1

Sarah Cremin

From: Derek_Finnegan@health.gov.ieSent: 08 February 2019 17:11To: Public Accounts CommitteeCc: Kieran LenihanSubject: Fw: Fw:Information for PACandJOC Minutes of CHP&P Board meetings for Deputy

Alan KellyAttachments: Final Minutes of CHP&P Board 14 September 2017 (Mtg No 1).pdf; Final Minutes

of CHP&P Board 12 December 2017 (Mtg No 2).pdf; Final Minutes of CHP&P Board 17 January 2018 (Mtg No 3).pdf; Final Minutes of CHP&P Board 14 March 18 (Mtg No 4).pdf; Final Minutes of CHP&P Board 20 June 18 (Mtg No5).pdf; Final Minutes of CHP&P Board 19 September 18 (Mtg No6).pdf; Final Minutes of CHP&P Board 16 November 2018 (Mtg No7).pdf; Final Minutes of CHP&P Board 11 December 2018 (Mtg No8).pdf; Draft Minutes of CHP&P Board 18 December 2018 (Mtg No9) .pdf

Dear Committee of Public Accounts Secretariat, Please find attached minutes of the CHP&P Board meetings for the Committee Members' attention. Kind regards, Derek Finnegan. __ Derek Finnegan Parliamentary Affairs/FOI/Records Management __ An Roinn Sláinte Department of Health Bloc 1, Plaza Miesach, 50 - 58 Sráid Bhagóid Íochtarach, Baile Átha Cliath, D02 XW14 Block 1, Miesian Plaza, 50 - 58 Lower Baggot Street, Dublin, D02 XW14 __ T +353 (0)1 635 4030 health.gov.ie

----- Forwarded by Derek Finnegan/SLAINTE on 08/02/2019 17:08 ----- ----- Forwarded by Fionnuala Duffy/SLAINTE on 08/02/2019 16:20 ----- From: Siobhan Kennan/SLAINTE To: Paula Smeaton/SLAINTE@SLAINTE Cc: Fionnuala Duffy/SLAINTE@SLAINTE Date: 29/01/2019 18:36 Subject: Minutes of CHP&P Board meetings for Deputy Alan Kelly

Hi Paula As a follow on to a PQ reply given to Deputy Alan Kelly, the Department undertook to forward the minutes of the CHP&P Board meetings. There were nine meetings, the minutes of the last meeting are still draft. Fionnuala is checking one last thing, and will let you know when it is OK to release the documents to Deputy Kelly. Kind regards Siobhán

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__ Siobhán Kennan Assistant Principal Officer, Acute Hospitals Policy Unit 2 __ An Roinn Sláinte Department of Health An Roinn Sláinte, Bloc 1, Plaza Miesach, 50-58 Sráid Bhagóid Iochtarach, Baile Atha Cliath, D02 XW14 Department of Health, Block 1, Miesian Plaza, 50-58 Lower Baggot Street, Dublin, D02 XW14 __ M +353 (0)87 2802211 T +353 (0)1 635 4387 health.gov.ie ******************************************************** Email Disclaimer and; Legal Notice: http://health.gov.ie/email-disclaimer/ ********************************************************

Children’s Hospital Project and Programme Board Meeting (No 1)

Date: Thursday 14th September 2017, 2.00pm Hawkins House

Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, SecGen, DoH Dept of Health: Tracey Conroy, A/Sec Fionnuala Duffy and Siobhán Kennan, Secretariat John Pollock, NPHDB – Project Director Eilish Hardiman, CHG – Group CEO

HSE: Tony O’Brien, DG John Connaghan, D/DG Operations

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Welcome and Terms of Reference

The Sec Gen welcomed all to the meeting, outlining the separate roles of the CHP&P Board and Steering Group, the rationale for the Board’s composition of key accountable people to ensure the project is monitored and delivered against the agreed parameters for the programme in relation to timeline, scope and funding and the need to ensure that issues are addressed and resolved at the Steering Group with escalation to the Board only on an exceptional basis. The Board’s terms of reference were discussed, and an amendment agreed to provide for oversight by the Board of key dependencies of the project. It was noted that they may need to be adapted further in the future as the project progresses. Action: terms of reference to be amended with the inclusion of reference to need for the Board to maintain oversight of key dependencies. Board Secretariat

2.

CHP&P Steering Group Report

Update from John Connaghan, Chair of the CHP&P Steering Group

John Connaghan reported on the 2nd

meeting of the Steering Group, held on 29 August 2017. He noted the clear engagement by all parties to the work of the Group. Project Management Office support is required to manage the work, and interim support arrangements are in place pending the October appointment of a manager who has been identified for the post. The discussion identified clearly the key dependencies for the project, namely national ICT project, funding/estimates, legislation, workforce approval and equipping approach. ICT - March 2018 is a critical deadline for EHR approval by Government - all work and approvals necessary to enable the award of contracts to deliver the Acute Hospital and Shared Care Record elements of the EHR programme must be completed by then to ensure they are aligned with capital timelines and hospital commissioning requirements. A detailed mapping of the approval process is needed to ensure that the required work is completed in time. Equipping – MES is the preferred strategy of NPHDB. End February 2018 is the deadline by which a business case on equipping

Children’s Hospital Project and Programme Board Meeting (No 1)

