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1billion to build children's hospital

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    #92
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    cabledude wrote: »
    Anita Blow wrote: »
    You can try dismiss it by suggesting the terms of reference were deliberately framed to place it at James' (despite this report being commissioned almost a decade before James' was settled on as the location). The reality is that the evidence favours co-location with a major tertiary hospital. The major tertiary hospitals are located in and around the city, and so this takes precedence over ease of access for outpatients. In fact, a quick check on google maps shows that there is less than 6 minutes in the difference in travel time for someone travelling from the west of the country to Connolly VS James'.
    Evidence to support co-location:
    • 16/17 of the top paediatric hospitals are co-located with a major adult teaching hospital (McKinsey 2006)
    • "Children's acute hospital services should ideally be located in a children's hospital, which should be physically as close as possible to an acute general hospital" (Bristol Enquiry 2001). For example, the cardiothoracic surgeons in Crumlin (which acts as the national centre for paediatric cardiac services) also work on adults in James'. At present they are 8 minutes away if they are needed for emergency care in Crumlin. A children's hospital at Connolly would increase this 3-fold.
    • "Children's specialist acute hospital services should be co-located with adult, maternity & neo-natal services" (Scottish review of paediatric services, 2004)
    • The Queensland Review 2006 recommended the merger of 2 paediatric hospitals into a single hospital, on the campus of a major adult hospital "to act as the hub of state-wide network of paediatric tertiary services"

    Co-location is international best practice. That is a fact. Quality of care for the kids of the country takes precedence over ease of finding a parking space. We're not the first nor are we the only country that has their major hospitals located throughout the capital city.
    What does Google say about travel times from Limerick/Galway/Wexford to a greenfield site out aat the M50 vs inner ciry Dublin. A car travelling un-escorted. An ambulance under blue lights is a difference scenario obviously.
    From Limerick to Peamount, which is a greenfield site just outside the M50, is just 9 minutes less travel time than St. James'. A severely stunted children's hospital located miles from the adult hospitals & maternity hospitals it depends on is not worth 9 minutes less travel time for a non-urgent outpatient


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    #93
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Post above coming out weird and won't let me correct. In response to the post above
    From Limerick to Peamount, which is a greenfield site just outside the M50, is just 9 minutes less travel time than St. James'. A severely stunted children's hospital located miles from the adult hospitals & maternity hospitals it depends on is not worth 9 minutes less travel time for a non-urgent outpatient


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    #94
    cabledude
    Registered Users Posts: 842 ✭✭✭cabledude


    Anita Blow wrote: »
    Post above coming out weird and won't let me correct. In response to the post above
    From Limerick to Peamount, which is a greenfield site just outside the M50, is just 9 minutes less travel time than St. James'. A severely stunted children's hospital located miles from the adult hospitals & maternity hospitals it depends on is not worth 9 minutes less travel time for a non-urgent outpatient
    I don't think you get it. Getting into Dublin city centre, for those of us who don't live in or around Dublin, is a nightmare. Its a hideous city to try and get around by car. Imagine, if you can, having a child who is going through some sort of treatment. Mum will be in the back most likely. Dad or some other family member will be driving. Add all these factors into the traffic, abundance of road signs for every place except where you want to go. Then you have the heavy traffic, car parking issues and all the rest.

    If you and the people making the decision to locate this new hospital in the middle of an already congested city cannot see the merit of what I posted above, I don't know what to think. Co-locate by all means. Build the new hospital out in the M50 and build a new maternity hospital under the same roof.

    The families and children and logistics should not be discounted.

    And if you can drive to the M50 in 9 minutes less than getting to inner city Dublin you are some woman for one woman.

    PS. No-one believes Google Maps or AA route planner or any other app.


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    #95
    Sephiroth_dude
    Moderators, Computer Games Moderators, Social & Fun Moderators Posts: 80,003 Mod ✭✭✭✭Sephiroth_dude


    Typical Ireland overpaying again :rolleyes:


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    #96
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    cabledude wrote: »
    Anita Blow wrote: »
    Post above coming out weird and won't let me correct. In response to the post above
    From Limerick to Peamount, which is a greenfield site just outside the M50, is just 9 minutes less travel time than St. James'. A severely stunted children's hospital located miles from the adult hospitals & maternity hospitals it depends on is not worth 9 minutes less travel time for a non-urgent outpatient
    I don't think you get it. Getting into Dublin city centre, for those of us who don't live in or around Dublin, is a nightmare. Its a hideous city to try and get around by car. Imagine, if you can, having a child who is going through some sort of treatment. Mum will be in the back most likely. Dad or some other family member will be driving. Add all these factors into the traffic, abundance of road signs for every place except where you want to go. Then you have the heavy traffic, car parking issues and all the rest.

