Ms Eilísh Hardiman:

I shall reply. I thank the Senator and agree because our primary focus is to improve services and patient safety is always of paramount importance. The reference to loss of life is usually made to the transportation of neonates just born. We are all on the same side in terms of supporting the tri-location argument.

The leading clinical expert in the transportation of neonates, who are small babies, is the neonatology transportation programme. Dr. Jan Franta, who leads that programme, presented at the oral hearing on the 4,000 transfers that happen between the maternity hospitals located all around Ireland and the children's hospitals and maternity units in Dublin. All of those transfers were analysed for an instance or learning that can take place and nothing untoward has occurred in the transportation approach.

We have a challenge because the vast majority of the population that we want to serve, the people who live in the greater Dublin area, need a new hospital. That is one of the hospital's functions. In addition, we can only have one hospital on the island that deals with highly specialist cases and, therefore, it must be based in the greater Dublin area. How do we work as a system to ensure that, where we have rural-based sick children, they safely transfer? That is how other jurisdictions like Wales and Scotland look at the issue and the same happens in Australia, which has a large landmass to cover.

We have clearly identified, in the national model of care for paediatrics and neonatology, that while one centralises highly specialist services one must put in what we call a retrieval service where we retrieve really sick babies and children. At the moment the retrieval service is 24-hour and seven days a week for neonates, who are the small babies born in any of the maternity units. I shall let Dr. Sharon Sheehan talk about this matter too. I note the vast majority of babies who are born with serious medical issues tend to be diagnosed beforehand and tend to experience a planned delivery, predominantly in the Coombe but also in the other maternity hospitals in Dublin. Even with that one will have babies who are born with a condition that went undetected. We have put in place a process where a highly specialist neonatologist who works in intensive care and a nurse or midwife will travel to the maternity unit where the child is stabilised. They will stabilise the child there and bring him or her back to Dublin. That system has been demonstrated internationally as a much safer way than trying to do this work in another way.

The retrieval service is fine for children up to the age of six weeks. In paediatrics we are looking to roll-out a similar retrieval service for children aged six weeks up to 16 years. We have managed to do so on a Monday-to-Friday basis. We continue to recruit paediatric intensivists and will expand the programme to provide a 24-hour and seven-days-a-week service. The plan is if there is a really sick child anywhere outside of Dublin, or even within Dublin, one needs to use the ambulance service, which is very good at dealing with these cases. I have heard some of the parents talk about travelling in ambulances with really sick children but travelling is the right thing to do. The children can be stabilised and we send our specialists to places like the Cork, Limerick or Galway units, where the child should go to be stabilised, and then we bring them back to the children's hospital. We would use the helipad and helicopters or roads, whichever is the best method of transportation. That model is part of the national model of care for paediatrics. We will roll it out over the next five years. I wish to assure the public and parents that really sick children should use the ambulance or go to their regional hospital where we will go to retrieve the really sick children and bring them to Dublin. This type of model has saved lives in other systems.