Lets be real here: The Children's Hospital is a scam

Pete_Cavan wrote: »

Per bed is too crude a metric here. .....

It isn't really. It trying to build the Grand Designs version of Hospital, with an expensive shape and in an expensive location. We can't afford it.

Pete_Cavan wrote: »

We have created this parking issue by trying to allow everybody drive everywhere all the time. The NCH has good transport links, the population that can access it within an hour by walking, cycling, Luas, Dublin Bus and Heuston station is huge. Most of the daily journeys will be from staff and visitors who can and should use public transport. Children go there for long term treatment but because they scrapped their knee....

Having sat and stood for hours in overflowing children's outpatients and A&E. I think a lot of daily journeys are from outpatients. Looking at temple street 51% of children are in outpatients, 38% emergency, 11% inpatients. I have cycled to the childrens hospital, but I've never cycled an hour to one WITH a child needing to go to hospital.

Hamsterchops

Ireland's new National Children's Hospital, to be located in Dublin's city centre, squashed into The already over crowded St James hospital site :cool:

Should have been built on a new greenfield site (outside the city centre), readily accessible from anywhere on the island without the need for total stress & anxiety travelling into Dublin's city Centre, in heavy traffic?

beauf wrote: »

Having sat and stood for hours in overflowing children's outpatients and A&E. I think a lot of daily journeys are from outpatients. Looking at temple street 51% of children are in outpatients, 38% emergency, 11% inpatients. I have cycled to the childrens hospital, but I've never cycled an hour to one WITH a child needing to go to hospital.

I was clearly referring to staff cycling to the hospital. Do you think members of staff bring a sick child with them to hospital every day? I don't know why it is so hard for people to understand that only a small percentage of the journeys to the NCH will be with sick children. There will be hundreds of movements to and from the hospital every day which can and should be by public or active transport. It suits some peoples narrative to keep saying you can't bring a sick child on public transport or a bike but that is irrelevant. I would hope that mods would step in where people come out with that as it seems every page has multiple posts of the same inaccuracy.

The NCH is for seriously ill children, most of whom require long term treatment. These children are generally sent there under a treatment plan where arrangements are put in place before hand. The comings and goings are for outpatient and emergency care which are provided for at two satellite centres beside the M50. So the services which see children regularly coming and going to/from the hospital are beside the M50, the acute care is co-located with a highly specialist hospital which already has the sophisticated equipment and labs in place so children don't have to be transported to them.

Northernlily wrote: »

I don't think it's a scam. I think senior civil servants are as incompetent as they seem for letting BAM get such a contract like this in place.

Governance and accountiblity has failed. Heads need to roll.

What specifically would you have done differently with the contract if you were in charge?

PearseCork92 wrote: »

We may as well shut down boards altogether then. Any topic we touch on will have experts that you can defer to and outsource all your thinking to - and we can all go to bed at night happy in the knowledge that said experts get it right all the time and it's a waste of time probing what they commit to a report.

Tell you what - next time you or your family member is facing a serious medical issue, we'll bypass all those bloody medical experts and we'll organise your treatment based on what the Boards experts will say. Are you happy to put your future in the hands of Boards.ie advisors?

Hamsterchops wrote: »

Ireland's new National Children's Hospital, to be located in Dublin's city centre, squashed into The already over crowded St James hospital site :cool:

Should have been built on a new greenfield site (outside the city centre), readily accessible from anywhere on the island without the need for total stress & anxiety travelling into Dublin's city Centre, in heavy traffic?

You know that lots of people, probably the highest density housing in the country, live directly in the city?

TheW1zard

They went to construction with no spec in the contract. It will cost more than 2 billion.

TheW1zard wrote: »

They went to construction with no spec in the contract. It will cost more than 2 billion.

So you would have delayed the tendering of construction for the additional year or two that would be required to produce a detailed design spec? How much additional time would this have added to the project schedule? How much would construction inflation have added?

Yuser.

AndrewJRenko wrote: »

What specifically would you have done differently with the contract if you were in charge?