    If you and the people making the decision to locate this new hospital in the middle of an already congested city cannot see the merit of what I posted above, I don't know what to think. Co-locate by all means. Build the new hospital out in the M50 and build a new maternity hospital under the same roof.

    The families and children and logistics should not be discounted.

    And if you can drive to the M50 in 9 minutes less than getting to inner city Dublin you are some woman for one woman.

    PS. No-one believes Google Maps or AA route planner or any  other app.
    If you're coming from the country then you won't be driving through the city. James' is on the outskirts to the west and from the Rialto exit is 10 mins to the nearest M50 exit. I worked in St. James' for 2 years and travelled to and from there every day, I'm well acquainted with access.
    As I have said 3 times now, the planners have not discounted travel considerations. In fact they expressly did consider it and weighed it up VS the other competing factors. They reached the same conclusion that almost every other developed health system has, and they backed it up by citing several reports across 17 countries that showed that safety & quality of care, which only co-location can offer, trumps the relatively minor improved travel times that an M50 location offers. 
    Your alternative is not practically feasible. James' is 3 times the size of the NCH and also has an academic campus and several research facilities. It would cost multiples of what the NCH is costing to move the hospital, and would then cost many more hundreds of millions or even billions to establish the transport links (both roads & public transport- James' is served by Dublin Bus, Luas & Heuston station) that James' already offers. It would then cost hundreds more millions to build a maternity hospital there and it would severely stunt emergency care for neonates requiring transfer to the NCH. 

    If we could magic up an adult tertiary hospital, a national paediatric hospital and a maternity hospital with all the necessary transport links for them to function at the same time then it would work. But we can't. So in the 15-20 years it would realistically take to build a new adult hospital on the site of a greenfield paediatric hospital, quality of care for children would be severely compromised.


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    #97
    cabledude
    Registered Users Posts: 842 ✭✭✭cabledude


    Anita Blow wrote: »
    If you're coming from the country then you won't be driving through the city. James' is on the outskirts to the west and from the Rialto exit is 10 mins to the nearest M50 exit. I worked in St. James' for 2 years and travelled to and from there every day, I'm well acquainted with access.
    As I have said 3 times now, the planners have not discounted travel considerations. In fact they expressly did consider it and weighed it up VS the other competing factors. They reached the same conclusion that almost every other developed health system has, and they backed it up by citing several reports across 17 countries that showed that safety & quality of care, which only co-location can offer, trumps the relatively minor improved travel times that an M50 location offers. 
    Your alternative is not practically feasible. James' is 3 times the size of the NCH and also has an academic campus and several research facilities. It would cost multiples of what the NCH is costing to move the hospital, and would then cost many more hundreds of millions or even billions to establish the transport links (both roads & public transport- James' is served by Dublin Bus, Luas & Heuston station) that James' already offers. It would then cost hundreds more millions to build a maternity hospital there and it would severely stunt emergency care for neonates requiring transfer to the NCH. 

    If we could magic up an adult tertiary hospital, a national paediatric hospital and a maternity hospital with all the necessary transport links for them to function at the same time then it would work. But we can't. So in the 15-20 years it would realistically take to build a new adult hospital on the site of a greenfield paediatric hospital, quality of care for children would be severely compromised.
    You work in the health system then? So you have skin in the game, as they say. Also, 15-20 years is total BS


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    #98
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    It is now 11 years since planning begun for the NCH and building hasn't even started. It's estimated completion date is 2021, which is 15 years from when it planning started. How will relocating a hospital 3x larger, an on-site university campus and the numerous research facilities be completed quicker? Even barring the enormous physical task, where do we get the money to complete it in a shorter timeframe? The NCH which is 450 beds is now 1-1.5 billion (when you include equipment cost) for a single building. James's is over 1200 beds with numerous other state-of-the-art research and academic facilities. Rebuilding all that will not be cheap and I'd wager we do not have the money for it.