NO. Agenda Item Discussion and Actions Agreed

Future Reporting arrangements from the Steering Group to the Board

the hospital and OPD Urgent Care centres must receive the necessary approvals in order for the MES option to be progressed in line with hospital / centres completion timelines. The NPHDB has appointed a team of experts to develop the business case. However engagement with DPER is needed now and the involvement and support of the Department, HSE and National Development Finance Agency (NDFA) on establishing DPER requirements and progressing the evaluation and decisions on the MES proposal is required. A Steering Group, chaired by DOH Deputy Sec Greg Dempsey, has been established to work on this issue. Future reporting arrangements: The reporting from the Steering Group Chair to the Board should be on the basis of reporting by exception on performance and project delivery against the approved parameters of specification, timelines and funding. In addition, selective qualitative information on other issues should be reported to the Board, including staff and hospitals’ Boards’ engagement on the integration process. Action: (1) ICT - Muiris O’Connor, Ass/Sec Department of Health, and Richard Corbridge, Head of ICT HSE to work out and work through the steps necessary to secure DPER support and EHR Government approval by the March 2018 deadline to enable contract awards. (2) Equipping - The Steering Group chaired by Greg Dempsey is to meet to advance the work necessary to progress the decision making process, including the identification of dependencies, and clarify roles of the NDFA in this process. This Group is to report to the CHP&P Steering Group and problem solve there in the first instance, with escalation to the Board if necessary. (3) Reports - Format for Chair reports to the Board to be agreed - John Connaghan/Board Secretariat

3.

Capital Project Status Reports

Construction project – John Pollock

John Pollock described the two phases of the main hospital build - Phase A (works below and up to ground level) has been agreed and is underway. The detailed design aspect of Phase B (works above ground) works is to be completed by January 2018, allowing the pre phase agreement and value engineering process to be completed by end June 2018. June 2018 is another major milestone as final scope and Guaranteed Maximum Price (GMP) will be known at that stage. A Memorandum to Government may be required in advance of instruction to contractor to proceed on basis of GMP. He outlined the work undertaken prior to signing the contracts in August 2017 and gave an update on projected final project cost following signing of contracts. It was noted that €62m of value engineering must be achieved in order to stay within approved project budget - €35m agreed to date and a further €27m required. An outline was provided of further potential costs, associated mainly with updated timeline for construction, contractor programme alignment and fire certification- for Board information at this stage rather than Board action. The necessity of managing the project within fixed approved parameters with additional costs avoided or addressed through amendments in scope was emphasised, and all options for addressing the potential variance are to be explored. It was noted that the actual costs will become clearer over the coming months as, for example, prime cost sum allowances are substituted with the actual prices. Action: John Pollock to prepare a brief for the Steering Group regarding the extent of additional costs establishing clearly the certain and less certain elements of any additional costs, timeline by which uncertain costs will be crystallised, and a risk management strategy including risk minimisation, possible savings through value engineering, design/scope changes, deployment

Children’s Hospital Project and Programme Board Meeting (No 1)

NO. Agenda Item Discussion and Actions Agreed

of contingency and philanthropy. (It was noted that value engineering trends should be clearer early in 2018. Fire certification will also be determined by that stage)

4.

Service Integration Status Reports

Children’s Hospital Programme progress – Eilish Hardiman

EH outlined the body of work being undertaken on preparing the CHG Board for their role in this phase of the programme, on due diligence, transfer of balance sheets, and engagement with the Boards and staff of the three hospitals to ensure readiness for single entity commencement. While a January 2018 commencement date would be preferable - – driven mainly by financial requirements - a plan setting out the steps required to enable all party buy–in to an early commencement date while ensuring operational stability is being developed for agreement with the three hospitals. Meetings with staff groups on integration have begun and initial response has been positive and cooperative. It is recognised that the integration phase, and requirement for additional staff, will put pressure on the HSE HR Directorate. EH has met with the HSE National HR Director and secured support. The extension of the programme to 2022 when the main hospital is scheduled to open means that annual funding requirements for the Children’s Programme integration investment and workforce need to be rephased. A person with international experience in opening hospitals has been appointed to the CHG team. The name of the new body, the result of an extensive process involving staff and stakeholders, is determined and likely to be revealed at the event to mark the first sod turning at the centre at Connolly. Action: Eilish Hardiman to agree a plan setting out the steps required to enable all party buy-in to an early commencement date while ensuring operational stability for agreement with the three Children’s Hospitals.

5.

Legislation Update

Update re establishment of legal entity and amendment of NPHDB functions – Tracey Conroy

The timetable for enactment of the legislation by end of year was noted. Engagement between the OPC and the Department on drafting of the Bill as quickly as possible is on-going. The General Scheme, referred by the Minister to the Chair of the Joint Oireachtas Committee on Health on 31 August, has been circulated by the Clerk of the Committee to members of the Committee for their consideration prior to their meeting on 20 September 2017. The strong reservations of the Chairs of the three hospitals regarding the viability of a 1 January 2018 commencement date, and the need to have an agreed commencement date as soon as possible were noted. In addition to completing the due diligence and legislation processes, a range of practical issues need to form part of detailed planning and preparations, e.g. the three hospitals need to write to all staff advising them of their change of employer.

6.

Strategic issues Status Reports – Eilish Hardiman

Model of Care for paediatric healthcare services

The roll-out of the national Model of Care for Paediatrics is key to the success of the new hospital. There was a discussion on the challenge in moving the Paediatric Model of Care (MOC) from design to implementation phase and appropriate implementation plan ownership within the HSE.

Children’s Hospital Project and Programme Board Meeting (No 1)

NO. Agenda Item Discussion and Actions Agreed

Philanthropy and fundraising

Dublin 8 Health & Innovation Corridor

EH has met with the three Foundations, who have agreed to become one Foundation and noted the challenge in fundraising for the three hospitals now that it is known the new hospital will be developed. The establishment of the new entity is required in advance of the establishment of the new Foundation and to establish a body to carry out philanthropy on behalf of the new body. Notwithstanding, a business case on philanthropy to the Department need not await the commencement of the legislation. The importance of the new body in fostering paediatric research, and the interest expressed in this by the EIB during its visit this week to Ireland as part of its assessment of the viability of investing in the project, were noted. A working group comprising representatives from SJH, CHG, the Coombe, IDA, John Pollock and the Deputy CEO of Dublin City Council is working on the concept for a proposal. Action: (1) Eilish Hardiman to submit a business case on philanthropy for the recruitment of a Director of philanthropy to the Department via the Steering Group. (2) DG to examine the issue of HSE responsibility and direction for MOC implementation

