Dáil Éireann debate -
Tuesday, 24 Sep 2024

The debacle surrounding the construction of the national children's hospital continues. At the weekend, we learned that the hospital's completion date will be missed yet again. We are now looking at a completion date of 2026, and we cannot even be sure of that. A report from KPMG published this morning calls into question whether the hospital will be ready to open even when it is built. There are fears about gaps in staffing and senior leadership teams and a lack of clarity regarding the future operating model and resourcing of the hospital.

On the watch of Fine Gael and Fianna Fáil, the biggest investment in health infrastructure in the history of the State has descended into complete farce, with never-ending delays, an ever-growing massive overspend and zero accountability. Nobody in government can say for certain when the hospital will open its doors or what the final bill for the taxpayer will be. This fiasco is rooted in Government incompetence. It was the Taoiseach, Deputy Harris, who gave the go-ahead for the contract with BAM in 2017. In 2019, despite the major concerns and problems that had emerged, he again gave the developer his seal of approval by signing the contract for phase 2 of construction. This is the source of all of the problems that have beset the building of the hospital.

There have been weak contracts that do not protect the public purse, do not hold the developer to delivery dates and do not allow for effective oversight of the project. Who signs a contract for anything, let alone a hospital, without an idea of what the final cost will be or when the job will be finished? The answer to that question is the Taoiseach, Deputy Harris. Yesterday, he said that the Government will not be a pushover on the children's hospital. Of course, that is just another sound bite. The horse has truly bolted on that score.

Let us go through this. The completion date has been delayed 17 times. The spending on the hospital has ballooned by €1.5 billion. According to the board overseeing the project, not one of the hospital's 5,000 rooms has been completed to the standard set out in the contract. Most importantly, the hospital is still not open. Not a single child has been treated there, despite the billions of public money spent. That is not a Government being pushed over; it is a Government being rolled over repeatedly. Is é Simon Harris agus an Rialtas atá freagrach as an bpraiseach a bhaineann le hospidéal náisiúnta na bpáistí.

Everybody in the Dáil wants the hospital finished. We want its doors open for children. The scandal of children with scoliosis and spina bifida waiting years in agony for their operations remains front and centre. The hospital should be open for them and for so many other children in need of care and treatment. Of course, BAM must step up to the plate and fulfil all contractual obligations. Let us be clear, however. It is the job of the Government to protect the public interest. When it comes to the delays and ballooning costs, the buck stops with the Government. Can the Minister tell us what the Government is doing to ensure that it does not continue to be a pushover? What is it doing to stop the massive cost overruns? What is it doing to ensure that this hospital gets built and opens?

I thank Deputy McDonald for raising this issue. Week after week in the Dáil, she and other Deputies, including Government Deputies, raise the ongoing concerns relating to the need to meet the healthcare needs of sick young girls and boys and the improvement we have to make to how healthcare is provided to our youngest. That is why the national children's hospital is so important and why its completion, including the provision of surgery facilities, additional care facilities and bedrooms, is fundamental to how we can, in a far better way, rise to the challenge of meeting the healthcare needs of our youngest. That is why this hospital is needed and why, when it is open, it will make a massive difference to our ability to meet the healthcare needs of our youngest, particularly those with the most difficult and sensitive healthcare needs.

The message from the Government regarding where the project stands is clear. We want the hospital open as soon as possible, with the rooms and surgery facilities completed. We want to see a building that is currently a structure turn into a hospital providing state-of-the-art care to those who need it most. The progress on this hospital has been delayed, as the Deputy said. On the recent track record of delays relating to the project, due to decisions made by the contractor, in the past four years the project has been delayed 14 times. In the past 12 months alone, it has been delayed four times.

Deputy McDonald asked what the Government is doing about this and what steps it is taking to ensure that the hospital is completed and can meet the healthcare needs of our children. The National Paediatric Hospital Development Board, which is responsible for the oversight of the hospital, is acting on behalf of the Government in respect of the project. On our behalf, the board is taking the necessary steps to ensure the contractor is held to account and to get the hospital open as soon as possible. The board is challenging the contractor on costs and taking the right action to challenge the delays and ensure the right amount of resources are present on site to ensure the hospital opens. The delays that are taking place at the moment are unacceptable. The Government wants to see the hospital open. The board is acting on our behalf to take the steps necessary to allow it to open and to be turned from a building into a hospital that gives care to those who need it most.