    I've raised several valid points and cited international sources for best practice. Instead of citing anything to counter them you're trying to insinuate I've something to gain. I've treated very sick kids during my time in hospital. My sole concern is the quality of their care, which is already severely compromised by the broken system we're forced to work in here. I'm not prepared to accept that being needlessly eroded further because Paddy thinks he's cracked some code that no other country has and wants to build a children's hospital miles from any of the adult hospitals it relies on for skilled staff, or maternity hospitals which depend on nearby paediatric facilities for emergency transfers, routine MRIs etc.


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    #99
    cabledude
    Registered Users Posts: 842 ✭✭✭cabledude


    Anita Blow wrote: »
    It is now 11 years since planning begun for the NCH and building hasn't even started. It's estimated completion date is 2021, which is 15 years from when it planning started. How will relocating a hospital 3x larger, an on-site university campus and the numerous research facilities be completed quicker? Even barring the enormous physical task, where do we get the money to complete it in a shorter timeframe? The NCH which is 450 beds is now 1-1.5 billion (when you include equipment cost) for a single building. James's is over 1200 beds with numerous other state-of-the-art research and academic facilities. Rebuilding all that will not be cheap and I'd wager we do not have the money for it.
    Thats the problem. Takes too long to make decisions in Ireland. A built on a green field site should take no more that 30 months.

    I've raised several valid points and cited international sources for best practice. Instead of citing anything to counter them you're trying to insinuate I've something to gain. I've treated very sick kids during my time in hospital. My sole concern is the quality of their care, which is already severely compromised by the broken system we're forced to work in here. I'm not prepared to accept that being needlessly eroded further because Paddy thinks he's cracked some code that no other country has and wants to build a children's hospital miles from any of the adult hospitals it relies on for skilled staff, or maternity hospitals which depend on nearby paediatric facilities for emergency transfers, routine MRIs etc.
    My bad, you are right. I've had a long weekend in front of a computer screen doing stuff I shouldn't have to be doing for people that are not worth it.

    Your passion for your work comes across very well. Our health service is lucky to have folks like you in it......

    And your arguement stacks up. Debate is about teasing out all the issues.


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    #100
    Spanish Eyes
    Registered Users Posts: 15,865 ✭✭✭✭Spanish Eyes


    Doctors and consultants agreed to this. That is the end game.

    Nothing will entice them to Tallaght or Blanchardstown. Not enough specialities there.

    They decided, not us, not the Government, they did. And they will all get designated parking too in James so they are all happy out.


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    #101
    xLisaBx
    Registered Users Posts: 901 ✭✭✭xLisaBx


    Am I the only one here who doesn't mind that this is costing 1 Billion? If it has decent facilities, better than the care we can currently provide for kids, is aesthetically pleasing and will help save countless lives, can we not put it down to a long term investment?


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    #102
    cabledude
    Registered Users Posts: 842 ✭✭✭cabledude


    xLisaBx wrote: »
    Am I the only one here who doesn't mind that this is costing 1 Billion? If it has decent facilities, better than the care we can currently provide for kids, is aesthetically pleasing and will help save countless lives, can we not put it down to a long term investment?
    Its not about the cost, as such. Its the inflation from the cost a couple of years ago. At a million euro per bed, a 487 bed hospital should cost €487m. Where does the other 513 million come into the picture?


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    #103
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    cabledude wrote: »
    I don't think you get it. Getting into Dublin city centre, for those of us who don't live in or around Dublin, is a nightmare. Its a hideous city to try and get around by car. Imagine, if you can, having a child who is going through some sort of treatment. Mum will be in the back most likely. Dad or some other family member will be driving. Add all these factors into the traffic, abundance of road signs for every place except where you want to go. Then you have the heavy traffic, car parking issues and all the rest.

    If you and the people making the decision to locate this new hospital in the middle of an already congested city cannot see the merit of what I posted above, I don't know what to think. Co-locate by all means. Build the new hospital out in the M50 and build a new maternity hospital under the same roof.

    The families and children and logistics should not be discounted.

    And if you can drive to the M50 in 9 minutes less than getting to inner city Dublin you are some woman for one woman.

    PS. No-one believes Google Maps or AA route planner or any other app.

    I think that it is you that cannot see the merit in the decision that was taken.

    If co location means that children's outcomes are better then what of it if out patients are slightly inconvenienced. Are we really going to value the 30mins of an out patient sitting in traffic higher than a critical 5 mins to save a child's life in an emergency?