Loose design costs money

It's that simple

Pete_Cavan wrote: »

I was clearly referring to staff cycling to the hospital. Do you think members of staff bring a sick child with them to hospital every day? I don't know why it is so hard for people to understand that only a small percentage of the journeys to the NCH will be with sick children. There will be hundreds of movements to and from the hospital every day which can and should be by public or active transport. It suits some peoples narrative to keep saying you can't bring a sick child on public transport or a bike but that is irrelevant. I would hope that mods would step in where people come out with that as it seems every page has multiple posts of the same inaccuracy.

I'm pointing out the high volume of long term outpatient trips. It's not grazed knees as you do condescendingly inferred from over protective protective parents. It's the NATIONAL children's hospital. 2/3s of it's catchment is not in Dublin.

Likewise the staff will not all live beside it. A large % will be in the commuter belt which can be long way from the hospital. I saw a report once that 90% of staff drive to work, as they were promoting the cycle to work scheme.

Their already had serious parking issues at St James

https://www.google.com/search?q=st+James+parking+dispute&oq=st+James+parking+dispute&aqs=chrome..69i57j33i160.13189j0j7&client=ms-android-xiaomi-rev1&sourceid=chrome-mobile&ie=UTF-8

Was the same with the Mater, even with the new car parks.

You promote public transport and cycling as it's a personal interest. I'm also cyclist and advocate of public transport and getting out of the car. But the reality is the infrastructure isn't there and won't be there when this hospital is finished. St James is on my old 14k cycling route to work. It's an awful location to get to.

What your talking about is aspirational not realistic.

Pete_Cavan wrote: »

The NCH is for seriously ill children, most of whom require long term treatment. These children are generally sent there under a treatment plan where arrangements are put in place before hand. The comings and goings are for outpatient and emergency care which are provided for at two satellite centres beside the M50. So the services which see children regularly coming and going to/from the hospital are beside the M50, the acute care is co-located with a highly specialist hospital which already has the sophisticated equipment and labs in place so children don't have to be transported to them.

The problem is the specialist and their team that you're concentrating in the national hospital work will mostly be the same team in outpatients. So those people can't be a short walk from both locations. You seem to operating under this idea of the grazed knee mindset. Minor/Major treatments in different locations. From a catchment that's mostly beside it. Not a long term on going care with the same team for many years in the same location. With people coming from all over the country for appointments.

Usually appointments are during business hours so everything is concentrated at peak gridlock. In one of the most gridlocked locations in Dublin.

That's before you get into the politics of the location, or how the reports choosing the location were manipulated. If the Mater was unsuitable it makes no sense that an sure with the same unsuitable characteristics, was chosen. Cost was largely ignored. Because to consider that would have eliminated the politically advantageous locations.

Ok the flip side choosing a location that's a nightmare to drive to. Will force some people out if cars. No matter how much more difficult it make their commute. Though personally before CV Covid I'd actually stopped using the train for my commute because of the overcrowding and gone back to the car. First time in about 20yrs I didn't have a tax saver ticket.

TheW1zard wrote: »

They went to construction with no spec in the contract. It will cost more than 2 billion.

Worse just like grand designs or Bannon they constantly changed it. They picked a site almost guaranteed hit issues once they broke ground.

None of this matters. No fixing it now.

AndrewJRenko wrote: »

How well do construction standard benchmarks in the Western world apply to Ireland for, say road building or say, residential developments? Would it be fair to say that construction costs in Ireland is generally significantly ahead of Western world benchmarks?

You don't have to concern yourself with roads or residential.

On previous hospital developments, we have been in line with other western countries.

You're missing the point though - it's not enough to say "ah sure we'd be 5 times dearer to build a hospital than anywhere else, aren't we dear for everything"
Construction projects are costed to the penny, so it is easy to see where costs are equal to or above international norms.
You need to ask why are we 5 times dearer.

wassie

I found this thread laughable. So many 'armchair experts' who either have zero understanding of commercial contracting on major public infrastructure projects or design & construction of hospitals.