On the charges Deputy McDonald made about the Taoiseach and the Government, on one hand, she says she wants us to better meet the healthcare needs of the young and, on the other, she is always against everything that relates to this hospital. She says she has great concerns about the way the costs have gone up, but when the Government takes any steps to deal with those costs, she is critical of that. She says she wants to see the hospital open as soon as possible, but when we take the steps needed to lead to the hospital opening, she stands up in the Dáil and criticises that as well. It is the same old Sinn Féin. We see it again in what she has said today. When you are against everything, you are for nothing.

Yet again, we see not just a grossly incompetent Government, but one that is entirely unprepared to take responsibility, much less to be accountable, for anything. It is the board's fault. It is the contractor's fault. Of course, it is Sinn Féin's fault. How could it not be?

Let me recite this again. On 17 occasions, the completion date has fallen through. There is an overspend of €1.5 billion. According to the CEO of the board, not a single room has been completed to the required standard in this project. That is his account of things. Most importantly, the hospital is not open and not one child has been treated.

I asked the Minister a direct question. I asked him what he and the Government, as the custodians of the public purse and the people ultimately accountable, are doing to provide access to this healthcare for our children? I can only surmise from his response that the Government is, in fact, doing nothing.

It does not matter what answer I give to the House. It does not matter how I look to answer Deputy McDonald today. Her response is always going to be the same - to find any answer insufficient and to find any evidence of progress or an attempt to deal with the issue not good enough. I outlined in my answer to her that we do not accept as sufficient or satisfactory where this project stands and that we, too, want to see the hospital open as soon as possible. I have acknowledged at other points, and I do so again today, all the difficulties and learnings we have had in regard to the cost of the hospital, which have been acknowledged and taken on board in how we cost other projects.

The Deputy asked me what the Government is doing in this regard. I explained what it is doing. I pointed out that the Government, through the development board that has responsibility for the hospital, is taking the action that is needed in respect of the timeliness of delivery of this project, the challenge of claims and the work we are doing and what we are demanding of the developer to have that work done. I put it to Deputy McDonald that rather than continually coming in here and doing the work on behalf of the contractor, she would be better off making the case for this project being completed, supporting the children of Ireland and getting this hospital complete.

I want to ask about political accountability for what is happening with the children's hospital or, rather, what is not happening. I read the coverage of the letter sent by the Minister, Deputy Donnelly, to the Taoiseach about the latest delays relating to the building of the new hospital. Perhaps that correspondence could more accurately be described as a letter from the Minister to the RTÉ newsroom, copied to the Taoiseach. Clearly, there are questions to be asked and answered about the purpose of that letter and why a letter was needed between two Cabinet colleagues who presumably speak to each other frequently. Regardless, we are led to understand from the text of the letter that the Minister is very angry at the continued delays to this vital infrastructure.

The Minister is not alone. We are all angry. We all want to see the children's hospital built. However, it is not for the Minister for Health or, indeed, the Minister, Deputy Donohoe, to be angry about or to take offence at these issues like bystanders. It is simply not good enough for the Minister opposite to comment, as he has just done, that the delay is unacceptable, as if the Government has no role, oversight or accountability. The job of the Government and the Minister for Health is to take charge of this and ensure that the hospital is built, rather than engaging in what seems to be a sort of unedifying psychodrama played out in letters to the press.

With an endless litany of delays and cost overruns, people are losing faith in the Government's capacity to deliver major public projects. We will not be able to see the sun soon for all the kites being flown above Government Buildings in advance of the budget. None of those kites ever seems to result in delivery, either of the children's hospital or other much-needed projects, including the homes that need to be built and the upgrades to public transport that are so badly required. I am thinking of the Taoiseach's recent kite-flying about a new Department for infrastructure. Respectfully, it seems to many of us that the Minister's Department, namely the Department of public expenditure and reform, should be delivering infrastructure. That is what his Department is for. Indeed, it has questions to answer about the cost overruns and delays in the children's hospital. I recall previous concerns raised about why the chief procurement officer, who sat on the board of the hospital, did not inform the Minister about cost overruns some years ago when this first stated to become an issue.

