Oireachtas Joint and Select Committees
Thursday, 27 October 2016
Joint Oireachtas Committee on Health
National Paediatric Hospital: Discussion
The purpose of this part of the meeting is a discussion with representatives of the Connolly For Kids Hospital Group and the National Paediatric Hospital Development Board on the decision of the Government to proceed with the construction of the new children's hospital at the St. James's campus, which was endorsed by Dáil Éireann on 8 November 2016.
I propose that we suspend for a few minutes to allow witnesses to take their seats. Is that agreed? Agreed.
We will hear first from the Connolly For Kids Hospital Group which has been invited here to air its views on the suitability of the St. James's campus as a location for the new national paediatric hospital. On behalf of the committee I welcome Ms Valerin O'Shea, group chairperson, Dr. Jimmy Sheehan, orthopaedic surgeon and hospital developer, Dr. Finn Breathnach, children's cancer specialist, retired; Dr. Eamonn Faller, ex child patient and non-consultant hospital doctor; Ms Aisling McNiffe, parent representative and Dr. Róisín Healy, retired children's emergency medicine specialist of the Connolly for Kids Hospital Group.
While the committee has no function in choosing the location of the hospital which has already been decided, we welcome the opportunity to engage with the Connolly for Kids Hospital group and the National Paediatric Hospital Development Board to hear their views on the Cabinet decision to locate the hospital on the site of St. James's Hospital. In 2012 the then Cabinet agreed to build the hospital on the site of St James's Hospital and planning permission was granted in May this year. Site clearance has commenced and final construction contracts will be signed in the near future.
There has always been agreement that a purpose-built and dedicated hospital for children is a necessary component of a fully functioning health service. The debate, however, has centred on its location. The national paediatric hospital will be the largest infrastructural development in the health service. It will provide essential specialist services for all children in Ireland at a single location and co-located with an adult teaching hospital and a future maternity hospital when the Coombe Women & Infants University Hospital is relocated to the site.
By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they are to give to the committee. If, however, they are directed by it to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of thier evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or an entity by name or in such a way as to make him, her or it identifiable. Any submission or opening statement submitted to the committee may be published on its website after the meeting.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official, either by name in such a way as to make him or her identifiable.
I ask Ms O'Shea to make the opening statement on behalf of Connolly for Kids Hospital.
Ms Valerin O'Shea:
We thank the Chairman and members for giving us the opportunity to bring our very serious concerns to the attention of the joint committee. We are a group of parents, grandparents, doctors and ordinary citizens who have no vested interest in the location of the children's hospital. I am an ordinary member of the public, not a doctor. I represent over 60,000 people who have signed a petition requesting that the site of the children's hospital be changed to Connolly Hospital instead of St. James's Hospital in the inner city.
We are here to alert the committee to the consequences of the gravely mistaken decision to locate the new children's hospital on the site of St. James's Hospital and want to expose the ongoing political sham of trying to defend the indefensible. It seems that only members of a medical and academic inner circle and some politicians are refusing to recognise the scale of the disaster to come if this decision is allowed to proceed. A RED C poll has found that 73% of the public think the site of St. James's Hospital is the wrong one. Nineteen city and county councils agree, as do almost all health care professionals. A staff survey at Our Lady's Children's Hospital, Crumlin, in November 2015 showed that 84% thought that the site of St. James's Hospital was not the best one for the children's hospital. Well over 60,000 people signed a petition which was given to the Taoiseach last July requesting that the children's hospital be built on the site of Connolly Hospital in Blanchardstown beside the M50 and that the children's satellite urgent care centre, planned for Connolly Hospital, be built instead on the site of St. James's Hospital, in other words, that the sites be flipped. We state categorically that flipping the sites would save time, money and, crucially, lives. If there was the political will to do it, the hospital could be constructed on the site of Connolly Hospital within three years of the date of the decision at a saving of approximately €200 million. If the sites were to be flipped, work already undertaken on the site of St. James's Hospital would not be wasted. Crucially, the Connolly Hospital site also offers space in which to grow, space which is not available on the site of St. James's Hospital.
We recognise that the job of the hospital development board is to get the hospital built on the site chosen by the Government. It had no part to play in site selection, but, unfortunately, it has been put in a position where it appears to feel it has to make false and misleading statements to counter valid criticisms and major shortcomings of the site chosen. A national advertising campaign in local area newspapers last month was riddled with incorrect statements. Why does the board believe there is a need to deceive the public? How are people like Liam McEntee's parents from Galway to feel about their needs being dismissed by the board in its cavalier attitude in stating only 1.45% of inpatients come from Galway? How dare the board spend taxpayers' money to try to make patients from outside Dublin feel they are not important?
It was a flawed decision from the start. It is most important for the committee to know that An Bord Pleanála's decision cannot be used to justify the choice of site. It was based solely on planning considerations. It avoided considering how the children's hospital would function; it was not the board's role to determine whether the building would be fit for purpose as a hospital now or into the future. That responsibility lies with the Department of Health.
We wish to point out that no report, either national or international, ever recommended the St. James's Hospital site. The reason given for choosing that site was "the overriding priority of best clinical outcomes for our children". This reason had no basis in fact and no evidence could be found to support it.
In reference to co-location with an adult hospital, the person who recommended the St. James's Hospital site to the Cabinet, Senator James Reilly, recently said the primary clinical driver of the decision was that children with very rare diseases could be treated by St. James's adult hospital consultants and would not have to travel abroad. This is false and nonsensical. There is no evidence of any advantage for child patients if a children's hospital was to be built beside an adult hospital.
We wish to highlight a few of the important issues in addressing the location of a children’s hospital which is to last well into the 22nd century. What is critical is co-location of a children's hospital with a maternity hospital, not an adult hospital. As advised by the most senior paediatric intensive care specialists in the country, to proceed with the children's hospital without a co-located maternity hospital will result in avoidable deaths and disability of many newborn babies. It is simply not possible to construct a full service maternity hospital on the site of St. James's Hospital without impacting negatively on the functioning of the other hospitals on the site. An Bord Pleanála specifically excluded an assessment of whether a maternity hospital would fit on the site. The committee will be interested to hear that the area identified for the notional maternity hospital has already been built on; it is the location of the existing excellent outpatient department and half the size of the existing Coombe hospital site. Furthermore, this small site would have to be shared with an emergency department, an intensive care unit and a new facilities-management hub, all in the adult hospital. The obvious optimum location for the children's hospital would be beside the new Rotunda Hospital to be built on the site of Connolly Hospital.
Space for expansion is a fundamental consideration in all hospital developments worldwide. The children's hospital in Toronto has doubled in size every ten years since the 1950s. Our Lady's Children's Hospital, Crumlin, has increased in size by 75% in 15 years. However, it turns out that even before a brick is laid the new children's hospital is too small. The severe lack of space on the site means that many important elements have had to be scaled down. The children's research building and the family accommodation unit are already smaller than requested, with no space for expansion. Senior scientists at Temple Street Children's University Hospital have described the paediatric laboratory as too small and akin to placing an engine for a Mercedes in a Mini - impossible. It appears as if it has been designed to fail. Only 41 additional beds will be provided. Based on projected growth rates in patient numbers, we know that by the time the hospital opens it will already have proportionately fewer beds than in 2012. Because of the lack of space, the cut-off age for admission will be the eve of the 16th, not the 18th, birthday.
We know that it is 25% cheaper to build on a greenfield site than in an urban location. Building on the St. James's Hospital site is particularly costly owing to the amount of preparatory work required, so much so that it will take at least one year to complete. Despite what we are being told, construction work has not started and cannot start for at least one year until all of the preparatory works are completed.
These preparatory works include the demolition of 13 functioning adult hospital departments to make room for the children's hospital and the re-routing of a multiplicity of underground cabling once it is accurately located. The relocation of the Drimnagh sewer alone will cost approximately €18 million. What is most shocking is that, due to the extensive excavation required, the cost of each additional parking space being provided at St. James's is over €130,000. In contrast, the cost of each surface parking space at Connolly would be €2,000. How could such extraordinary spending on parking spaces be justified when the money could be used for medical equipment or other much needed projects? The €200 million saved if the sites are flipped is more than enough to build the new Rotunda maternity hospital. It is impossible to envisage a fully functioning children's hospital opening in 2020 as promised. It is not going to happen. There is evidence of delay already. Delays cost money, and in this case they cost lives.
