Official Report: Minutes of Evidence

The Acting Chairperson (Mrs Dillon): I welcome Ciaran Mulgrew, chair of the Belfast Trust; Maureen Edwards, interim chief executive of the Belfast Trust; David Porter, director of estates at the Belfast Trust; Chris Matthews, deputy secretary of resources and corporate management group in the Department of Health; and Philip McClay, director of health estates in the Department of Health. Thank you for coming to discuss this agenda item. As you know, there has been some interest in it. I will allow you to give us a briefing. We want some detail because, as you know, there have already been questions and queries, and you might be able to give answers to those during your briefing. However, if we can allow as much time as possible for members to ask questions, that will be appreciated. Thank you very much. I open it up to you.

Mr Chris Matthews (Department of Health): Thank you. I will make a few brief opening statements and then pass over to Maureen. Thank you for inviting us today. We welcome the opportunity to address any further questions that the Committee has on this issue, particularly following the debate last week. As I said, I will keep my remarks very brief, because, as you said, members want to ask questions. Hopefully, you will have had a chance to see the Minister's written ministerial statement, which was a follow-up to the debate, and, obviously, we are happy to add further details this afternoon. In particular, I know that there are concerns about the medical gas pipeline. My colleagues are here to provide details on that issue and, crucially, how it will be resolved.

On maternity more broadly, colleagues will be able to give the Committee some sense of what the next steps will be in getting to the place where we all want to be, which is the facility operating and people getting services. Although it is fair to say that it is not uncommon for hospital builds to face delays and cost overruns, we are clearly not complacent about this, and it is important for us to understand where things have gone wrong and where we could have done things better. As part of that, we welcome the scrutiny this afternoon. As you can imagine, this is part of the ongoing process of learning and evaluation that goes along with any large capital work such as this. With your permission, I will hand over to Maureen, who will make some more detailed opening remarks.

Ms Maureen Edwards (Belfast Health and Social Care Trust): Thank you. I also offer my thanks for the opportunity to return to update you on the challenges that we are experiencing. I will speak in a bit more detail, given that concerns were raised at the last Health Committee meeting and subsequent to that, and my remarks will, hopefully, address some of the questions that you may ask today. I will also give you the opportunity to ask further questions. I will skip introductions, Chair; you have already done that.

You have received our paper, which outlines the next steps now that we have received the interim report from Hydrop, which, along with the UK Health Security Agency at Porton Down, led an independent review of the water systems in the maternity hospital. When I was last with you, in September, I advised that we had engaged the services of those independent industry experts to help us to better understand why pseudomonas was present in the domestic water systems and, crucially, how we will combat the issue so that we can safely open this much-needed hospital. Today, we will give you an update on those interim findings and outline the proposed next steps, which are key. I will briefly address the recent issue that has been in recent public discourse: the section of deficient gas pipework. I will also reference the emerging learning that we have taken from the issues in the building and the further learning that we will take. I will go back to the issue of handover, which members had raised and about which further questions were asked after our previous attendance at the Health Committee meeting.

I will begin with the interim independent report. First, I acknowledge that it has taken longer than we first envisaged. The longer timescales were driven by a number of factors, including the robust criteria that were applied to the sampling processes and the governance arrangements associated with same; the volume of samples required; the constraints on the transporting of samples to the laboratory without risk of degradation; and the scheduling of work in the laboratory. It is therefore quite a forensic report, but it is really important to stress that the draft report is interim. It does not cover all aspects of the agreed scope of services that are to be addressed by the independent expert, who is prioritising questions about how we can move on now and move into the building.

I highlight the fact that, while the report is based on the latest sampling from the building, not all results are available at this point. At such, the report is subject to further review and development. Notwithstanding that, the trust can report that the latest sampling results of tests undertaken by Hydrop appear to show a reduction in the overall quantum of bacteria in the water systems. While the previous results of tests undertaken by the trust showed that some level of pseudomonas was detected in 36% of outlets, the latest results show that the number of outlets in which pseudomonas aeruginosa (PsA) or pseudomonas was detected has reduced by approximately 50%. Of course, caution is recommended in considering those results, as they are based on a single set of samples.

On the basis of the sample results and a number of observations from site visits to and inspections of the new building, the independent expert made several recommendations that we are progressing in conjunction with Hydrop. Our focus is to implement those recommendations and agree a clear path to opening the hospital. The work to do that can be summarised in two phases, as laid out in the report. The first phase involves implementing the recommendations to reduce contamination levels in the system and doing targeted sampling. Later, we will do wider testing to give a broad picture of the extant levels of pseudomonas in the system. On completion of that phase of the remediation plan, a review will be undertaken with Hydrop and a number of trust clinical teams and trust subject matter experts to assess whether assurance can be provided that the building is safe to occupy, after some routine minor remediation works to the engineering system and, of course, with our normal processes for detecting and addressing pseudomonas, or whether further remediation will be required.

Depending on the outcomes of the review, there are three main options. The first is minor, localised remediation works, which will have a three- to four-month timescale and a cost of probably around three quarters of a million to a million pounds, depending on what remediation works need to be done. The second option is that there might be some local minor works in non-augmented care. As a reminder, augmented care refers to areas that have the most vulnerable patients, such as neonatal units and theatres. That option involves doing minor works in non-augmented care areas and putting a new domestic water system into the neonatal and theatre areas, if that is warranted as per the outcome of the independent report. The final option is the full replacement of all domestic water pipework. That would be implemented in the event that neither the criteria for acceptance of the system nor the criteria for acceptance in the augmented care departments and all the other areas were met. That would be a three- to four-year remediation process at a probable cost of around £7 million to £9 million. I stress that, on the basis of the latest sampling results and subject to the success of the revised flushing regime that we will implement, at this stage, neither the trust nor the independent expert anticipate an outcome where that worst-case scenario of full replacement of pipework will be the preferred route.

Once the remediation pathway is agreed and implemented, our normal commissioning process will take place, which will take about five or six months. That is the final commissioning stage: staff training and familiarisation; and, obviously, the transfer of equipment and services from the existing maternity hospital to the new hospital.

Members had requested more detailed information on the building handover process, which I will cover now. On the contractual position, responsibility for accepting the new maternity hospital as having met all the standards and requirements of the construction contract lay with the private-sector multidisciplinary consultant design team. At the time of the handover, the trust's senior responsible officer (SRO) for the project recommended acceptance of the new building to the trust's chief executive. That recommendation was based on assurances received from the consultant design team and the Department of Health's health estates. The chief executive accepted the handover on the basis of the assurances received. Those contractual relationships and the associated chain of assurance are common to all health projects and many other major capital projects across Northern Ireland's public sector.

It should be noted that, while the contract documentation requires an individual's signature for the certificate of completion, there is no single individual with the skills and experience to assess every element of a new building of the scale and complexity of the maternity hospital. As a result, the project manager for the consultant design team relied on assurances from a variety of subject matter experts in the multidisciplinary team, which includes architects, engineers, surveyors, fire consultants and others.

In advance of the handover, there was considerable liaison between the consultant design team and the subject matter experts in the trust, as well as with the Department of Health for additional advice and challenge. That involved liaising with trust representatives from the capital redevelopment and estates teams, the trust's water safety and usage group and the Department of Health's health estates colleagues, who are with us today.

Committee members are particularly interested in the criteria used for water safety as part of the handover and acceptance. It would be useful to provide a bit more clarity on that matter. When the tender documentation for the maternity project was issued in May 2016, the documents dictated that the completed water system should be safe. However, the tender documentation at that time did not specify quantifiable criteria or thresholds for the levels of bacteria in the water; nor did it specify the percentage of sampled outlets that must be free from bacteria. While more recent guidance documents require those to be considered, our approach was in line with extant guidance at the time of the maternity tender.

Following the initial discovery of pseudomonas in the system by the contractor, the trust arranged a series of review meetings to determine how the contractual deliverables should or could be amended and strengthened in advance of accepting the handover. Discussions at that time included representatives from the multidisciplinary consultant design team, trust capital redevelopment and estates staff, the trust's water safety and usage group and the trust's independent expert, Hydrop. Discussions at that time focused on the maximum levels of bacteria that would be permissible to determine that the water and systems were safe.

At that time, the trust's independent expert noted that the 2% failure rate for sampled outlets sought by trust representatives was a higher standard than Hydrop had witnessed in similar build projects in the NHS and advised that 5% would be considered an industry norm. Nevertheless, after extensive review, the contract requirements were updated to include the higher standard of a 2% failure rate, and the contractor was able to demonstrate, through sampling prior to handover, that the 2% rate had been achieved. On that basis, the trust accepted the handover.