Beyond the cost overruns, there are other serious issues. A leaked report today from KPMG questions the capacity of Children's Health Ireland to run the hospital whenever it is finally built, which is partly attributed to the extraordinary delays in construction. It appears that there is blame lying with the developer, BAM. Again, we in the Opposition have to ask what the Government will do about those delays. What is the Minister for Health going to do? What did his predecessor, the Taoiseach, do? What did the Taoiseach's predecessor, Deputy Varadkar, do?

What does Deputy Donohoe propose to do, as public expenditure Minister? Will he protect public procurement from third parties that lowball cost estimates at tender stage and then continually revise figures upwards? Can he say now when the children's hospital will be delivered and how much it will cost?

In the Deputy's question to me, she made reference to all the other projects that are under way across our country, whether it be homes or the delivery of public transport. In many cases, the delivery of capital projects by this Government happens in the way the public wants and happens on time. Despite the surge in inflation we have seen in recent years, many of these projects do happen in line with the expectations we have for their cost. I have already acknowledged all the difficulties as regards the delivery of this hospital, the change in cost and its delay and will do so again. I have stated what we have learned from it and, for projects of this scale, what we are now doing differently as regards our tendering and procurement processes. The fact is that we have completely different processes in place now for other big projects of scale, like our metro and the national broadband plan, that reflect the learnings we have had-----

-----from the delivery of the children's hospital.

Deputy Bacik asks what steps the Government is taking to ensure this hospital is delivered. As she rightly says, the most important thing now is how we learn from what has happened, how we get the hospital open and how we get it providing care to sick young children. What steps are we taking in this regard? Two main steps are being taken. First, as regards the cost of the hospital, the board of the national children's hospital, acting on behalf of the Government, continues to challenge claims that are put in as regards costs being accrued in the delivery of the hospital and is successful in getting better value and better outcomes for the taxpayer in challenging many of those costs. As to what we are doing for the timeliness of the hospital's delivery, the board has the ability to withhold certain payments to the contractor in order to ensure that timelines are delivered even at this point. This is something the board does and continues to consider doing in the future to ensure we get closer to the point of the hospital being open and children receiving the healthcare they need and deserve.

Clearly, children need this hospital built. We all need and want to see it built. We want to see it open and delivering the necessary services. It is just not good enough, however, for Deputy Donohoe, as Minister for public expenditure, or for the health Minister to simply say what the board is doing and not to reassure people what the Government is doing to ensure an outcome here. I think what is frustrating people is the lack of outcome, the lack of accountability and the constant impression of passing the buck and blaming others for cost overruns and delays.

There is here a pattern. The health Minister is the Government line Minister who is politically responsible and accountable for the spend in health, but every time another health scandal or cost overrun hits the headlines, the health Minister is nowhere to be seen. When the cost-saving recruitment embargo transformed into a suppression strategy, whereby 2,000 vacant posts are being quietly abolished, the health Minister was nowhere to be seen. When that embargo was debated earlier this year, it was more often than not the former Taoiseach who went out to bat for it. The annual health budget has become a joke; it is such a fiction. Yet every day we see hundreds of people still on trolleys waiting for beds, childhoods spent on waiting lists, crowded accident and emergency departments and appalling tragedies like the awful death of Aoife Johnston.

It is not good enough to say what the board is doing; what we want to hear is what the Government is doing to ensure this hospital will open.

The board is a representative of the State here. The board is taking action on behalf of the Government. The Deputy knows well that that is the case. She is making a claim regarding the Government not being involved in this despite the fact that the board of the hospital is acting on behalf of the Government.

As regards the charges the Deputy made regarding the performance of our health services at the moment, what she neglected to say in the charges she made against the Minister, Deputy Donnelly, and the Government is that 2023 was the second year in a row in which waiting lists fell for key procedures in our hospitals, we have seen a reduction of almost one third in the waiting times for really important procedures and we see a reduction in outpatient waiting lists, despite the big increase we see in the demand for healthcare in the aftermath of the pandemic.