Access to the St. James's site is a major problem. We know that 90% of child patients arrive by car. The narrow roads around St. James's are so congested that ambulances are regularly blocked and cannot get past other vehicles. The air and sea rescue helicopter cannot land at St. James's because the site is too small. There is not even space for a taxi rank. Parking at St. James's will pose enormous problems for parents of sick children. Despite the hospital development board claiming that parking spaces will be trebled, the parking provision at St. James's turns out to be worse than what was on offer at Crumlin in 2010. The adult hospital will lose over 600 spaces. There will not be one single additional parking space for the notional maternity hospital.
We agree with the CEO of the hospital group board on one point alone. She has, at last, admitted that there will be serious staffing problems. Clinical excellence requires excellent staff, but staff are already leaving the adult hospital in droves. What lies ahead for the children’s hospital?
The decision to locate the new Rotunda at Connolly was a game changer and makes Connolly not just suitable but ideal. There are none so blind as those who will not see. It offers 145 acres for tri-location of the children's, maternity and adult hospitals and future expansion of all three, with 50 acres to be retained as parkland. The M50 has a hard shoulder which ambulances and emergency vehicles may use. Connolly is on a slip road off the M50/N3 interchange. The fact that it would be faster and cheaper to build the hospital at Connolly makes this a no-brainer.
Following the economic crash we were told that we are where we are because no one shouted "Stop". Actually, many did, but no one wanted to hear it. We are shouting "Stop" and will continue to shout until reason prevails. We know this hospital will be an unmitigated disaster with terrible consequences. There are also huge concerns about the viability of the adult hospital. If the committee allows it to happen, it will share responsibility for the consequences. We ask the committee to urge the Minister for Health to make the right choice for the children of Ireland and immediately set in motion the process of flipping the sites, with the children's hospital to be re-sited at Connolly and the smaller urgent care centre to be located at St. James's. If the Minister fails to do so he should know with certainty that he will be responsible for the deaths of many children and the avoidable anguish of countless parents - constituents - who will not forget that the blame for this decision cannot be parked at the door of An Bord Pleanála. This committee's constituents will remember that their politicians had the power to change it, but did not.
This statement is endorsed by Professor Conor Ward, Emeritus Professor of Paediatrics, University College Dublin, Professor Barry O'Donnell, Emeritus Professor of Paediatric Surgery, Royal College of Surgeons in Ireland, and Professor Niall O'Donohoe, Emeritus Professor of Paediatrics, Trinity College Dublin.
I welcome Ms O'Shea and thank her for her statement. The statement is a troubling one to me because she and those she represents are clearly of great eminence. Ms O'Shea used very forthright language about her concerns, which she stated are shared by eminent professionals in the field. As noted by the Chairman, it is fair to say that there is a lot of concern about the fact that this committee does not have the legal power, if one likes, to reverse a Government decision. I want to confirm if Ms O'Shea is aware of that fact. Am I right in thinking that what she is asking this committee is to form a view, either individually or collectively, on whether the Government has made the right decision? Is she then asking us to use whatever moral force we might have as a committee, if we are convinced by her argument, to call on the Government to change its decision at this stage? Does Ms O'Shea understand that we do not have the power to change a Government decision and is it her view that we ought to use our collective voice as a health committee to call on the Government to change the decision? Whatever decision we might choose to make is a separate matter.
Ms O'Shea stated that the group has no vested interest. I have no reason to disbelieve her, but is that true of each of the members of the group individually as well as collectively? For example, Dr. Sheehan, who I have heard speak very impressively, is a man of considerable accomplishment in the provision of health care in the private sector. Is it the case that none of them has, if one likes, skin in the game in terms of their professional or financial interests? I do not mean to be offensive in asking that question, but it is important because this group is making serious claims about a decision it believes to be seriously wrong financially in terms of children's health care and so on. We have to ask if those in the group have any skin in the game that we ought to know about when considering what it has to say.
If the decision is so wrong on so many fronts, why does Ms O'Shea think it was taken? Does she believe it was some kind of a political decision. I think it was noted in a submission by Dr. Sheehan that the Government decision was announced very quickly after the receipt of the Dolphin report. I think it was overnight, as it were. Does Ms O'Shea believe there was anything improper in that?
What is Ms O'Shea's view on the question of whether the St. James's site is future-proofed for expansion? She claims it cannot happen and that there are limitations around parking and the size of certain important facilities etc. What is her view of the case being made by the proponents of the St. James's site about future expansion?
Can Ms O'Shea stand over her claim about the net cost. It is important to note that steps have already been taken. We can all recall the electronic voting scenario. Steps were taken and machines were purchased but then it never happened. There was quite a lot of scandal that tens of millions of taxpayers' money was wasted. Surely that argument can be made were the diggers in St. James's to be stalled now. Is it seriously Ms O'Shea's view that the net cost of continuing is far greater than the net cost of changing at this stage. That is obviously a financial costs question rather than one concerning children's welfare.
Ms Valerin O'Shea:
The Senator asked several questions there. The first one related to the powers of the committee. I will ask Dr. Róisín Healy to address the question about the powers of this committee and whether we are aware that the committee does not have the power to make changes and what it is we are requesting it to do.
Dr. Róisín Healy:
I have been an emergency medicine consultant in Our Lady's Hospital Crumlin for 20 years. I was a sole practitioner, permanent, in the department for 14 years before I received any help. This is my first time in a committee room. I read up on the function of Oireachtas committees on the Oireachtas website. The function of the committee is to monitor the Department of Health and it was for this reason and on the basis of the absence of any other forum or means to make our concerns known to members of the public and to make the public's concerns known to the Government that we are here today. I thank members for inviting us.
As Senator Rónán Mullen noted, there is a disconnect here. The first issue is whether the new children's hospital building will fit in its environment. That matter is the function of An Bord Pleanála. No committee can address what we refer to as the service function or model of care. Perhaps the Committee on the Future of Healthcare chaired by Deputy Róisín Shortall could be a forum for debating this issue but until now there has been no place to discuss the issue.
Our Lady's Hospital Crumlin stayed out of the development board for two and a half years because it objected when the Mater Hospital site was chosen. The archbishop chairman of the board stated the core value of Our Lady's Hospital Crumlin was a co-located, co-built hospital with a short corridor between the maternity hospital and children's hospital. After some years, everybody was exhausted and decided to concentrate on his or her work. More than 60 eminent doctors, including the 15 top ICU specialists, have said this is a red line they will not cross. The Government has ignored any question that has been asked about this matter. I do not believe it has any intention of locating a maternity hospital on the Crumlin hospital site. If it had, why has it not done anything for the past ten years? This is a serious concern and the delay speaks for itself.
We would like the Government to change the decision. The Dolphin report was published at the beginning of June 2012 and the decision was made on 2 November 2012. The then Minister for Health and Children and Deputy, Senator James Reilly, did not explain the clinical considerations we were told about, nor did we ever find out who advised him. We know, however, that there was a major row in the Cabinet on the day the decision was made. The then Tánaiste, Deputy Joan Burton, and the current Minister for Social Protection, Deputy Leo Varadkar, stated the hospital should be located in Blanchardstown. If we were discussing demographics, we could argue the toss on that issue. We want the Government to change the decision and we want the joint committee to recommend that it does so.
We have been told by senior politicians that the only people who have power in this dysfunctional Government are the Taoiseach and his Ministers. Given the new politics, will the joint committee please contact the Taoiseach and Minister for Health on this issue? The Minister has not done us the simple courtesy of acknowledging receipt of or responding to the 60,000 signatures which were sent to him from the Department of the Taoiseach. For the sake of the children of Ireland whom we are meant to look after, let us change this decision before it is too late.
