Fear of failing our children must far outweigh all other anxieties


Acceptance of Mater site greatly influenced by idea that plans could be shelved altogether, writes BREDA O'BRIEN

MUCH OF the support for the proposed National Children’s Hospital on the Mater site is not based on unequivocal approval, but on a grim anxiety that this is the only alternative. Acceptance of the site is being greatly influenced by the fear of being left in the crumbling facilities that currently exist.

However, there is palpable fear among people opposing the development, too. There is a fear of being locked into an unsuitable site, where the most vulnerable children will not be best served.

For the moment, put aside issues about access and parking, important though they are. More fundamental problems exist. Look at one of the most vulnerable groups of children, very premature babies and very sick newborns.

For these children, co-location is vital – co-location with a maternity hospital. A vulnerable tiny baby, who requires specialised diagnostics or intervention at the paediatric hospital, currently has to endure an ambulance trip on an often bumpy road across the city. Under the present proposal, this will still happen.

It should just be a short, smooth, warm trip up a corridor in an incubator. Equally importantly, the specialist can come to the baby if the maternity hospital is in the immediate vicinity. This is standard best practice internationally.

While there will always be unexpected emergencies which require ambulance transport, we should at least plan to limit the avoidable hazards.

Intensive care units for such sick babies should only have 80 per cent occupancy, to ensure the emergency bed is always available. Overcrowded neonatal ICUs are now the norm, so an unacceptable level of haggling for beds has to go on.

You can see why people are fearful of being left in this situation. However, is it not appalling that people feel so powerless? They have to regretfully ignore international best practice, because the alternative may be seeing plans for a National Children’s Hospital get shelved indefinitely.

The need to co-locate with a maternity hospital was explicitly recognised by the report of the Joint Health Service Executive/ Department of Health and Children Task Group.

The ideal is tri-location – maternity, child, and adult services all on one site. The task group said it was particularly important in complex neo-natal cases. The report also acknowledges that tri-location is vital for high-risk obstetric cases and for the developing area of surgery for babies still in the womb. The maternity hospitals all support this model.

Somehow, all of this got lost. The same task group that dealt so lucidly with the need for co-location with a maternity hospital eventually recommended the Mater hospital site.

There are plans sitting in a drawer somewhere for the Rotunda to move to the Mater. This is precisely the wrong way around. In fact, it would make more sense to locate the new National Paediatric Hospital on a greenfield site along with a maternity hospital, and build an adult facility later.

More to the point, the Coombe would have been delighted to move to the St James’s site, which would make far more sense than the current choice.

The late, great Maurice Neligan was initially enthusiastic on the site, but while still deeply respectful of the Mater’s expertise, he found that in conscience he could no longer support it. As he wrote in his Irish Times column: “This wasn’t about me, or the convenience of my colleagues or prestigious and academic considerations. It was about the ‘little problems’, the sick children and what was best for them.”

The needs of the littlest of the “little problems” are not being served by this site. Maurice Neligan did a rare thing. He admitted he was wrong. Remember, he was a pioneer in children’s cardio-thoracic surgery, the major area of expertise the Mater will bring to the co-location. He was still big enough to recognise an error of judgment. Could we possibly see the same from our politicians?

It is entirely understandable that dedicated professionals should fear that if this hospital is not built, it will be back to the grim desert of review committees, and nothing will happen. That is truly an appalling vista.

However, this hospital will be in place for generations in a completely unsuitable city centre location. It has already happened in existing children’s hospitals that “soft” areas are sacrificed when need arises for expansion of the medical facilities.

What are “soft” areas? Things like rooms where parents can get a break, children’s play areas, conference rooms or areas dedicated to research. In other words, the essential facilities that make a hospital a human place and a centre for learning. The same will happen here.

The Government is obsessed with saving money. For example, such a wonderful organisation as the Jack and Jill Foundation is threatened with having to cut its services by 30 per cent due to lack of Government funding.

Given the demand to economise, it is deeply ironic that an alternative site would save money. Yet there is a determination to press ahead with a facility with no room for expansion, which does not follow international best practice, and does not have adequate access. Where is the sense in that?

Fear of being left with nothing is understandable, but the fear of not developing the best facility to serve our children should frighten us much, much more.

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