That is our record on healthcare. The Minister for Health, Deputy Donnelly, has been instrumental in the delivery of those improvements, just as he has been in the agreement we have reached regarding the better funding of healthcare services in Ireland for this year and next year.

In each of the answers I have given to the Dáil this afternoon on this topic, I have acknowledged what should have gone better in relation to this hospital, my role in it and what we have done to try to fix it for the future and ensure learnings are learnt in this regard. I have also emphasised the steps the Government is taking to minimise cost at this stage and to get the hospital open as soon as possible.

For almost a year, Israel has been waging a genocidal war against Palestinians. More than 40,000 people in Gaza have been murdered. Israeli attacks on Lebanon have not just started in recent days, but rather they have been escalating over the last year. Over the last year, there have been approximately 10,000 attacks on Lebanon, resulting in the deaths of more than 1,000 people.

Israel has now massively escalated. It is indiscriminately carpet-bombing southern Lebanon. It is consciously and openly targeting civilian homes. In the last 24 hours alone, Israel has killed in excess of 500 people and murdered more than 50 children. There are now tens of thousands of people desperately trying to flee southern Lebanon. This comes after the acts of state terrorism, in which thousands of walkie-talkies and pagers were blown up across the country, maiming and killing women, children and men.

Similar to before the genocide in Gaza, we have public statements from Israeli leaders telling the world their intent to commit war crimes. The Israeli minister for foreign affairs tweeted that any civilian living near Hezbollah weapons should leave their homes immediately for their own safety. That is an admission it is targeting people's homes in Lebanon, with exactly the same justification it used to destroy Gaza. The Israeli minister for diaspora affairs openly stated that Lebanon does not meet the definition of a country and that the border needs to be changed.

Despite war crime after war crime for a year, the US continues to send weapons to Israel to commit these war crimes. A figure of $20 billion worth of weapons was agreed just last month. Is there no line Israel cannot cross? Is a ground invasion of Lebanon coming next, an all-out regional war? Will the Minister condemn these as the war crimes they are? Will the Taoiseach call at the UN for the US to stop sending Israeli weapons? We need actions more than words. Will the Government stop blocking the occupied territories Bill? Will the Government impose sanctions on Israel? Will it tell the Israeli ambassador not to come back?

Have any of the bombs that are raining down on Lebanon passed through Irish airspace? The Taoiseach told the Dáil that no airport in Ireland or Irish sovereign airspace was being used to transport weapons to the conflict. We know now, because of The Ditch, that was untrue. At least nine flights have carried tens of tonnes of Israeli explosives, ammunition, detonators and parts for fighters through Irish airspace. Will the companies involved, which are breaching neutrality and the law, be prosecuted? Can the Minister guarantee that no other flights, other than those nine flights, have gone through Irish airspace on the way to Israel, or does the Government have a do-not-ask, do-not-tell policy?

We know now------

I thank Deputy Murphy for raising what is such a deeply important issue for all of us, for the Middle East and for the world. The Taoiseach, the Tánaiste and the Government have been at the forefront in responding to and representing the views of the Irish people on the conflict in the Middle East and what this means for the people of Gaza and Lebanon.

The Taoiseach and Tánaiste, who are continuing this approach and this work in New York at the UN at present, have at every stage of this awful conflict made the case for and called for an immediate ceasefire, for the release of all hostages, and for unhindered and free humanitarian access to be provided to ensure those who are left, particularly within Gaza, have access to the care they need in conditions that are truly awful and terrible. The Government will continue to make the case for this at the UN and to engage with partners within the EU and across the world on this issue. The Deputy will be aware of the initiative under way on the part of Egypt, Qatar and the US to try to put in place the conditions for a ceasefire. We call again for that to happen and to be adhered to.

On the point the Deputy has made on allegations regarding the passage of munitions through Irish sovereign territory, I inform the Dáil again that, for 2023 and the period to date in 2024, no applications have been received or exemptions granted for the carriage of munitions of war on civil aircraft to a point in Israel. The House, including the Deputy, will be aware of our law in this area. The orders of 1973 and 1989 very explicitly prohibit the passage of munitions on civil aircraft through our airspace. No permission was sought and no permission was given. Of course, I am aware of the issues the Deputy has raised regarding the passage of aircraft through our airspace and the allegations being made in this regard. The Department of Transport is now conducting an examination into these reports and engaging with the carriers involved. We take any such allegations very seriously, but I go back to the substantive issue referred to, which is our ongoing condemnation of the loss of life and our active diplomacy within the EU and the UN to create the conditions for that to come to an end.