Dr. Jimmy Sheehan:
I have a vested interest in this issue, namely, the future of our children. What strikes me when dealing with the other people seated by my side is the extraordinary commitment they have made to the future of our children. I have been involved in health care for all my life and this is my 60th year in health care. Having been involved in developing, commissioning and operating in the Blackrock Clinic, Galway Clinic and Hermitage Clinic, I have seen the importance of health care development over my lifetime. The reason I became involved in this issue is that I was disturbed by many of aspects of what was happening and concerned for the future of our children. As a result, I invested considerable time and effort in making an application to An Bord Pleanála about the difficulties arising from the decision.
One of the major difficulties is future proofing. I have seen what happens with hospitals over a period of 30, 40 or 50 years. It is 34 years since we developed the Blackrock Clinic and I have seen its expansion. In the Galway Clinic, we have had seven separate building projects in the 12 years since the hospital opened. Every hospital evolves and I became involved in this issue for these reasons. I assure the members that I have no interest in the matter from a commercial point of view. I can also state with absolute certainty that the same applies in respect of every member of the Connolly for Kids Hospital Group. We are all here for the same reason, namely, that we have a binding interest in the future of our children.
I have examined the costs involved in this issue. Developing on a greenfield site in Connolly Hospital as opposed to St. James's Hospital would save taxpayers approximately €200 million. This figure can be broken down very simply. There is no site available at St. James's Hospital. The only part of the chosen site that was not built on was a car park. I can provide the joint committee with a list of the 21 separate departments, including a number of non-clinical departments, located on the site. I estimate it will cost a minimum of €100 million to decant and replace these departments.
The diversion of the sewer will cost approximately €18 million. The building housing the car park has three floors, consisting of a two-floor car park and an underground energy centre. This will add approximately €30 million to the cost. Building on an inner city site will, as our application noted, cost approximately 25% more than the alternatives. This includes the €30 million cost of excavation to which I referred. There is an additional premium of 10% or €40 million. Considerable work must be done to fire-proof buildings when a helipad is located on them. The establishment of a helipad on the roof of a building is not recommended for medical use, other than in a last resort. This proposal to do so will add another few million euro to the cost. A large number of costs have not been quantified, for example, the protection of existing patients in St. James's Hospital from contamination with organisms such as aspergillosis by installing air conditioning and locking up the building. When one adds these costs together, one arrives at a minimum additional cost of €200 million for locating the hospital on the St. James's Hospital site.
Dr. Finn Breathnach:
I set up the children's cancer haemotology-oncology unit in Crumlin hospital when I returned to Dublin from Great Ormond Street in London in 1981. I worked single-handed for 15 years, during which time I was on call for 365 days of the year. The unit, which I built through fund-raising money, was completely redeveloped 23 years after it was built because it was not fit for purpose.
Doctors take clinical decisions on the basis of evidence. Each of us will get sick at some stage in our lives and we will be offered treatment. It would be very sensible to ask whomever is offering the treatment what the evidence is for the success of the treatment or plan of action. The decision on the location of the national children's hospital was also supposed to be based on clinical matters and we are right to ask what is the evidence for the decision. The claim has been made that the clinical outcomes for children will be improved if the children's hospital is built next to St. James's adult hospital. This has been repeated by the former Minister for Health and Children, Senator James Reilly, his successor, the current Minister for Social Protection, Deputy Leo Varadkar, and the current Minister for Health, Deputy Simon Harris. The literature does not provide a single scrap of evidence to support that claim. Nowhere in the world has anyone made a claim for improved clinical outcomes through locating a children's hospital with an adult hospital.
Deputy Kelleher took the trouble to travel a long way to the southern hemisphere to visit the Royal Children's Hospital in Melbourne, and we had a brief conversation about this some months back. He noted the children's hospital was built in a wonderful healing environment with acres of space and that there was not an adult hospital in sight. Of course, the most recently built children's hospital is in Liverpool in the United Kingdom, which is the very famous Alder Hey Children's Hospital. It was built in a particular area with enough space near it to build a new hospital. It is on its own and stands nowhere near an adult hospital.
I do not care what medical expert the other side brings in, I can tell the committee with absolute certainty there is absolutely no evidence whatsoever to benefit children through co-location with an adult hospital. I listened to the CEO of the children's hospital, Eilish Hardiman, on radio recently. She was challenged to provide evidence, and said there is lots of evidence and to look at Manchester, Sweden and Glasgow. Manchester does not claim improved clinical outcomes through adult co-location and neither does anyone in Sweden or Glasgow. What she was referring to, of course, is tri-location, which we support. Stand-alone children's hospitals can function, as the hospital in Crumlin has done wonderfully well, providing excellent care for decades without the need for any adult input. The minute we attach an essential co-located maternity hospital, then we introduce a separate group of patients who are mothers, and the children's doctors are not qualified to look after them. They need an adult hospital. The Rotunda Hospital will go to Blanchardstown, and it will be very happy to have the adult teaching Connolly Hospital at Blanchardstown look after its sick mothers once the intensive care unit has been upgraded and additional haematology sessions are added. It will be very happy that its mothers will be cared for.
Unlike adult co-location, for which there is absolutely no documented evidence, I can provide scores of scientific papers to show improved outcomes, not only regarding survival but quality of life for children, who are delivered next to a children's hospital. In 2006, Our Lady's Children's Hospital in Crumlin stated the new children's hospital must be co-located with a full service maternity hospital. This is in keeping with a recent report, published ten years later, which stated there must be a full service maternity hospital. The hospital also stated the effects of such will show lasting improvement in neonatal and newborn morbidity, which is damage such as brain damage, and mortality. These benefits have been demonstrated in well-researched submissions by many obstetric and neonatal consultants. It also stated these benefits are of such magnitude that its board believes the maternity component of the development should proceed simultaneously with the new children's hospital.
A specialist group comprising the department of cardiothoracic surgery, the department of cardiology in Crumlin, and the joint department of paediatric intensive care medicine at the hospitals in Crumlin and Temple Street wrote to An Bord Pleanála that:
Co-location with a physically linked maternity hospital is, in our expert opinion, non-negotiable. We are unwilling to endorse a national children's hospital on a site that cannot accommodate this truly critical adjacency. To do so would be to fail those infants whom we are entrusted to protect. To proceed with such a project will result in the avoidable death or disability of many new-born babies for years to come.
It is absolutely critical that a full service maternity hospital be built on the St. James's Hospital site. I wrote to the previous Minister, Deputy Leo Varadkar, pleading with him to apply simultaneously for planning permission for the children's hospital and a maternity hospital. Once a children's hospital is built on the site the State will have to go back for planning permission for the maternity hospital, but at that stage there will be a huge children's hospital and a huge adult hospital trying to function. The transfer of St Luke's Hospital, which is also to go on site, has been delayed. There will be no room for a maternity hospital because the site allocated in St. James's Hospital is smaller than the site already occupied by the Coombe hospital. Where is the space for the maternity hospital at the St. James's Hospital site? There is space, but only if the 18 year old excellent outpatient department for adults is knocked down and moved somewhere else. I do not know where it would be put. This is an added expense. According to the documentation supplied to An Bord Pleanála, which I have cut and pasted, a new adult intensive care unit, a new adult accident and emergency department and a new adult facility management hub would have to be built, after which a maternity hospital could be built. This is all because of a claim for improved clinical outcomes by building the children's hospital next to an adult hospital, for which there is not one scrap of evidence.
Dr. Jimmy Sheehan:
The development board states there is potential for 20% added expansion, but when we look at what is required for hospitals, and I alluded briefly to this earlier, they are a bit like airports as they evolve constantly. We do not know what technology is coming down the road. Take the history of St. Vincent's University Hospital, which is relatively new at 45 years and I returned to work there in 1970. It has doubled its frontage, leaving the old hospital behind. It has added a multi-storey car park. In that period the original St. Vincent's Private Hospital has been taken over by the public area and there is a new private hospital. I reckon the total size of St. Vincent's University Hospital has increased between three and four times in a period of 45 years. This is typical of what happens with hospitals.
