Ms Eilísh Hardiman:

I hope it is okay to group some of the questions on services. Specifically, questions were asked about the figures that had been made public for health care planning. To be clear, the figures quoted for the children who attended the three children's hospitals are factual. We collate the data for the counties from which children come to avail of inpatient and day case services. Not only that, we have carried out a geo-analysis of where children attend emergency departments. We did this with the health intelligence unit and found that 95% of the children had attended their local emergency department. Using CSO figures, with the health intelligence unit, it has been mapped that the children were from within a 10 km radius of St. James's Hospital. The mapping exercise was engaged in using postcodes. It has demonstrated to us that 48% of the children living in Dublin are within 10 km of St. James's Hospital. This was a key element in identifying where a hospital should be sited. Most of the rest, from a health care planning perspective, was focused on where we saw the population growing in the fuure - to the north west and south west of the city and in the greater Dublin area. Hence, both the analysis and the social deprivation index, an indicator of where families use health care facilities, were used in identifying where paediatric outpatient and urgent care satellite centres should be based - in Tallaght and Connolly hospitals.

One of the primary objectives, as a service provider, is to locate a hospital where most of the population live - the inner city - and then provide what is predominantly used on a daily basis, that is, outpatient and urgent care centres, at locations convenient to these families, that is, off the M50 to provide access to outpatient and emergency services. That would meet most of their needs.

A first draft of the model of care to be used was developed in the planning of the hospital at the location of the Mater hospital. This was endorsed by the three children's hospitals. The HSE has since established the clinical care programmes, as part of which a clinical care programme for paediatrics and neonatology was established. There was extensive engagement that was much wider than that engaged in previously in all of the paediatric, neonatal and maternal units. A consensus based model of care has been developed, the engagement on which not only included the doctors, nurses and health and social care professionals in the three Dublin children's hospitals, as well as the maternity hospitals in Dublin, but in all 20 paediatric units throughout Ireland, as well as in the three regional units at Galway, Limerick and Cork. A family advisory group that represented many of the advocacy groups on children's diseases and health care issues also took part in the process.

The fundamental principles underpinning a single hospital have never been refuted. Everyone understands we would all be better under one roof. However, that it be at the centre of a network for paediatrics is a strong requirement. We do not want it to be all about a building. We believe the services for children in Cork, Limerick and Galway and regional areas need to benefit from us working in a networked way. Therefore, while we are coming together as specialists under one roof, the plan is to afford specialties opportunities to support our colleagues in the regions. For example, five doctors are working across the three locations in endocrinology and diabetics. Many of them could subspecialise if they were all working together and help our colleagues in the regional units.

Expansion was one of the issues raised. Again, this is a health care planning objective of ours. We have planned to 2046, which was as far as we could go using CSO projections. When we looked at the issue of expansion, we took into account all activity in the children's hospitals, all unmet clinical needs because of capacity issues, future population growth and trends in epidemiology. As hospitals expand, it occurs predominantly in two areas - intensive care and high dependency units and outpatient units. Taking these into account, we have demonstrated that the hospital will meet population requirements until 2046. We are doubling capacity in the facility in the area of critical care. We will not open all of the beds when it opens in 2021. We have designed the hospital in such a way that the corporate offices will be located beside critical care services in order that they will be able to expand by one third within the existing building by moving the corporate offices to another part of the campus. We have also identified grey space in services that cannot be moved within the hospital such as the emergency department, the imaging department, ICU and the theatres. We are building rooms that are probably bigger than the ones we are in in the middle of the imaging department. In ten or 20 years new technology could be developed and we will have the capacity in the imaging department to take it on board.

When looking at the provision of an outpatients department, it is important to note that everything does not necessarily need to happen at the hospital, as we have demonstrated in locating paediatric outpatient and urgent care centres at Tallaght and Connolly hospitals. The intention is to have the people whom we serve in the greater Dublin area use them and not the hospital when it opens. If we need to expand further after 2046, we will look at having further outpatient and urgent care centres, as opposed to everything having to be provided in a hospital that provides for the tertiary-quaternary needs of children.