A new national children's hospital should not be located in the centre of Dublin, argues Pat Dohertyof Our Lady's Children's Hospital
Our Lady's Children's Hospital, Crumlin welcomes and supports the policy of the Department of Health and Children and the Health Service Executive (HSE) to centralise all tertiary-level acute paediatric services in a single hospital. This policy is, indisputably, in the best interest of the health of our children and is supported by a wide body of evidence and was advocated in the HSE-commissioned report (February 2006) of the international healthcare consultancy company, McKinsey & Company.
Crumlin hospital's report on A World Class Tertiary Children's Hospital for Ireland(published last September and available on www.olchc.ie) points out that there is a once-in-a-generation opportunity now to provide a children's hospital which is on a par with the best children's hospitals around the world, such as those in Great Ormond Street in London, Melbourne, Auckland and Toronto.
There is a clear, supported national policy position, capital funding is available and there is philanthropic interest in the project. The time has never been better to do what is right for the acute care of our children in Ireland.
The key concerns of Crumlin hospital in relation to the choice of the site for the new children's hospital on the Mater hospital campus can be summarised under the following headings:
Access to the site is difficult, in particular by the vast number of parents who will have to bring their sick children to the hospital by car and taxi - many from remote parts of Ireland;
The Mater site is too small to accommodate a new children's hospital which will amalgamate the three existing children's hospitals at Crumlin, Temple Street and Tallaght and provide a maternity hospital. For example, it is only the same size as one of the hospitals - Temple Street - and a quarter the size of the Crumlin hospital site;
There will be little or no room for open space which is so important for sick children, many of whom spend very long periods in hospital;
The number of beds to be provided in the new hospital (380 beds) is 100 less than the current total of 480 beds in the three children's hospitals, at a time when the paediatric population is growing;
There will be very little room, if any, for the new children's hospital - or indeed the Mater hospital itself - to expand in the future;
Vital services, such as family accommodation, research and education, will not be accommodated within the hospital itself but on a nearby location - these are core hospital services and have to be accommodated as integral parts of the new hospital;
It will take much longer to develop than envisaged, ie up to nine years, including the related and necessary development of services on the vacated Temple Street hospital site.
There is little clarity on how the co-located maternity hospital will be accommodated on the site.
The McKinsey report was widely welcomed and Crumlin hospital was a party to this welcome. It is to be regretted, however, that the optimism generated by McKinsey - that the years of fragmentation of tertiary paediatric services between the three children's hospitals in Dublin, was coming to an end - has waned considerably.
This has come about as a result of the processes and decisions taken subsequently to implement the recommendations contained in the report, notably, the absence of any meaningful input from - or consultation with - the paediatric community (including the three children's hospitals) into the work of the Joint HSE/Department of Health and Children Task Group.
It was the task group which recommended (June 2006) that the new children's hospital be located on the Mater site. The location and scope of the site is causing serious concern to Crumlin hospital, as it is totally inadequate to provide a world-class children's hospital and would not, in our view, be in the best interests of the health of our children, now and into the future.
A location has been chosen for the new children's hospital, before any detailed consideration has been given to planning and other key matters which eventually determine the size, orientation and configuration of the hospital buildings to be put on the site. The location has been chosen in advance of a consensus on the model of care and is simply "putting the cart before the horse". The decision represents poor service and capital planning, and will be bad value for money, now and over the lifetime of the new hospital.
The new children's hospital will serve our children for the next 50 years or so. By any yardstick, it is very difficult to see how the location chosen will enable the shared vision of a world-class tertiary children's hospital to be achieved.
Going back to the McKinsey report - the starting-point for this project - it is worth noting how McKinsey saw the project evolving. McKinsey's criteria to achieve an optimal solution are very clear.
Co-location with an adult hospital is not essential, according to McKinsey. Other McKinsey criteria were absolute, in particular the need for future expansion (including education and research) and easy accessibility by road and public transport. All of the criteria were subject to "suitability and flexibility of available sites".
The Crumlin hospital report is a well researched and evidence-based document. It represents a strong argument for the strategic building of the new children's hospital, "tri-located" with a new maternity hospital - and eventually with a single tertiary-level adult hospital - on a site large enough and more easily accessible to the majority of the national and local paediatric population.
• Dr Pat Dohertyis a consultant anaesthetist and chairman of the medical board of Our Lady's Children's Hospital in Crumlin, Dublin