Dr. Finn Breathnach:

I set up the children's cancer haemotology-oncology unit in Crumlin hospital when I returned to Dublin from Great Ormond Street in London in 1981. I worked single-handed for 15 years, during which time I was on call for 365 days of the year. The unit, which I built through fund-raising money, was completely redeveloped 23 years after it was built because it was not fit for purpose.

Doctors take clinical decisions on the basis of evidence. Each of us will get sick at some stage in our lives and we will be offered treatment. It would be very sensible to ask whomever is offering the treatment what the evidence is for the success of the treatment or plan of action. The decision on the location of the national children's hospital was also supposed to be based on clinical matters and we are right to ask what is the evidence for the decision. The claim has been made that the clinical outcomes for children will be improved if the children's hospital is built next to St. James's adult hospital. This has been repeated by the former Minister for Health and Children, Senator James Reilly, his successor, the current Minister for Social Protection, Deputy Leo Varadkar, and the current Minister for Health, Deputy Simon Harris. The literature does not provide a single scrap of evidence to support that claim. Nowhere in the world has anyone made a claim for improved clinical outcomes through locating a children's hospital with an adult hospital.

Deputy Kelleher took the trouble to travel a long way to the southern hemisphere to visit the Royal Children's Hospital in Melbourne, and we had a brief conversation about this some months back. He noted the children's hospital was built in a wonderful healing environment with acres of space and that there was not an adult hospital in sight. Of course, the most recently built children's hospital is in Liverpool in the United Kingdom, which is the very famous Alder Hey Children's Hospital. It was built in a particular area with enough space near it to build a new hospital. It is on its own and stands nowhere near an adult hospital.

I do not care what medical expert the other side brings in, I can tell the committee with absolute certainty there is absolutely no evidence whatsoever to benefit children through co-location with an adult hospital. I listened to the CEO of the children's hospital, Eilish Hardiman, on radio recently. She was challenged to provide evidence, and said there is lots of evidence and to look at Manchester, Sweden and Glasgow. Manchester does not claim improved clinical outcomes through adult co-location and neither does anyone in Sweden or Glasgow. What she was referring to, of course, is tri-location, which we support. Stand-alone children's hospitals can function, as the hospital in Crumlin has done wonderfully well, providing excellent care for decades without the need for any adult input. The minute we attach an essential co-located maternity hospital, then we introduce a separate group of patients who are mothers, and the children's doctors are not qualified to look after them. They need an adult hospital. The Rotunda Hospital will go to Blanchardstown, and it will be very happy to have the adult teaching Connolly Hospital at Blanchardstown look after its sick mothers once the intensive care unit has been upgraded and additional haematology sessions are added. It will be very happy that its mothers will be cared for.

Unlike adult co-location, for which there is absolutely no documented evidence, I can provide scores of scientific papers to show improved outcomes, not only regarding survival but quality of life for children, who are delivered next to a children's hospital. In 2006, Our Lady's Children's Hospital in Crumlin stated the new children's hospital must be co-located with a full service maternity hospital. This is in keeping with a recent report, published ten years later, which stated there must be a full service maternity hospital. The hospital also stated the effects of such will show lasting improvement in neonatal and newborn morbidity, which is damage such as brain damage, and mortality. These benefits have been demonstrated in well-researched submissions by many obstetric and neonatal consultants. It also stated these benefits are of such magnitude that its board believes the maternity component of the development should proceed simultaneously with the new children's hospital.

A specialist group comprising the department of cardiothoracic surgery, the department of cardiology in Crumlin, and the joint department of paediatric intensive care medicine at the hospitals in Crumlin and Temple Street wrote to An Bord Pleanála that:

Co-location with a physically linked maternity hospital is, in our expert opinion, non-negotiable. We are unwilling to endorse a national children's hospital on a site that cannot accommodate this truly critical adjacency. To do so would be to fail those infants whom we are entrusted to protect. To proceed with such a project will result in the avoidable death or disability of many new-born babies for years to come.

It is absolutely critical that a full service maternity hospital be built on the St. James's Hospital site. I wrote to the previous Minister, Deputy Leo Varadkar, pleading with him to apply simultaneously for planning permission for the children's hospital and a maternity hospital. Once a children's hospital is built on the site the State will have to go back for planning permission for the maternity hospital, but at that stage there will be a huge children's hospital and a huge adult hospital trying to function. The transfer of St Luke's Hospital, which is also to go on site, has been delayed. There will be no room for a maternity hospital because the site allocated in St. James's Hospital is smaller than the site already occupied by the Coombe hospital. Where is the space for the maternity hospital at the St. James's Hospital site? There is space, but only if the 18 year old excellent outpatient department for adults is knocked down and moved somewhere else. I do not know where it would be put. This is an added expense. According to the documentation supplied to An Bord Pleanála, which I have cut and pasted, a new adult intensive care unit, a new adult accident and emergency department and a new adult facility management hub would have to be built, after which a maternity hospital could be built. This is all because of a claim for improved clinical outcomes by building the children's hospital next to an adult hospital, for which there is not one scrap of evidence.