Mr. Paul Donnelly:

There have been many discussions on the matter. To step back for a moment, my background is in the software industry. One can spend a great deal of time building software products and getting everything perfectly right, but by the time one has done that, whatever market one sought to address has gone. I echo the comments of Deputy Ó Caoláin, Senator Crown and Deputy Byrne in that we must shut up, get going - all of the terms that were used today - and move on with it. There comes a time after we have made a choice to do that. We cannot procrastinate.

Deputy Ó Caoláin asked about maternity services. A maternity services review is under way. To my knowledge, and I hope that I am not paraphrasing inappropriately or incorrectly, there is an assumption that some form of maternity services will move to or be established on the St. James's Hospital campus. I believe that the review is considering what form that will take. I do not want to prejudge it. On the assumption that there will be maternity services on site in some form, it will provide us a unique opportunity to have a whole-of-life model of care and care pathway for our patients. This provides interesting and major opportunities in terms of service delivery as well as education and research, for example, long-lived studies that are led from one campus and that our patients go through to various stages in their lives.

There is a link between the Coombe hospital and St. James's Hospital in that they share consultant posts. It is through feet on the ground and other such bonds that the organisations are brought together. It is great that the boards can talk and have a good relationship but it is when there are shared consultant posts, people working in both organisations and patients transferring from one to the other, which is a common practice, that linkages are really established.

Moving on from the referenced "first term" to where I see the situation at the end of the term, I would love to have successfully established and integrated the children's hospital. Senator Crown referred to the organisation's ambition. It might be overly ambitious to say, "to have successfully embedded maternity services also", without leaving a hostage to fortune. I am allowed to have an ambitious vision. I am also allowed to not achieve it all. I would like to see both of these projects established. They give scale. There are a great deal of secondary benefits, for example, opportunities to establish linkages with philanthropic and commercial organisations that could be of great benefit to the patients and community and that, on a global scale, do not have the resources and cycles to deal with small local organisations but can support larger ones.

It gives us an opportunity to form a different scale of partnership which would be quite useful.

Senator Crown raised several questions around the philosophy of board structure and the rationality of the organisation versus my position. I am not leaving the rational world as he would describe it. I hope to form a bridge between his version of the rational world and the irrational. I know from the 12 years with the Coombe hospital that they are slightly different worlds and that there are differences between the two. There are also commonalities between the two. In particular, through the presence of board members with commercial experience and ongoing commercial experience not just in St. James's Hospital and the Coombe hospital but in other organisations, the opportunity to bring ideas from one world, as Senator Crown would say, to the other is growing and getting stronger. Senator Crown referred to his personal experience in the United States working in successful academic medical centres. There are already several group linkages of which St. James’s Hospital is a key member. One is Trinity Health Ireland which encompasses the academic teaching hospitals associated with Trinity College, Dublin, namely, St. James’s Hospital, the Coombe hospital and Tallaght hospital. There is also the wider group which is the Dublin Midlands Hospitals Group which encompasses those organisations together with Tullamore, Laois and Naas hospitals. These are new groupages which are finding their feet. It is not a bad time to have this philosophical debate but maybe not at the St. James’s Hospital board level but at the group level.

To address Senator Colm Burke’s questions, I am acutely aware of the systems situation. There are positives and negatives to having one unified system. If one builds everything into one unit, it becomes hard to effect change and move it. I concur with the Senator that the health service needs to get a grip on its use of modern technology. Some work is already happening around that. I am encouraged there is a central enterprise resource planning system in St. James’s Hospital which is the same calibre of software which is used in most substantial organisations in Ireland and worldwide. I am in the fortunate position to be entering a role in an organisation which is better prepared than many of the organisations to which he referred.

He also raised the valid point about the ability of the broader health service to deal with mistakes. There were some good quotes in today’s newspapers from a family who suffered a similar journey to what he described. The father made some spot-on comments. Mistakes happen everywhere in the world but when they happen in the health care system, they have grave consequences potentially for patients and their families. There is some understanding that mistakes potentially happen. The process that happens afterwards can be the most dispiriting for those who have suffered as a result of an error or an unfortunate happenstance. I would welcome a review of how we deal with that in the health service. It is unfortunate that we have a liability-mitigation culture in many ways. Many of the clinicians who display those tendencies, unfortunately do so on management and legal advice. It would be great to have a system where there could be more transparency without exposing the organisation to potential liabilities. Unfortunately, in my small part of the world, I am not sure I will be able to single-handedly address this. However, these are well-placed sentiments which I support entirely.

I hope Deputy Catherine Byrne does not mind me describing her comments as a reflection of local rumblings. As she correctly pointed out, there is a division between positives and negatives felt there. To be honest, it is a division between the perception of potential positives and potential negatives. When there is change on any scale, there is always a little bit of apprehension. This is an issue for us all as individuals. It becomes more amplified in groups. If we have a common concern and we talk about it, it becomes a bigger issue. Over the course of this development, as things become more concrete and more real, the people’s apprehensions, and perhaps unfortunately their optimism about the upside, come closer to the centre. As I said to Senator Colm Burke about the claims liability issue, I probably cannot do an awful lot about that. However, in this very specific case, I can do a lot about it. What I can do is encourage the organisation to be transparent and open. As we are transparent and open, we give a better understanding of what the opportunities will be for the local community and what impacts there are going to be. Inevitably, there are going to be impacts. As we take a national institution into our community, we have great sense of pride about that. The pride is also centred around the fact we are doing our bit for the nation. There will be a sense of that in the community. The one thing I can do is to encourage the institution to be open and transparent.