I mentioned seven building projects in Galway. A number of these were for new technology that was not present 12 years ago. For example, we put in a 3-tesla MRI scanner, which was not available ten years ago. We had to build for it. We put in a new radiotherapy bunker for stereotactic radiotherapy, which was not available. We also put in an interventional operating theatre, we added 50% to our capacity for inpatient beds, we doubled our day care and we trebled our laboratory space. All of this was in a very well-planned hospital that was only opened 12 years ago.
Talk about 20% potential for expansion for a children's hospital which is supposed to last for between 50 and 100 years is one of the reasons that motivated me to get involved in the Connolly Hospital project, because I saw how absolutely daft the whole situation is. It would be catastrophic for the future. What will actually happen in a very short timeframe is that new facilities will have to be added off-site. Take the example of a new facility for proton beam therapy, which is much more sophisticated than radiotherapy. It requires huge infrastructure. The Mayo Clinic has just built a new department which cost $200 million. This cannot be incorporated into an existing building. I am happy to pass around a leaflet to committee members to show why this is not possible. It is because a linear accelerator is the base of the proton beam. The leaflet will show committee members how sophisticated it is. It is groundbreaking therapy for children with brain and other tumours. It will become an essential part of our infrastructure but it could not possibly be on site. There is an absolute disaster down the road in terms of further development if the St. James's Hospital site is proceeded with.
I thank the witnesses for their presentation. Will the witnesses confirm the Taoiseach had not even sent them an acknowledgement regarding the 60,000 signatures submitted? Is there planning permission for the Rotunda Hospital to relocate? Has the relocation of the Rotunda Hospital to Connolly Hospital been locked down?
It was stated that the only publicly mentioned driver was improved clinical outcomes because of co-location with the adult hospital. I am not saying the witness was being dishonest in saying it was the only one, but is that, honestly, the only reason that has been advanced in favour of the St. James's Hospital site in all of the discussions on this?
Dr. Healy said this was the first opportunity there has been for this matter to be aired. My understanding is that the previous health committee considered it, heard submissions and met with representative groups from various sites. Can she enlighten me on that? I understand the witnesses are here as the Connolly for Kids group. Can it be outlined for my own benefit and that of other members if the group is an amalgamation of a number of organisations or if the witnesses are speaking individually? Are there organisations allied to the group? If so, what are they? That would provide the committee with an understanding of the kind of people and organisations or groups who share the concerns the witnesses are bringing to us this morning.
Dr. Róisín Healy:
We have but we have not received a reply from the Minister for Health to Connolly for Kids. We also sought a meeting with the Minister for Children and Youth Affairs, Deputy Katherine Zappone. She forwarded our correspondence to the Minister for Health and I understand through the Minister, Deputy Zappone, that we are on a stand-by list. However, we have had no acknowledgement. I spent an hour on the phone trying to find out what was going on and it turned out, because we had written to several Departments, that it was the Department of Children and Youth Affairs that we had a reference number with. We do not know when that will happen. Our concern is that if the main contract for construction is signed, a deadline will be reached. We have a window of opportunity of perhaps a year or maybe less where people can see sense.
Everything that has been done at St. James's will not be lost. The smaller unit can go there because that is where the smaller population is. The demographics show that there are 75,000 people in the main catchment area for St. James's. That comes from the planning application from the development board itself to An Bord Pleanála. I refer to under 16 year-olds. There are 100,000 under 16 year-olds in the Tallaght area and 100,000 in the Blanchardstown area who are within 30 minutes of the hospital. The application did not say whether that was 30 minutes driving distance, but I presume that is what was meant. That leaves another 140,000 children unaccounted for. I do not know where they are meant to go. I refer to the Wicklow kids and to others. Be that as it may, of the children who will be using this hospital as their ordinary hospital in the way that Cork kids use the Cork hospital and Limerick and Ennis children use the Limerick hospital, two thirds will come from outside the M50. Only one third will come from inside the M50.
The demographics of the under 18 childhood population for the country show that nine out of ten children live outside the M50. Yet, here we are putting in all the tertiary children who are the sickest ones. They are the ones who will use the hospital most, who will have the longest admissions and will include the highest number of day cases. Dr. Breathnach is very familiar with those. Over 50% of children coming to Crumlin for day care belong to that sickest group. At the time of the Mater application, the then development board said 72% of admissions would come from the greater Dublin area while 28% would come from outside. That has now been reversed. It is now being stated that 22% will come from outside and 78% will come from inside. I am referring to the sick children, which is to say the tertiary care children.
There are nonsense statistics going around at the moment in every county. They have been published in the local newspapers. The first sentence in this states that construction work started in August. Construction work has not even been signed. The tenders are due in one of these days. I am reading from The Sligo Championbut the reports have been similar in all the county newspapers. Ms O'Shea touched on this. The paper reports that 1.3% of children attending the three Dublin children's hospitals come from Sligo. However, what it does not say is what the 1% represents. Does that 1% represent 50 children, 500 children or 5,000 children? This statistic is a nonsense. The other thing it does not say is for how long those children are in hospital. They look at the database and see what the address is. We have a parent on the committee whose child was in Our Lady's hospital in Crumlin for three years. Someone mentioned Liam McEntee from County Galway who spent the first four years of his life in Crumlin. One has all the access problems to deal with in that regard.
Dr. Jimmy Sheehan:
I add the following in relation to contact. I tried for a six-month period a few years back to meet the Taoiseach to express my concerns because of my background and interest in the future of our children but I failed to get an appointment. I tried to meet the then Minister, Deputy Leo Varadkar, and I got a reply to say he was too busy with media and other affairs to meet with me. Any attempts I have made to meet with people that matter have been rebuffed. I felt so concerned about it that I put a great deal of time and effort into trying to meet those people.
Mention was made of the Connolly for Kids Hospital group and people coming together. What happened in my case was that I was acting purely as a concerned individual. I made a 17-page submission to An Bord Pleanála and put a great deal of time and effort into trying to have a balanced argument as to why St. James's Hospital was unsuitable. Other people came from different areas. It was after the meeting with An Bord Pleanála that we came together as this group, realising that we shared the same concern for the children. It just evolved in that fashion.
Ms Valerin O'Shea:
I was asked about the planning permission for the Rotunda, which has not yet been granted. The decision has been made that the Rotunda will move to the Connolly site, but in relation to planning permission, I have before me the section from the Martin and Clear report, a planning assessment document which accompanied the Dolphin report. It lists all the advantages and weaknesses of each of the hospital sites being considered for the children's hospital. The Connolly Hospital assessment lists no weakness. It is a greenfield site and planning issues are highly unlikely to arise. In fact, the only item that is listed in the weakness section is the requirement to vary the development plan. However, local authority members have already agreed to do that. As such, it is not an issue and could be done contemporaneously. On the other hand, there is an endless list of the strengths of the site meaning it should not be a problem just as for the children, it is a very straightforward site in relation to planning.
The Master of the Rotunda has said it will take perhaps five years to move to the site.
Ms Valerin O'Shea:
The two hospitals, the children's and the maternity, really could be delivered at the same time with far greater ease and far less risk of delay. The city centre site at St. James's Hospital is likely to encounter severe delays because of construction complications associated with a site in the inner city. I will ask Dr. Breathnach to address Deputy O'Reilly's question about clinical outcomes and whether it was the only reason given.
Dr. Finn Breathnach:
I thank Deputy O'Reilly for her very important question. I had mentioned earlier that the claims for improved clinical outcomes were made by previous Ministers for Health, Senator Reilly and Deputy Varadkar and by the current Minister for Health, Deputy Harris. I wrote an eight page letter to then Minister, Deputy Varadkar, and - after 30 years in the health service - I received a one line reply thanking me for my letter. All of the concerns I have raised with this committee were in that letter to Deputy Varadkar and yet he continued for one and a half years or so afterwards to claim improved clinical outcomes. My jaw dropped because I was advised of an interview which Senator James Reilly gave recently to Sean Moncrieff on Newstalk radio. My jaw dropped for a number of reasons. The Senator was asked why he picked the wrong place for the children's hospital. He said that he had picked the right place and he proceeded to explain why. He said that co-locating the national children's hospital with St. James's Hospital would allow children with very rare disorders, who currently have to travel abroad for treatment, to be treated in Ireland through bringing together the experts who are the super specialists who deal with adults and children for these very rare conditions, and that this was a primary concern and the primary clinical driver of the decision. This is complete and utter nonsense and the Cabinet believed him. Senator Reilly is asking us to believe and accept that if highly-trained children's doctors cannot manage a rare disorder, the children will be made better through some miraculous process of handing them over to the doctors who treat adult patients and who have absolutely no experience or training in looking after sick kids. Of course there are children born with rare conditions and they will still be born with rare conditions such as conjoined twins, known as Siamese twins, but these cases are so rare that they have to be treated in a hospital with a global referral pattern. There are children who need liver transplantation. We have liver transplantation but not at St. James's Hospital. It is in St. Vincent's Hospital, but they do not perform transplants for child patients because the number of children who require liver transplants is so small that they are afraid, and quite rightly so, that their expertise in looking after adults with not be sufficient to allow them to look after children.
