One person must be ‘on the hook’ for children’s hospital, HSE report states

Potential for future cost increases remains, according to HSE document

The HSE report found there is a “lack of individual accountability for the success” of the national children’s  hospital.

The HSE report found there is a “lack of individual accountability for the success” of the national children’s hospital.


One person needs to be appointed who is “on the hook” for the budget, quality and timeline of the new national children’s hospital, a Health Service Executive report has recommended.

Advisers to the project need to be more rigorously scrutinised and there should be one single point of accountability, it says.

The relationship between the builders BAM and the main hospital board should be “reset” and needs to be more “constructive, collaborative and trusting, and not combative or hostile”. A neutral mediator was also suggested as a way in which to create a “safe environment” to discuss any tensions.

The document referenced “entrenched behaviours” between the project teams and the builders.

The report was compiled late last November and detailed options for the project including the potential to “mothball” certain sections of the build. It was circulated to members of the Public Accounts Committee this week.

The memo found there is a “lack of individual accountability for the success” of the hospital.

“It would be beneficial for there to be a single point of accountability for the project in the role of senior responsible owner: one individual needs to feel that he or she is on the hook for the performance of the project in terms of commercials, budget, timetable and quality.”

It also states that is “unclear that appropriate scrutiny and management of advisers has taken place consistently across the project. It would be of benefit to input this rigour into the project going forward.”

It also calls for peer reviews to ensure a “further level of scrutiny”.

The Government decided last December to proceed with the second phase of the build with the current contractor BAM instead of putting the project out to tender again, but the HSE said in the report that BAM was in a stronger position from the very beginning. “BAM are likely to understand that the other options are less attractive than continuing with themselves, meaning discussions do not start from a position of strength.”

Potential risk

Despite the conclusion of the process to find a guaranteed maximum price, it was considered that there is still the potential risk that “relations do not improve” and the entirety of the next stage of the build proves difficult. There is also still the potential for future cost increases.

A large section of the report deals with measures which could potentially improve the relationship between the hospital board and BAM.

“The collaborative nature of the relationship must still enable the National Paediatric Hospital Development Board to hold BAM to account.

“Mediation is a process that will take time. It is not a one-off event, behaviours will not change as a consequence of a single meeting. A neutral external mediator should be considered as a way of diffusing potential areas of tension and to create a ‘safe’ environment in which to explore potential barriers to the type of relationship that BAM and the NPHDB need going forward.

“While it is important to understand historical events to enable the relationship to move forward, emphasis must be put on the relationship needed to deliver phase B successfully, rather than damaging the relationship by debating historical events.”

The report also found that certain elements of the hospital could be “mothballed” if needed, including elements of the fit-out.

It comes after a report by consultants PwC was published this week which found that “red flags” were missed from the very start of the project.

The PwC report found that there remained a “significant risk on this project, which would require careful monitoring and control.”more, elements of the design still have not been finalised.

The cost could rise by almost €100 million if construction inflation increased to 10 per cent this year.

If an upwards trend inflationary continued, there would be a “material cost implication over the duration of the construction” of the hospital out to 2022. There is “very limited protection” for the State against such inflationary increases, the report said.