At the last meeting, there was a question about who carried out the handover samples and how they were assured. The contractor submitted sampling protocols in advance of undertaking the final samples before the handover. The contractor's process of on-site sampling was witnessed by the consultant design team on behalf of the trust, and the samples taken by the contractor were tested by a laboratory accredited by the United Kingdom Accreditation Service (UKAS).

Others have questioned what happened after the handover. Following the acceptance and handover of the building, the trust undertook a period of steady-state operation of the building, in accordance with the industry norms. Owing to concerns about the history of bacteria in the water systems, additional sampling was undertaken on the completion of the steady-state period. It was at that juncture that the increased levels of pseudomonas were reported, as we discussed at the last meeting.

I will move on to the gas pipework defect, which was raised recently by the Committee and in the media. At the time of handover, a list of defects under the terms of the construction contract was recorded. That process is common to all health construction projects and other major construction projects in the public and private sectors. The contractor is responsible for repairing those defects promptly and, contractually, has the right to do so within the defined defects liability period under the terms of the contract. Medical gas pipework was one such defect, and it had been identified in November 2023. To be clear, at the time of handover, the issue with what we now know is a defective 30-metre section of medical gas pipework was known to the trust. The trust was given assurances that the issue was limited in its scale and that it could be resolved promptly without having an impact on the opening of the new hospital. That remains the case. Whilst there has been a delay in commencing work on the pipe because of the need to sample etc, it is not a critical path issue, and resolution of the 30 metres of gas pipework will not delay the opening of the building.

Finally, I want to touch on learning from the issues encountered with the building. I recognise and, indeed, share the Health Committee and the public's frustration with the delays and cost increases associated with the maternity hospital scheme. At this juncture, our focus is on safely opening a 21st-century hospital that the mothers and babies of Northern Ireland deserve, but we know that it needs to be safe. We know that there will be a great deal of learning to be gained from this scheme, and we are committed to taking that learning, particularly as we embark on our children's hospital, which is one of Northern Ireland's most ambitious capital schemes to date. To try to reassure the Health Committee, I will say that, in building a maternity hospital, we had already taken learning from previous capital builds in the trust, including, for example, the critical care building. There had been a contractor defect in that building, and the contractor accepted and paid for that, but that led to revisions in the specification of components within water systems. Learning from hospitals across the NHS and, indeed, across the world, particularly where things have gone wrong, is a key component of the planning and design stages of all our buildings, and we also learn throughout construction when new learning emerges.

Given the delays in the project, particularly the issues that we have encountered during the commissioning of the building and specifically in relation to water safety, we recognise the need for a comprehensive review of the project to identify and incorporate all learning for us going forward. We have already built in learning from our maternity hospital and emergent water safety learning from recent major hospital schemes in the NHS, and we have built that learning into the design and commissioning arrangements for the children's hospital scheme. That has included the definition, for example, of more detailed criteria for water safety standards to be met in advance of handover. We know from the interim independent water report that there is further learning for us and other parties involved in our schemes. In light of that, the Belfast Trust has already investigated broadening the scope of the commission of the water safety expert undertaking the review of maternity water systems to cover a wider review of the Belfast Trust's handling of water, particularly in relation to our recent major capital projects.

I will leave it there so that we have time for questions. Hopefully, that will have addressed some of your concerns and some recent questions. We are happy to answer any other questions.

The Acting Chairperson (Mrs Dillon): Thank you very much. I will ask one question and then go to members. First of all, I will make a statement. I am absolutely confused, even after that, Maureen. I accept that what you have given us is very comprehensive, but I am still confused about where the responsibility lay or whether it lay with a number of people along the line. Learning is one thing, and I am absolutely open to a culture of learning in every sphere, but, if there is accountability, that also needs to play its part. If there are people who did not do the right thing, made mistakes or knew that something different should have been done, we need to know and understand that — whoever or wherever, whether that is in the private sector or the public sector. Even if it is in the private sector, we need to know and understand, because it was public money. It does not matter what sector they work in; this was public money, and we need to understand. For me, that is as important going forward as it is in the context of what happened here.

Other members have very detailed questions, but I will ask about the scope of the independent review.

Will the review explicitly identify who, if anyone, is responsible for the failures in the water systems and the medical gas pipework? I know that you are saying that is not as big an issue. If it is not, all of that will make its way out, if that is to be a part of it. As I said, it is regardless of who that is, whether it is the trust or another entity and whether it is technical or the private sector. Will the review also examine procedural and contractual lapses, if there were any?

Ms Edwards: When I talk about learning, all those things will be part of that learning. I will hand over to David, who will give a more comprehensive response.

Mr David Porter (Belfast Health and Social Care Trust): For clarity, I will say that the overall terms of reference and the scope of the advice to be provided by that independent expert cover many of those things and others, so it will look at the potential causes. It will look at some of the management systems from the trust and so on to see whether there are any improvements to be made or lessons learned. We have an interim report at the minute. We asked the expert to expedite the review of the analysis of the new samples and to provide advice on the steps forward. We also asked for that advice to be expedited, as we obviously want to define that route forward as soon as possible. We have an interim report based on those issues alone, and some of those broader areas that you have touched on are part of the terms of reference. They will be part of the final report from the independent expert, but we have asked the expert to bring that section forward as quickly as possible so that we can update the Committee and start to define those steps forward. It is an interim report, and there is a broader report to be provided at a later date.

The Acting Chairperson (Mrs Dillon): I will ask other members to come in. As we have a one-item agenda and we want to allow people to try to get to the nub of other issues, people will be able to come back in.

Mr Chambers: It is obvious that the entire maternity project has lurched from one problem to another with all the accompanying delays, some of which may have been avoidable. As such, I would be failing in my scrutiny role in the Committee were I not to question the level of day-to-day oversight and awareness that the trust's senior management has had in the project. Where does the buck stop?

Obviously, there are lessons to be learned, as you mentioned in your presentation. Perhaps you could share with us the most important lessons that have been learned and how you will commit to acting differently, especially going forward with the children's hospital.

Ms Edwards: There are a couple of things in that. I hope that my opening remarks showed that these are major, complex builds that involve many parties. Yes, the trust has managerial oversight, but we work with the Department of Health. Its health estates directorate procures for us and manages the consultant design team, which is a multidisciplinary team, and it, in turn, manages the contractor and teams of subcontractors. It is multifaceted, and the issues that arise are multifaceted. Those are part and parcel of a major, complex scheme.

In every scheme, there are issues. There is learning all the way through. We know that this is not just the case in the Belfast Trust, but we will always take learning. I want to give an assurance. Yes, we acknowledge passage of time since the outline business case (OBC) back in 2011. However, hopefully, you will see in the timeline that there have been multiple changes in guidance during that time. Those bring different design changes, which bring with them time and costs We had Grenfell — that led to design costs — and then COVID and other delays.

I would like to give assurance on our governance arrangements and project management. Every time that we go from OBC to full business case (FBC), which are normal business case processes across the private and public sector, we will have explained, in multidisciplinary teams, any changes, ratified the changes and gone through robust business case approval processes whereby we get sign-off for those changes and their associated costs from the Department of Health and the Department of Finance.

We also have regular gateway reviews by external gateway teams. Those cover where we are in projects, whether we are in line with timescales, whether we have good project management arrangements in place and whether our main risks have been identified and are being addressed. Again, those happen at critical points across the project to give independent assurance on how the scheme is being run.

Mr Chambers: Other people may have had better experiences than I have had, but I find it difficult to understand how I have had regular meetings with the trust over the past couple of years, yet nobody ever flagged this. Nobody ever said, "Look, we are having a problem here, and we need a bit of help and support. The hospital will not be finished in time, and it will be well over budget. Here are the facts". Only over the past month or two has it all come out into the open. Why was the fact that you were having difficulties not flagged? We all could have helped you to understand those difficulties and perhaps to address and overcome them. Is anyone in senior management reflecting on the part that they have played in this? A lot of people and organisations seem to be getting blamed, but, at the end of the day, as I said, the buck stops with somebody. Where did it stop?

Ms Edwards: As I said, we will have a comprehensive look back and review. In answer to your question, we have a project management team — a project board — that all parties are involved in. It raises any risks to the trust board etc and, where required, the Department of Health. Until the recent water issue, we were within our business case approvals for cost. COVID moved the timescales back, but, as an addendum, there are legitimate reasons for those business case cost approvals being higher than the OBC, and they were approved in advance. We were given the approvals, and we were within them.

