublin 8 area, including the development of a Health and Innovation Hub.
In addition, the new children’s hospital is one of the first projects on this scale in Ireland to include social clauses as part of its construction contracts which will benefit surrounding communities by providing job opportunities for the unemployed, early school-leavers or people new to construction. A total of 1,700 job years are expected to be generated during the construction phase along with various other significant benefits in terms of total economic activity and employment in the long term when the hospital is operational. Work experience placements for students will also be available to work amongst all the contractors and sub-contractors during the main construction phase.