Forgetting about the children

Last May, the Health Service Executive and the Department of Health and Children issued the report of their joint taskforce on the location of the proposed new national paediatric hospital. In the body of the text, the word "children" appears fewer than 30 times, almost always in references to the Department of Health and Children, to a previous consultants' report called Children Health First or in simple phrases such as "hospital for children".

Children themselves - actual living, breathing kids with real lives and real emotions - are almost entirely absent from the report. And that absence is crucial to the current debate over the location of the new national children's hospital. It is symptomatic of all that is wrong in the formation of public policy in Ireland: those who are most affected by decisions are neither seen nor heard.

Sick children are, first and foremost, children. As well as having to deal with the things that are going wrong in their bodies, they find themselves in an unfamiliar environment, often for very long periods. They are removed from the people that shape their lives - parents, siblings, friends, teachers - and placed into intimate contact with people they did not know before - doctors, nurses and other hospital staff. The hospital has to treat their illness but it also has to accommodate their childhood, to rebuild as far as possible a world in which they can thrive.

As the taskforce report put it, in its one substantial nod at this broader context, the need is not just for world-class medicine, but also for "holistic care for the child and its family". Yet there is no evidence that the decision to site the new hospital at the Mater arose from any real thought about the experiences of children and their families.

There are so many vested interests in the Irish health system - churches, institutions, professions - that it is easy to be sceptical about the opposition to the Mater site from the boards of Our Lady's in Crumlin and from Tallaght hospital.

At first glance, this looks like a typical Irish row - everyone agrees on a grand plan until the decision goes against them. But while it would be naive to think that old-fashioned turf wars are irrelevant to this debate, it would be equally naive to accept the decision-making process at face value.

The claim by Des Lamont, chairman of the Mater's board, that he had been given an assurance by Taoiseach Bertie Ahern that a new paediatric hospital would be developed at the Mater, cannot be ignored.

No less worrying, though, is the taskforce report itself. Mary Harney claimed last week that it was "a rigorous and robust and independent assessment process", but on any objective reading, it seems thin, hasty and poorly argued.

Rigorous it ain't. It makes a strong case, for example, that the new hospital should share a site not just with an existing teaching hospital, but also with a maternity hospital. It notes that the Mater site has a limited capacity for this kind of development. But it nevertheless jettisons its own logic, cops out with a call for "a review of the configuration of maternity services in the Dublin region" and opts for the Mater anyway. This is simply bad policymaking. If a maternity hospital should be part of the package with the new paediatric hospital shouldn't a review of maternity services take place before, and not after, a decision on the latter is made?

It is not even true that the taskforce actually made a clear, reasoned decision in favour of the Mater site. In fact, the report says that it couldn't decide on objective criteria between the Mater and St James's Hospital. In tortured prose that seems to indicate a degree of discomfort, the taskforce says: "On the basis of the above considerations it would not be possible for the Joint Task Group to put forward one of the above locations on a basis that renders it clearly distinguishable from the other site."

Or, to put it in English, there was no objective basis for choosing the Mater over St James's. Why, then, choose the Mater? Because, the taskforce explains, it is under pressure to deliver quickly and "the project will be delivered more quickly on the site of the Mater Misericordiae Hospital" - a view that it declines to explain. It is hard to avoid the impression that the need to be seen to be acting speedily and decisively outweighed the need to make the right decision for children and their families. What we'll get on the Mater site is a high-rise building in a very crowded area of the city, with little or no green space around it.

There is not a word in any official document or in any statement by the Department of Health or the HSE to tell us why this is the optimal place for children to spend what will be, in many cases, years of their lives.

As the mere objects of the policy, it is clearly none of their business.