Mr Ciaran Mulgrew (Belfast Health and Social Care Trust): Alan, may I say something on the governance of the process? Certainly, there are lessons to be learned for everyone who was involved. There are lessons for the trust, the estates department, the Department of Health and the private company that built the building. The pseudomonas issue was raised at the trust board in September 2023. That was when the board first became aware of it. As Maureen said, until then, we were reasonably happy that things were progressing in time and towards the financial stipulations that we had been given. It was discussed again in October 2023, December 2023, March 2024, July 2024, September 2024 and December 2024. There were separate briefings for non-executive members of the trust board in March and September 2024 to bring them up to speed on what was going on. The issue has been well known and well discussed internally.

At the end of the project, there will be plenty of lessons to be learned, but, at this stage, we want to try to move towards how we complete it. Obviously, where there are things from which we can learn, no one will shirk from that when the time comes.

Mrs Dodds: Thank you for the presentation. I want to explore a couple of issues, and I will come back in on some of them as well. The first is about how the issue of water sampling and pseudomonas was conveyed to the board and through the trust and, ultimately, why it was accepted.

My understanding is that, in May 2023, the water safety group indicated that the trust should seek an assurance from the contractor that the water system was free of pathogens. Is that correct?

Mr Porter: May I take that one?

Mrs Dodds: Of course.

Mr Porter: You are referring to when the pseudomonas was first detected and the trust's response to that. When it was originally detected, it became clear as part of that review that the mechanisms in the contract as it was let — it was let in accordance with the current guidance at that time — were not sufficient to give the trust the assurance that it required.

The particular issue was that there were no measurable or quantifiable defining thresholds in the contract to say what constituted "safe". A review was undertaken at that time.

Miss McAllister: Was that in May.

Mr Porter: Yes.

Mrs Dodds: May 2023.

Mr Porter: It may even have begun earlier.

Mrs Dodds: It may have begun earlier. I have been told that pseudomonas was first detected in 2022. I think that that date came from your original briefing.

Mr Porter: Yes. When it became clear that there was pseudomonas in the system, there was an internal review of how the trust should respond to that within the project. It became clear that the mechanisms in the contract were insufficient and that it would have to be amended. There were extensive discussions at the time, which involved a number of parties, including the consultant design team that was employed by the trust and a number of representatives of the trust, including the water safety and usage group and our colleagues in health estates. However, for any decision of that scale on a project as complex as the maternity hospital, we need to ensure that a breadth of opinion and knowledge is contributing to the discussion to make sure that we fully understand all the implications of any change to the contract, including cost and programme implications. Of course, in that instance, there were safety implications.

A large number of people were involved in those discussions. It is correct to say that, at an early stage in the discussions, it was suggested that an assurance should be sought from the contractor that the building's water system would be completely free from waterborne pathogens.

Mrs Dodds: I want this to be a conversation, so can I jump in?

Mr Porter: Yes, sure.

Mrs Dodds: Was there any conversation with the water safety group in which it said that its formal assessment that the system should be free from pathogens had changed? I am talking about a later stage, when you were approaching the contract handover.

Mr Porter: We have records of further correspondence from that time, including emails, and discussion on the matter. There was an acknowledgement at a later stage of the potential for isolated areas of pseudomonas to develop in any new build. There was agreement on that, and the discussion at that stage effectively moved on to what should be the definable threshold for what is "safe" and "not safe". Where there was a smaller number of isolated pseudomonas cases, it was agreed that they could be dealt with under the trust's normal protocols for a live hospital. If there are one or two outlets that test positive in a live hospital, someone will step in and remedy that at a local level. The discussion became, effectively, about the criteria or threshold for what level of pseudomonas is acceptable. There were a number of points of view and opinions at that stage. The decision at the time was to go with 2% of the outlets that were being sampled as an acceptable threshold.

Mrs Dodds: Was that 2% contamination or 2% of those examined?

Mr Porter: Do you mean of the samples taken?

Mrs Dodds: Yes.

Mr Porter: The threshold was 2% of the samples taken testing positive for pseudomonas. As Maureen said earlier, there was a challenge at that time, which said that 2% was, effectively, a higher standard than that in other comparable projects in the NHS, but the decision was taken to proceed with that as the acceptable threshold in the contract.

At the time of the handover, the contractor undertook the samples. As Maureen said, the sample process was witnessed on behalf of the Belfast Trust by the consultant design team. The samples were sent to two UKAS-accredited laboratories to be processed. Under the terms of the contract at the time, the criteria had been met at the time of the handover. Reference was made earlier to points of learning: some of the learning from those criteria has already been applied to some of the tender and contract documentation for the children's hospital. That is not to say that we will not be open to further learning when the fuller report is published.

In any discussions where a decision of that nature is to be made on a complex project, there needs to be challenge, and a breadth of experience and knowledge need to be applied to be sure that we have a full understanding of all the implications. I caution against taking one isolated piece of advice, relying upon it and suggesting that following it would have provided a better outcome, because that is an untested thesis. It is difficult to give any assurance or guarantee.

Mrs Dodds: Let me put it another way to pursue that element a little bit further. Do you believe that there is a safe level of pseudomonas?

Mr Mulgrew: David will know the answer to that better than me. If we were to examine the taps in Stormont, we would find pseudomonas.

Mrs Dodds: That is an entirely different issue. I am talking about a hospital, where there are premature babies and mothers who are unwell. Do you believe that there is a safe level of pseudomonas? Do you believe that the hospital is safe when there is pseudomonas in the system?

Ms Edwards: We have rigorous processes to identify pseudomonas and address it.

Mrs Dodds: I understand the ongoing processes.

Ms Edwards: Our water safety group talks about 2% because we have incidents of pseudomonas in augmented care areas. We only test in augmented care areas because it is ubiquitous. We have robust arrangements in place to detect and address pseudomonas. There is no prescribed safe level. As David and I said earlier, in other schemes, 5% is deemed to be safe, and the Belfast Trust usually works to 2%. We will never be able to achieve 0% across all the hospitals in Northern Ireland, because there will always be isolated cases. The focus is on being able to detect it and on putting mitigations in place to detect it early. As my colleague from neonatology explained to the Committee in September, they live with that risk and other risks in the trust, day and daily, as well as with clinical risks. However, they know how to put arrangements in place for early detection and prevention and how to deal with any incidents that are detected. Our water safety group is made up of specialists, and the water safety teams in estates do that as part of their job. There are teams of people for whom that is their job.

Mrs Dodds: Am I correct to say that you believe that the hospital was safe to handover given the level of pseudomonas at that point, which quickly grew, as revealed in answers to later questions, to about 36% of all the water outlets?

Ms Edwards: There were two positive samples for pseudomonas at the point of handover. That met the criteria and was within the tolerance levels.

Mrs Dodds: Was one set of samples taken or were a series of sets of samples taken prior to the handover of the contract? Help me to understand it. Did you rely on one set of samples on any one day?

Mr Porter: There was one set of samples at that time, but a large number of samples were taken. I appreciate what you are saying, Diane: it would have been a risk to have a small number of samples. Under the terms of the contract, that is what was applied at the time. We await the fuller report from the consultant to see whether lessons can be learned on that, but those were the criteria at the time. A large number of samples was taken, which met the criteria.

Mrs Dodds: I am going to ask about a couple of other things.

The Acting Chairperson (Mrs Dillon): Diane, do you mind if Nuala comes in on the same point?

Mrs Dodds: That is fine.

Miss McAllister: I want to clarify how the samples were taken. When you say that samples were taken, were they taken at source or from water taps in various areas? If they were taken from taps in various areas, was the threshold 2% of all the taps that were tested? I want to be clear about the samples.

Mr Porter: Sure. It is water taken from the outlets. We refer to "outlets", which predominantly means taps. There are other outlets, such as shower heads and drinking fountains, but the term is predominantly used to refer to taps. That refers to water taken at the outlet.

Miss McAllister: The samples are all taken from outlets rather than at source.

Mr Porter: That is correct.

The Acting Chairperson (Mrs Dillon): Go ahead, Diane.

Mrs Dodds: I take it that you are saying that, given the contract, the trust was contractually obliged to accept handover of the hospital, even though pseudomonas was detected in the system. Is that right?

Mr Porter: It met the criteria, and we accepted it.

Mrs Dodds: Have I understood that correctly?

Mr Porter: That is correct, yes.

Mrs Dodds: I will pursue the issue of pseudomonas for another minute, then I will move on to another area. My understanding is that you were advised on the handover of the hospital by an independent expert company called Hydrop. Is that right?

Mr Porter: That is correct, yes.

Mrs Dodds: That independent company, which advised on the handover, is now advising on what to do about the problem.