I believe the committee had an opportunity on 20 October, which was just last week, to meet the National Paediatric Hospital Development Board during a walk-in session in Leinster House and that the members subsequently received a document on important information about the new children's hospital. Consider the other reasons, apart from co-location, and the board's claims for the benefits of the co-location with the adult hospital. It would take me a long time to go through this but the document was previously headed as Addressing some Myths. It is a great public relations exercise. Tens of thousands of euro have been spent on public relations and yet only 20% of the population think that St. James's Hospital is the right place. The document states that St. James's Hospital "has the greatest number of clinical specialties and national services in the acute adult hospital system". So what? They do not benefit children and they do not look after children. It says it is a main teaching hospital, meaning that "they have matching levels of service complexity delivered by highly specialist staff". This is nonsense. The largest number of specialties in any hospital is in Our Lady's Children's Hospital, Crumlin. It has far more than in any adult or other children's hospital. If one adds the Temple Street hospital specialties, we then have another couple of specialties to bring it up to 41 or 42, including neurosurgery and kidney transplantation, which are not available in St. James's Hospital. The document speaks of "synergy" between the hospitals. It just goes on and on. It is ridiculous. It also says that the co-location offers a best practice model for the transition to adult services for children and young people. This implies that when a young patient turns 18 years of age and needs to transition to an adult hospital, just because St. James's Hospital is there it is going to be wonderful. Well, where is the national centre for cystic fibrosis? It is in St. Vincent's hospital. Where is the national centre for neurosurgical problems? It is in Beaumont Hospital. Where is the national centre for children with congenital heart disease and who are now going into adult life? It is not in St. James's Hospital; it is in the Mater Hospital. I could go on and on. Orthopaedic surgeons who operate on children in Our Lady's Children's Hospital, Crumlin, will, if they operate in the new children's hospital on the St James's site, see them as adults in their adult hospital, which is Tallaght hospital, not at St. James's Hospital. Those orthopaedic surgeons who operate on children in Temple Street hospital will, on the child becoming 18, see them in their adult hospital, which is Cappagh National Orthopaedic Hospital, not St. James's Hospital. Other children will transition to somewhere it is convenient for them such as Cork University Hospital, University Hospital Limerick etc.
On economies of scale, the document is so disingenuous that it troubles me. It states:
Co-locating with St. James’s Hospital will mean that the new children’s hospital will have access to highly specialised equipment that it would not otherwise have access to. An example of this is a PET scanner.
At the moment the PET scanner at St. James's Hospital cannot be used for small children. The board knows full well that the children's hospital will have its own PET scanner. Another benefit mentioned was a mass spectrometer available in St. James's Hospital, as if the children will be fed into this machine and come out fixed at the other end. It is a piece of machinery through which tissue is analysed. That tissue can be posted from anywhere in the world and is dependent upon somebody who is expert in operating the machine. There has been nobody in St. James's Hospital to operate it since a person left.
The plan is to also relocate the Coombe Women and Infants University Hospital to the St. James's campus - the Rotunda Hospital and Connolly Hospital Blanchardstown are at the same stage - but there is no room to fit the full-service maternity hospital of the Coombe into the St. James's site. The site that is on offer is too small; it is half the size of St. James's, as I have said before, and there is already a huge existing building there so the added cost of doing that is going to be a problem, including trying to find the money. Almost certainly what the board will end up doing is having a high-risk maternity unit, which is smaller, having to rebuild the Coombe, which needs a rebuild and also having to staff this new high-risk maternity facility. This goes against the recently-published maternity strategy in which a full-service maternity hospital is recommended.
Dr. Eamonn Faller:
First, I will introduce myself to the Deputies and Senators. My name is Eamonn Faller and I am a doctor who has spent a considerable amount of time working at St James's Hospital, but I will return to this later. I was diagnosed with cancer at the age of 14. I am from Galway and the experience of living in Galway and requiring twice-weekly trips to Dublin for treatment lends me pretty good insight into the profound effect the location of this hospital will have on patients and their families. The effect is profound and I will tell the committee why. What is not being realised here is that one extra hour in traffic for a sick child is heaping misery upon mystery. Among the most visceral memories I have of my own experience is being spread out across the back seat of my parents' car, nauseous and weak as the car crawled through Dublin traffic and wishing away every second of that car journey. This experience was not particular to me; it will resonate with families up and down the country. There is no doubt in my mind that an enormous amount of patient hardship would be saved by locating the hospital at Connolly Hospital Blanchardstown. Nine out of ten patients who require complex and specialist care are from outside of the M50 and these are the people who will suffer most due to this poor decision.
With regard to teens transitioning to the adult service, I am a patient who would have benefitted from this co-location with St. James's Hospital. My care was eventually transferred to St. James's Hospital after I reached the age of 18. The other problems with the site absolutely dwarf any potential benefit that could be achieved in this regard. On a personal level, issues with access during the acute phase of my illness caused me far more hardship than attending a different centre for follow-up after the age of 18. The transition argument does not stack up at all in Dublin, given the fragmented nature of services. A very small proportion of patients would have the potential to benefit. Neurosurgery and renal transplant patients will still go to Beaumont Hospital, cystic fibrosis patients will still go to St. Vincent's University Hospital and cardiac disease and spinal surgery patients will still go to the Mater Hospital. This brings us back to the potential for expansion, at least, in Connolly Hospital Blanchardstown over the coming decades and there might be potential to transfer services there.
Ms Valerin O'Shea:
On the composition of our group, we got together after the oral hearing where some of us met for the first time in December last because Connolly Hospital had come on the radar. There are various backers of the Connolly for Kids Hospital. There is the New Children's Hospital Alliance, one of the larger groups and one to which I belong. Then there are the Extra Special Kids Group, Fionnbar Walsh, father of Donal from Kerry, the founders of Jack and Jill and many other backers.
I welcome the witnesses and thank them for their presentation. It is important a forum is offered to them to express their concerns about what they see as the wrong choice for the national children's hospital. There is no doubt we all agree on the need for a national children's hospital. In doing that, however, it must be put in the most appropriate location. We are here because the group suggests the choice of the St. James's site is not. They have outlined many reasons for it, some compelling. I am sure others will argue the opposite in support of the St. James's site.
Would any of the group have expressed views previously on the Mater site being the wrong one? It would strike me that if St. James's is considered wrong, then the Mater would have been equally problematic for the same reasons.
Dr. Fin Breathnach referred to the fact that I was in Melbourne when I was a Minister of State and saw the site of the children's hospital there. I did not travel specifically to see the site but I did take it upon myself when I was there to see it during the final stages of construction. It was in a beautiful parkland setting. The key issue, however, is about the services for sick children. Why is the group arguing that Blanchardstown will give a better outcome? Its submission stated locating the hospital at the St. James's site will result in avoidable deaths and disability of many newborn babies. That is quite a profound statement. Will the witnesses elaborate as to why this would be the case?
The group proposes the flipping of the site. In other words, the satellite hospital would be located in St. James's and the major hospital would be located in Blanchardstown. One can work out rough costings such as greenfield versus brownfield at around 25% and the cost of car parking. Has a detailed analysis been done by the group? The group claimed the relocating of the Drimnagh sewer at the St. James's site would cost €18 million. Has this been quantified by people who have experience in the costings of large projects?