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    #104
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    I think its important that project costing and tendering be explained to those here that do not understand it.
    • Initially there is a budget, this is usually high level and generated quickly and unfortunately, generally ambitious.
    • The design team and the client sit down and work out exactly what they want and where they want it.
    • A planning application is made
    • Following planning a tender is produced. This is costed internally by the design team, and is then sent out to contractors for pricing. The internal costings are extremely sensitive (as this gives the contractors a target) and the contractors bids are commercially sensitive.
    • The tenders are evaluated and the most economically advantageous is selected to construct it. This is usually the lowest price, and it is fixed. The contractor cannot charge more than the tender price unless there are changes after the contracts are signed.

    There can be a huge difference between the initial high level cost and accepted tender price due to a number of factors:
    • Feature creep
    • Difficulties with the site not initially foreseen e.g construction access, contamination.
    • Inflation
    • Higher level of finish quality
    • Different final design to the initial one envisioned.
    • Market climate

    Without knowing the specifics, I would take a guess that the increase in cost from the initial budget vs todays price is a combination of all of the above, but that market climate has a large part to play in it.

    Finally, building in Ireland is extremely expensive. This is largely down to the high cost of labour. If we want cheaper buildings, then we would have to pay our brickies, electricians and other trades less.


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    #105
    mikeoneilly
    Closed Accounts Posts: 479 ✭✭mikeoneilly


    oppenheimer1 wrote: »
    I think its important that project costing and tendering be explained to those here that do not understand it.
    • Initially there is a budget, this is usually high level and generated quickly and unfortunately, generally ambitious.
    • The design team and the client sit down and work out exactly what they want and where they want it.
    • A planning application is made
    • Following planning a tender is produced. This is costed internally by the design team, and is then sent out to contractors for pricing. The internal costings are extremely sensitive (as this gives the contractors a target) and the contractors bids are commercially sensitive.
    • The tenders are evaluated and the most economically advantageous is selected to construct it. This is usually the lowest price, and it is fixed. The contractor cannot charge more than the tender price unless there are changes after the contracts are signed.

    There can be a huge difference in the initial high level cost due to a number of factors:
    • Feature creep
    • Difficulties with the site not initially foreseen e.g construction access, contamination.
    • Inflation
    • Higher level of finish quality
    • Different final design to the initial one envisioned.
    • Market climate

    Without knowing the specifics, I would take a guess that the increase in cost from the initial budget vs todays price is a combination of all of the above, but that market climate has a large part to play in it.

    Finally, building in Ireland is extremely expensive. This is largely down to the high cost of labour. If we want cheaper buildings, then we would have to pay our brickies, electricians and other trades less.

    Lol at this

    It's all the Brickie's fault


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    #106
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    mikeoneilly wrote: »
    Lol at this

    It's all the Brickie's fault

    Go on then, you tell us why its so expensive to build here.

    I'm all ears.


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    #107
    kupus
    Registered Users Posts: 4,151 ✭✭✭kupus


    oppenheimer1 wrote: »
    Go on then, you tell us why its so expensive to build here.

    I'm all ears.

    Health and safety.

    It used to be about common sense. Then they realised they can make money from common sense.

    They repackaged it and called it health and safety.

    It caused costs to rise for small time builders and all businesses in general so much so, that a lot of them went wallop.
    Their businesses were taken over by the bigger ones, who of course were canvassing the gov for health and safety.


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    #108
    JupiterKid
    Moderators, Social & Fun Moderators Posts: 12,575 Mod ✭✭✭✭JupiterKid


    Ridiculous and totally unjustified cost hike. How can this be ok in any sense?

    Should be a matter for the Public Accounts Committee and the Dept of the Auditor and Comptroller General.


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    #109
    mikeoneilly
    Closed Accounts Posts: 479 ✭✭mikeoneilly


    Construction inflation doesn't explain it

    More likely miscalculation and the usual vested interests and brown envelopes to be taken care of


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    #110
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    kupus wrote: »
    Health and safety.

    It used to be about common sense. Then they realised they can make money from common sense.

    They repackaged it and called it health and safety.

    It caused costs to rise for small time builders and all businesses in general so much so, that a lot of them went wallop.
    Their businesses were taken over by the bigger ones, who of course were canvassing the gov for health and safety.

    In case there was any doubt, you've confirmed to us that you know nothing about the construction industry.

