Dr. Finn Breathnach:

In regard to problems with the Connolly site, the document which the committee received from the National Paediatric Hospital Development Board states that pollution levels at the Connolly site are higher than at the St. James's site. That is total nonsense. The monitoring station is located at the junction of the N3 and M50. It falls off 10 m away from the hospital. The new hospital would be built 300 m away from that. The pollution levels have been assessed and they are at rural levels. It is claimed that the pollution level at the St. James's site does not exceed the EU standard: it does. According to its own environmental impact statement, the nitrogen oxide level exceeds the statutory requirement of the EU. Even worse, it greatly exceeds the World Health Organization's recommendations but we are told we can ignore those because they are not statutory for a health service.

On deaths and disability, I do not believe a unit will be built on the St. James's site. Last year, there was a coroner's case concerning a baby who was transferred in a five-minute journey from the Coombe hospital to Crumlin hospital. We are told that the neonatal transport service has not lost a single baby in transport. This is because resuscitation of babies who are collapsing in the ambulance continues all the way to the children's hospital and at the children's hospital. When resuscitation fails, the death is noted as having taken place in the children's hospital and not in the ambulance. According to a Newcastle study, 25% of transfers create a problem for babies. Only six days ago, there was a report in the UK presented at a neonatal meeting which showed that the haemorrhage rate into the brains of premature babies who are transferred is twice that of babies who are left in their cot. Transfer, of itself, of vulnerable babies introduces brain damage and increases the risk of death. The latest model for maternity is integration. In terms of the McKinsey report and the history of the development of paediatrics, it states the next phase is a stand-alone children's hospital integrated with a maternity unit, where all of the births occur not in the maternity section of this one building but in the children's hospital. Some 95 of every 100 transfers from a maternity hospital are sick babies and five are sick mothers. Those mothers could be easily cared for in an upgraded Connolly memorial hospital. A children's hospital, inclusive of a maternity unit, is a new international standard.

It cannot be achieved at St. James's Hospital for the next 100 years because of the way they are going to build it.

If one looks at the Dolphin and McKinsey reports, it is stated that ideally the children's hospital would be co-located with an adult hospital. According to the McKinsey report, the number one priority was space. It states we must be pragmatic because international experience shows that space and access are needed. That aspect has been totally ignored. There is no space. We are not talking about space in which to build it but the space needed to enable it to survive for 50 or 100 years. The Melbourne site is so big they were able to build a new hospital, move from one to the other and then demolish the old one. It is the same at Alder Hey. Great Ormond Street Hospital is unique. We talk about primary, secondary and tertiary care, but it provides quaternary care. It is a hospital that accepts transfers from all over the world. It does not have an emergency department. It was built in 1850 on the edge of a much smaller city. It has a name and will not move from the street on which it was built because it draws in lots of funding. The transport infrastructure is so different from that in Dublin. The hospital is easily accessible and the majority of its referrals are not emergency cases; they are electives, which means that one can plan a transfer.

Is there anything bad about Connolly Hospital? Of course, there are medical politics. I have never been a politician; I have done the best I can for kids all my life. I do not recall ever attending a faculty paediatrics meeting because it is just a talking shop. I have been too bloody busy looking after sick children while people talk about institutional chauvinism. I am tired of it. Some of the internal politics are revolting. The position is that 85% of the sickest kids are looked after by Crumlin hospital consultants, but where are they in any of the committees? Will you find one of them on them? Their members are all from the less important units. The politics are just incredible.