7. AOB & Dates for Future Meetings Time is to be left at the end of each Board meeting for reflecting on how the Board is working and can best contribute to the success of the project. The Board will meet again in early December. Action: (1) Two Steering Group meetings are to take place before the next meeting of the CHP&P Board in early December John Connaghan (2) December meeting date to be agreed Board Secretariat

Children’s Hospital Project and Programme Board Meeting (No 2) 12 December 2017

Date: Tuesday 12 December 2017, 2.30pm Hawkins House Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, SecGen, DoH Dept of Health: Tracey Conroy, A/Sec Fionnuala Duffy and Siobhán Kennan, Secretariat John Pollock, NPHDB – Project Director Eilish Hardiman, CHG – Group CEO

HSE: Tony O’Brien, DG John Connaghan, D/DG Operations

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Minutes and revised terms of reference

Agreed.

2.

CHP&P Steering Group Report

Update from John Connaghan, Chair of the CHP&P Steering Group

Draft CHP Integrated Programme 5-year Plan was circulated and explained by JC. To note, issues requiring discussion at a given meeting of the Board will be denoted by an asterisk. The progress on actions from CHP&P Board meeting No 1 were discussed, and new actions identified in relation to the following: Commencement mid-year: EH explained briefly the perceived benefits of a mid-year commencement, primarily in having legal authority to drive the integration-related discussions and negotiations with staff and unions. It was noted that the options appraisal to be undertaken by DoH will inform the final commencement date decision. Action 10/2: EH to look at the feasibility of both establishing the new entity on a statutory basis and transferring to the new entity the three hospitals at the same time, and establishing the new entity on a statutory basis in advance of the transfer to the new entity of the three hospitals and submit to DoH. Philanthropy – Director of philanthropy business case: EH stated that she had forwarded a draft business case to DoH for its views in advance of formal submission to DoH through the CHP&P Steering Group. Action 11/2: EH to circulate a formal business case for a Director of Philanthropy to CHP&P Steering Group for consideration by the Steering Group prior to submission by JC to DoH. Additional capital costs: Current estimated costs exceed approved programme budget of €983m by €61m. JP circulated a draft capital budget backstop plan which sets out means identified by the NPHDB in conjunction with the CHG of effecting savings totalling €61m. Following a review by the CHP&P Board of this plan, it was agreed that the proposals could not be

Children’s Hospital Project and Programme Board Meeting (No 2) 12 December 2017

NO. Agenda Item Discussion and Actions Agreed

recommended. Other means of effecting the savings or of securing alternative funds were discussed - including descoping areas which are not directly related to patient care or not required from commencement but with more modest savings, use of the existing €20m discretionary contingency fund (the remaining €15m of the €35m contingency fund being identified by JP as required to close out the GMP with the contractors); philanthropy; sale of existing or future assets including OLCHC. It was also noted that the potential shortfall in funding would not create a cash flow problem before 2022/23. In relation to philanthropy, EH stated that the three existing hospitals’ Foundations have agreed to merge and explore how they will work with the CHG. A group of the CHG Board, Chair Jim Browne, Catherine Guy and Peter Steer, has been formed to engage formally with the Foundations on this. The Foundations currently raise a total of €20m annually, and are of the view that a target of €100m is achievable for this project. If this sum were realised, it would provide €20m for the construction investment (as stated in the Memo for Government), and a possible €52m for further construction costs. The CRIC would be funded separately. In relation to assets, EH stated that only OLCHC have property assets which can transfer to the new entity, and a due diligence process is underway. She confirmed that further detailed information would be ascertained in relation to Temple St. She has met with HSE Estates to identify how to drive best value from the assets. JP stated that the €20m required for the installation of sprinklers in every room (which no other hospital has had to do) consequent on the decision by an Bord Pleanála is an externally driven cost, could not reasonably have been foreseen, and represented a change in scope for the project. Action 12/2: JP to submit a business case to DoH for additional funding of €20m to meet the cost of the fire safety sprinklers, required on foot of the recent decision by An Bord Pleanála. Action 13/2: The €20m in contingency funds to be assigned to known increases in costs as identified by the Board. Action 14/2: EH and JP to bring alternative options for addressing the shortfall to the SG for consideration. Action 15/2: JC to submit a full brief for Board meeting No 3. Equipping: JP stated that the NPHDB needs clarity on the business case model that DPER/NDFA will require to allow a decision on the equipping sourcing solution to be taken early in 2018, which is the timeline required for advancing the MES equipping solution (if such is the agreed mechanism for equipping the new children’s hospital). The business case required by DPER may also need to set out a cost benefit analysis with quantifications. Action 16/2: DoH to arrange a meeting between NPHDB/HSE/DoH and DPER/NDFA for week beginning 18 December, to clarify DPER/NDFA requirements for business case/CBA for equipping solutions. EHR/ICT: the drift in timeline to commence procurement of EHR for the new children’s hospital from April to August 2018 was discussed. Efforts are being made to identify if there is scope for mitigating the effects of this drift. Clarity on the process required to secure the necessary approvals within the required timeframe in 2018 is needed. Action 17/2: DoH to arrange a meeting between DoH (Muiris O’Connor) and HSE (JC, Jane Carolan and Fran Thompson) and CHG for week beginning 18 December to clarify next steps and process for securing necessary approvals in required timeframe. JC to prepare a briefing paper for the meeting.

Children’s Hospital Project and Programme Board Meeting (No 2) 12 December 2017

NO. Agenda Item Discussion and Actions Agreed

HSE Model of Care: JC reported that discussions are ongoing within the HSE regarding the appropriate governance structures within the HSE for delivery of the Model of Care, with two options under consideration – the Service Delivery Board within the Programme for Health Service Improvement, and the CHP&P Steering Group. Action 18/2: JC to report to the Board on progress made on the proposed governance structures at Board meeting No 3.

