Medical need is key in deciding on hospital site


Fine Gael in opposition promised to review the decision to site the children’s hospital at the Mater. That promise should be delivered upon

IN JANUARY 2007 the Fine Gael national press office issued a statement from its leader Enda Kenny calling for an independent review of the process surrounding the selection of the site for the national paediatric hospital to be conducted and completed within two months.

It stated: “if the Mater is the correct site, then Fianna Fáil and the Progressive Democrats or the Health Service Executive should have no difficulty in having it stand up to that [review] scrutiny”.

A review was never held. Since then there has been an ongoing media debate on the location, with more than a 150 articles and more than 100 letters published in national newspapers as well as radio and television coverage.

Yet, government refused any engagement in debate.

A hospital development board was established by statutory instrument the day before the 2007 general election, thus side-stepping a Dáil debate.

Its chairman was invited by the health minister to resign 3½ years later when he questioned the location choice.

The story of the national paediatric hospital may enter the history books as the episode best defining the moral bankrupcy and the breakdown of legitimacy of a government by its abuse of power and scorning of the democratic process.

On February 24th, the eve of the general election, the Fine Gael campaign office stated: “If in government, Fine Gael will review the entire proposal [the development of the paediatric hospital] as a matter of urgency.”

Perhaps in anticipation of such a review, David Vaughan (Opinion and analysis, March 14th) argues that no site other than the Mater could deliver a world-class system of care for our children. His arguments do not stand up to analysis. Children did not die in Bristol children’s hospital just because “paediatric heart surgeons were doing too few operations”.

What the Bristol cardiac surgery inquiry actually found was that children were operated on in Bristol’s adult hospital; there was no separate paediatric ICU (intensive care unit) for post-op cardiac patients; and there was no full-time paediatric cardiac surgeon.

Yes, “size does matter”. We are totally in favour of one national paediatric hospital.

It is that hospital being squeezed on to the Mater site that is the problem. It is notable that cardiac children from Manchester (where the children’s hospital is co-located with maternity and adult hospitals) travel to the stand-alone Alder Hey Children’s Hospital in Liverpool for surgery, for quality and safety reasons. Co-location with an adult hospital is not a panacea.

Access gets summary treatment from Dr Vaughan. Car ownership is not, as he suggests, a valid basis on which to consider emergency access to the national centre – medical need alone is.

Yet, ambulance transport times were not studied by the Department of Health and Children-HSE location task group. His arguments on cost containment and staff satisfaction are not based on adult hospital co-location and therefore not relevant to the current debate.

Were the Mater hospital on a university or biomedical education and research campus one might see certain advantages for the children’s hospital in co-locating with it, but those facilities are based at University College Dublin, in Belfield.

Finally, let us consider “vested interests” and the Mater site. The submission (obtained by us under Freedom of Information legislation) by the Mater hospital to the location task group states: “Paediatric neurosurgery will move to the new children’s hospital to allow a paediatric level 1 trauma centre to be provided. This fits well with the Mater hospital’s ambition to become a level 1 trauma centre for both children and adults.”

We now learn of the adult hospital’s ambition to be Dublin’s designated adult trauma centre. To be accredited as such requires that adult neurosurgery be on site. With children’s neurosurgery on site in the paediatric hospital, the case for moving all neurosurgery from Beaumont to the Mater is strengthened. A helicopter landing facility is planned for the paediatric hospital. This would further enhance the Mater’s position. It is not insignificant that the HSE is reviewing adult emergency departments in north Dublin with a view to rationalising the number of sites from three (Beaumont,Mater and Blanchardstown ) to two.

Perhaps there should only be one adult emergency department, either in St James’s or the Mater hospital, in the city centre? A letter from the president of UCD to the task group (obtained under FOI) states that UCD “strongly supports” the Mater bid for the co-location of the national paediatric hospital. Vested interests?

The position of the New Children’s Hospital Alliance is presented on “The Future” page of The new Government has shown its regard for our young citizens by creating a full Department for Children. Justice for sick children must now be seen to be done. The promised review must occur.

Róisín Healy is a paediatric emergency medicine specialist and is part of the New Children’s Hospital Alliance which opposes the Mater site decision.