The Minister cannot with any sincerity on the one hand condemn the loss of life, saying we are doing everything we can to push for a ceasefire, and then turn a blind eye to weapons travelling through Irish airspace against the law to be used by Israel to commit these war crimes. He cannot in all sincerity claim to be doing everything he is doing to secure a ceasefire while refusing to mention the one thing that enables Israel to do what it is doing, namely the tens of billions of dollars worth of weapons given to it by the US to commit these war crimes. He refuses to mention it and answer the question. Simon Harris should use his position at the UN to call for an end to those weapons, which facilitate the genocide happening and the assault on Israel.

The Minister did not answer the question as to whether any weapons currently being used against the people in Lebanon passed through Irish airspace. We know the same sort of explosives used in the pagers that blew up all across Lebanon, killing children, passed through Irish airspace. We do not know whether they were the exact same ones.

Even in matters of such importance, the Deputy cannot park his normal tactics of allegation and division. The Government has made clear again and again its condemnation of what is happening. It is this Government, with the support of the Oireachtas, that brought forward our recognition of the State of Palestine. It is the same Government that took action to protect UNGA to ensure the distribution of food to those who need it the most. Our Taoiseach and our Tánaiste have been at the front line within the EU in condemning what is happening and calling for and pushing for further action to be taken. The Deputy is looking to create a sense of some kind of tacit support for the passage of anything through our airspace. I have reminded him of what our law is and how it has been implemented and confirmed to him that no permission was sought or given. I do not believe any permission would have been given.

As for the action that will be taken in this regard, as I said, it consists of the investigation that is under way - I am sure the Minister for Transport will be able to give an indication of the outcome from it on its conclusion - and will be the continued implementation of our law saying we do not support and it is illegal for such materials to come into Irish sovereign territory or airspace.

It is time for us to recognise the profound impact the carer’s means test has on the lives of carers and those for whom they care, and to advocate for its abolition. The means test undermines the principle of fairness and social justice that should underpin our welfare system. This test assesses not just the needs of the person being cared for but also the income and assets of carers themselves. Under this system, even a modest income can disqualify carers from receiving the carer's allowance, making it harder for them to maintain financial independence. The intention behind this test was to ensure fairness but, in reality, it places an unfair burden on carers, forcing them to choose between providing essential care and earning a living wage. It has inadvertently become a barrier to the very support it aims to provide. It creates a cruel paradox whereby carers are penalised for trying to earn a living even when their caregiving duties prevent them from working full-time.

Caring for a loved one is not merely a responsibility, it is an act of compassion and love that often comes at great personal sacrifice. Carers perform tasks, often around the clock, without the luxury of regular working hours or financial compensation to match their efforts. The means test ignores the emotional, physical and financial toll that caregiving imposes on individuals. By restricting access to financial supports, the test devalues the significant contribution carers make to society. Without carers, many people would rely more heavily on State-funded care facilities, which would increase the cost to the State.

Many carers struggle to make ends meet, yet the means test cuts them off from crucial supports if their income is deemed too high in the context of arbitrary thresholds. It is a system that overlooks the fact that caring for someone is not just emotionally taxing, but can also be financially draining. Carers frequently face additional expenses, including medical equipment, home adaptations and transport to medical appointments, which put immense strain on household finances.

I also highlight that the carer’s allowance provides more than just financial assistance. It acts as a gateway to other essential services, such as free travel, household benefits and respite care. By restricting eligibility through the means test, many carers are also denied access to these critical services, making it even harder for them to manage their caregiving responsibilities.

Carers often experience high levels of stress, burnout and isolation due to the demands of caregiving and the financial strain imposed by the means test exacerbates these issues. This disproportionately affects women, who make up the majority of carers, and those from low-income backgrounds who are already vulnerable. This test creates a disincentive to engage in employment or pursue professional development, trapping carers in precarity.