3.

Legislation Update

Update re establishment of legal entity and amendment of NPHDB functions – Tracey Conroy

Engagement between the OPC and DoH on drafting of the Bill as quickly as possible is on-going, and a third, almost complete draft by the OPC, has been received. The report of the Joint Oireachtas Committee following the pre-legislative scrutiny session on 25 October was received on 6 December. DoH and OPC are working to settling the Bill to allow for an end of January decision by Government to publish, leading ultimately to a possible end of May enactment date. Issues for consideration before the Bill is finalised include functions which the new entity should and could have, in a scenario whereby the entity was established in advance of the transfer of staff etc from the three hospitals (see Action 10/2), and what the new entity will be called in the Bill. The OPC has advised that a name for the new entity will have to be included in the Bill. While this name will be its legal name, it is possible to give the Minister an order-making power to give the new entity a different name for so-called operational purposes. Action 19/2: DoH to address these issues before finalising the Bill.

4.

AOB & Dates for Future Meetings Name of the new entity: JB noted that the Minister has stated publicly that the name Phoenix is unlikely to be the name of the new entity, and accordingly a decision is required as to the process for deciding on a new name. He stated that the Government will need to be satisfied with the process, and that the CHP&P Board should consider the process and advise the Minister. The recent naming process overseen by the CHG’s Naming Steering Group may inform the final process. As a major Government project, it would be necessary to seek approvals before the finalisation of a suitable name. Action20/2: CHP&P Board is to give further consideration of options for the process and timelines for selection of a name for approval by the Board in advance of a submission of a naming process proposal to the Minister in January – this may require convening a January meeting of the Board. Action 21/2: Secretariat to arrange meeting dates for 2018.

Children’s Hospital Project and Programme Board Meeting (No 3) 17 January 2018

Date: Wednesday 17 January 2018, 4.30pm Hawkins House Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, SecGen, DoH Dept of Health: Tracey Conroy, A/Sec Fionnuala Duffy and Siobhán Kennan, Secretariat John Pollock, NPHDB – Project Director Eilish Hardiman, CHG – Group CEO

HSE: Tony O’Brien, DG (by telecon) John Connaghan, D/DG Operations

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Minutes of Meeting No 2 Agreed.

2.

Naming process

“Naming of children’s hospital entity and facilities: process proposal” note circulated for the meeting was discussed. Agreed to recommend to Minister: (a) that the legal name of the entity to be established under the Children’s Health Bill be “Children’s Health Ireland”; (b) the naming process set out in in the proposal, subject to the following amendments: ensure criteria for consideration of potential names must allow for as wide a range of naming options as possible; and provide that the shortlist of 5 names emanating from the process is submitted to the CHG Board prior to submission to the CHP&P Board for consideration. (c) the announcement of the name will be made post enactment. Action 22/3: Secretariat to amend naming process proposal as discussed, and submit to Minister. Action 23/3: Subject to approval by Minister, EH and Secretariat to progress arrangements for the naming process

3.

Legislation update

The OPC third draft of Bill was circulated to the HSE, NPHDB and CHG Legal Entity Committee on 16 January 2018 - JC, EH and JP undertook to revert with comments by COB 22 January. OPC working on 4

th draft. Outstanding issues for the drafter include the preamble, and text required in the event that the entity

is established on a statutory basis in advance of the transfer to the new entity of the three hospitals. (Ref EH action 10/2 re feasibility of so doing.) Action 24/3: Secretariat to address any outstanding issues with the CHG and with the OPC.

4.

Status update on MES

Ref action16/2, DOH/HSE/NPHDB meeting held in December to clarify DPER/NDFA requirements for business case/CBA for equipping solutions. Further clarity and guidance is required in relation to the NDFA input to agreeing the approach to the monitorisation of risk transfer to facilitate completion of Business Case by End Feb 2018. Action 25/3: DoH to bring clarity to the role of the NDFA to enable JP to conclude the MES business case within required timeframe.

Children’s Hospital Project and Programme Board Meeting (No 3) 17 January 2018

NO. Agenda Item Discussion and Actions Agreed

Status update on EHR/ICT Ref action 17/2, meeting was held on 19 December 2017 between HSE, CHG and DoH to clarify next steps and process for securing necessary approvals for EHR within required timeframe. It was noted that the overall HSE governance arrangements for driving eHR implementation are to be discussed at the next CHP&P Steering Group meeting (25

th Jan).

Action 26/3: Secretariat to circulate to CHP&P Board the action log from minute of meeting of 19 December 2017. Actions therein to be progressed by relevant Action Owners.

Status update on capital budget and draft backstop plan No 2

JP circulated draft backstop Plan no 2 (16 January 2018). Options proposed for reducing cost overruns and for raising capital contributions were discussed. The proposed budget saving of €6m (derived from transfer of existing equipment and deferred procurement of medical equipment for 8 ICU beds) was noted and accepted as feasible. It was noted that the business case for the appointment of a Director of Philanthropy is being progressed through the CHP&P Steering Group as a priority requirement to develop and execute the philanthropic campaign. Action 27/3: NPHDB Board to note that the €20m in contingency funds is to be assigned to known cost increases as identified by the CHP&P Board (ref action 13/2) (JP). Action 28/3: JP to submit business case to DoH for €20m for sprinklers as an out of scope additional project cost (Ref action 12/2). Action 29/3: Alternative funding contribution options to be explored further including philanthropy, options on securing existing funds of the three children’s hospitals’ Foundations for this project; initiate/continue review of existing children’s hospitals’ assets and how to drive best value from them, including a value and disposal strategy for OLCHC and possible use of Temple Street (EH and HSE) - to be brought to the CHP&P Steering Group.

4.

AOB and next dates Meeting No 4 is scheduled for 14 March 2018 from 11.00 to 12.30 in Hawkins House.

