Professor Chris Fitzpatrick:

It is a valid question. I do not believe so. The issue with benign gynaecology is that it is deprioritised in the general hospitals. It is very difficult. A percentage of women with symptoms that are suggestive of benign disease will actually have an occult cancer. Where women have, for example, problems with menstrual dysfunction and are on a waiting list to go into a maternity hospital or a general hospital, unfortunately a small percentage of them may change from pre-cancer conditions to cancer conditions because there is such a long delay in evaluating them, which is a tragedy. The issue is the model of care we need for gynaecology care. I am looking at the development of an integrated campus. It is not that what would happen in the Coombe would be very different from what happens in St. James's. The distance between our hospital and St. James's Hospital is less than the distance across St. James's Hospital. Our vision is that over time this part of Dublin, and a great deal of spin-off development will happen with the paediatric hospital coming into it, will be a medical quarter and over 20 to 40 years both hospitals will grow together.

There are governance issues to be addressed, but the main thing is to focus on patient outcomes, quality of care, access and choice. There is a wonderful opportunity to develop a customised gynaecology centre, an ambulatory centre, where women would have a range of treatments that are very difficult to access now. The Coombe hospital currently has a submission with the HSE to develop a new day care centre to cater for all women's reproductive needs, in terms of a one-stop-shop with en suite scanning and so forth and procedures on the day of presentation.

That is a wonderful model. It does not necessarily sit well in a cancer hospital. The spatial organisation of a hospital has to be flexible and allow for a configuration of services in the right spaces. Regarding space, if we moved our maternity hospital to St. James's Hospital, we would retain our gynaecology services as an integrated service across both sites. What is currently needed in Dublin and in our hospital group network is ready access to day-case, ambulatory and short-stay gynaecology surgery. Not only would that be possible in St. James's Hospital, it could be integrated with what is happening in Tallaght University Hospital, Midland Regional Hospital, Portlaoise and Naas General Hospital. That would allow a network of care, not segregated but integrated.

I have seen issues around staff flexibility, concerning new contracts for nurses and midwives and how people work across sites. I would like the Committee of Public Accounts and the Government to give impetus to prioritising the development of women's healthcare services and the co-location of a maternity hospital on the site of St. James's Hospital. I am concerned with space, money, and providing the best possible access. We can be flexible in how we could do that. It would not be a segregated service, but an integrated one.