The Dolphin report was commissioned after the Mater site was rejected by An Bord Pleanála and reported in June 2012. It is quite a detailed report in many ways which I read from cover to cover. It laid out many of the reasons for site location, not only for the physical building but the specialties within it, and the services to which Dr. Róisín Healy referred. Is the group saying the Dolphin report, or its terms of reference, was flawed in its assessment in deciding that St. James's was the right location? Why does the group believe the Dolphin report got it so wrong?
On public transport, and the lack of it, there is traffic congestion around St. James's. As the lead arbitrator, An Bord Pleanála felt these issues could be addressed and overcome in other ways. There are quite good public transport services to the St. James's' site. For example, Heuston and Connolly Stations are linked by the Luas which actually goes through the St. James's site. Does the group accept this may be important to many people who may wish to attend the site? I accept initial transportation to the proposed hospital would be by car or ambulance. However, for the parents and siblings of many patients who might be there for a long time, they may have the choice to use public transport directly to St. James's.
On the issue of bilocation versus a single modular stand-alone hospital, there is a proposal to put a maternity service in the St. James's site. Part of the strategy is for the Coombe maternity hospital to go there. I do not know whether that can be done, as I am not an expert in engineering or architecture. We are led to believe it can happen, however. Part of the longer term policy will see both maternity hospitals move from their present positions, namely, the Rotunda to Blanchardstown and the Coombe to St. James's. Does the Connolly for Kids Hospital group believe the Coombe maternity site could move in its entirety or would it just be the high-dependency maternity unit with the rest of the hospital remaining on the Coombe site?
Since I became my party's health spokesperson and being a political person, I have also found there is politics in medicine too. I remember during the debate around the Mater site that it was quite political, both in this forum and among medical professionals. Many made their arguments with genuine and compelling reasons. Is there any medical politics either in the context of the Dolphin report's recommendations or in the group's views that the report got it wrong?
Ms Valerin O'Shea:
On the Deputy's remark about some of our arguments being compelling while others will argue the opposite, we have listened to the arguments of the others and find them very misleading. We are continually finding they are deceiving the public in their arguments. I would hope that those listening to us will come back to us if they have any question for verification. We can provide documentary evidence to back up any of our arguments. The first question was about the benefit of Connolly Hospital over the others and the statement that in choosing Connolly we would avoid deaths and disability. Dr. Breathnach has dealt with that but if-----
I thank the witnesses for coming here this morning. I commend their dedication to this project. I am coming at this issue from a political viewpoint but I also had the misfortune of my first child - I had all my children in the Coombe hospital - having to be transferred to Crumlin hospital for immediate treatment after birth. The issue involved here highlights the challenge one has to deal with when faced with the scenario where after giving birth one's child has to be taken by ambulance straightaway to another hospital. I believe one of the witnesses' offspring treated one of my children at one stage. In terms of the colocation of the maternity and paediatric services, I was struck at that time in the hospital by the challenge facing people who came from outside Dublin and I come from outside Dublin originally. It was fine for me to go home at night and get clothes washed or whatever. I remember there was a lady from Killarney in the hospital. There are the difficulties faced by families, the health outcomes for the children, bonding and so on. In their personal opinions do the witnesses realistically think that maternity services at the Coombe hospital will be moved to the St. James's Hospital site? Do they think there is any possibility that it will not be a high risk maternity centre that is placed there?
Dr. Breathnach mentioned he worked in Great Ormonde Street Hospital. Hospital access is one of my primary concerns about the St. James's Hospital site. It will have emergency patients, children as well as adults together with people attending for outpatient appointments. Somebody told me this would involve an additional 10,000 patients but that figure might be wrong. How will the infrastructure cope with that? How does Great Ormonde Street deal with that? Guy's Hospital, St. Thomas's Hospital and London Bridge Hospital in London, in all of which I have worked, all seem to function fine in that city. Are we just not able to cope with the infrastructure? Have the witnesses any solutions to offer to the difficulty in terms of our infrastructure? Dr. Valerin O'Shea or Dr. Róisín Healy mentioned there was no weakness in the Connolly Hospital site. Does that refer to only planning issues or is there anything they could objectively say is bad about the Connolly Hospital site?
In his professional view does Dr. Breathnach believe that moving maternity services from the Coombe hospital to a restricted site at St. James's Hospital goes against the national maternity strategy? To follow up on Deputy Kelleher's question about medical politics, do the witnesses have any views on that and the role that has played in this?
I have just one question for Dr. Finn Breathnach. First, I would like to thank each of the witnesses individually and collectively and all the folk who work with them. The witnesses have certainly helped me and the committee to better understand what is involved. One of the witnesses make the point, in response to the case being by those on the other side, that there were no advantages to the children's hospital being located beside an adult hospital. To put it layperson's terms, are the witnesses saying that a child is simply not a smaller version of an adult or it could be put the other way around? I am not a doctor. Can the witnesses give me one or two practical homely examples of how that is not the case? I am referring to how putting one's hands to a child is different from dealing with an adult in the same specialty?
I thank the witnesses for their presentation and detailed submission. The issue of the location of the new children's hospital has been discussed for literally 25 years. We had decided on the Mater hospital site ten years ago. The planning for it from Dublin City Council was almost through when An Bord Pleanála overturned it. The decision on this matter was taken in 2012 and the site is only now being cleared four years on. It will take a number of years yet before it is finished, if it goes ahead. A process was followed by An Bord Pleanála. It looked at all the issues the witnesses raised regarding traffic, congestion, access and parking. Would the witnesses agree that An Bord Pleanála took a decision in regard on the Mater hospital site because it had concerns about those issues but when it took a decision this time round, it did not have the same concerns? Would the witnesses accept that? Are they saying that An Bord Pleanála arrived at this decision incorrectly by not taking into account all of these issues, whereas it did take them into account in its decision on the Mater hospital? The witnesses raised all these issues in their presentation. Are they suggesting that the information given to An Bord Pleanála was misleading and it was not able to adequately examine it?
The witnesses raised the issue of flipping the site. Would they accept that we are now four years on from the decision having been taken, we are still only at the stage of clearing the site and that if we were to start all over again with the Connolly Hospital site we would have to go back to the drawing board? It would not possible to transfer the building because it would be a totally different structure. There is underground parking on the St. James's Hospital site but Connolly Hospital is a different site and we would have to go back to the drawing board. It would take anything up to 12 months to do a drawing, a presentation and the site outlay. The planning process would take another six months and even then we are talking about 18 months. The witnesses said that it could be all turned around in three years. Do they think it a little optimistic to claim that the site could be flipped in three years?
The three clinical directors of the National Children's Hospital in Tallaght, Our Lady's Children's Hospital in Crumlin and Temple Street Hospital are all in support of this development. The last line of the group's submission states: "If the Minister fails to do so he should know with certainty that he will be responsible for the deaths of many children and the avoidable anguish of countless parents - your constituents". Are the witnesses saying, in that final statement, that those clinical directors are jointly responsible? It is a serious suggestion. If they are backing this project, are the witnesses saying that the clinical directors will jointly be responsible in that situation? It is important that we clear the lines here. A decision has been taken and it has taken four years to get to this stage. We have been discussing this issue for 25 years. Are we going to add another five years to it? I am concerned about the time delay that would occur.
I appreciate the opportunity to attend this meeting of the committee as I am not a member of it. I welcome the witnesses. They have made an excellent presentation, much of which I did not hear because I was doing a radio, so my apologies for that. Many of my concerns about this issue have been raised by others. The witnesses must be commended on their campaign, highlighting the concerns about this issue of the 60,000 who have signed the petition and those of many more. They make a compelling and staggering argument for the Connolly Hospital site. Having listened to what I heard of their presentation and their answers to my colleagues' questions, it is disappointing and extraordinary that nobody - from the Taoiseach's office or the offices of the Minister, Deputy Harris or the Minister for Children and Youth Affairs, Deputy Zappone - has offered to meet them. That is disappointing. If nothing else, they should be afforded the opportunity to put forward their argument and points in order that their case can be evaluated properly in the course of a democracy. That is very disappointing.