Having works on new hospitals in 3 different countries, in my experience hospitals are amongst the most complicated public buildings that are designed & built in our society.

Advances in medical technology & equipment outpaces long construction times. Factor in the cost of this technology & equipment also rises many multiples over inflation, resulting in changes to design, time & cost.

A hospital is not homogeneous in its function, but a highly dynamic system of various parts & operations, not unlike its own village. Again, given the long construction times, often parts of the internal hospital layouts & functions invariably change in response to the dynamic needs of a hospital, again resulting in changes to design, time & cost.

Hospitals are never delivered on 'time & budget' because they are dynamic projects rather than static by their very nature.

Of course their should be high levels of scrutiny & oversight and errors will be made and people held accountable. But is that a reason not to build it versus the lives that will be altered for the better as a result of the health care that will be afforded to many in most cases for free?

5 years after completion people wont be bemoaning their new hospital.

Pete_Cavan wrote: »

Per bed is too crude a metric here. All the rooms in the NCH are single occupant with en suite and larger than normal to allow a family member stay the night, that is very unusual as most public hospitals would generally be based around multiple occupancy wards. It also has another family accommodation unit, a school for the kids there, educational facilities for staff and a research centre. The NCH has 22 operating theatres, more than it itself needs as it is also sized for the needs of a future maternity hospital to replace the Coombe. It also provides new facilities to also service the entire James's campus including Central Sterile Services Department, Catering Department, Deliveries receive and distribution, Waste Management Facilities, space for a future St James’s and Maternity energy centre, tunnel link to James’s for FM. I don't know what level of parking would be included in that rate but unlikely includes for three times as many parking spaces as beds, as is the case with the NCH. The NCH project also includes two other >5,000m2 satellite centres which include urgent care and general paediatric facilities. All of this hugely distorts a simple per bed rate.

I doubt those rates are applicable for a new hospital to replace James's either given the high level of clinical specialism and acute services there which is well above a standard hospital. It also has numerous national services including our National Blood Centre. The MISA building only opened there a few years ago which would be a €40m facility written off if abandoning the James's.

You're wrong I'm afraid.

The rerason there is a wide range to the per bed figure I gave you is because it covers every type of hospital built.
You seem to think all the others hospitals built in the western world in recent years are simple open-ward types with little facilities. You couldn't be more wrong.
There is absolutely nothing (other thn an inefficient design, which nowhere near covers the difference) that would make the NCH cost near the top of the international scale, and there is certainly nothing that would make it cost 4-5 times as much. All the elements you raise above would not be atypical for a large European or American hospital.

wassie wrote: »

I found this thread laughable. So many 'armchair experts' who either have zero understanding of commercial contracting on major public infrastructure projects or design & construction of hospitals.

Having works on new hospitals in 3 different countries, in my experience hospitals are amongst the most complicated public buildings that are designed & built in our society.

Advances in medical technology & equipment outpaces long construction times. Factor in the cost of this technology & equipment also rises many multiples over inflation, resulting in changes to design, time & cost.

A hospital is not homogeneous in its function, but a highly dynamic system of various parts & operations, not unlike its own village. Again, given the long construction times, often parts of the internal hospital layouts & functions invariably change in response to the dynamic needs of a hospital, again resulting in changes to design, time & cost.

Hospitals are never delivered on 'time & budget' because they are dynamic projects rather than static by their very nature.

Of course their should be high levels of scrutiny & oversight and errors will be made and people held accountable. But is that a reason not to build it versus the lives that will be altered for the better as a result of the health care that will be afforded to many in most cases for free?

5 years after completion people wont be bemoaning their new hospital.

I have worked on major hospital projects in Ireland and abroad, and I find your post unbelievable.

There are international benchmark costings for every type of building, including hospitals, honed through decades of quantity surveying and construction experience. The NCH project is multiples of any other hospital project on record.