Children’s Hospital Project and Programme Board Meeting (No 4) 14 March 2018

Date: Wednesday 14 March 2018, 11.00am Hawkins House Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, SecGen, DoH Dept of Health: Tracey Conroy, A/Sec Siobhán Kennan, Secretariat John Pollock, NPHDB – Project Director Eilish Hardiman, CHG – Group CEO

HSE: Tony O’Brien, DG John Connaghan, D/DG Operations

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Minutes of Meeting No 3 Minutes agreed. Noted that Minister approved naming process, which is to be progressed in due course.

2.

CHP&P Steering Group report Action 30/4: JC advised he would submit reworked CHP&P Steering Group reporting format, and critical path setting out activities, dependencies and timelines. EHR / ICT: JC reported on recent efforts and progress to bring clarity to the EHR / ICT process – (a) governance and management, (b) approvals process, (c) programme timelines and, based on progress on (a) to (c), a possible requirement for a contingency plan for the new children’s hospital. An agreed plan mapping out the EHR process (with timelines), and governance (including how it relates to the CHP&P Steering Group and Board) is required. Action 31/4: JC to seek convening of special HSE Leadership meeting re approval to a National EHR /ICT governance programme structure plan, including approvals process and timelines and, if agreed, submit to DoH for approval. To be referred back to the CHP&P Board only in the event that the plan is not agreed by HSE and DoH.

2. Backstop plan (No 3) Backstop plan (No 3) was discussed, including the issue of cash flow, including potential revenue generation through philanthropy and other means over the duration of the project; Department of Education contribution; children’s hospitals’ assets; naming rights; liquid assets of existing Foundations; car parking. The previous decision of the Board to assign €20m in contingency to cost pressures was re-affirmed, while noting that the expectation was that the contingency would be refilled though the strategies outlined and also that NPHDB would need to retain some discretion to make operational decisions to maintain the programme. TC reported on the preliminary discussion she had at a meeting on 13 March with Myles Gallagher (CEO of US-based Superlative Group), Jim Brown (Chair of CHGB) and EH, on naming rights revenue funding possibilities for this project. It was agreed that, subject to the Minister’s approval, the Superlative Group could be asked to carry out a preliminary analysis of the revenue generation possibilities for the project. Action 32/4: EH to submit to CHP&P Steering Group draft terms of reference and membership of project team (NPHDB, CHG, HSE Estates and others as appropriate) to oversee process for determining how to maximise the realisation of the value (both revenue and alternative

Children’s Hospital Project and Programme Board Meeting (No 4) 14 March 2018

NO. Agenda Item Discussion and Actions Agreed

best use) of Crumlin Hospital site. Action 33/4: EH and CHGB to progress engagement with the Mater Misericordiae Board Chair re future of Temple Street Hospital. Action 34/4: DoH engagement with Department of Education on the latter’s contribution to the capital cost of the education facilities in the hospital to be concluded by May, in time for subsequent inclusion in Memo for Government on costs. Action 35/4: Subject to clarification and sign off on governance arrangements for philanthropy (EH to submit business case for Director of Philanthropy to Steering Group (action ref 11/2 refers), DoH to submit naming rights preliminary analysis proposal to Minister.

3. MES Action 36/4: DoH to build on recent engagement with NDFA and aim to reach agreement on NDFA input as soon as possible.

4. Integration project EH reported on progress made in the integration project, and advised of appointment of Connolly OPDUCC manager, with 20 years’ experience running such centres in Canada. The CHP&P Board made special note of the excellent work and progress on the integration project. Action 37/4: JC and EH - Integration project is to be a standing order on the CHP&P Steering Group agenda, with a more detailed integration report provided to the March Steering Group meeting.

5.

Due diligence (Pre-CAR)

EH reported on the pre-CAR process - aiming for an action plan by end of March with listed actions, actors, and timelines. The CHP&P Board was of the view that each hospital Board member should sign a letter of representation attesting to the completeness and accuracy of all information and representations provided, rather than the CEOs on behalf of the Boards. It was also noted that while there was a general understanding that the relevant transfers would occur under the operation of the legislation, the pre-CAR process could identify exceptional liabilities which the new entity would not accept. Action 38/4: JC and EH – Pre-CAR is to be a standing item on the CHP&P Steering Group agenda, with a more detailed report on pre-CAR process and action plan, setting out timelines, clarifying decision-making pathways, and sign off etc required for the March Steering Group meeting.

6. Model of Care - implementation

JC gave an update on the work overseen by the DDG Strategy and Planning, and advised that the focus of the work is on what is needed for the CHP. The order of work, drawing from the Model of Care, is to devise a resource plan (including a reconfiguration of existing services) followed by an implementation plan. Action 39/4: JC to provide a detailed report on progress at the next CHP&P Board meeting.

7. Legislation update SK reported on textual changes and additions made on foot of consultation with HSE, LEC and NPHDB. While the Bill will not include a preamble, the Explanatory Memorandum which accompanies the Bill, and is published on the Oireachtas website, can be drafted to explain the background to the establishment of the new entity. OPC is satisfied that the existing text allows the entity and the Board to be established on a statutory basis in advance of the transfer to the new entity of the three hospitals. Legal advice on indemnification of Crumlin and Temple Street directors is under consideration. Action 40/4: Secretariat to address any outstanding issues with the OPC and on foot of indemnification legal advice.

Children’s Hospital Project and Programme Board Meeting (No 4) 14 March 2018

NO. Agenda Item Discussion and Actions Agreed

8. AOB: Sprinkler Funding Business case Date of next meeting

DoH has received the report and will take necessary action. No action required by CHP&P Board or Steering Group. Next meeting is scheduled for Wednesday 20 June at 2.30pm in Hawkins House.