The Minister is aware of the number of people who are in nursing homes because they have nobody to care for them. He is aware of the number of bed-blockers in hospitals for the same reason. Caring is a vocation. I ask the Minister and the Government to abolish the means test.

I thank the Deputy for raising this important matter. We all know that those who provide care to loved ones within the community make an invaluable contribution in supporting those who need help. By doing that, they complement the work of the State and alleviate pressure on our hospitals and nursing homes. Without the work of our carers, the pressures they face would be even bigger. In fairness to my colleague, the Minister for Social Protection, this is an issue she really understands. I will come on to the issue the Deputy raised in regard to the means test in a moment but, due to her recognition of this issue and the work the Government has done in recent years, carer’s allowance and carer’s benefit have been increased by €29 per week over a number of budgets. It is the reason the carer’s support grant was increased to €1,850, its highest level in the history of the State.

As for the Deputy's point in respect of means-testing, it is in recognition of this that the income disregards have now been changed, most recently in June of this year when they were increased from €350 to €450 for a single person and up to €900 for carers who have a spouse or partner. What the Government has aimed to do is to change the income disregards, recognising the issue people face, namely, that when a means-tested payment is provided, it can create difficulty for those who are just outside of it and that difficulty is added to when they are providing care for those they love in situations that are frequently very difficult.

I remind the House of probably the most significant change that has been made, which is the introduction of the long-term carer's contribution, doing more to help ensure that if somebody has been a full-time carer throughout their life, they have a better chance of accessing the State pension later in life in recognition of what they have done.

Deputy Fitzpatrick raised the issue of getting rid of the means test. What we have aimed to do over a number of years is increase the value of the payment and change the income disregard. Regarding the full abolition of a means test, for many social welfare payments, a means test is at the heart of how we can ensure our money goes to those who need it the most. The Minister has put a working group in place to assess this issue. I understand the working group will come back to the Minister and her Department with a report on this issue in quarter 4 2024, before the year is out. It is a complex issue but, as we are dealing with it, we have changed the value of the payment and the income disregards to recognise the immense work carers do in our country.

I thank the Minister for his response. In fairness, a lot of the things he mentioned are very good. However, in my situation, and I am sure it is the same for nearly every TD in the Chamber, many people come into constituency offices with the problem of having loved ones stuck in hospitals and nursing homes, and they have nobody to look after them. Nobody wants to be stuck in a hospital for six or seven weeks waiting for someone to look after them. There is a serious shortfall of carers. Both the Minister and I know the money is good, but it is not going to put bread and butter on the table for a family looking after a loved one. There are many genuine people out there who want to look after their loved ones but the means test is putting them off. It is a no-brainer because it will benefit everybody. The amount of money carers save the State is not thousands or millions of euro; it is a serious amount of money. There are many people out there affected by this. I know many people who are trying to get a place in a nursing home but cannot get one, and many people who are in nursing homes who should not be there. My proposal would be a win-win for everybody. I will put my hand up and say the Government has done a good job on the issue of carers in recent years, but an awful lot more could be done. There has to be an in-between. As the Regional Group will state in our motion tabled for tomorrow, we believe the best way forward is to abolish the means test and try to get these people looked after.

I meet the same people as Deputy Fitzpatrick does. They do such great work keeping family members out of nursing homes and hospitals, keeping them at home and giving them love and support. I also see the cost and impact it has on them as they provide that support. It is because of that we have made the changes I outlined to the Deputy, which he has been gracious enough to recognise in his supplementary question.

In terms of the means-testing element of what the Deputy is making the case for, the Department of Social Protection informed me that were the means test to be removed in its entirety, the cost of that alone for the carer's payment would be between €600 million and €2 billion per year. That is just for that payment. I am sure that if we changed the means testing for carer's payments, we would face equal calls to change it for other important social welfare payments. As I said, in recognition of the importance of this payment and the difference it makes, it is being examined. I am sure that will yield conclusions and some practical next steps. As that is being done, I know the Department of Social Protection, the Minister, Deputy Humphreys, and the broader Government will try to find practical ways to support our carers through payments and the other forms of support we make available to them.