Mr Porter: To be clear, it provided advice at the time, when discussions were taking place on what the criteria should be. Hydrop was not directly involved in any contractual way in the handover process.

Mrs Dodds: I accept that.

Mr Porter: It simply provided independent advice to the trust at that stage.

Mrs Dodds: Its independent advice was that you had to accept the contract of the hospital. The issue remains that the same company is now advising on the problem and that it will advise on a review. Is that normal practice?

Mr Porter: On a point of clarity, Diane, it did not advise on whether the building ought to have been accepted at the time of handover.

Mrs Dodds: I accept that. It advised on the water —.

Mr Porter: It advised on some of the issues of water safety, yes.

Mrs Dodds: Yes, but it is now advising on the review and on further issues and learning. Is that normal practice? How was that process arrived at?

Mr Porter: The independent —.

Mrs Dodds: I am not making a comment about the company; I just want to know the process.

Mr Porter: I appreciate that.

Mrs Dodds: I do not know the company. I am just asking whether it is normal practice to have the same people advising over and over again to provide an independent look at what is happening. Is that normal practice?

Mr Porter: It is a very specialist area, Diane. At the time, that company was appointed through the trust's legal advisers to undertake the independent review. Its previous advice to the trust was known and had been reviewed by the legal advisers, who were satisfied that none of it had had any material impact on the terms of reference for, or the scope of, the independent review. That was all reviewed by the trust's legal advisers at the time of the appointment and was deemed to be in order.

Mrs Dodds: OK. I will move on to how to fix the problem. How long does the defect period for the contract run?

Mr Philip McClay (Department of Health): Twelve months from 29 March 2024.

Mrs Dodds: In the paper that you have provided to the Committee, there is a lot about the defects and how we might fix them, but there is not a lot about who will pay for them. I understand that that is a legal issue, and I do not expect you to go into the detail of that here and now, but we will need to understand that as we go forward.

You say that you have taken samples from the taps again. Going back to the initial paper that you sent to the Committee for its meeting of 26 September, you said that you had started work on the pipework in the neonatal unit. Is that right?

Mr Porter: We are looking at commencing the design work. It is not physical work on site; we are just looking to commence the design work for it.

Mrs Dodds: Have you already decided to take out the pipework in the neonatal unit?

Ms Edwards: At that time, we discussed designing it so that, in the event of us having to replace the neonatal unit, which would be the priority, work could start on that immediately, because the design takes an amount of time and we would then have to get approvals etc. The final report will determine whether we need to replace the neonatal unit pipes, the whole building or any of that, but if we have done the design work, we will be ahead of the game. We are conscious of further delays and associated costs.

Mrs Dodds: You have done one set of samples. Was that done across all the pipework in the maternity hospital or selected pipework?

Mr Porter: The independent expert wanted a new set of samples, obviously, but from across the entire hospital. It was a single set but very broad set of samples.

Mrs Dodds: Had you been flushing the pipes in between times?

Mr Porter: Yes, flushing was undertaken in between times. In some of the outlets, particularly in augmented care areas or clinical areas, there are automatic flushing devices, which can be set to flush at certain times and for certain periods. At the minute, in other areas of the building where there is no automatic flushing, we have people going around and doing that manually.

Mrs Dodds: OK. There is a 12-month defect period for the contract.

The paper that you have provided is your synopsis of the interim report. Do you dispute that you did not take enough cognisance of the microbiologist's report on water pathogens at the time of the handover? Your paper says that you dispute various issues, but you do not list them. Is that one of the findings that you dispute?

Mr Porter: Is that a reference to the draft of the interim report?

Mrs Dodds: Yes.

Mr Porter: The process around that is to ensure the independence of that individual. We are not trying to steer them in any way as part of their initial review. When the report comes in, we check it for factual inaccuracies or any issues that we may not —.

Mrs Dodds: Is that one of the issues that you dispute?

Mr Porter: That has not been flagged as an issue of dispute to the independent expert.

Mrs Dodds: So, it is not identified in the independent review as being a problem.

Mr Porter: We have undertaken a review of the draft of the interim report with various members of the trust team and have provided feedback on a number of items and a number of areas on the issue of factual accuracy. To be clear, it is not for us to challenge opinions: the expert's independent opinion stands as is. As part of that process, however, we have the capacity to look at any factual inaccuracies within the report.

Mrs Dodds: I will rephrase my question. Is that one of the independent expert's opinions?

Ms Edwards: That he disputes his own findings?

Mrs Dodds: No, he does not dispute his own findings. He says that the trust did not take enough notice of what people, like the water usage group, said about pathogens in the water system. Is that one of the independent expert's findings?

Mr Porter: Again, Diane, the fuller report may go into the trust's handling of some of those issues. We have not got the full report as yet. We asked the independent expert to prioritise the analysis of the samples that were recently taken and to provide guidance on the steps forward. To expedite that, we have effectively asked for that section to be brought forward. The report does not yet go into some of the other areas, so the expert has not, at this stage, provided an opinion on the issue that you raise.

Mrs Dodds: Do you have a list of the kinds of defects that the contractor is going to fix? If so, does it include things like fire alarms and the on-call system for nurses?

Mr Porter: It is common practice, of course, for any construction project in the private sector and public sector to have a defects list.

Mrs Dodds: Of course it is.

Mr Porter: We have a defects list, and some of those items are on it. I took up my current post recently, and, when I did so, I asked for a review of any outstanding defects. That was for my own assurance to see whether there was any particular area of concern or anything that needed escalation. I am sure that everyone knows about the issue of water safety and, recently, there have been discussions on issues with the medical gases, but nothing else was reported to me that was worthy of escalation at that point. We had received details on the fire alarm system as there are issues with the panels that need to be rectified. However, that is not, by any means, listed as being something that will have an impact on the opening of the building. It is something that we can look at concurrently with the other issues.

Miss McAllister: I have some questions that follow on from that, which are more for clarity. This might seem like a simple question for you but I want to be clear that I understand all the definitions. Is the correct term, "handover ready" or "steady ready"?

Ms Edwards: Steady state

Miss McAllister: Steady state, sorry. Will you explain what exactly that means for any capital that is handed over?

Mr Porter: Steady state is effectively a process. Before we occupy a building, we run normal operational conditions within it to ensure that everything is balanced, operating well and all that type of thing. It is a check that is in place on behalf of the trust, as part of our assurance process, to make sure that the building is safe and ready to use.

Miss McAllister: OK. I thought that, but I was not too sure so I wanted to clarify it. It was handed over and pseudomonas was at 2%. As it is a maternity hospital, its occupants are going to be the most vulnerable and those who are at most risk from pseudomonas. Given that deaths have occurred in recent years — they happened not too long ago — has there or will there be any review of the entirety of contractual arrangements when it comes to pseudomonas? The word is that pseudomonas in water supplies resulted in the deaths of tiny babies, so was that, and the need to change, taken into account at the time?

Mr Porter: In the trust, we are conscious of that history. We are very aware of that, the sensitivity around it and the additional need for scrutiny in the trust on that basis. It was one of the factors that we considered when we were looking at the criteria for handover. The criteria for handover were not intended to suggest that 2% was an acceptable level for proceeding: the intention was for the 2% to be dealt with under the trust's normal protocols for dealing with any isolated instances of pseudomonas. The criteria were not intended to suggest for a second that 2% was insignificant the trust: was simply saying that it could be dealt with under the normal protocols.

Miss McAllister: I understand that. Do we think that the Department should now take that forward? We are talking about reconfiguring our entire hospital network. The Minister was talking about the possibility of midwifery hubs. Could the tender and the contractual agreements on the pathogen levels at the point of handover be looked at in a wider context?

Mr McClay: Yes. I apologise for my voice. I had a voice this morning, but I have not been well all week. Every hospital or health building that we build is designed in accordance with the health technical memoranda (HTM) and the health building notes etc. In Northern Ireland, we rely on the guidance that is provided by the UK NHS. We input into that, but we just do not have the resources to compile guidance specifically for Northern Ireland. All our schemes are designed in accordance with those health technical memoranda.

Miss McAllister: Is that where the difference between 5% and 2% comes in?

Mr McClay: I will ask David to come in and help me answer that, as I am relatively new in post. One of the things with these projects is that health technical memoranda are constantly being reviewed. The guidance can change as a project is being developed and even as it is being constructed.

It is about making sure that, if there is a risk to people's health, we take cognisance of that. What I want to say at this Committee meeting is that there is no question about whether anyone in health estates or the Department is looking not to apply those health technical memoranda. If there is a risk to safety, they are implemented.