Children’s Hospital Project and Programme Board Meeting (No 5) 20 June 2018

Date: Wednesday 20 June 2018, 2.30pm, Hawkins House Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, SecGen, DoH Dept of Health: Tracey Conroy, A/Sec Fionnuala Duffy} Siobhán Kennan} Secretariat John Pollock, NPHDB – Project Director Eilish Hardiman, CHG – Group CEO

HSE: John Connaghan, Acting DG Dean Sullivan, D/DG Strategy

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Minutes of Meeting No 4 Minutes agreed.

2.

CHP&P Steering Group report Action 41/5: DS advised he would submit reworked CHP&P Steering Group reporting format in time for next CHP&P Board meeting The recent changes of CHP&P Steering Group Chair, and of support staff was noted. As new Steering Group Chair, DS identified the following areas as currently most challenging:

capital funding - (level of income, potential contribution from asset realisation and philanthropy)

capital build - (GMP negotiations are taking longer than initially thought to resolve; expectation that BAM will want to secure an increase in payments, and need to bring parts of Phase B works into Phase A – elements that would not affect price negotiations)

MES – (finalising the business case process will not be straightforward)

EHR/ICT - (if it is required, the timeframe for a decision on contingency is tight) and

integration programme – (separate to the availability of funding to implement the new children’s hospital portion of the Model of Care, there are challenges in implementation, particular in relation to recruiting the specialised staff required).

3. Backstop plan and capital funding – status update

JP reported on capital costs challenges and pressures – delay in completing the GMP negotiations (pushed back from end of June to October); unanticipated level and continuation in rise of construction inflation (now running at 9%); costs linked to the quantification now of the cost of the “gaps” in the 2016 partial design of the hospital; programme alignment delays (adding 4 months to the 48-month build); seeming resistance of contractors to engage meaningfully and helpfully in the value engineering process. He stated that the savings to be made through value engineering will be known at end of June. There was a lengthy discussion on the cost challenges, and how these might be mitigated against. JP sought and received approval in principle from the CHP&P Board to his proposal that the NPHDB would explore with the contractor

Children’s Hospital Project and Programme Board Meeting (No 5) 20 June 2018

NO. Agenda Item Discussion and Actions Agreed

what Phase B works could be moved into Phase A during September and October, in order to maintain critical path deadlines. This is required on foot of the completion of the GMP negotiations being pushed out from end June to October. Action 42/5: NPHDB to make all efforts to maximise leverage around value engineering for the project Action 43/5: NPHDB to engage with contractor on moving Phase B works into Phase A, subject to this having no impact on planned capital cost expenditure in 2018 or on GMP negotiations.

4. MES – status update JP reported that NDFA is not in a position to support the development of a business case for MES. As an alternative, a cost benefit analysis of MES is being carried out by EY/DKM, to be completed by end of August.

Action 44/5: NPHDB and DoH to progress work on MES Business Case ensure that critical path deadlines are met.

5. EHR / ICT – status update EH stressed that EHR is a key dependency for the new hospital’s ICT programme. The Peer Review Group examining the EHR Business Case has raised questions, including in particular in relation to governance. EH advised that this is being worked through, with the aim of agreeing a clear and workable governance structure, showing the interface with other groups working on the NCH, with the intention of being signed off shortly by HSE Leadership. DS noted that weeks rather than months remain for the development of a contingency plan for the new children’s hospital if so required. Action 45/5: HSE and DoH to progress work on EHR / ICT to ensure that critical path deadlines are met.

6. Integration project – status update

EH reported that she is to present a recast of the update report on the integration plan to the next Steering Group meeting (Action 37/4 refers). The 2019 estimates process, due to begin soon, must take account of the need for development funding and early approvals for recruitment of staff for Connolly Outpatient and Urgent Care centre opening next year. Nurse recruitment is the most challenging workforce issue, in relation to which EH has prepared a five-year plan for submission to the Department through the HSE HR. Action 46/5: A recast of the update report on integration to be provided to the June CHP&P Steering Group meeting.

7. Due diligence (Pre-CAR) – status update

EH reported on the progress in implementing the pre-Commencement action plan, which includes actions emanating from the pre-CAR process. The action plan is being worked through, and no issue of concern requiring any escalation has arisen at this stage. Action 47/5: DS and EH – pre-Commencement action plan is to remain a standing item on the CHP&P Steering Group agenda, with, as agreed at the CHP&P March Board meeting, a greater detailed report on pre-CAR process and action plan.

8. Model of Care – implementation – status update

DS advised that a Model of Care paper is due to go to HSE Leadership the following day (21 June 2018). DoH undertook to revert with initial comments by COB today. DS noted that the Plan assumes sufficient capacity in the broader system to deliver the required care, which is not the case. Action 48/5: DoH to revert on Model of Care paper to DS by COB 20 June 2018. Action 49/5: DoH to submit Memo to Government on the Model of Care and associated costed Implementation Plan when appropriate to do so.

Children’s Hospital Project and Programme Board Meeting (No 5) 20 June 2018

NO. Agenda Item Discussion and Actions Agreed

Updates on actions arising from previous Board meetings

Temple Street Hospital: Further to Action 33/4, EH reported that CHG met with Mater Misericordiae Board of Governors and have agreed to enter a process by end 2018 on the future value and use of Temple Street Hospital. Terms of reference and review process to be developed by September. Crumlin Hospital: Action 50/5: EH to submit to CHP&P Steering Group draft terms of reference and membership of project team (NPHDB, CHG, HSE Estates and others as appropriate) to oversee process for determining how to maximise the realisation of the value (both revenue and alternative best use) of Crumlin Hospital site. Director of philanthropy: Further to Actions 11/2 and 35/4, EH noted that the three Foundations which will merge are currently carrying out due diligence, and will need to continue raising funds for the existing hospitals. The importance of philanthropy to fund the building of the new hospital facilities was noted, and that this will require a different fundraising, fund disbursing and governance model than currently exists. It was agreed that EH would submit a Business case setting out the requirements for the new children’s hospital director of philanthropy urgently. Action 51/5: EH to submit, either for Steering Group June meeting or shortly thereafter to DS, a draft business case for the Director post. Education: Further to Action 34/4 regarding Department of Education’s contribution to the capital cost of the education facilities in the hospital, FD reported that a meeting between DoH, HSE and Education in early May resulted in agreement, in principle, that DES would contribute €4.3m to the capital budget towards the construction of the school and either provide school equipment directly or contribute700k (whichever is the lesser). Before DES formally commits to a final DES capital contribution figure towards third level facilities, the question of a contribution from the universities/RCSI must be considered. CH Group Chair and NPHDB Academic advisor now engaging with universities on this issue.

