Dr. Paul Oslizlok:

I thank the Cathaoirleach and Senators. I am also very grateful for the opportunity to address the joint committee on behalf of the board of the all-island network. I will speak on behalf of the board but I also try to give the committee a bit of flavour of how the network developed from the view of the South as well as a consultant in the South. I am also a consultant paediatric cardiologist. I was trained here in Dublin and also in London and in the United States, in Boston and Charleston, before I came back to my post in Crumlin. I worked as a paediatric cardiologist at Our Lady's Children's Hospital, Crumlin, now CHI, and recently retired from that position. As Professor Casey has outlined, worldwide wherever we worked, experience has taught us that to achieve and maintain the highest standards in cardiac surgical outcomes, a critical minimum population for each centre was required and we learnt that in a very painful way with the Bristol inquiry.

On the island of Ireland we have a population of just 6 million people throughout the island and that is just about sufficient for one surgical centre for congenital heart surgery. This population of 6 million will ensure that about 400 to 500 children a year will require congenital heart surgery. These surgical numbers are required to maintain the surgeon's skills, particularly as many of the conditions that we deal with are relatively rare and we would only see a few of them perhaps every decade or so. As a result, this critical number is needed.

The implementation of the Good Friday Agreement was very welcome and timely on many fronts. For paediatric cardiac services on the island of Ireland it had long been evident that greater co-operation between the units in Dublin and Belfast was required and overdue. When Professor Casey and I began our training, paediatric cardiology was a very small world. We knew every paediatric cardiologist throughout the world. However, we did not know each other, North and South, because there was a Border there. Perhaps the paediatric cardiologists closest to us were almost unknown to us, and we were aware that we needed to address this.

The forced cessation of paediatric cardiac surgical services in Belfast, as Professor Casey has outlined, combined with the report of the international working group, provided us, North and South, with a unique opportunity to combine our services. There were, however, many obstacles to overcome. At the time, a cross-Border all-island healthcare service had never previously been undertaken. The care of newborns and infants with complex heart disease is notoriously difficult, requiring close teamwork relationships and significant funding. Perhaps most importantly, it requires the trust and the confidence of highly emotionally stressed parents and their families. This was perhaps our most difficult obstacle to overcome. There were already long waiting lists. Perhaps the members can remember back to press coverage at the time.

There were long waiting lists for congenital heart surgery in Crumlin back then. Staff numbers, especially medical and nursing throughout all the necessary subspecialties, were already insufficient and infrastructural improvements would be required.

For these reasons and others, there was initially considerable reluctance among my colleagues, medical and nursing, in Dublin, and indeed patients and their parents throughout the island, to buy into an all-island congenital heart network. To address these concerns, the all-island congenital heart disease network board, together with doctors, nurses and allied healthcare professionals and parents, commissioned EY to produce and cost a template for a world-class all-island service. The EY report and the funding model, somewhat to our surprise, were endorsed not just by our board but by the medical teams and parents' groups, and was accepted by the health Ministers and Governments, North and South. That was crucial to setting up this network.

Progress initially was slow because we had to build up trust and confidence, which takes time and patience. However, in the intervening ten or 15 years, this all-island congenital heart network has grown and matured. The clinical outcomes for infants and children with congenital heart disease are in the top tier of world-class results and that has been very important for us in reassuring our patients and their families.

Professional bonds of trust and team-building continue to develop. A key factor in the success of this venture has been the close co-operation and collaboration between the Departments of Health, North and South, the HSE and our congenital heart disease network board, between the medical and nursing staff and, crucially, with parents' groups. This has required time and many meetings, a lot of them held up in Ballymascanlon and other locations. Crucially, there has been a slow but progressive building of trust. The future of the network will depend on encouraging new medical and nursing recruits into our network. As part of the all-island congenital heart network, an all-island training programme, to which Professor Casey alluded, has been developed to train doctors in congenital heart disease. This is important. As members know, for many subspecialties, the only way we can train is to go abroad for long periods, so we lose the expertise and input of our young, bright trainees for decades while they go abroad, and sometimes they stay there. Having a training scheme on the island of Ireland, within the network, with enough expertise to train doctors and nurses has been very important. It is a significant part of what the network has brought us. Apart from medical training, we also have nursing training schemes and training schemes for other graduates in others subspecialties.

Research has been greatly enhanced by the appointment of two professorial units. Professor Casey leads the one in Belfast and my colleague, Professor Colin McMahon, leads the one here in Dublin. They work with their own research groups and work together, so we have an all-island research basis, which in itself also attracts graduates and trainees to Ireland.

On behalf of the all-island congenital heart disease network board, we are all very grateful for those Deputies and Senators who have promoted and facilitated the implementation of the Good Friday Agreement, for many reasons. The establishment of our network and all that it has managed to deliver for infants and children with congenital heart disease simply could not have happened without their work and that of their predecessors. We are very aware that there are several other paediatric medical and surgical specialties looking at the success of our network as a possible future model for their own patients. I thank the committee for its interest and attention.