    You may call it common sense, but it isn't all that common especially on sites where time and profit are on the line. If it wasn't for the legislation on H&S deaths would be still at the levels seen in the 70's on Irish sites. There is a cost to proper health and safety, but it is far less than the cost of an accident, both in human and financial terms.

    The drivers of construction cost in Ireland are land and labour. Materials are also more expensive but they only form a small proportion of the build cost (typically 33%). In the case of the hospital, they already have the land, so the reason this building costs more in Ireland than in another country is the price of labour.


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    #111
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    mikeoneilly wrote: »
    Construction inflation doesn't explain it

    More likely miscalculation and the usual vested interests and brown envelopes to be taken care of

    Have you any evidence for the above?

    No. Thought so.


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    #112
    cnocbui
    Registered Users Posts: 19,692 ✭✭✭✭cnocbui


    oppenheimer1 wrote: »
    Have you any evidence for the above?

    No. Thought so.

    The testimony of Ahern is pretty good evidence.


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    #113
    kupus
    Registered Users Posts: 4,151 ✭✭✭kupus


    oppenheimer1 wrote: »
    In case there was any doubt, you've confirmed to us that you know nothing about the construction industry.

    I know it only too well lol


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    #114
    oppenheimer1
    Closed Accounts Posts: 6,084 ✭✭✭oppenheimer1


    cnocbui wrote: »
    The testimony of Ahern is pretty good evidence.
    Ahern is long gone and has had nothing to do with the hospital since it moved from the Mater.

    kupus wrote: »
    I know it only too well lol
    You clearly don't lol.


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    #115
    cnocbui
    Registered Users Posts: 19,692 ✭✭✭✭cnocbui


    Nice deflection.


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    #116
    satguy
    Registered Users Posts: 1,745 ✭✭✭satguy


    All these builders will need somewhere to park their cars if they go with JS.

    That should be fun ..


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    #117
    Idbatterim
    Registered Users Posts: 17,840 ✭✭✭✭Idbatterim


    no, no proof of any shady dealing. But its Ireland... But you are 100% right, because WE dont have any proof, Im sure its all above board, the taxpayer is number 1 concern, I'm sure we have top people making the best decisions... Ill let you know when I hit Vicar street lads...


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    #118
    kupus
    Registered Users Posts: 4,151 ✭✭✭kupus


    http://www.independent.ie/irish-news/health/hse-forced-to-remove-details-of-billions-in-payments-from-website-30455702.html


    shady dealings for all

    \0/

    Money really grows on trees


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    #119
    satguy
    Registered Users Posts: 1,745 ✭✭✭satguy


    satguy wrote: »
    It's in the wrong place..
    It's same size as the one its replacing..
    It will overrun on cost and will end up costing 1.2 Billion..
    It will cost another 500 or 600 Million to fit out..
    It will lay idle when built as there is no Staff, or no parking if they do find Staff..
    It's going to be a Rush Hour nightmare, so only get sick on Sunday's ..

    There is 100 acres at Newlands Cross,, or there is another 100 acres at Peamount Hospital..

    Newlands Cross is where it should be.. the luas goes past, the Nass Road is a fine 3 lane road with many bus routes nearby.

    Just quoting and old post I made /said in / on 23-02-2017, 22:25


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    #120
    Lone Stone
    Registered Users Posts: 3,405 ✭✭✭Lone Stone


    Comes across as one of those old mafia construction jobs where they just never finish it and go over budget to suck up as much payroll as they can. What a ****ing a joke they should get as much of that back as possible and throw some one ln prison scamming *****.


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    #121
    professore
    Closed Accounts Posts: 5,857 ✭✭✭professore


    Anita Blow wrote: »
    Because a greenfield site doesn't have the level of public transport access nor co-location it would need.

    Outside the M50 and extend the Luas to it. Plenty of public transport options then and people from outside (and inside) Dublin could actually get there without further clogging up the city.

    As someone who had a child in Crumlin for several months, this was a much better location than in the city centre. The quality of care was excellent.

    I get the specialty argument thing ... but you still have to go to other hospitals at other locations anyway for specialty treatment even after this is built.

    The last thing families need with a sick child is to be struggling paying several hundreds a day for accommodation in Dublin City Centre - which is what it costs now. How many rooms are planned for parents of sick children?

    Also for front line and support staff, this choice severely limits the liveability. It's grand if you are a consultant on several hundred grand with reserved parking, but not so much for junior doctors, nurses, janitorial staff etc.


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