The "forget the cost, think of the lives saved" and "it'll all be fine once it's built" arguments are frightening if you really have worked on hospital projects, if you worked in any senior position - this attitude is part of why costs are out of control.
The NCH could have been built for less than a quarter of what the costs are projected to be, based on international norms.
You, I, and all the other taxpayers will be paying back the difference for the rest of our lives. How many people will go without essential services because of the money wasted here?
I'd rather see those billions go to Irish healthcare rather than into the pockets of a Dutch multinationals shareholders.

Yuser.

It's great to be getting this first hand account from 2 hospital builders

AndrewJRenko wrote: »

Yes, you certainly know more than me about construction, by the sounds of it - so let's talk about the construction issues.

Let's not pretend you or I are hospital planning experts or health strategy experts. Let's not pretend that we know about what scams happened, though we have no actual detail when challenged.

So what are the construction/contract issues here? Are you saying this could have been done as a fixed price contract? How long would it have taken to complete the design work to the stage that a fixed price contract was feasible - every power outlet, every network point, light fitting, every water connection and drain?

The same as any other large, complex project (though honestly, the NCH is neither particularly large, nor particulalry complicated).
This is not the first hospital to be designed. It's not the largest or more complex to be designed. And designing hospitals is something that's done every day.
I'm sorry, but I laughed at your comment about "every power outlet..." etc.
That stuff is bead-and-butter. There are M&E consultants to design the layout of all that stuff, that's what they do, day in, day out.

A lot of the posters here seem to think this is the first time a hospital has ever been built.

wassie wrote: »

I found this thread laughable. So many 'armchair experts' who either have zero understanding of commercial contracting on major public infrastructure projects or design & construction of hospitals.

Having works on new hospitals in 3 different countries, in my experience hospitals are amongst the most complicated public buildings that are designed & built in our society.

Advances in medical technology & equipment outpaces long construction times. Factor in the cost of this technology & equipment also rises many multiples over inflation, resulting in changes to design, time & cost.

A hospital is not homogeneous in its function, but a highly dynamic system of various parts & operations, not unlike its own village. Again, given the long construction times, often parts of the internal hospital layouts & functions invariably change in response to the dynamic needs of a hospital, again resulting in changes to design, time & cost.

Hospitals are never delivered on 'time & budget' because they are dynamic projects rather than static by their very nature.

Of course their should be high levels of scrutiny & oversight and errors will be made and people held accountable. But is that a reason not to build it versus the lives that will be altered for the better as a result of the health care that will be afforded to many in most cases for free?

5 years after completion people wont be bemoaning their new hospital.

If the hospital is constantly changing and dynamic it makes no sense to build in location with no space or capacity to expand. A design of a building that makes its very difficult to change or add on to.

If the costs are massively overrunning, we are talking on global scale. Kinda indicates any future work on the same building, and location will be similarly difficult and overly expensive.

Hamsterchops

AndrewJRenko wrote: »

You know that lots of people, probably the highest density housing in the country, live directly in the city?

Not sure what your point is there?

BrianBoru00

Pete_Cavan wrote: »

James’s is Ireland’s largest adult teaching and research-intensive hospital with 39 clinical specialities and numerous national facilities. Some of these have highly specialised staff and equipment. For a population as small as ours, you can only provide this in one location, having them in two locations means buying twice as much incredibly expensive equipment and having twice as much staff each doing half the work. If the NCH isn't located where this is, you have to bring the patients to it and back which is not efficient. No patients or teams will have to be transferred now, thats the point. Not everything is different between adults and children, the person turning 18 means nothing to a serious disease.

While that makes sense it's quite abstract at the same time. I'm trying to understand why its so important on a practical level .
so the part from the OLHC website :
"
"The Cardiac team consists of 9 consultant paediatric cardiologists and 3 consultant cardiothoracic surgeons, with a further 9 non consultant doctors. The nature of congenital heart disease and its treatment requires a large multi-disciplinary team (MDT). The MDT team includes nurses, clinical nurse specialists, advanced nurse practitioner, advanced nurse pracitioner candidates, health care assistants, anesthesiologists, intensivists, psychologists, social workers, physiotherapists, clinical nutritionists, a pharmacist, play specialist, spiritual councillors, household staff and a large administrative team"

From my reading of that, they are a standalone team. From my ( thankfully ) relatively small dealings with that hospital they have all the facilities they require there and where they don't have the facilities it generally requires children to go to GOSH or the states.