Ms Edwards: There is relatively new guidance on water safety, which will be incorporated into the children's hospital scheme, along with learning emerging this year from a hospital in England and anything that we get out of our independent review. We will make sure that they are embedded in our new hospital.

Mr McClay: The new guidance was published in August 2024.

Mr Porter: It was in August. The HTM that is most applicable here is health technical memorandum 04-01, which is specific to water safety. The latest update and addendum to that was released in August this year. We are dealing with some fairly emergent findings here, some of which have come out of other NHS hospitals. The issues are not unique to Belfast. Sadly, there were other deaths elsewhere, and some of the reviews of those deaths have led to updates to the HTMs. We are very conscious of some of that emergent learning. We will review all of it, and, as I said, we await any other lessons that can be learned from our independent review.

Miss McAllister: It is reassuring that the guidance is constantly being updated. Levels of 2% could have been dealt with under the trust's guidance and operational matters, but how quickly did levels jump from 2% to 36%? How quickly did we see that jump? How quick was it?

Mr Porter: I understand the question. To be honest, I cannot give a definitive answer on that. We hope that the wider report will give some guidance and advice on where the cause may have been and from where the increase arose. At the minute, we are not in a position to specify that. Pseudomonas is naturally occurring. There are any number of areas where it could have occurred and increased. I cannot give you that answer at the minute, but certainly we will look to learn from it in the future.

Miss McAllister: Is it a pathogen that can originate and expand? Can it originate outside the outlets and expand elsewhere? I am very much simplifying the science of it, but if it is jumping from 2% to 36% in a short period, it is coming from somewhere. Is there somewhere on that specific health estate that is the source? We had an expert in a while ago talking about the ways in which they deal with it in the current hospital, and we know that the water is constantly tested. It just seems like quite a significant jump from 2% to 36%. Is there a wider problem here?

Mr Porter: Some of the information that may assist us in that is yet to be provided by Porton Down. We are referring quite a bit to Hydrop, but it is worth noting that that team was strengthened. We brought in Porton Down to do some of the more specialist testing. The testing and sampling that we have referred to was undertaken by another UKAS-accredited laboratory, Andersen Caledonia, which looked at whether pseudomonas was detected. Where positive samples were detected, those were sent to Porton Down for more specialist type testing, which is, effectively, a DNA-type test of the bacteria. That potentially gives us more information. We are waiting to get some of those results back from Porton Down. When they come back, they may help to guide our independent expert on where some of those things and causes may have arisen.

Miss McAllister: Hopefully, then, it is not a source — again, I am not speaking as an expert on pathogens — where, when we build the children's hospital a few feet away, we are going to encounter the same scale of problems. We will come back to that when the review is complete.

A written ministerial statement said that the cost to repair the medical gas pipes will be £50,000.

Mr McClay: That is an estimate at this stage.

Miss McAllister: We have been approached by individuals who have questioned that £50,000 amount, given the extent of what needs to be done. They suggested that the figures may be much lower than that — quite significantly so. How did we get to the £50,000 figure?

Mr McClay: I am happy to explain that. These pipes are concealed above a ceiling. We are in a neonatal unit that is complete bar the problems that we are talking about, which are keeping us out at the moment. To get access to the pipe, the contractor will have to go in, protect all the finishes, remove the ceiling, remove the pipe, replace —

Miss McAllister: Do you mean 30 metres long?

Mr McClay: — 30 metres, yes — remove the pipe, replace the pipe, and then reinstate the finishes to bring them back to the standard of finish that is required. You are correct in that the pipework element — the 30 metres of pipework — as a cost per metre — I do not want to play it down, but it is not massive. However, the cost of the remedial work is the going in and disrupting the finishes and reinstating the finishes. That is where the cost comes. That cost has been prepared by the professional quantity surveyors on the scheme. It was not prepared in-house, but we have checked it and are content that £50,000 is a reasonable sum, with the making good being the lion's share of it.

Miss McAllister: Just remind me again, because I do not have the ministerial statement in front of me, whether it is the same contractor repairing the work that installed the initial work. I could not remember.

Mr McClay: Medical gas pipework will have been installed by subcontractors.

Miss McAllister: Is it going to be the same ones?

Mr McClay: It is likely, to maintain warranties etc on the medical gas system, that it will be the same supplier. However, just to be clear, this issue, as we said, has been known about. It was not rectified because it is in the area where the sampling that we have referred to is taking place, so that has delayed the resolution. We received a report from our design team, which was working with the contractor to get to the bottom of the issue. Three options were suggested, and it is looking like we are going to do the replacement of the 30-metre run of pipework. It is likely to be the same subcontractor, and it should be the same subcontractor. I am not apportioning blame. I am not laying blame at the —.

Miss McAllister: No, and I understand in terms of warranty.

Mr McClay: We need to just work out how this issue arose, but that is the solution.

Miss McAllister: You said that the issue was known about. However, the Minister said in the Chamber that he had only just become aware of it, but it was on the agenda for Assembly business, I think, two weeks prior, was it not —

Mrs Dodds: Yes.

Miss McAllister: — before it was due to be debated, so it was public knowledge that it was going to be debated, two weeks prior to when it was debated in the Assembly. Was is known during that period? I am bringing that up not to cause an argument but to ask —

Mr McClay: No, I am comfortable with your questioning.

Miss McAllister: — whether there anything else? Are we going to, in the next six months or a year, find out that there is another thing? Can we be assured that everything has been drawn back and that this is going to be it?

Mr McClay: The first thing that I would say is that these are complex schemes, and we already touched on the point. However, if I brought to the Minister's door every issue across the health estate that we were dealing with on a day-to-day basis, he would be outraged at me. We were preparing — I think that you were referring to the motion that was being spoken about.

Miss McAllister: Yes.

Mr McClay: We were preparing for that. Maybe I am willing to put my hand up and say maybe I dropped the ball. I was focusing on the water issue. A question was asked the day before, "Are there any other issues?", and that brought it out. Given the scrutiny, and knowing that the Minister was going into the Chamber, we advised the Minister. We had a meeting on the Tuesday morning, which has been referred to. Yes, the Minister was frustrated, and I put my hands up to that. I will not make that mistake again, and I have told him that. That is on me, but I would —.

Miss McAllister: It is more about whether there is anything —.

Mr McClay: I will move on to that point, and maybe David will come in on it from the Belfast Trust. At the moment, we are not aware of any other issues. The only two red-rated issues are water and gas. The gas is going to be sorted out, but it is rated as red. We are not aware of any other things, but, as with all these issues, as Maureen pointed out, there is going to be a period of steady state, with staff moving in. Every building project has teething problems, so I am not going to sit here and give you 100% assurance, but, based on the information that we have — I am looking along the desk at David and hoping that he agrees — there are no other issues that we are aware of.

Mr Porter: As I said earlier, it was a question that I asked myself recently, when I took up my post, to provide assurance to myself on whether there were any other known issues or anything that would be worthy of escalation or could have an impact on the opening of the hospital in particular. We went through those and discussed any outstanding defects. As I said, I am aware of some that have been mentioned recently, but I was assured that there was nothing else that could not be rectified within the period that we are looking at and that there was nothing else that, as we see things at the minute, could have an impact on the opening of the new hospital. As Philip said, it is difficult to give an assurance that there can be no other latent defect that could come to light, but there is nothing else that we consider to be worthy of escalation at the minute.

The Acting Chairperson (Mrs Dillon): Colin is next, but before you come in, Colin, if you do not mind, there are couple of things that I would like the trust to come back to us on. When will we know what is going to happen and whether it is going to require any replacement of pipes, partial or full? I am not asking you for an answer to that today — you have given us something of a timeline, but that is based on different things — but we want to know what you know, when you know it, so that, as soon as you know what needs to be replaced, we will know that.

The Committee should also be kept up to date in real time on the results of sampling, rather than our saying that we would like an update every two months. If we said that, and you were to do sampling today, it would be two months before we got that information, and that would not be of much benefit to us or to you in our getting the information and coming back to you with questions. Getting those results in real time will give us a sense of the direction in which things are going. That is based on Nuala's last point about whether anything else is liable to come out — "These are the things that are liable to come out; this has gone up again; you need to know; the work cannot be done; the pipes have to be taken out; and these are the complications that we are most likely to face". We want that information in real time in order to be helpful. If we have the information, we know what is happening, rather than our coming at you to bring you in front of us and say, "Why did you do this?". If we are informed, and we can then help in any way, that is what we want to do. Sorry, Colin.

Mr McGrath: Thank you, Chair. Notwithstanding those who are represented here, let us face it: most of us were in short trousers when these projects began. It has taken us that long to get to this point —

The Acting Chairperson (Mrs Dillon): You are a bit younger than me.

