Location, location, location

The row over the planned national children's hospital on the site of the Mater is the first overt manifestation of the deeply ingrained rivalries in the sector, writes Kathy Sheridan.

For years, it had been a rather civilised, muted rivalry between eminent doctors in Dublin hospitals. Indeed, a deferential public would have expected no less, had they been aware of such rivalry. It goes something like this: quietly, almost surreptitiously, a particular hospital becomes flavour of the year with the powers that be, a few specialities are poached or drift over, a hospital grows to become a power player, reputations are forged, legacies are polished . . . Meanwhile, out in the long grass, their humiliated rivals are waiting. To many, they may seem like gods, but they are, after all, only human.

As always, in the hitherto refined row over the proposed siting of the new National Children's Hospital (a title already owned, remember, by a bitterly-disillusioned Tallaght Hospital, which believed it had a solemn undertaking from the Taoiseach regarding the retention of its paediatric hospital), words had been delicately couched, stridency carefully avoided, and every discussion sanctimoniously book-ended by the phrase "sick children come first".The plan will see the three existing hospitals for children in Dublin - Crumlin, Tallaght and Temple Street - merged into one national facility on the Mater site. It supercedes the previous plan integrating Temple Street into the Mater complex.

Enter Prof Michael O'Keeffe (brother of Ned, Fianna Fáil deputy for Cork East), carrying a whiff of the no-holds-barred cumann meeting about him. Combine that with a 15-year, well-honed sense of injustice, of watching impotently as his beloved Temple Street hospital was "asset-stripped" as he puts it, despite his and others' tireless lobbying to anyone with a titter of political influence, while trying to fund-raise for a "falling-down, inner city hospital in the middle of a rundown area", with hardly a celebrity parent (apart from Brendan Gleeson) or sympathetic RTÉ presenter to its name.

NO ONE SHOULDbe too surprised, therefore, that Prof O'Keeffe finally cuts loose, characterising the heretofore civilised exchanges as - good grief - a "turf war"; alleging that there is a medical cohort too scared or snobbish to venture over to the northside; singling out Sinn Féin as being "amazingly helpful at every level" to Temple Street during the lean years; and branding the constituency boss, Bertie Ahern, as "useless".

"Limerick, Cork, Wexford all greatly benefited as a result of having a local man who was minister for health. We had Bertie Ahern, the most powerful man in Ireland and what did we get? Nothing. Bertie obviously believed that the Mater was the important institution. If the Mater got a new door or pane of glass in a window, he was invited to open it," Prof O'Keeffe says, with a wry laugh.

"I even got to the stage when I said to one of his advisers, 'unless he has cranes on the site by the election, there will be no second seat here for Fianna Fáil'. I haven't voted for Sinn Féin - I come from a different political background - but I can well see why they're doing so well electorally, because they're on the ground, they're working."

For Temple Street, the bête noirein rival hospital terms has been Crumlin, which under the favoured gaze of the Department of Health and an energetic board gathered in dozens of specialities and eminent medical teams to a de facto centre of excellence, attracting tens of millions in funding for research labs and operating suites. "We tried to fight it but it became a juggernaut. That's why I turned to political lobbying," says O'Keeffe.

The upshot of the latest proposal for the new children's tertiary hospital is that the tens of millions of taxpayers' money and private funding spent on facilities in Crumlin and the €50 million already sunk into preparing the ground for the previous plan for the Mater/Temple Street complex will be money either run into the ground or put to extremely short-term benefit.

And it appears that absolutely no one saw it coming. "We were really taken aback, because we thought it would be anywhere except the Mater," says Mary O'Connor, who runs the 400-member Children in Hospital Ireland organisation, which has been lobbying for a single hospital in Dublin for 20 years.

Tallaght Hospital is flummoxed by the absence of transparency. Dr Fergus O'Ferrall, a board member, says that its representation as "an institutional turf war" would only hold up "if everyone had had a true and fair opportunity to participate in the process that led to the decision".

He refers, among other things, to "misuse of the Task Force in terms of expertise" and the "disgraceful" traffic flow report in the plan. A study carried out by Trinity College's geography department for Tallaght hospital stated that 75 per cent of the country's children would "have better access to Tallaght", says Dr O'Ferrall.