I have three brief questions.
What, in their view, if they do not feel they have dealt with it compellingly already, is the justification for the St. James's site and not the Connolly site, which was the decision taken by Cabinet and Government, the planning authority and also by An Bord Pleanála? What, in their view, is the best practice in other countries and jurisdictions with centres of excellence for children and how does what is being offered compare with that? Have they been offered an opportunity to debate their concerns with the advocates for the St. James's site in order that they can have a formal discussion rather than hearing one side on one occasion and another side on another? I wish to get their views on those.
Ms Valerin O'Shea:
I can answer a couple of these and it probably would be best to start with me.
Deputy Kelleher asked whether our views on the Mater site were the same as they are on the St. James's one. Many of us met at the Mater oral hearing and all of us, I think, were opposed to the Mater site. It is interesting to note that the Mater site was chosen. That was the only site that was ever recommended. It was recommended by the independent review group, and it was recommended over St. James's. It was considered a better site. The world and his mother could see that the Mater site was a ridiculous suggestion. That puts into perspective the merits of the St. James's site, that it was considered not to be as good as the Mater site in the only report that ever made any recommendation, because no report recommended the St. James's site.
On Deputy Kelleher's question on the Dolphin report and whether we are saying it is flawed, we are not saying it is flawed at all but the Dolphin report has been misinterpreted as having somehow recommended a site. The Dolphin report did not recommend any site. In fact, the Dolphin report stated, "Having reviewed the sites, and the options presented to us, we are in a position to present these options to the Minister." They were options that were presented, nothing more. It is not a case of the Dolphin report being wrong. The Dolphin report was exactly right. It went into great detail on the planning matters as opposed to the medical functioning of the hospital.
Deputy O'Connell asked about the weaknesses at the Connolly site and said that since I had pointed out that there were no weaknesses mentioned for the Connolly site, she wondered whether that was just planning. That was purely planning. It was in answer to the question on the planning for the Rotunda.
On the question of An Bord Pleanála that Senator Colm Burke raised, the Senator is stating that An Bord Pleanála has looked at this in great detail and that it has decided that this site is suitable. In fact, An Bord Pleanála rejected the Mater site because it stated that it was an overdevelopment for the site. That was very obvious to everybody. The hospital simply did not fit on it. In the case of the St. James's site, the board avoided addressing any of the medical issues. It purposely did not look at whether the maternity hospital will fit on the site. It directly avoided doing that. It did not consider that the medical concerns were a matter for it . It deliberately avoided addressing those issues. Space for expansion was the third matter that we consider crucial for the development of the children's hospital. The board also deliberately avoided addressing it. It said it was simply not a matter for it.
We have ended up with a decision from An Bord Pleanála that essentially looked at the structure and it has stated that this building will fit on this site. The board has not looked at the function of it, and that is what is so remarkable. It was a strategic infrastructure development because it was a national children's hospital but the board did not address that aspect of the planning application. It struck me at the time as being akin to a strategic infrastructure development application for a road. We would not view it favourably if the board decided that it did not have to consider traffic in this case. The decision is akin to that.
The next question I would like to address is that of public transport that was raised by Deputy Kelleher. Maybe Ms McNiffe, having experienced transporting a child to hospital, would address it.
Ms Aisling McNiffe:
I will give the committee a tiny bit of background. My little boy was born 11 years ago and, like Deputy O'Connell's child, had to be transferred to Crumlin hospital from the Coombe hospital. Little did I know that would be our home for the next three years. Of course, it still is a big part of our lives and we are in and out a lot. Children like my child and many children throughout Ireland cannot go on a Luas or a bus. My little boy is in a wheelchair and is fed by a pump. He is often on oxygen and requires a lot of medication. He is also immunosuppressed and public transport is out. We also live in Kildare and there is no public transport from my house. It is really important to remember that 90% of those bringing their child to hospital, and it should be borne in mind that this will be the tertiary hospital for the sickest children, not children with a broken leg, coming from all over Ireland, will not be getting the Luas, the bus or the train. They will be coming by car or by ambulance.
That brings me to access. The committee members will know as they have already heard about it, but from a parent's point of view, can they imagine driving their child when it looks like they are going to die and they cannot get an ambulance? Can they imagine that? A person needs a hard shoulder or the M50. The St. James's site does not offer that so it is not the right site.
Parking is also really important. Can the committee members imagine in the same situation getting to the hospital and having nowhere to park if they had to take their child out in a wheelchair? A person cannot park in Crumlin and walk up, as somebody said to me before. Committee members know what the weather is like in Ireland. I have a vulnerable child who cannot get wet. They have to put themselves into the shoes of parents like me and many others throughout Ireland. We are not that few and far between. There are quite a lot of us.
The importance of space is one of the biggest problems with the St. James's site. Without space, as the committee knows already, there is no room for expansion. We know already that it is very unlikely that maternity co-location will be possible, but there will not be any green spaces. We keep being told about this rooftop garden that will be the size of Croke Park. It will not be. It is to be almost the length, but not the size, of Croke Park. It will be oval so that it will be a narrow space. It will be split into two so there will be one third of an acre on both sides. Then there is a little garden above that which will be half an acre in size, which must be evacuated if there is a helicopter landing. All these matters have to be taken into consideration. If committee members think of my little boy in a room of 10 ft. by 12 ft. for three years, and who has hospital acquired bugs, such as MRSA, he cannot leave his room.
He is also immuno-suppressed and so he cannot leave his room for his own protection. There is no garden at Crumlin hospital. We had our first walk around the streets of Crumlin. I witnessed drug users on my way to the park. I was too away far from the hospital and I had to walk around the park to get home. My little boy was on an oxygen saturation monitor. At that stage of our journey I was not competent and confident in caring for him without a nurse by my side. You have to think of what our children need. We have to give our children the best we can. We must give them space. The most important thing for a child is to be able to play. It must be remembered that some of these children's lives are lived out in hospital and many never get home. My son could have been one of those children. It is important for us to have green areas where they can play. We know from studies that nature has healing benefits. One study of patients in a ward that overlooked a garden showed that the wounds of the patients that overlooked the garden healed faster than the wounds of the patients on the other side of the ward. One's mental health is better when one has fresh air and green pastures to walk in. You have got to think of the children. The children have not been considered. Quality of life is the most important thing. Hospitals are not just for dying: they are also for living. That is what our doctors are here for. I thank God that we have doctors here today advocating for the most vulnerable of society.
In terms of time management, as the committee is also meeting with another group this morning and we have to finish the meeting by approximately 12.50 p.m. because there is a vote due in the Dáil, I will allow another ten minutes for this session.
Dr. Jimmy Sheehan:
The issue of the delay that might occur if the decision was made to locate the new hospital at the Connolly hospital site rather than the St. James's campus, is one of concern for everybody. The enabling works at the St. James's site started in August. The timeframe for completion of those works is 12 months. This means that the main contract will not be signed until some time next year. The enabling works involves clearance of the site to bring it up to a greenfield site standard. In regard to moving the project to the Connolly hospital site, almost all of the architectural work has been done twice already in respect of the Mater hospital site and the St. James's site and has been paid for twice by the taxpayer, such that there would be little further architectural work required. While there would be some architectural work required, most of the detail in terms of proximity of departments, interaction between departments and so on has been worked out twice. It would be easy to transpose that into a final plan for the Connolly hospital site.
Three years ago I took the trouble to have tentative plans drawn up for the Connolly site to see how a hospital would sit there. I reckon that within a six-month timeframe the remainder of the planning could be undertaken. The construction programme and commissioning could be undertaken safely in a two-year period. I say that because it took ten months to complete Blackrock Hospital. Construction of Galway hospital, which was much more extensive, took 13 months to complete. The commissioning period was two weeks. The construction timeframe for The Hermitage was 15 months. The timeframe around construction and commissioning is entirely dependent on organisation. I am sure everybody here is familiar with the Empire State building. It was designed and built in 20 months. The timeframe from the laying of the first foundation to the capping off of the 86th floor was six months. That building was built at the rate of one floor per day. This was due to organisation and pre-planning. My interest in hospital construction is around pre-planning and doing things in a rapid way. There is huge advantage, if the intention is to do things within a 12-month timeframe, in specifying all of the equipment before any ground is broken so that everything is purpose-built for what is being put into it. Unfortunately what we do in this country is build the hospital and then look at equipping it, which results in much of what has been done being torn down and a further two or three years lost on commissioning. That is not the way I have operated. It would give me extraordinary pleasure to make some contribution towards the construction of the new hospital in a rapid manner at the Connolly site on a purely benevolent basis. I am prepared to give my services to the State for as long as is required and to have the hospital up and running within a three-year timeframe from the date the go-ahead is given.
