John Crown (Independent) | Oireachtas source

I apologise for missing the beginning of Mr. Donnelly's presentation. I wish him the very best in his new role. My first oncology job was in St. James's Hospital many years ago and I have a large well of warm and sentimental good feeling about the institution. It is, in the Irish context, a wonderful hospital. While things in Ireland are not great by international standards, the hospital certainly punches above its weight and is a great place.

Mr. Donnelly has left a world of fairly rational and understandable forces in international business and is about to engage in a world in which the forces are less rational and the consequences of actions less predictable. Moreover, there are not necessarily positive incentives in place for good behaviours on the part of the hospital. For example, if it does things right and increases efficiency, it may well find itself having its funding reduced.

I hope that, as he steps forward into this job, Mr. Donnelly will turn his thoughts to an issue which has been close to my heart for 22 years and about which I am increasingly despondent. I refer to the need for fundamental reform of the health system. While I do not intend to personalise this issue, I work in an institution in which the board structure has not worked well. We have seen considerable evidence of this recently. The true stakeholders in the system need to become engaged again with the people who choose and run the board of an institution. Having an absentee landlord mode for hospital boards, such as that in place in many hospitals where people no longer involved in the running of the hospital choose the entire board, is not a rational system. The model in place in St. James's Hospital has worked better.

It is my dream that St. James's Hospital will some day be taken over lock, stock and barrel by Trinity College to become the TCD medical centre. We have never got our heads around this type of model, which works extraordinarily well for major academic medical centres around the world. I once hoped that at one stage my medical school, University College Dublin, would take a similar view towards its two large constituent hospitals, the Mater hospital and St. Vincent's Hospital, by, as it were, liberating these hospitals from their current ownership and redirecting them to become the types of leading academic centres they should become. We are not good at this in the health system.

I once stated, only half-sarcastically, that one sometimes gets the impression that the people who planned the Irish health system studied all the other international models of success and decided to do exactly the opposite. If Mr. Donnelly has not done so already, I suggest he examine the five or ten largest and most successful medical systems in the world to see how their board structures work. The place in which I was most involved in the United States, Memorial Sloan Kettering Cancer Center, was an entirely private, not-for-profit institution which was based on an ideal, namely, to cure cancer. People served on the board for this reason and because they wanted to be part of the war on cancer. In some cases, their lives had been touched by cancer, while in others they were co-opted because they brought expertise. Many great donors were also appointed to the board. It is necessary to examine alternative board models. I would be interested in having a chat with Mr. Donnelly in a year's time to discuss his experience in the intervening period.

Mr. Donnelly failed to mention that St. James's Hospital has been an ambitious institution which has sought to become bigger and better. It aggressively campaigned to become the designated location for the national children's hospital and was ultimately successful in this regard. I admire and respect it for that. My position in the debate on the location of the national children's hospital continues to be that it was nearly impossible to obtain a medical opinion on the location of the hospital that was not, in some sense, biased by institutional loyalty on the part of the person making the statement. I do not propose to debate the issue again.

At the time, I argued that we should all support locating the hospital at one site and that once a site had been chosen, we should all shut up and get on with it. This is exactly the point we have reached with the national children's hospital. The debates are over and it is time to get on with building the darn thing, rather than condemning children to additional years of substandard accommodation when their care is being delivered.

This is not a loaded question but is being the chairman of the board of an institution such as St. James's Hospital a full-time job or will Mr. Donnelly pursue other jobs at the same time? Is it a full-time vocation? I do not understand how this works.