Two significant things happened in January 2007. Apple unveiled the iPhone to the world. In Ireland, the government formally decided to build a new national children’s hospital, and promised it would be ready by 2011.
So how has that turned out, almost 20 years on? The iPhone has revolutionised how people live and redefined communication; more than three billion of them have been sold around the globe. The children’s hospital – well, we’re still waiting, and we don’t even know when it will open.
How can that be? How can a project everyone supported and desperately wanted be arriving so late? How is it that the hospital is going to cost a multiple of what we were originally promised? What does this mean for other big projects in the offing – the new National Maternity Hospital and MetroLink, for a start? And, more generally, how we run our country?
Stranger still is the lack of outrage at the waste of money. The media has, by and large, switched off on this story; the Opposition too. The public, fed a circular narrative of ‘Bam [the main contractor] versus hospital development board’, shows little interest. As Paul Weller sang so long ago, “the public wants what the public gets”.
But then Irish public life has become pretty surreal in the third decade of the 21st century. Billions of euros flow into the public coffers from international tax arrangements. We hardly have to worry about funding the present, though we’re fearful about the future. What if the tech tax pipeline gets switched off? Will we wait till then to start bemoaning the waste incurred on public projects? And our failure to even start other much-needed pieces of infrastructure?
Public spending profligacy was a recurring theme in my journalistic career, from interminable tribunals to botched IT projects and repeated overspending in health. Small scandals – such as the Leinster House bike shed or the National Gallery printer – seem to catch the public imagination while larger overspends induce a weary shrug of the shoulders.
Like Paul Weller, however, “I don’t get what this society wants”. Overspending at the children’s hospital bugs me; it’s our money as citizens, my money even. So I started digging deeper into the project, trying to understand what happened, interviewing dozens of people involved at various stages of its development. I talked to patients and their families, politicians, policymakers, builders and architects, on and off the record. I didn’t believe anyone deliberately set out to deliver an over-priced, massively-delayed hospital, but I wanted to see if the errors made could be identified and lessons learned.
The result is Billion Dollar Baby, a detailed but by no means exhaustive look at how the hospital is heading for a €3 billion pricetag and being completed a generation late. The problems on this project, I found, have roots going back many decades but which were made worse at nearly every turn through hubris, over-optimism, inattention to detail and institutional infighting. Many could have been avoided, or at least minimised.
I had lived with this story for many years. In 2014, I was the first journalist to tour the proposed site for the facility, which was then a jumble of old buildings and overgrown patches of weeds at the western end of St James’s Hospital. Even by then, the project had had a controversial history, marked by political machinations, resignations and money issues. The location had been changed once, but planning permission to build it southwest of the city centre had been granted two years earlier.
Gazing over the area from an elevated vantage point, the project director and I tried to imagine the giant building that was to arise on this spot. Ireland’s biggest construction project; a cutting-edge hospital for the sickest children. It was hard not to be excited at this impending symbol of the country’s modernisation.
After that visit, the site was cleared and an enormous hole was dug for the foundations of the hospital. But for a long time, and with apologies for the punning, nothing concrete appeared above the hoardings. Something was amiss.
In 2018, rumours reached me of money problems at the hospital. Just as construction was due to get under way, I started hearing how the bill for the project was increasing by millions of euro every week. How the final cost of a hospital that started with a €650 million pricetag was now heading for well over €1 billion. How, if this continued, the building could become the most expensive hospital in the world.
While the public remained blithely in the dark, officials in several government departments were aware of the problem, I was told. Some had even given the increasingly grandiose project a nickname – the Edifice Complex.
At the time, I was living nearby. I would often cycle past the site hoardings, gaily decorated with computer-generated images showing happy patients and doctors inside the clean-edged concrete and glass of a brash building. There was a panel illustrating the timeline of the project, which was regularly updated, yet always seemed to be out of date as deadlines constantly slipped.
No one would confirm the rumours. No firm information was available, I was informed. Finally, in December 2018, the exact figures for the overrun were set down in a cabinet memo, which was leaked to this newspaper. In just six weeks, the officially cited cost of the project had grown by €400 million. And further increases were forecast.
