Endless talk will kill off our children's hospital


OPINION:Populist fixation on parking and access at the Mater site misses out on its clinical merits, writes KARL ANDERSON

THE PUBLIC debates that frequently surround healthcare decisions in this country are important but they can strangle progress.

In the past they have forced important decisions to be shelved or watered down to the point where the right decision is traded for what is acceptable to those who are most vocal. Think Hanly 2003.

We must not allow this to happen to one of the most important and exciting healthcare projects this country has ever embarked on: the new national children’s hospital.

Dr David Vaughan, consultant general and respiratory paediatrician, reminded us last week that the expert who many years ago suggested rationalising cancer services in the midlands needed a Garda escort, such was the level of public objection to his proposal. Ultimately the desire for consensus and compromise prevailed ahead of quality. It took the unfortunate cancer misdiagnosis in the midlands that came to light in 2007 for us to accept that if we want quality we have to compromise convenience and if we want convenience we have to compromise quality. We all can’t have both.

While the contributors to the current debate on the location for the new children’s hospital are well-intentioned, what is absent since the Eccles Street site was selected in 2006 is a viable alternative. Why? Because there is none.

The current objections can be distilled down to access and parking. It shouldn’t be so. There were no public debates on the construction of the new Mater hospital, which is now reaching skyward, on the basis of access or parking.

Nobody has ever said that Temple Street children’s hospital should be moved because of the access or parking problems. Access and parking did not deter the sale in 2007 of a majority share in the Mater Private Hospital on Eccles Street, which valued it at €350 million.

Access and parking have emerged as the key objections because they are communicable – while the clinical merits of tri-location are difficult to communicate yet are far more important.

Last week, I spoke to parents from Limerick, Clare and Waterford who attend Temple Street hospital regularly and parking and access issues are simply irrelevant to them in the scheme of things.

Worryingly, what has emerged through this debate is an Abes (Anywhere But Eccles Street) movement, confirmed by the array of alternatives being put forward.

Some suggest that the existing three hospitals should remain in place. That would be a tragedy. The facilities at Our Lady’s children’s hospital, Crumlin and Temple Street are desperately outdated and beyond improvement.

Because paediatric expertise and facilities are spread across three locations, they are not as efficient as they could be and, as a result, children are waiting longer for treatment than they should, given the €200 million-plus invested each year.

Keeping three hospitals operating independently of each other a few miles apart when there is, for the first time, an unequivocal Government commitment to build one of the best children’s hospitals in the world is impossible to justify.

Breda O’Brien (The Irish Times, October 23rd) opined that it would make more sense to locate the new hospital on a greenfield site along with a maternity hospital, and build an adult facility later.

However, she is silent on the fact that Dublin does not need another adult hospital and does not suggest which one should close. It is unrealistic to suggest we could have a tri-located facility (paediatric, adult and maternity) on a greenfield site. It is simply not going to happen in our lifetimes.

Dr Róisín Healy, a leading figure in the New Children’s Hospital Alliance, does not believe the hospital should be built on Eccles Street but does not have a view on where it should be built. Dr Healy is willing to take her case to Europe to stop the planned hospital being built.

Dr Finn Breathnach, one of the leading advocates for the new hospital to be built on an alternative site close to the M50, presented a new option on Joe Duffy’s Liveline show last week (October 18th).

When questioned about the fact that, under his preferred option, there would be no children’s hospital on the north side of Dublin, Dr Breathnach said a solution would be to move Temple Street hospital to the Mater.

Clearly with this two-hospital approach the status quo could be maintained. It would mean that Crumlin’s position as Ireland’s largest paediatric hospital would be secure; it would remain independent and continue to have the largest budget (€125 million in 2010).

This suggestion is, however, diametrically at odds with the undisputed finding of the McKinsey report, with which all three children’s hospitals agreed: because of the small size of our population, to provide quality paediatric care we should have only one national children’s hospital (national tertiary and local secondary).

The new paediatric hospital debate must be about the quality of care that a tri-located hospital (children, adult and maternity) can provide, the calibre of clinical staff it can attract and the ground-breaking cures its combined research facility could unearth. It should not be about access and parking.

If the need for consensus and compromise is again put ahead of quality, we will repeat the mistakes of the past.

The unacceptable status quo will remain. Our political leaders will invest their energy in alternative projects that attract less controversy but are equally worthy.

If the prospect of a new children’s hospital becomes a distant memory smothered in reviews and endless circular debates (which it will because there is no perfect location), those who are most vocal against the current plan will be silent. Those who are actually responsible for providing services will be held accountable.

Karl Anderson is a former chairman of the New Crumlin Hospital Group (2002-2005) and former adviser to former chief executive of the Health Service Executive Prof Brendan Drumm

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