Our health service is in a state of perpetual crisis. Overcrowding at our accident and emergency departments and hospitals worsens by the day and yesterday the Midlands Regional Hospital in Mullingar became the latest hospital to announce it was at maximum capacity and to advise patients to stay away. That follows the dangerous level of overcrowding we have witnessed in Cork University Hospital, in University Hospital Limerick, Mayo University Hospital, Castlebar and Kerry and on and on it goes. Hospital waiting lists continue to grow and we now have the worst waiting lists in Europe.

Nurses and midwives have had to engage in industrial action, and general practitioners have protested outside the gates of Leinster House here because of the Government's refusal to adequately invest in primary care. Now to top it all we have the scandalous cost overrun in respect of the national children's hospital. All of this has happened on the watch of the Minister for Health, Deputy Harris.

The PwC report, published yesterday, shows that mistakes were made at every turn and illustrates how a risky and untested two-stage procurement strategy was pursued, which was known to have grave risks in terms of cost escalation. The sole advantage of producing a quick outcome was the opportunity for a Fine Gael Minister to cut a ribbon early.

The report highlights significant issues with governance and oversight and points to the serious matter of non-compliance with the public service spending code. It raises questions about the future of the project and the ability of the development board and the Minister for Health to deliver it within the current expected budget of €1.7 billion. Unfortunately, they have proved time and again unable to navigate this project and are responsible for the €450 million overrun which may grow.

The Taoiseach responded yesterday that the report makes for "grim reading". Ministers have said that they "accept all its findings". The Members of Government need to be reminded that they are not spectators to all of this, they are the authors of this fiasco and the people responsible. I understand that Government has accepted responsibility for this shambles. Who is accountable for the clear and gross incompetence, administrative, professional and political, and who will be held to account?

It is important to be honest about what has happened here. I understand the frustration and anger being expressed this morning and on many occasions in this House. We thought we could build a national children's hospital for much less than it will cost. That is what happened here. We unfortunately have seen a process that, until late last year, was proposing that a national children's hospital of this scale could be built for far less than it is going to cost.

This report makes very clear that most of the cost increase relates to a gross underestimate which should have been flagged much earlier and it does point fairly clearly to who was at fault in that regard and we need to learn lessons to ensure that if there are projects of this complexity, and there will be in the future, that this does not happen again. There needs to be a more proactive oversight of projects like this, that is clear. There needs to be more intense scrutiny of projects as the projects move ahead in terms of estimates, design, bill of quantities and so on. That is where this project primarily has failed to date. We now, I think, have a much clearer picture of what this is going to cost and we need to try to ensure that systems are in place to keep the cost within that final estimate that the Government approved in December. That is what happened here. People keep talking about waste and overspend. This money has not been spent yet.

The Government says it has no choice but to spend it.

This is a project that we now have a clear understanding of in respect of costs. This is a project that was grossly underestimated in terms of cost until relatively recently. Yes, the Government and politicians need to take responsibility for that.

The Government was warned in 2017.

We will and that is why we are changing systems-----

By cutting other budgets.

-----to make sure we take account of that. The public spending code is being updated and will strengthen the steps required in public investment evaluation and management. As part of the review of the public spending code, the Department of Public Expenditure and Reform is conducting a full assessment of how cost estimation and management for capital projects could be improved. Updating guidance on better cost estimation and management resulting from this will complement and strengthen guidance on preparing all aspects of business cases for capital projects in the future.

This will strengthen the selection, design and delivery of capital projects, which is clearly necessary on the back of this report.

For those of us who live in the real world, let me set out what has happened. There has been a €450 million overrun and counting. Those are public moneys that will have to be found somewhere. This whole fiasco has been overseen by a Minister who is clearly incompetent. At this stage he is a lame duck Minister whom the Government, with the assistance of Fianna Fáil, insists on keeping in office. This fiasco has happened on the watch of an out of touch Government that is only concerned with cutting ribbons and is clearly not capable of managing public - taxpayers' - money. To add insult to injury, the Government refuses to afford any level of accountability. I put a very simple question to the Government. Who is accountable? We know that the Government is responsible, we know that its partners in Fianna Fáil are responsible for allowing a Minister or Ministers who are asleep at the wheel, as Deputy Micheál Martin puts it, to continue in office, but I would like an answer from Government on who is accountable for this fiasco, for these public moneys and for this gross incompetence. Who will be held to account and how will they be held to account?

The Government has been clear. The Minister for Finance and Minister for Public Expenditure and Reform, Deputy Donohoe and the Minister for Health, Deputy Harris, have said repeatedly that the Government takes responsibility for this underestimate and for the cost increase of this project. There have been people who have felt the need to step aside because of accountability. The chairman of the board has stepped aside and there is a new person in charge of leading the board for this project now, so there has already been some accountability.

Closing the stable door after the horse has bolted.

With respect, the whole point of getting PwC to do the report that is now being published is to understand fully what happened here and who was at fault so that we can have accountability, we can learn lessons from it and we can put structures in place to ensure-----

Blame nobody.

-----that this kind of underestimate does not happen again in projects such as this.

It is not an underestimate, it is an overestimate

Of course it is. The money has not been spent yet. Is anybody in this House seriously suggesting that we can build a hospital of this scale and complexity for less than what is currently estimated?

The whole Government is.

No, they are not.

Let the Tánaiste respond.

Jimmy Sheehan would build it for €900 million.

The issue is around how we learn lessons from a process that was flawed in getting us this far while at the same time building a hospital for children in Ireland. That is what we are doing and we have been open about that. We have asked PwC to put a detailed report together so we can act on the recommendations of that. It has done that independently and without fear or favour. Within a month, the two Ministers concerned-----

A glossy report.

-----will bring a plan to implement those recommendations and they will be accountable to this House on that plan.

They are in hiding.