These were telephone-book numbers, in an era when telephone directories still existed. Their revelation triggered a political firestorm. A plethora of reports and investigations was ordered. The government of the time tottered but ultimately survived. After all, as Leo Varadkar tells me in an interview for the book, “the hospital was always a ‘hundreds of millions problem’ rather than a ‘billions problem’ like Brexit or tax policy”.
Construction started – and so did further problems. Turmoil in the wider world intruded. Covid-19. The Ukraine War. The aforementioned Brexit. As costs further escalated, the development board and Bam, fell out in the most public manner and ended up suing each other.
Fast forward almost a decade, and the cost is officially estimated at €2.24 billion, though few would be surprised if the final bill reaches €3 billion. There is still no end date for a project that was promised over 20 years ago. The completion date at St James’s has been delayed almost 20 times.
In 1919, Kathleen Lynn founded St Ultan’s children’s hospital in Dublin with £70 in the bank and two cots in a room. Over a century later, the national children’s hospital will open at some point with almost 480 beds and an operating budget likely to exceed €1 billion a year. It is not the most expensive hospital in the world, we are officially told.
I toured the as yet incomplete facility earlier this year. On the day of my visit, the vast interior space was eerily silent save for the sound of beeping alarms. The only people traversing the tiled ground-floor concourse were building workers and delivery staff kitted out in hard hats, high-vis jackets and plastic shoe-covers. The planned shops and food outlets along the concourse remained boarded up and empty.
The architecture is impressive, the materials used top-notch. The design, encompassing generous use of granite, glass and aluminium, shouts ‘no expense spared’. There are generous play areas between each finger of the building, a ‘meadow garden’ sits at the end of the concourse, a state-of-the-art hydrotherapy pool and gyms on upper floors, a rooftop helipad.
Standing above the atrium, the real meaning of the building can be gleaned not from these fancy elements, but from the fresh air in front of me – four storeys of it rising up from the entrance area and three more above me. This is dead space that would never exist in a private facility, the clearest expression that this is a statement building, designed to boost the morale of citizens. As my guide for the day remarked, “this is the sort of thing you see in Dubai”.
The building is a wonder, and I wish it well. But my concerns won’t go away once it opens. It will be expensive to operate, staff and expand. The job of amalgamating staff from different institutions with different work cultures is a mammoth undertaking, as the ongoing scandals at Children’s Health Ireland show. There is little sign that the promised maternity hospital will be built on the St James’s site in the near future, though this tri-location of adult, children’s and maternity hospital is regarded as the gold standard for patient care.
This is the story of a building but with patients at its heart. For many years, children’s care was the Cinderella of Irish health. Extremely sick patients were – and still are – being treated in often crumbling facilities in our existing, dilapidated children’s hospitals. With the hospital being completed almost a generation late, something like 900,000 children have missed out on the chance of being treated in it. Meanwhile, at a rough estimate, about 5,000 social homes could have been built with the over-spend on the project, or more than 1,500 hospital beds. Depending on what eventually happens in the courts between Bam and the development board, the final overrun on this project could be higher than currently projected.
The story of the children’s hospital, in all its twists and turns, its shocks and reverses, fascinates and appals in equal measure. It is a story about Dublin, and great rivalries in a small place. About promises that were made to a generation of children who, ultimately, were let down by the delays that occurred. It touches on medicine and money, obviously, but also politics, religion, academia and business.
Current headlines tell us only part of the story; the project’s problems have their roots in decisions and events from years, even decades, ago. Overspending, delays and underestimation of costs occurred well before Bam got involved. One minister summed it up pithily as “the wrong design, on the wrong site, contracted in the wrong way and built by the wrong main contractor”.
Most of all, this story is about people; families who have been let down too often before, and whose children have had to wait far too long for the world-class hospital in which they were promised they would receive treatment.
Paul Cullen is a former health editor of The Irish Times. Billion Dollar Baby – How Ireland Built Its National Children’s Hospital – At Any Cost, is published by Hachette Ireland
