The site is being cleared, the bids to build the project are coming in and the legislation required to make it a reality is due shortly – the vision of a new national children’s hospital is finally beginning to take shape.

Given the number of false starts the project has seen, it is hard to credit that the hospital is due to open its doors in just four years.

"People are really starting to get excited about it now," says Eilish Hardiman, chief executive of the Children's Hospital Group. "We're at the stage where detailed decisions on the new hospital are being made, such as where to place the plugs in the 6,000 rooms in the new building."

The project, which was granted planning permission last April, faces two crucial hurdles over the coming months. Government will have to approve the price negotiated by the project team with the builders, and legislation providing for the amalgamation of the three existing children’s hospitals in Dublin will have to find favour with all those affected.

Not surprisingly, given the size of the project, the tender to build the hospital has attracted keen interest from the construction. Five consortiums are submitting bids to build what will be Ireland’s largest public sector contract, but until their proposals are opened after the deadline on October 26th, the ultimate cost of the project remains a guesstimate.

The original price-tag of €650 million has already been pushed up by €60 million to allow for inflation in the construction industry. That's to build the hospital and two smaller satellite centres at Tallaght and Blanchardstown but it doesn't include the cost of equipping the facilities. This is likely to cost another €60 million, not including the cost of the all-essential IT.

Once the bids have been analysed and ranked, the project team will prepare a memo to go to Government, setting out the cost and scale of what is planned. Assuming the Cabinet gives the green light, most likely early in the New Year, there will be no going back.

As things stand, the satellite centres are scheduled to open in 2018 and the main hospital in mid-2020. However, delays have been a constant with the children’s hospital project since it was first conceived, so it is possible rather than probable that this target will be achieved.

Aside from the construction work, the three existing children’s hospitals in Dublin have to be merged. Legislation is needed to create a single entity but has been slow to appear. Hardiman says she expects the head of a Bill to be published next month, and the measure to become law by the middle of 2017. The children’s hospital would then formally take over the running of the three hospitals in January 2018, all going to plan.

But as the current row between St Vincent's Hospital and the National Maternity Hospital over the latter's relocation from Holles Street shows, very often things do not go do plan when medical politics are involved. The botched creation of Tallaght hospital from three institutions with very different backgrounds also showed the pitfalls involved.

Hardiman says the amalgamation of the children’s hospitals is “fundamentally different” from the maternity hospital situation. All the hospitals bidding for the project did so on the condition that their provided the site free and unencumbered; St James’s has already handed over to the HSE the land on which the children’s hospital will be located.

In addition, the children’s hospital has its own board, separate from the St James’s board or any other. “It’s important that the board is not seen as a State board and that it behave in the way board of voluntary hospitals do. The way to achieve this is to give it enough independence.”

She sees the board having an independent chair, with members serving voluntarily (no fees), and chosen for the particular competences. Department of Health and HSE representatives would be in a minority.

Whether the civil servants who will frame the legislation agree with this vision remains to be seen. It is likely transitional arrangements would apply in the first year to allow for the move from three hospitals to one.

Finding qualified staff to work in the new hospital is a big worry; Hardiman estimates at least 600 additional staff will be needed. Most of these will be clinical, with the areas of greatest need including specialties such as urgent and intensive care, stem cell, anaesthesia and general paediatrics.

She argues strongly for a Dublin weighting to be applied to the salaries of clinical staff, in recognition of the higher costs they face. Another suggestion is for the city council to provided affordable housing on its own land banks for key staff.

Hardiman also says specialist nurses working in intensive care and operating theatres should be paid additional allowances. “We’re talking about 100-150 nurses, the crème de la crème with the highest points before studying, who are looking after the sickest children.”

The new institution will be given a distinctive name, one that is child-centred, easy to understand, progressive and that captures the nature of its role, she says. Some 25 names are under consideration and a winner will be announced later this year. Hardiman won’t give any clues, but she does approvingly mention New Zealand’s largest paediatric hospital, which rejoices in the name of Starship Children’s Health.

Public access is the key concern among crtitics of St James’s

A diverse collection of critics have repeatedly criticised the siting of the hospital in St James's and are continuing to do so. Their arguments got short shrift from An Bord Pleanála but have gained more traction in public debate, most prominently through the support of broadcaster Pat Kenny.

Arguably, the single criticism that has resonated most with the public concerns access.

Any parent can relate to it: imagine you have a child who suddenly falls seriously ill and needs to be transported to hospital. Invariably, this transport will take place in an ambulance or, failing that, in your car. What is the risk you will be delayed in getting to the children’s hospital in St James’s because of traffic congestion? Could this cost lives?

The project team behind the hospital has published a “myth-busting” document that seeks to “clear up misunderstandings” about the project but this does not deal with the arguments about traffic.

Hardiman maintains that arguments made about potential traffic snarl-ups outside St James’s are “scaremongering” and are not “based on the facts”. She puts forward a number of arguments in support of her view that families will enjoy smooth access to the hospital, even in extremis.

Staff commuting is a significant contributor to traffic bottlenecks around the existing hospital and the removal this summer of 350 staff car parking spaces as part of site clearance has effected a “remarkable” improvement in traffic flow, she says.

St James’s currently has an ambulance base, which has “the best turnaround times of any hospital”, she adds.

The opening of a third entrance to the St James’s campus will further ease the traffic situation, she says, and apps are being developed to help families navigate to the hospital.

As for parking, she says there will be 675 car-parking spaces for families, including dedicated emergency parking. This will include 22 set-down spaces, offering valet parking.

Three out of every four patients using the new hospital will come from the greater Dublin area, and 40 per cent of emergency cases will be handled by the satellite centres in Tallaght and Blanchardstown rather than at St James’s, she predicts.