At University Hospital Limerick last month, Minister for Health Jennifer Carroll MacNeill officially opened an extension aimed at tackling the chronic overcrowding that has affected patients in the midwest for years.
The Minster promised that it would be just the beginning of measures to increase capacity; by 2031, an additional 572 inpatient beds would be delivered.
The new ward block comprised 96 beds.
But doctors attending the opening believed that two or possibly three similar developments were needed to meet demand for healthcare.
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Standing at the site that day, Fianna Fáil TD for Clare Cathal Crowe wondered why the new extension ran to five storeys when there was immediate demand for much more hospital capacity in the region.
“I made the point that we should build up ... go to 10 or 12 storeys,” he said.
“I wrongly believed that there was some planning barrier to this. They [doctors] told me it was because of the €200 million spending cap.”
Crowe told the Dáil last week that this spending restriction was “ludicrous” as it was much more expensive to have to go back to the start again on each occasion to develop an additional extension from scratch.
He appealed to Minister for Public Expenditure Jack Chambers, a member of his own party, “to raise the cap so that when we are building a new block we go higher, we go bigger and we build as many wards with as many beds as we need, not just as many as we can afford to do at that particular time.”
Crowe was not the first to argue that official rules governing large public projects had become too onerous.
Across the public service, for years senior officials have complained privately that the various hurdles – known as approval or decision gates – put in place by the Department of Public Expenditure and through which capital projects had to clear – were slowing down delivery and actually driving up costs.
The department itself is an institution created out of financial prudence and caution, established during the post-economic crash in 2011 to put a tighter grip on State spending in the wake of the international EU-IMF bailout of the government.
One former political adviser told The Irish Times that the requirement to bring projects back to government several times and to have their viability and financial projections reassessed on multiple occasions was “a boon for the management consultancy industry”.
Crowe, in his comments to the Dáil last week, set out publicly the view that a number of senior public servants have expressed privately over the years about the implementation of requirements under the Government’s public spending code, more recently called the infrastructure guidelines.
“I spoke to an official in a department recently and he told me that back in the recessionary years, gateways were introduced. It was a way of slowing down projects without killing them off,” he said.
“Let us take out the gateways for all the public projects.”
He argued for just “three or four stages from conception and planning to funding and, eventually, building”.
“We do not need additional gateways involving analysing and reanalysing. What these inevitably do is raise the cost, and that is the last thing we want,” he said.
Chambers appeared to be on the same page and indicated that revisions were being planned to the rules governing large public projects.
The Minister said the infrastructure guidelines, which had multiple gateways, “need to be reformed and changed”.
“There is too much circular analysis, which in many instances does not add value and adds time. That is why there is going to be change,” he said.
He promised “practical steps” to “reduce the time and help deliver infrastructure better”.
The Irish Times reported earlier this month that Ministers were looking at emergency planning powers which would enable the Government to bypass existing laws and requirements for critical national infrastructure projects.
It is expected that an overall package of reforms will also include changes to the rules governing the judicial review process under which administrative decisions by public bodies can be challenged in the courts. Critics contend that these contribute significantly to the delays of many projects.
However, Chambers also indicated that the Government’s internal spending rules were likely to be loosened as part of its new plan to accelerate infrastructural developments which will be launched in the next couple of weeks.
“Rebalancing regulation and removing some of the barriers, steps and internal systems will all be part of the report. These are practical steps that narrow timelines but also rebalance risk,” he said.
“Increasing the risk appetite is critical if we want to deliver more social and economic infrastructure. It is a matter of backing public servants to make the decisions and get on with doing what we know is required, be it in terms of healthcare infrastructure or water, energy, transport and housing infrastructure across our economy.”
The Minister also appeared to support an argument made by the former political adviser that repetitive analysis of projects fed into a culture of reluctance to make big decisions on projects for fear of being criticised.
“There are too many constraints that promote a culture of risk aversion. Risk aversion permeates the system, and that is why we have long lists and not delivery now. Part of what we are doing in our infrastructure reforms is cutting a lot of that out, addressing and reforming internal systems and really focusing on delivery,” he said.
The public spending rules were introduced in 2012 but have been changed a number of times since then.
Tom Ferris, who lectures on the infrastructure guidelines at Public Affairs Ireland, said following the controversy over the growing costs of the new national children’s hospital, the Department of Public Expenditure tightened the requirements for large projects.
In essence a series of checkpoints or decision gates were put in place that had to be passed through at different points.
At each checkpoint, the Government assessed progress and decided if a project determine should continue, be modified or halted.
Ferris said in the wake of the criticism over spending on the new hospital, “the pendulum swung” but by 2023 there were arguments that the process had become too bureaucratic and it began to swing back.
“The number of gateways was reduced from four to three on 21st December, 2023 – and for projects under €20 million there are now only two gateways,” he said.
The Minister’s comments now suggest that pendulum is about to swing back further.
Ferris maintained that the €200 million figure referred to by Crowe in the Dáil was not a cap on spending on the hospital extension in Limerick but rather the threshold beyond which capital projects were considered to be “major”.
At that point they had to be examined by the Major Project Advisory Group – set up in 2021 to help the Department of Public Expenditure on the management of projects – with requirements for a business case and assurance reports to be considered.
“The main problem doesn’t lie with the guidelines; the problem is with delivery of projects,” said Ferris.
He said if, in future, there were only to be two gates to be passed through before a project was authorised, that might not be too bad.
However, he argued there would still need to be individuals who would stand back and assess the need, viability and cost projections of various projects on a dispassionate basis.