9. Legislation update SK reported that the legislation is ready to be circulated to Government Departments prior to submission to Government for approval to publish, with the intention of enactment in mid-November. The Department and CHG have recently agreed that the new entity and its Board will be established on a statutory basis in advance of the transfer to the new entity of the three hospitals.

10. AOB: Business case Date of next meeting

Next meeting is scheduled for Wednesday 19 September at 2.30pm in Department of Health, Miesian Plaza.

Children’s Hospital Project and Programme Board Meeting (No 6) 19 September 2018

Date: Wednesday 19 September 2.30pm, Miesian Plaza Board Attendees: In attendance: Attendees:

Chair: Jim Breslin, Sec Gen, DoH (JB) Dept of Health: Tracey Conroy, A/Sec (TC) Fionnuala Duffy} Deirdre Morgan} Secretariat John Pollock, NPHDB – Project Director (JP) Eilish Hardiman, CHG – Group CEO (EH)

HSE: John Connaghan, DG (JC) Dean Sullivan, D/DG Strategy (DS)

DISCUSSION and ACTION POINTS

NO. Agenda Item Discussion and Actions Agreed

1.

Minutes of Meeting No 5 Minutes agreed. Actions arising from previous meeting (Meeting 5) dealt with under relevant agenda item below.

2.

CHP&P Steering Group report

DS presented the report to the Board in a new format (ref Action 41/5) and advised that this new reporting format needs some further refining, in particular to reflect risk management areas such as EHR process, scope and implementation. DS also plans to refine the overall report process to the CHP&P Steering Group.

3. Backstop plan and capital funding – status update

There was a detailed discussion on the GMP process and challenges relating to delay in completing the negotiations with main contractor, in particular the concerns that construction costing is trending very significantly over budget - estimated to be €191m over the construction value notified to Government in April 2017. JP advised that the timeframe for agreeing the GMP has extended from August deadline to estimate of additional 3 months’ work with high degree of cost certainty by end October. He outlined the factors that are contributing to the significant emerging increase in cost over budget – €100m arising from programme alignment (€20m), underachievement of value engineering savings (€45m), additional fire sprinklers (€35m). In addition, scope change, design development and gaps/omissions identified in design are estimated at a further €91m. €20m of this has been adjudicated on by the Independent Expert. JB expressed significant concern about the construction cost trend. It was noted that NPHDB shares these concerns. There was a discussion in relation to the overall responsibility of NPHDB to control project scope and design changes e.g. authorising changes arising through user engagement. JP reported that NPHDB is currently interrogating the design team’s report and are not in full agreement with all changes in scope made by the design team (approx. €2.5m of scope change has been formally agreed by NPHDB). Some cost creep arises from issues such as changes to doors/materials /partitions /socket requirements and M&E items missed in the bill of quantities. JB emphasised that NPHDB needs to consider mitigation to bring the project back within cost parameters. JP stated that the additional cost breakdown is preliminary at this stage, and that NPHDB is seeking further clarity and certainty on the additional cost component breakdown to report to the CHP&P Board. JP confirmed that the GMP costing process is based on project alignment requirements and bill of quantities, and that it would not be practical at this stage to change or unpick elements that are being

Children’s Hospital Project and Programme Board Meeting (No 6) 19 September 2018

NO. Agenda Item Discussion and Actions Agreed

costed through the GMP process. The current GMP negotiations need to be concluded following which scope could be reviewed if necessary and an instruction could be issued to omit certain design elements of the project to cut back on costs. JP noted that the main contractor also submitted substantial additional cost claims to NPHDB in late August - €200m over and above that as set out above. On 5

th September the NPHDB board members were briefed on the overall capital costs, including the late submittals of claim,

and a decision was made to notify the main contractor that their performance to date has delayed the overall project and that this delay authorises the NPHDB to delay the awarding of the contract for Phase B of the build for 3 months without incurring additional costs. There was verbal agreement from the contractor on 19

th September 2018, with written agreement to follow based on a legal agreement being

drawn up by NPDDB. The NPHDB has instructed that the GMP process must be robust, all issues be resolved in advance of GMP completion, a change in behaviour of the main contractor must occur, and that the contractor must commit to adequately resourcing the next phase of the project. JP also advised that the NPHDB discussed the option of an audit of the process so far and it was agreed that such an audit is required. It was noted that separately the HSE, as funder, may wish to consider potential external input to inform decisions. JP noted that there is sufficient work remaining in Phase A such that a 6-week to 3 month further delay in determining GMP is not expected to impact on the overall project end date in 2022. Mitigating actions were discussed, and the CHP&P Board agreed that more detail would be required on the cost breakdown and scope changes. NPHDB will need to provide justification for all cost components in order for Government to have sufficient confidence in the project and process. It was agreed that the next six weeks are required by NPHDB to complete the bulk of the GMP work and arrive at a robust cost and identify any issues remaining. To inform subsequent decision-making, the following are required:

1. Allow a 3-month window to complete the process 1. Arrive at a robust GMP 2. Assurance from main contractor in relation to resourcing the full project 3. A contingency plan from NPHDB.