Mr McGrath: — that we really cannot be offering any judgement on the professionalism of anybody who is here, because these projects go so far back. However, when it comes to the Department, if we look at the maternity hospital, we see that it has jumped from £50 million-odd to £90 million-odd, and the children's hospital from £200 million-odd to £500 million-odd. In the papers, there is the written answer to Diane's question about the acute mental health inpatient centre — £4 million to fix pipes there. The potential top line for pipework here is £7 million and, for the gas pipes, it is £50,000. You guys are supposed to be keeping an eye on those guys and the work that they are doing, so —

Mrs Dodds: What are you doing?

Mr McGrath: — I suspect and politely suggest that, if it were happening anywhere else, those guys would be in special measures, if it was a particular other area, saying, "Maybe the trust cannot be trusted with public money in delivering services, because it is going way over budget". I can think of schools and councils that would like money. I can think of roads that need to be built. I can think of a whole load of things that are not going to happen because we have gone way over budget with those projects. What extra measures are you putting in place to keep an eye on the trust as it delivers the services, or is it still the same oversight that would have been provided previously, and which is provided for other trusts?

Mr Matthews: First, I absolutely recognise the point about finances. We have been here before, talking about the state of Health finances overall. The Department is frustrated and concerned about not just that project but all of them. In the case of the maternity hospital, we have intervened a couple of times over and above what we would ordinarily do. One instance is the fact that David is here now. That was as a result of our permanent secretary, the accounting officer, asking the trust to increase its capacity for managing projects. The second thing is more recent, in light of the current concerns: I have been asked by the permanent secretary and the Minister to meet the team once a week to monitor progress and see how we are getting on. I am a member of the departmental board; it is really unusual for me to be that closely involved in a project, but that is in recognition of the public interest.

As we have heard today, there is a significant amount of technical expertise that policy officials like me cannot second-guess — we cannot intervene, because we are not qualified — but the role of the Department is to assert the public interest in keeping the cost to a minimum and making sure that the building opens in a reasonable time. As we have all discussed, here and in other places, there is a very robust need, and a robust business case, for this hospital. That takes me back to the two sets of controls that we have. The first is on the engineering and technical side of things. Our health estates colleagues are in constant communication with the trusts. Separately — I think that Preeta was here last week — we have our capital investment team. Each time a cost increase occurs, there is a robust process that has a dual layer of assurance, which is not just that the Department accepts the cost increase but that the Department of Finance must also be satisfied that the increased costs remain value for money for the objective of the business case. Obviously, the public interest is very high in having something like the maternity hospital delivered. As you mentioned, some of those cost overruns are because of the sheer length of time for which the project has been running. Some of them are to do with inflation, COVID, global conflict and all of that sort of stuff. There are a significant number of areas in which we can learn how to avoid avoidable delays and make decisions more quickly, but there are areas where costs are going to increase. The issue for is that the more those costs overrun, the more that will eat into our ability to do other things. You mentioned other areas that would like additional funding. Part of our job, and part of the Department of Finance's job, is to ensure that, at each stage, if we are looking at a cost increase for a project, it remains good value for the public that we invest that amount of money.

We have mentioned the children's hospital a couple of times. We in the Department are starting to turn our attention towards thinking about what the lessons of the maternity hospital can tell us about the safeguards that we need for the children's hospital. There will always be something that you cannot predict; we are in a very complex world. As colleagues have mentioned, even the technical guidelines that you start a project with can change halfway through it. There are all of those sorts of things. The issue for us is about minimising the impact of those things. We cannot control them or prevent them from happening, but we can control our behaviours and the systems that we have in place. We have taken a number of steps regarding the maternity hospital. The permanent secretary, as the accounting officer, felt the need to step in. When we think about the children's hospital, we are thinking about what the experience of the maternity hospital tells us and what additional mechanisms we need to put in place for it.

Ms Edwards: You made a comment that we are overspending. I think that you need to put that in context. The first significant increase was between the original OBC in 2011 and 2017. That was at procurement stage; that was not the trust making spending decisions. Most of that gap was because we had no value-for-money tenders in, so the tender had to be collapsed. The trust does not carry out the tendering process. The market speaks, and the market did not come in under the tendering price; it was significantly over.

In the meantime, new guidance came out on neonatal cots and on the number of cots, meaning that there had to be a significant change to the design of the building, which added to the cost. That £25 million cost was before the project was being managed in the trust. It was reflective of market conditions, competition in the market, price increases, new guidance etc. As Chris said, things changed throughout the project, particularly between the outline business case and the full business case, and they carry cost and time. Those things are robustly challenged and evaluated by not only the Department of Health but the Department of Finance. At that point, the trust is not spending money. That is a procurement or enabling stage. We have been within the approvals. I completely recognise that the approval levels increased, but they went through proper public-sector business case approvals to get to those levels. They were not overspends. That increase represents a change to the budget that is recognised and approved by others.

Mr McGrath: That sounds a little defensive. Looking at the overall project, when we start something at £50 million and it ends up costing £100 million — with the children's hospital, it started at £200-odd million and has ended up at £600-odd million — I see that as an overspend. Whether that has come about because of design changes or whatever other reason, if an Executive sets a budget for a project and that project ends up costing more than twice that amount, there is an issue. It is important that, as a scrutiny Committee, we drill down into that issue.

Ms Edwards: It is a significant increase in costs, and it is limited public sector. We take that very seriously, and we have very robust performance management systems, including financial performance; I can give you that assurance. It is not that I am being complacent, and I hope that it did not come across like I was saying, "Well, that's just the way it is". I am just trying to explain why some of the costs moved.

Mr McGrath: As you said, issues with costs and delays were caused by COVID, Grenfell and a whole list of things, but none of those contributed to the issue of pseudomonas. That is a completely separate issue, and it is the issue that we are left with. We now have a project that has had significant delays and changes. There is an element of it going on and on from one issue to the next. It does not seem to have happened like that for many other projects, except other projects in the Belfast Trust, which is a bit concerning. The current situation is that there is the pseudomonas issue and the project will potentially cost more money.

Ms Edwards: At the risk of sounding defensive again, you were probably talking about the critical care building there.

Mr McGrath: Yes.

Ms Edwards: That was completely outwith the trust's control. The contractor at that time claimed full responsibility and paid in full for the delay.

Mr McGrath: I will move on to the issue of liability for this. I got a sense — I will check Hansard before I say that I am 100% on this — from all the stuff that you said, that you were explaining that most of what happened was within normal guidelines and procedures, and that you were saying, "This is the normal way that handovers happen. This can normally happen within that period". Given all that talk of it being normal, is there any opportunity for the redress for this issue to be to a third party, or does it have to be taken 100% by the trust and the Department? Is it still an option for it to go to a third party? Given that you said that everything happened within normal parameters, it would be difficult to go back to a contractor and say, "You acted outside of those things".

Ms Edwards: The full review will give us more of an idea of whether any or all parties — the trust, the design team, the contractor and others — fell short and contributed to any of the delays or costs. Decisions will be made about recovering costs at that stage. That is also normal process.

Mr McGrath: I got a sense, from how you explained it in your opening remarks, that everything was within —. It felt almost like a presentation of, "There is nothing to see here: 2% is normal, and it could go higher. We do not have guidelines for that".

It just felt as though it was, "We are here, where we are, because we are here". If that is the basis of it, it will be difficult to go back to a third-party contractor and say, "Well, actually, you are liable for that". At this stage, is it a case of what has happened has happened but we still do not know how it happened, and therefore there is still an opportunity in the future that there could be —?

Ms Edwards: Yes. That is a key decision.

Mr Porter: We are very cognisant of that. Our priority at the minute is defining the steps forward, but I am sure that you will note that, understandably, our priority is to make the building fit for occupation as soon as we can and safely, of course. We are very cognisant of the fact there may be recourse for the public purse as part of this. We do not want to say anything here that might jeopardise that, of course, but we have asked for legal advice on where we can perhaps give a bit more information to the Committee without in any way undermining the potential for legal recourse in the future. We are taking steps to get a bit of advice on that from the legal team, and we are keen to be as transparent as we can and provide the information as best we can to the Committee, but, of course, we do not want to do anything that would in any way undermine any legal position.

Mr McGrath: I have a final request. Our job is to hold the Minister to account, and the Minister holds the Department to account. Can I ask for a written reply from Chris on the extra measures that you will put in place for the next project? This was bad enough, but the next one goes up by five times the amount of money, so we need to make sure that the checks and balances are there for everybody to make sure that we do not end up here again.