The hospitals' reaction is no surprise to Mary O'Connor, who says that official sources stated over many years that while the single hospital plan was feasible, the three children's hospitals would not co-operate.

Pragmatically, now, the group is taking no stand on where the hospital should be sited, although O'Connor says that Tallaght would have presented a problem for them, say, in the case of people having to travel from Swords. And what about people travelling from Cork, Kerry or Galway? "I feel everyone is going is going to have to hit the M50 wherever they're coming from. I'd like to see a better analysis of journey times."

DR KEVIN O'CONNOR, a paediatrician with a special interest in cardiology at the Portiuncula Hospital in Ballinasloe, Co Galway, strongly believes that there has been a Dublin bias to the debate. "The instance of medical problems is not significantly different between Dublin and the rest of the country," he says. "So it may be that two-thirds are from outside Dublin. For a significant number of children - such as a child with cerebral palsy in a wheelchair or a child with a problem with his immune system - public transport is not an option."

In any event, Mary O'Connor's group is holding fire about the site until the next stage of the plan, when questions about access, adequate and free parking, family accommodation under the same roof and outdoor space will be addressed in exacting detail. But apparently lessons have been learned by the powers that be. O'Connor's organisation has now been invited to meet with the design group, RKW. "I personally feel that Crumlin's pulling out of the process has been a little premature, because they haven't heard the answers. Maybe the designers will have some magic answer with some imaginative design".

There were many such "maybes" floating around this week, many stemming from the tight timescale in which the report was produced and what many people perceive to be an almost total absence of consultation with people on the ground.

If Mary O'Connor was flabbergasted, so was Crumlin, which produced its own robust response to the report, and denizens of the Department of Health itself. "I was in America when the decision came out that Temple Street was moving to the Mater," says Prof O'Keeffe. "I couldn't believe it because it came down to James's Street or the Mater site, and I was aware that many on the task force would be totally unsympathetic to Temple Street. When I saw the composition of that committee, I was greatly alarmed; several of them had actively wanted to close it down. But to my amazement and that of many around me in Temple Street, the decision was for the Mater. It restored my faith in human nature."

IT IS BECAUSEall of all these factors, and especially Bertie Ahern's apparent indifference over the years, that Prof O'Keeffe is convinced that there was no political interference in the decision. "I believe the process was completely fair. There was no interference. Crumlin, who for all these years had been taking all these specialities, becoming the major power player, they couldn't believe it. They were shell-shocked and so were a lot of people on the southside of the city."

But is it fair to call it a turf war? "Oh it is . . . " Is that not a little offensive? "I think you can be a good and caring person - and many of the people involved are excellent people, professionally and personally - but when it comes to this, this has been a turf war, this has been like no other medical war, and we all saw it coming. This was bound to happen."

But would the Mater/Temple Street have been any more gracious if it had gone against them? "We would have been the same but I don't think we would have had the same aggressiveness to go this far. For instance, I don't think the board of Temple Street or the Mater would have taken that decision, as Crumlin did, to withdraw from the process. They would have been afraid to do so."

And yet, he is not convinced of the merits of the plan. His devotion to the current Temple Street model is based on the hospital's "small, manageable size". "Big is not beautiful. I can get a bed in Temple Street for patients any time of the day or night; I can't in the Mater. I can get surgery done in Temple Street as an emergency at any time; I can't in the Mater. I can do far more work in Temple Street, the staff are far more helpful, the place is far more productive, far more efficient . . . My fear is that with a big centre, we would get so bureaucratic and would lose the personal touch."

He should be celebrating, yet there is a deep core of frustration. He believes that the public health service is going down the tubes, "with private facilities being built on every corner". He is concerned that people on the ground such as himself are not listened to and hospital chief executives are rarely seen "walking down the hospital". He is weary of the bureaucrats and self-publicists, "doctors among them, who do none of the work on the ground yet are more and more in the ascendancy. They don't have to face clinics of patients, they don't have to do a surgery where it could go wrong, they do none of that. They talk all the solutions and they're never there. Meanwhile, we are getting less and less of a say and the whole thing is becoming more and more bureaucratic and we're getting all these pious platitudes about treating patients and children. In reality, we don't mean that. If I was to be even more cynical, I'd say that to some in the system, patients are becoming a nuisance. We need to get back to the question of how we can treat more patients, how can we look after them? We're losing all of that."