Richard O'Donoghue Urges Brochure Model for Faster Hospital Builds
Richard O'Donoghue spoke about rising health insurance costs and HSE staffing shortages, proposing a standardised contracted-build model to accelerate hospital construction. He urged the minister and the HSE to consider private-sector delivery and mortgage-style funding to deliver hospitals on time and on budget.
Main proposal
Richard O'Donoghue proposed a brochure-style procurement model that standardises hospital and facility designs. He argued the HSE should adopt fixed options - one bed, two bed, up to a hundred-bed hospitals - that contractors can build to a clear specification and deliver quickly.
Evidence and comparisons
He contrasted a private hospital in Limerick built in 16 months on time and on budget with public projects that have exceeded budgets, citing the children's hospital as an example of large cost overruns. He noted a recently opened 96-bed unit in Limerick and the regional consensus calling for further capacity including another 96-bed unit, an expanded emergency department and a new hospital site.
Model details
Mr O'Donoghue described a contractor willing to build a Midwest hospital and accept long-term repayment, suggesting a 35-year arrangement with the State able to buy the building back for a euro. He said standardised specifications - electrics, plumbing and fixtures - would reduce preliminary design costs and prevent mid-project changes.
Budget and procurement critique
He criticised departmental delivery of building projects for frequent overruns and contrasted that with private businesses' accountability for budgets and timelines. He argued that outsourcing delivery to accountable contractors would protect vulnerable people and help moderate health insurance costs by improving service capacity and governance.
Appeal to ministers and colleagues
Drawing on his experience as a self-employed builder and employer, he urged ministers, deputies and the HSE to listen to business practitioners and consider pragmatic procurement reforms. He emphasised the proposal as a practical solution to staffing and capacity pressures, offered in the interest of protecting patients and taxpayers.
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Minister, I'm going to start off with the headline from the Irish Examiner. HSE warns it cannot fill vacancies, even with agency, as staff shortages crisis deepens. So, we're here talking about health insurance and the rising cost of health insurance. And we can see that. Why is it that we're getting such a shortage in the HSE? And why is it that the private hospitals are being built and they're providing a service efficiently and efficiently staffed? We see the 96-bed unit opened in Limerick, which I welcomed. And then we see that we had strategic policy to look at A, another 96-bed unit, B, the increase of the emergency department, and C, was a hospital. To make it on another site, and then we could have a step-down facility. And what we came up with, a consensus was, even the meetings that all parties from the Midwest came up with, and we're united in it, and we're meeting the Minister tomorrow with this, to say that we want A, B, and C. Now, we've had a private hospital built in Limerick 16 months from the time they turned the sod to the time they finished. Built on budget, on time. We're looking at our children's hospital, gone 1.2 billion over budget. Now, how can you explain that departments can take on building projects, they don't have to call for profits, but they go over budget on every project the departments do, by 50, 60, 70 percent. And yet, when you look at every business in this country, regardless what business you're in, if you're self-employed, that you're accountable for your funding, you're accountable for your employees, you're accountable for your profits, you're accountable for your taxes, you can deliver projects on budget, on time. We have now a company that has came to me, and other deputies in the House, and said they will build you the hospital for the Midwest, and we don't mind if it's in Limerick, Clare, or Tipperary, we will build the hospital for you. We will work a contract out with you, like a mortgage for a house, we will build it on budget and deliver it in two years, for the hospital that is needed for the Midwest, for the protection of people in the Midwest, that's our elderly, our vulnerable, everyone. They can deliver that project in two years. If your department says they don't have the money for this, they said we can work it out over 35 years, and you can buy the building back for a euro after 35 years. The same as a mortgage. If you can't deliver the projects, let someone else deliver them, you can fund it with them, enter into a contract, they deliver it on budget, on time, you can facilitate it, it looks after the vulnerable people of Ireland. This is why I came up with a model that any hospital service, or any department network for schools and all the rest of it, you should have a brochure that opens up, I want a classroom that will suit 50 people, I want an operating table, this is the facilities I want, standard, open your brochure, you can do it for houses, there was a housing system before, it was a Macdonald home, you open the brochure, I want this house, that house. It allows you, buy the certain amount of doors, certain amount of windows, you can build it affordably, you can build it on budget, and you can actually look at the stock that you need to deliver. So what I'm asking now is for the HSE to look, and the Minister to look at this, look at a model for one bed, two bed, three bed, four bed, up to a hundred bed hospital, whatever you want to do. That's the model, you go to a contractor and you say, I want 50 rooms, or a hundred rooms. This is what I want in it, this is the standard procedure of all the electrics, all the plumbing, all the fit out, everything across the board. What it cuts out is, the preliminary is that, all your architects and engineers, are coming onto the charter, millions before we start off at all, and it stops any changes, midway, in the projects. So basically, you get your hospital, it's delivered, but that same hospital can be dropped into Limerick, into Cork, into Kildare, and they're providing the lands for you to do it. They're providing a solution to deliver it for you, so we can then look at, our health insurance is coming down, because the governance of this country then, can provide a model for people, provide a hospital and care for people, and a strategic plan going forward, for the universal health of everyone in this country. Why do I talk like this? I'm in business all my life. I'm self-employed all my life. My downtime last week, what did I do? For my headspace, I went laying a few blocks. Why? I'm a block layer by trade. I know what I'm talking about. I'm also a businessman. I have employees, and if I was in any other county, including Donegal, I would have got paid an awful lot more for doing what I was doing, than what I do to be here. But the reason I'm here, is to protect people. It's not about money. It's about protecting, and putting procedures in place, using the experience that I have, as a taxpayer, as an employer, having employees all my life. This is what we're here to protect, is give you the experience, give you the tools, to stop the departmental thing, wasting money. It helps you deliver it. I don't care, if you get all the praise. I'd praise you myself, if you take in, a business model. That's what I'm here to do. I don't need to score points with anyone. The day people, the day I can make a contribution to this stall, is the day I don't want to be here. Being quite honest, I don't want to be here, if I can't make a contribution. But I want you to listen, to people, that are in business, that pay taxes, make a profit in India. Because if I don't make a profit, the employees that work with me, and the subcontractors, have no other work to go to. So I'm providing a service, but they're also providing, the most vital service, for building for the future. So I'm asking you ministers, both of you, and all the other deputies, and ministers of this house, listen to people, that have a track record, of being in business. Listen to people, that can deliver projects. Let me give you a simplified model, and all the waste of money, that you're going out, to different departments, on your funding schemes, let me cut that out. Let's give you the brochure, to help you. Standard procedure. It's called common sense. And in fairness, if I could bucket it, and give it to you, but I need you to listen, to common sense. What I want here, is accountability. I want to give you value, for your money. I want to give you, make sure then, we can provide a service, like the private hospitals, in this country, are doing. I've been in a private hospital, myself, recently, because I need to be dealt with, like that. And I had to go, to the private hospital. I have a machine, on me here at the moment, measuring my heart rate. Do you think, if I had to go through, the A&E department, all the rest of it, I'll be here today, and I presume, it's reading fairly high, at the moment. I shouldn't say, your time is up then. Well then you shouldn't, because I had seven minutes as well. I'll have to teach you, how to read the clock, Chair. But, exactly. But, that is, what I do. And sorry Chair, seven and seven is 14, so I think that leaves me, about two weeks. You've just gone eight minutes. So, to conclude, to conclude on this, is, I'm offering you assistance, I'm offering you to simplify, I'm offering you to spend money, accountability, and delivery of services, so ye can then, stand over, and help the vulnerable people, in this country. Thank you.
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