Mr Matthews: We have not defined what that will look like yet, because we need to understand more fully what has happened here. However, we will provide information on what those structures look like, and, if it is helpful, we can maybe have a discussion about how that might work in practice and give the Committee an opportunity to provide input to that.

Ms Edwards: In the trust, we have put in extra measures for the children's hospital, particularly around commissioning processes. We are using the Building Services Research and Information Association (BSRIA), which is an industry expert, to help advise us as part of the normal learning. However, we are also conscious that this is a much bigger, much more complex building, and the trust has taken additional steps in resourcing, as well as having David dedicated completely, given the size and scale of the flagship project, which is why David has come on board.

Mr McClay: In that paper, we give a bit of an analysis of our resourcing. You will note that David Porter is sitting now in the Belfast Trust. That means that health estates is a person down, and recruiting specialist construction professionals with a health background is proving difficult at the moment. I do not want to appear defensive, but I want to make the point that there have been resource pressures on health estates. It is no excuse, but I just want to put that on the record. We cover that in the paper.

Mr McGrath: I am OK up to there, then I am not OK. [Laughter.]

I am sure that we will come back to that in the future, if we can.

The Acting Chairperson (Mrs Dillon): Diane wants back in.

Mrs Dodds: Following the questions to Chris regarding the issues of accountability, has the contract for the children's hospital been signed, given the issues that, we know, are relevant in the maternity hospital contract, and has the contract materially changed since the one for the maternity hospital?

Mr Matthews: The position that we are in is that we have business case approval but have not signed the contract.

Mrs Dodds: Will the new contract reflect some of the issues and learning that we have from what has arisen in the maternity hospital, particularly with thresholds around pseudomonas or similar issues?

Mr Matthews: My more knowledgeable colleagues have probably already thought about that, but the short answer is yes.

Mr Porter: The short answer is indeed yes, as Chris said. As we mentioned, Diane, some of that new guidance was issued as recently as August, so we will need to reflect on some of that and work with the contractor to implement it. I am sure that it is in the contractor's interest to ensure that this does not happen again. We will work with any new guidance, but to give you assurance, yes, some of the lessons learned from the maternity hospital have already been implemented in the tender documentation and the contract for the children's hospital.

Mrs Dodds: So, it is at tender and not —?

Mr McClay: The contract has not been signed.

Mrs Dodds: But there is a preferred contractor.

Mr McClay: Yes.

Mrs Dodds: Oh, right. That is OK.

Mr McClay: For clarity, there was one tender received for the children's hospital, but the contract —

Mrs Dodds: Will that contract reflect the learning from some of the issues that have arisen here?

Ms Edwards: From our own and other hospitals where learning emerges.

Mrs Dodds: Maureen, you referred to this after Colin McGrath talked about the critical care building: the critical care building also required about £20 million of resource money from the trust to sort it out, no?

Ms Edwards: Not that I am aware of.

Mrs Dodds: Maybe you will come back to me on that. That is fine.

Ms Edwards: That was not in a business case and approved. There will be revenue consequences, obviously, to any new building. Revenue consequences are agreed with the commissioner as part of the new build.

Mrs Dodds: Perhaps you will just write to us on that. It is something that you might want to explore.

Ms Edwards: OK.

The Acting Chairperson (Mrs Dillon): Alan, you indicated that you want to speak.

Mr Robinson: My question is quite broad, but it is an important question. Then we will narrow it down. The obvious question that, I am sure, those who are watching will ask is whether, given the sums of public money that are involved and the sums that will eventually be involved regarding the three options that we have before us, the Department believes that there will be an impact on services or other projects?

Mr Matthews: It will depend on which option. At the minute, the trust has given us assurances that its current sense — there are no guarantees here — is that the most extreme option is not the most likely. That being the case, we would be hopeful that we would be able to contain the new costs without impact on other projects. However, that is difficult to predict until we know exactly where we are.

Mr Robinson: You used the word "safely" in the report — it is at point 3 — in referring to the existing buildings. Can you give assurances that the existing buildings and maternity services are safe? I am sure that that is another question that those who are watching are asking.

Ms Edwards: In the current maternity services, yes. In the papers for the last meeting we had a bit more information on it. Our estates teams work closely with them, because that building is not fit for purpose. We need to move, and, in the intervening period, things will happen that need service and maintenance. The estates team is working closely with them. There is a risk of pseudomonas in that hospital, as in all our hospitals, but we have good arrangements in place. Those teams are robust.

Mr Robinson: That leads on to my next question. Has there been testing of the existing building for PsA?

Ms Edwards: There is regular testing —

Mr Robinson: Regular testing. OK.

Ms Edwards: — in augmented care areas across our hospitals.

Mr Porter: It is worth noting as well that there are standards for testing in augmented care areas, which are the more clinically sensitive areas. The standard of testing in the neonatal, given the issues there, is even higher, so we are particularly sensitive to that.

Mr Robinson: Another point that I picked up on is that, in 2013, works dug up lots of asbestos material. The term "significant" is used. No geotechnical survey picked up the extent of that. Was that a failure, or is it normal practice in building works? If it was a failure, will there be learning from it, given that there is much more work to do in the wider project?

Mr Porter: That is a reference to the enabling works that took place on the maternity contract in advance. In any such project, we would normally undertake what we call "geotechnical investigations". Typically, that would involve boreholes across the site, and then the analysis of what comes from those boreholes is provided to give, effectively, an indication of conditions across the site. Regrettably, the boreholes that were identified in that testing in advance did not pick up the contamination, and there were substantial areas of contamination on the site. The boreholes that were identified and taken prior to that work did not identify the contamination to the same extent.

Mr Robinson: Is that a failure?

Mr Porter: I am not sure that I would use the term "failure". It is one of those things. The locations for boreholes are chosen, and sometimes they are defined by where you can do it on a site, particularly on an acute hospital site. They are spread across the remit of the site, but there is no guarantee, where you make boreholes, that there will not be something in an area that has not been tested, unfortunately. Unless you were to do such a number of boreholes that you were effectively —.

Ms Edwards: There are cost consequences.

Mr McClay: You cannot cover the complete extent of the site, and, if you did that, the cost would potentially be greater than the cost of the asbestos.

I have a second point. I am a chartered quantity surveyor, and, many years ago, when I got cross about something that was an error or an omission in just missing a bit of ground, a mentor of mine said that the work was always going to have to be done, the asbestos would have to be removed. Just to make the point, if there is asbestos in the ground, regardless of whether it is known about, if you discover it, you have to pay for it in your tender. Whilst there was £4 million for that asbestos, it was always going to have to be paid for. The point is that it was not caught in the tender documentation because the borehole had missed it.

Mr Robinson: Do the chair and the board feel that they were kept fully abreast of everything throughout the entire process?

Mr Mulgrew: The process in 2013?

Mr Robinson: Yes.

Mr Mulgrew: I was not in position at that time, so I cannot say. With regard to the current issues with the maternity hospital, I have no doubt that we were kept abreast. Since we were informed of the issue in September 2023, it has been discussed at the trust board on eight occasions, and there have been two separate briefings from estates to non-executive directors to make sure that we are fully aware of it. So, yes, we can say that we are aware of it.

Ms Edwards: Since I took up the post as director in 2017 and SRO, reports go to the trust board on a two to three-month basis on all of our major capital schemes. Key risks, key challenges, costs and any forecasts go to the trust board for discussion. For the high-risk ones, where more detailed reporting is required, we bring specific schemas to the attention of the trust board as we have done in the last year.

Mr Mulgrew: I also have a one-to-one meeting with the chief executive every week, so the issues are discussed there on an ongoing basis as well.

Mr Robinson: That leads me nicely to my next question. Have there been any other concerns about the fire alarm system or temperature regulation in the heating system?

Mr Porter: I mentioned that there were a number of other known outstanding defects. We are satisfied that they can be remedied within the timescales that we have and will not impact on the opening of the hospital. So, yes, there are other defects — that is common to all construction projects — but we are satisfied that none of those were worthy of escalation to the trust board or, thereafter, the Department and the Minister.

Mr Robinson: What level of importance is put on them? Philip said that, if you were to provide the Minister with a detailed synopsis every so often, you would never be away. What importance is placed on the issues?

Mr McClay: Alan, just to clarify, I think I said, "if I went with every issue that was reported to me". As I said, I am two weeks in post. I have worked in health estates, so I am not shirking my responsibility, but I think that that will be another lesson learnt and that we will look at it with the Minister to agree parameters on where a trigger point is set for notification to the Minister. I would like to have that discussion with the Minister and agree those parameters.

Mr Robinson: Fair enough.

