There are two major hospital projects on the go in Dublin, both intended to be national facilities.

These are the National Maternity Hospital, currently embroiled in controversy about religious ethos, and the National Children’s Hospital (NCH).

The sites chosen for these projects, at the St Vincent’s site in Dublin 4 and at St James’s in Dublin 8, will add to cost and it is not clear that accessibility for a national clientele has played much of a part in the site selection decisions.

As has become the standard and tolerated practice, the capital cost estimates on which initial political approval was sought were far too low in both cases.

Co-location has been deemed desirable for these projects: there are advantages in being close to an existing acute hospital, but there were other options.

National facility

The preferred location for a national facility is often thought to be near a junction on the M50 around the city of Dublin. All the major provincial centres are linked into the M50, via motorways in most cases and the non-motorway sections are being upgraded bit by bit. It seems that these new hospital locations were not selected to minimise travel costs for users.

Tallaght hospital was one co-location possibility and Connolly in Blanchardstown another, both just off the M50.

Instead, the sites chosen are on brownfield sites in the inner suburbs.

Construction is proceeding at the NCH site in Dublin 8, a part of the city regarded by Dubliners as a black hole for traffic and best avoided.

Cost escalation is also likely at the St Vincent’s Dublin 4 site chosen for the National Maternity Hospital, another black hole for traffic

There have been disputes between the State and the contractor over claims and the final bill seems to be heading towards €2bn – which would be roughly three times the initial estimate.

Cost escalation is also likely at the St Vincent’s Dublin 4 site chosen for the National Maternity Hospital, another black hole for traffic.

Roughly one-third of passengers using Dublin Airport come not just from outside Dublin but from outside the province of Leinster – it is a national facility and offers the widest range of flights.

Fortunately, it is close to the M1 junction with the M50, and provincial users do not need to venture into the city at all.

If anyone suggested the airport should have been located in one of the inner suburbs, they would not be taken seriously.

Construction costs

In addition to making better transport sense, out-of-town locations for major projects help to keep construction costs down.

The airport has just completed a new runway at a cost of around €300m, one of the cheapest figures for a runway achieved in any European city in recent times.

The reason is that the entire project was foreseen decades ago – the land had been bought and sterilised as far back as the 1960s.

It is possible to get things right and there has been too much fatalism about cost overruns.

The public appears to accept that the cost estimates furnished by project promoters are not likely to be adhered to.

But much of the capital programme comes in on budget, or very close to it. For example, there has not been a significant overshoot on a road investment scheme for many years.

There will be a substantial health capital programme into the medium term, since demands on the system continue to expand and there is an inherited stock of older hospitals around the country that will need upgrading and replacement.

The experience with the two hospitals under way in Dublin suggests faulty site selection played a role in the cost overshoot.

Any builder will testify that a greenfield site with decent access keeps costs down.

When major projects cannot be delivered cost-effectively, the result is the denial of capital money to urgent projects elsewhere

Inner city brownfield sites can require design compromises too – you build whatever fits rather than what you really want.

The site selection decisions on these two hospitals have also ensured extra transport challenges for users, as well as costing more than had been budgeted.

Better sites were available but medical politics appears to have prevailed. It is not at all clear that the procedures laid down in the Public Spending Code have been adhered to and it has already emerged that the same happened with the National Broadband Plan.

Officials at the Department of Public Expenditure and Reform rejected the economic assessment that had been prepared for the project promoters, but the Government decided to fire ahead regardless.

Investment

One of the motors of economic development is efficient investment in infrastructure by the State.

When major projects cannot be delivered cost-effectively, the result is the denial of capital money to urgent projects elsewhere.

If these two hospitals cost a billion more than they should have done, thanks to poor site selection, that is a billion that cannot be mobilised for roads and schools.