A confidential report for the HSE has questioned the operational readiness to commission and operate the new National Children's Hospital.
This is largely separate to the controversy over the building completion date.
The April 2024 report by consultants KPMG, obtained by RTÉ News, points to gaps in senior leadership teams, a sub-optimal clinical governance structure, a lack of clarity around the future operating model and resourcing of the new hospital, plus the drift in expected completion dates.
The report says that during interviews with Children's Health Ireland (CHI) staff and site visits to the three existing hospitals, there was limited recognition of "the great opportunity" offered by the planned new digital hospital and the integration of the three hospitals to create a high-end safe and high-quality environment.
The report also notes that the reason for the move is not the centre of attention and that the top leadership spend 10-20% of time on the transformation and 80-90% of time running the existing services in the three hospitals, at Temple Street, Crumlin and Tallaght.
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The management consultants said it was apparent from interviews at all levels, that staff are understandably prioritising day-to-day patient care, over commissioning activity for the new hospital.
It also notes that the "different signals and opinions" around the handover date to the new hospital is significantly affecting Children's Health Ireland's ability.
Recent days have seen a clash between the Government and the new hospital builders BAM, over concerns that the opening date could drift into 2026.
The most recent completion date for the building was February 2025 with around six to nine months then needed for the commissioning.
BAM has said that Minister for Health Stephen Donnelly "may not have of all the facts" in relation ongoing controversy about he development.
Speaking to RTÉ News, BAM's executive director of the UK and Ireland, Alasdair Henderson, said: "Like everybody on the project we are keen to get this finished as soon as possible for the children of Ireland."
He added the company wanted to work with the National Paediatric Hospital Development Board to do that.
Mr Henderson said "we want to make sure the contract processes are followed and the project is well managed".
He added the company has responded to the "allegations" on Saturday and he did not want to add to that.
"The minister may not have all of the facts but that's all I want to say about it just now," he said.
This KPMG report concerns preparations for the operation of the new facility, and how well the three distinct hospitals will merge.
In their report, KPMG says that a key issue is the absence of a permanent CEO and the current arrangement of having an acting CEO, who has to combine duties with a large element of her deputy CEO/COO portfolio.
"This arrangement represents a very high risk to the overall programme," the report states adding that the lack of a permanent CEO has also affected other aspects of the management team.
The consultants found clearly marked differences in culture and organisational maturity across the three children's hospitals and while the new building represents a perfect opportunity to align the three organisations, it says this will require sufficient recognition and attention even before the actual move.
The report found that pressures on the hospitals, in particular with waiting lists and patients waiting for scoliosis surgery, are placing considerable strain on key personnel and the organisation as a whole.
The consultancy report sets out a variety of options for the opening of the new facility.
A Day 1 workforce model would require recruitment of 272 staff for a total of 4,319 staff.
If all facilities were to run at 100% and all standards were applied, it would require 5,133 staff but this is not seen as practical for the first day of operation.
The report notes that forecasting manpower needs will be challenging, because there will be the introduction of a new building, with single rooms. There is also the expansion of operating rooms and intensive care beds, plus new digitalised working methods.
Children's Health Ireland is responsible for the operational activities of the children's hospitals and the new facility.
The National Paediatric Hospital Development Board is responsible for the design, building and equipping of the new facility.
Funding for services comes from the HSE.
Children's Health Ireland said its Board has fully accepted the KPMG Operational Readiness Review.
It added that the Board has approved a detailed action plan, and CHI is working through the plan with the HSE to ensure all actions are addressed.
Labour TD Duncan Smith has called on both the Taoiseach and the Minister for Health to apologise to the Irish people over the ongoing debacle at the NCH.
Referring to the confidential report for the HSE, Deputy Smith said the lack of preparedness was an even greater sin.
Social Democrats Spokesperson on Health Róisín Shortall said it is a "very serious concern" that the confidential report questioned the operational readiness to commission and operate the new children's hospital.
She said her party wants a full time CEO appointed to oversee the transition from the three existing children’s hospitals into the NCH with a team of their own, arguing this would address the concern that no one is in charge.
Regarding the construction of the NCH, Deputy Shortall said Minister Donnelly needs to stand up allegations made by the body overseeing the NCH, the National Paediatric Hospital Development Board, against the main contractor BAM.
If the allegations are proven to be accurate, i.e., that BAM is responsible for the delays, then she said "sanctions need to follow".
Deputy Shortall said the minister and the Secretary General at the Department of Health should go before the Oireachtas Committee on Health.
Additional reporting David Murphy, Paul Cunningham