Action 52/6: Further work is required by JP/NPHDB on interrogating the components contributing to the estimate of €191m to determine the drivers - attributable to main contractor or NPHDB / design team. Action 53/6: Following Action 52, the NPHDB will conduct an audit of the GMP process to date to identify the how each key component arose and impacted on costs. NPHDB will identify lessons learned from the process so far. Action 54/6: NPHDB will prepare a contingency plan with options for consideration in the event of a decision not to instruct Phase B to commence. Action 55/6: NPHDB will review elements of the project that could be omitted to contain costs after conclusion of GMP process Action 56/6: NPHDB will produce a report to the CHP&P Board for its next meeting (15 Oct 2018) setting out how the current position has been arrived at to inform the audit. Action 57/6: JB will write to Chair of NPHDB setting out the actions agreed and requirement for a report on the how the current situation has arisen.

Children’s Hospital Project and Programme Board Meeting (No 6) 19 September 2018

NO. Agenda Item Discussion and Actions Agreed

4. MES – status update Ref Action 44/5: NPHDB and DoH to progress work on MES Business Case ensure that critical path deadlines are met. DS reported that the Cost Benefit Analysis has been submitted to DPER. There is no timeline for approval yet, the Equipping Procurement Strategy group is engaging with DPER to address any queries.

5. EHR / ICT – status update Ref Action 45/5: HSE and DoH to progress work on EHR / ICT to ensure that critical path deadlines are met. DS reported that DPER are still concerned about the implementation process and noted that DPER has requested a specific business case for the nch element of the EHR programme - this will need to be completed promptly before procurement process commences. Clarity is also needed for DPER on the potential for the HSE to secure the skilled workforce that will be required for the nch EHR implementation.

6. Integration project – status update

Ref Action 46/5: A recast of the update report on integration to be provided to the June CHP&P Steering Group meeting. EH reported that she had provided an Integration Programme update to the June and August Steering Group meetings, with a focus on nursing workforce planning and ICT work in preparation for the Urgent Care Centre opening in 2019. EH confirmed that the CHG are in the process of updating the multi-annual Integration Plan. DS highlighted the need for clarity on the recruitment process to obtain staff for the opening of the NCH and the two centres. He stated that a process must be put in place to ensure that enough staff resources will be available. Overseas recruitment cannot be over relied upon to provide the resources. DS confirmed that the CHP&P Steering Group meeting on 24

th September and will be looking at staffing issues, so

there will be greater clarity on the requirements and recruitment plans after that meeting. EH reported that resourcing issues encountered previously in terms of releasing staff to work on NCH projects has been resolved. Consultant post recruitment underway with interviews in October. 60 additional nurses will also be required next year and there is sufficient interest amongst existing nursing staff for the new posts. There will be greater clarity on how far this recruitment can progress after the Estimates process for 2019 has concluded. The governance of the integration programme and the format of exceptional reporting to the CHP&P Board were discussed. JB noted that, while there is a focus by EH on reporting on the immediate issues, there is a requirement for the CHP&P Board to have assurance that the overall integration programme is going well. DS noted that, as CHP&P Steering Group Chair, he seeks assurance from EH re milestones and any issues or risks arising rather than progress on the overall integration plan. JB stated that exceptional reporting works only when those involved have full knowledge of the plan. It was agreed that the integration programme reporting to the CHP&P Board would be revised to include:

- milestones achieved - milestones approaching - escalated risks - any issues arising

Action 58/6: EH to complete update Integration Plan. DS to report to future CHP&P Board meetings on milestones achieved and issues arising.

7. (Pre-CAR) – status update

EH advised that the pre-Commencement Analysis Report (an element of the Integration Programme) had been reviewed and approved by the CHG Board, and that only issues and risks that cannot be managed at that level are escalated to the CHP&P Steering Group.

Children’s Hospital Project and Programme Board Meeting (No 6) 19 September 2018

NO. Agenda Item Discussion and Actions Agreed

8. Model of Care – implementation – status update

Next steps on preparing an Implementation Plan under discussion with DOH/HSE officials. Discussion deferred to next meeting

Updates on actions arising from previous Board meetings

Ref Action 50/5: EH to submit to CHP&P Steering Group draft terms of reference and membership of project team (NPHDB, CHG, HSE Estates and others as appropriate) to oversee process for determining how to maximise the realisation of the value (both revenue and alternative best use) of Crumlin Hospital site EH noted that, this work has not progressed yet and is being pushed out to progress post dissolution of OLCH Crumlin. JB referred to the relevance of the recently-launched Land Development Agency established to unlock sites, such as hospital lands, for housing development. EH also noted that, in the context of dissolving, OLCH Crumlin will need confirmation that the hospital site asset /or its value will only be used to benefit children. This is provided for in the CHI Bill. Action 59/6: EH to submit draft terms of reference and membership of project team (NPHDB, CHG, HSE Estates and others as appropriate) to oversee process for determining how to maximise the realisation of OLCH Crumlin site to next CHP&P Steering Group. Director of philanthropy Ref Action 51/5: EH to submit, either for Steering Group June meeting or shortly thereafter to DS, a draft business case for the Director post. EH advised that the Business case for the Director post will be submitted to DS on 21

st September.

Action 60/6: EH to submit Business case to DS by 21

st September

Ref Action 42/5: NPHDB to make all efforts to maximise leverage around value engineering for the project JP reported that this is continuing Ref Action 43/5: NPHDB to engage with contractor on moving Phase B works into Phase A, subject to this having no impact on planned capital cost expenditure in 2018 or on GMP negotiations. Action superseded by further discussion on GMP negotiations

9. Legislation update It was noted that the Children’s Health Bill is progressing to schedule. Seanad Committee and remaining Stages for completion on 19 September.

10. AOB: Business case Date of next meeting

Next meeting will be scheduled within 4 weeks, immediately after the NPHDB meeting on 3rd

October 2018.* *Next meeting scheduled for 15 October 2018