So what additional benefits is that team going to get from moving to a site beside St. James?

TheW1zard

AndrewJRenko wrote: »

So you would have delayed the tendering of construction for the additional year or two that would be required to produce a detailed design spec? How much additional time would this have added to the project schedule? How much would construction inflation have added?

Eh yeah, and not 1.25 billion :pac:

Yuser. wrote: »

Loose design costs money

It's that simple

Why do you think that major projects all over the world are being done on a 'design and build' basis?

BrianBoru00 wrote: »

While that makes sense it's quite abstract at the same time. I'm trying to understand why its so important on a practical level .
so the part from the OLHC website :
"
"The Cardiac team consists of 9 consultant paediatric cardiologists and 3 consultant cardiothoracic surgeons, with a further 9 non consultant doctors. The nature of congenital heart disease and its treatment requires a large multi-disciplinary team (MDT). The MDT team includes nurses, clinical nurse specialists, advanced nurse practitioner, advanced nurse pracitioner candidates, health care assistants, anesthesiologists, intensivists, psychologists, social workers, physiotherapists, clinical nutritionists, a pharmacist, play specialist, spiritual councillors, household staff and a large administrative team"

From my reading of that, they are a standalone team. From my ( thankfully ) relatively small dealings with that hospital they have all the facilities they require there and where they don't have the facilities it generally requires children to go to GOSH or the states.

So what additional benefits is that team going to get from moving to a site beside St. James?

This is the second time you quoted this. It is one bloody team! Do you think the location of the NCH should be based on where that one team can operate from? There are lots of facilities and staff in James's which aren't available at Crumlin or any other hospital in the state. Even if they could continue to operate at a different location, I'm sure that team would benefit from operating from a bigger facility with more patients coming through and a bigger pool of staff together to share experiences. Scale is important in health care, particularly as it gets more specialised.

gctest50

RandRuns wrote: »

...............

The "forget the cost, think of the lives saved" and "it'll all be fine once it's built" arguments are frightening ................

The scumbags didn't seem too concerned about lives saved when they dropped the height by 10cm to skirt putting in sprinklers :

"The top floor of this iconic building is 29.9m high, marginally below the threshold of 30m, which prescribes an automatic requirement for life safety sprinklers," the report said. "It appears that the building has been re-engineered to deliberately avoid an essential life safety system given the fact that the top floor is just 100mm below the threshold for sprinklers."

https://www.independent.ie/news/environment/childrens-hospital-deliberately-designed-to-avoid-installing-sprinklers-claims-fire-brigade-36259501.html

RandRuns wrote: »

........
I'd rather see those billions go to Irish healthcare rather than into the pockets of a Dutch multinationals shareholders.

It'a just another wonky vehicle to get money into the pockets of friends of the right people

It's just this time its a childrens hospital - be something else next time

Nuclear power station perhaps ?

wassie wrote: »

Advances in medical technology & equipment outpaces long construction times. Factor in the cost of this technology & equipment also rises many multiples over inflation, resulting in changes to design, time & cost.

A hospital is not homogeneous in its function, but a highly dynamic system of various parts & operations, not unlike its own village. Again, given the long construction times, often parts of the internal hospital layouts & functions invariably change in response to the dynamic needs of a hospital, again resulting in changes to design, time & cost.

Yes, you can't specify large complex medical equipment at tender stage because it takes years from issue of tenders to when they are ordered and things move on in that time. It could be four years after the tender documents are completed to when it gets ordered and what was used when compiling tender docs can be replaced by something different.

Its for that reason that they introduced Reserved Specialists into the GCCC contracts. They realised that tendering everything under the main contractor at tender stage, some things need to be tendered separately later but the main contractor takes them as a subcontractor and coordinates installation.

Yuser.

AndrewJRenko wrote: »

Why do you think that major projects all over the world are being done on a 'design and build' basis?

Why do you think?