I have a final question. Could you explain the formal process of handover to the trust? Does the senior responsible officer, the chief executive or someone else, ultimately, have to sign their name at the bottom of a piece of paper?

Ms Edwards: Yes. As I said in my opening remarks, the chief executive signs that off on the basis of assurances provided by the consultant design team, which has sought assurances from the various experts on water safety, engineering, electrics etc. When the handover criteria are met, the consultant design team approves that and, on that basis, the trust chief executive signs it off.

Mr Robinson: That is helpful. Thank you.

The Acting Chairperson (Mrs Dillon): Thank you to all. I am not asking for an answer today, but maybe you could come back to us in writing. Obviously, the cost of the hospital is one thing, but there must be a cost

we talked how closely estates has had to work with the hospital just to keep it safe. I imagine it is not making it any better; it is just keeping it safe. There is a cost to not being in the hospital, so that is an additional cost, and we have no idea what it is. Could we get some idea of that, so that we can understand it?

Mrs Dodds: Chair, may I come in?

The Acting Chairperson (Mrs Dillon): Yes.

Mrs Dodds: I listened really carefully. Obviously, I have taken an interest in this as an issue. I hear a fairly defensive explanation of what has happened. I also hear warm words about how the trust will learn lessons around the issue, but I have not heard anybody describe what those lessons are and how they will be picked up, etc. I would like the trust and the Department to come back on that.

Despite my having been in politics for a long time, health is a new policy area for me and one that has probably energised me again in politics. One of the things that I really want to look at is accountability, and that is really important. Ciaran, you said that the board was told about the issues perhaps six, seven or eight times, but what were the actions from the board? What did you ask Maureen, as the senior officer in charge of the project, to do? What did you think the next steps forward were? What was the accountability mechanism that ran in that issue?

Accountability is really important because, as Colin said, we are about to embark on building a children's hospital. This amount is relatively small compared with the amounts of money for the children's hospital. If we double that, we will be at £1 billion before we know what we are doing. Things like the mother-and-baby-unit are not progressing. A lot of things in health estates are simply not progressing because there are overspends and delays here, there and everywhere. That issue of accountability, of board to trust, Department etc is key in trying to make this move forward.

Finally — this is important — there is a lot of talk about thresholds of pathogens in the water systems. When you told the chief executive to sign it off on the basis of all the other people down the line, did you believe that the hospital was safe?

Mr Mulgrew: Should I take the first bit, which refers to me, Diane? The questions that the trust board asked when the issue of pseudomonas came to us in September 2023 were very much the questions that have been asked here. They were questions like, "How did we get here? How safe is the hospital? Should we move into the hospital? What can we do?". We were then told of the steps that David has outlined: that we would go out to someone independent who would assess how the pseudomonas got into the system and would give us recommendations on the road forward. Those are the questions that were asked by the trust board.

Mrs Dodds: Ciaran, I accept that. I do not think that you were not asking any questions. When the issue emerged in June or July this year, I wrote to the Health Minister, who wrote back and said that an independent review would be commissioned. We are only at the stage where we have an interim report and your synopsis of that interim report all these months later, and you were told about it 12 or 14 months ago.

Mr Mulgrew: There is a process of getting someone to do the work for us, the process of actually doing the work and of sending it away to be assessed. You then have to have different regimes of detergent, which you flush through, and you have to assess whether that has worked. That process has been condensed, so, on the questions that have been asked and the actions that have been taken since, we have done as well as could reasonably have been expected. The reality is that, with a pathogen such as pseudomonas, which is probably prevalent in most places, it is difficult to come up with a situation in which we could say that we will never have pseudomonas in the hospital. The reality is that we have protocols to manage it because we accept that it will be there.

Once we were aware of the problems with the new build, we moved towards the regime that would get us out of that situation. It simply takes time to appoint someone and do the analysis. I do not want to be definitive, but I very much doubt that we have reached the worst-case scenario. We will be at option A or option B. However, we can make that decision only in light of the best scientific evidence that is given to us and by listening to the clinicians who will be responsible for the safety of the mothers and children who will be in the hospital.

Mrs Dodds: OK. Did you consider it to be safe?

Ms Edwards: I am not an expert, and it is not up to one individual to make an assessment. I took the decision on whether we would accept handover on the basis of the advice that the experts gave me, which was that the contractor had met the criteria and the standards that were required. That is the handover point, which is part of that process.

We will not move into the building until it is assessed as safe. That is the commissioning period, which is when we had the additional sampling, and risk-assessed decisions will be made with the engagement of clinical teams, which are best placed to decide the level of risk that they are able to take on, along with other experts.

We have not moved services into the building, which is why we are all here. Handover is one step of the process, and it happens when the building standards and criteria have been met. We then do the requisite testing. That is where we are now. We are using the independent expert because of the history of the building and the additional concerns that we had.

Mrs Dodds: Finally, did you contractually build a safe building?

Ms Edwards: We will use all the expertise that comes out of the report. When we move in, the building will be deemed, on the basis of feedback from the clinical team, to be safe for the services that are in it.

Mrs Dodds: In the worst-case scenario, we are looking at 2028 for people to move in.

Ms Edwards: At this point, on the basis of the information that we have, nobody believes that we will reach the worst-case scenario. We are just putting the worst-case scenario there. On the basis of the interim report, we are not considering that to be an option.

Mr Mulgrew: I sense the frustration in what you said. It is perfectly legitimate and is shared by everyone involved in the process. When we have finished and it comes to learning lessons, there will be enough to be learned by everyone involved. There are certainly lessons to be learned by us as a trust, by health estates, by the Department and by the people who built the hospital. The key thing is that we will have to apply those lessons so that we do not find ourselves in this situation with another project.

Mrs Dodds: Ciaran, I would like us to return to this, because it is important that we all understand the lessons that come out of it. It is not just about the money but about delivering the best services for very vulnerable mothers and children from across Northern Ireland. I suspect that we will return to it.

The Acting Chairperson (Mrs Dillon): Thank you, Diane.

I think that Alan wants to come in on a small point.

Mr Chambers: This is a small point, Chair.

Maureen, I appreciate the fact that you signed off on the handover on the basis of advice that experts gave you. Do you feel in any way that you were let down by those experts and their advice?

Ms Edwards: We are not at the point at which I can say that. By the same token, if one person had said, "I do not believe that this hospital is safe", I have to take my decisions on the basis of advice from experts in the field. I have to, and I did. The expertise and professional advice at that stage was that the building had passed the handover test and we could go to the next stage.

The Acting Chairperson (Mrs Dillon): Thank you, Maureen and all the panel. We really appreciate your answers to all the questions.

On the back of Diane's point, we will come back to this — we definitely will. We would like to do a site visit at an appropriate time, but we, as a Committee, certainly do not want to cause additional problems. We definitely want to speak to you again when we have the full report on the review. Maybe I missed this — I apologise, if I did — but when is that expected?

Mr Porter: There are sections of the report that we have asked the consultant to prioritise as they move through the work. Part of it may be determined by the final outcomes on the options, because, of course, we will need to reflect on all that.

The Acting Chairperson (Mrs Dillon): We do not have a date.

Mr Porter: We do not have a definite date.

The Acting Chairperson (Mrs Dillon): That is OK.

Mr Porter: It will be subject to any lessons that come from the new sampling that will take place during phase 1 and the outcome of that. The report will reflect on all that and will be released subsequently.

Ms Edwards: We were going to suggest that we come back when the final report is there and we have more information. We were also going to extend an invitation to the Committee to come and see the maternity hospital. If you have the time and if we plan it well enough, we could share the plans for the children's hospital and, at the same time, you could see some of the enabling works that have been done.

The Acting Chairperson (Mrs Dillon): The Committee definitely wants to do that, so we will make the time.

Ms Edwards: I hope that you will see that it is a magnificent hospital; it really is.

Mr McGrath: We will bring bottled water. [Laughter.]

The Acting Chairperson (Mrs Dillon): We will get a sense of when the final —.

Mrs Dodds: He always has the last word.

Mr McGrath: Thank you.

The Acting Chairperson (Mrs Dillon): We will get —

Mr McGrath: Diane, from childhood.

The Acting Chairperson (Mrs Dillon): — a sense of when the final —. Through the Chair. Behave.

We will get a sense of when we will get the final report after we get the information from you around the sampling, what will happen and what work you will have to do. I appreciate that.

I thank you again for coming before the Committee today. We know that the request was made at short notice, so we appreciate that you accommodated that. Thank you to all our Committee members, who have a special interest in the issue, for doing their work and making sure that we hold everybody accountable, which is our job. Thank you.