Ms Valerin O'Shea:
I will ask Dr. Breathnach to address the issues regarding maternity. First, Deputy O'Rourke asked what was the justification for the St. James's site. There was absolutely and categorically no justification for it. Deputy Kate O'Connell asked what are the weaknesses of the Connolly hospital site. We believe it is the ideal site. It is spacious and because it is already proposed to build a maternity unit at that site, it is ideal.
Ms Valerin O'Shea:
No. It is presented to us as an ideal site. The size of the site was increased following the initial reports drawn up on the various hospitals. That made a real difference. The fact that the Rotunda Hospital is moving to that site makes it a tri-location and that is considered the optimum by everybody.
Dr. Breathnach will respond to the questions about Great Ormond Street Hospital and whether there is room at the St. James's site for the new maternity unit and whether it would be a high-risk maternity unit.
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.
Dr. Róisín Healy:
The disconnect is the problem. The location was picked before the model of care to be used. The document which everyone saw in the Dáil last week states the model of care was chosen in July 2016. It refers to the function of or services to be provided by the hospital. It was putting a square peg into a round hole and it was never going to fit. It has involved compromise all the way. The clinical directors group, a new creation of the HSE, has only recently been set up. All of the people involved, including those on the hospital development board and the children's hospital group board, would not be if they were not pro-St. James's Hospital. As it occurred a year after the St. James's Hospital site was chosen, there will not be "No" people on the boards. Therefore, the committee should not believe anything they state. They are all pro-St. James's Hospital because they have to be or else they would not be in their jobs. There was probably only one application received for each position. At this committee former Senator John Crown complimented St. James's Hospital on its aggressive campaigning to be chosen as the site of the children's hospital.
I know that we are under time pressure, but I am very uncomfortable with the statement made about the clinical directors. In her submission Ms O'Shea uses the words "responsible for the deaths of many children". I appreciate that she shows a lot of passion in her campaign which I fully respect, but I am extremely uncomfortable with the statement made and will tell her why. I have no specific knowledge of the composition of the board or the manner in which the members were chosen, nor am I aware of their qualifications, only that they satisfied the requirement to be given the job.
The reason I raised the issue was what was stated in the last sentence of Ms O'Shea's submission. It implicates the three clinical directors. It is in that context that I raise the question because it is a very serious allegation that the decision will cause deaths. The three clinical directors support the proposal. I am a little concerned that Ms O'Shea is implicating them.
It is not an allegation. If it was being alleged that the clinical directors were acting in bad faith, that would be an allegation. If the opinion is that the clinical directors are equally mistaken in their view as the Government representatives have been, it is a legitimate expression of concern which might point us to the need to invite the clinical directors to ask them whether they agree or disagree. It is legitimate if they have a fear about the consequences for people to say certain parties will bear responsibility. It is not an allegation of acting in bad faith.
Dr. Róisín Healy:
To address Deputy Louise O'Reilly's concern, it was stated by the top 15 people in the country, not me. None of the clinical directors work in intensive care units. There is huge bias towards St. James's Hospital and Trinity College Dublin. The only person from Dublin in the Dolphin group was from St. James's Hospital. We recognise the statements made and know the people concerned. We have worked with them and they are excellent people and clinicians, but there is a variation in opinions. The New Children's Hospital Alliance opposed the Mater Hospital site, as did many consultants in Crumlin hospital. Over 60 doctors and consultant paediatricians wrote to the newspapers about it, but there was no forum. We were told to speak to the NPHDB or the children's hospital group. We cannot speak to them because they cannot change; they are committed to the St. James's Hospital site. There is no one to whom we can speak except legislators and elected Deputies. That is what we are saying.
There is a distinct difference between saying there is responsibility for the deaths of many children and that there are different views. It is very important to point that out. I am assuming that the people who have the letters "Dr" before their names on the list are medical doctors, not doctors of literature or something else. It would show great disrespect if we were to attribute this to them and their professional capacity.
We need to draw this session to a conclusion. If there are questions the delegates have not had an opportunity to answer, they can send the answers to us and we will take them on board. Unfortunately, we are constrained by time. Perhaps the delegates might give us a brief one-minute summary.
Dr. Róisín Healy:
We are not blaming the people in question. We are saying they also have no forum. It is up to the legislators. That is why it is the Minister to whom we are speaking. We are not speaking to the clinical directors and not criticising them, but they would not be in the job if they did ndot believe the hospital should be located on the site of St. James's Hospital. We are saying there are opposing views, but we have no forum in which to debate them.
Dr. Finn Breathnach:
There are a lot of people who have remained silent and will remain anonymous, yet they have expressed their concerns to us. We have received an e-mail from a consultant in St. James's Hospital which highlights an article I read recently in The Irish Timeson staffing. According to Eilish Hardiman, 600 staff will need to be recruited for the children's hospital. She has suggested affordable housing should be built for them. The consultant in question wrote that staff were exiting St. James's Hospital in droves and that they did not want to work there. The consultant said eight cardiothoracic intensive care nurses and seven radiographers had just left and that half of the staff in another department had applied for other jobs. Nurses are arriving one hour before their shift starts just to get a parking space and the parking problem will get worse. I made a telephone call to one of my former senior nurses in the oncology-haematology department in Crumlin hospital. I cannot believe that even at this late stage no workforce planning has been done in that department. No one has asked the specialist nurses who are impossible to replace because of a shortage worldwide whether they are willing to work in the children's hospital. Most of the nurses in the three children's hospitals live in a place convenient to them.
None of them will have elected to work the James's site. They require a car. They are fertile, they have children, they drop the child to the crèche, they live in Naas, Newbridge, Kildare, Ashbourne etc. and they drive. If they are not given parking they will leave. There is a great fear that both hospitals will fail.
We received under the freedom of information legislation the report of the expert independent international review of 2011. The author of the report said the ideal location for the children's hospital would be green space, provide for unfettered access, accommodate research and educational activity, provide sufficient space to ensure the aggregation of all patient care services meeting current and future care requirements and be tri-located with an adult tertiary care and a maternity facility. We agree that if there was a site and funding for such an aspirational location it would be a magnificent campus. That statement was made before an additional 90 acres was made available for the Blanchardstown site in 2012.
We are now going to hear from the National Paediatric Hospital Development Board, NPHDB, in relation to the decision of the Government to proceed with the construction of the new children's hospital on the St. James' site. On behalf of the committee I welcome Mr. John Pollock, NPHDB project director, who is accompanied by Ms Eilísh Hardiman, chief executive of the Children's Hospital Group, Dr. Peter Greally, group clinical director, children's hospital, Dr. Sharon Sheehan, Master of the Coombe Women and Infants University Hospital and Ms Caitriona Sharkey, patient and member of the Temple Street University Hospital Family Advisory Committee Temple Street, FACTS, committee.
The NPHDB has been invited here to update us on the progress of the site of the new children's hospital at St. James'. The committee has no function in respect of the site of the location which has already been decided but we welcome the opportunity to engage with the NPHDB to hear its views on the Cabinet decision to locate the hospital at the site of St. James' Hospital. The Cabinet of the day agreed to build a hospital at St. James' in 2012 and planning permission was obtained in May 2016. Site clearance has commenced and the final construction contracts will be signed in the near future. There has always been an agreement that a purpose built and dedicated hospital for children is a necessity for a functioning health service. The debate, however, centred on the location. The National Paediatric Hospital will be the largest infrastructural development in the Irish health service. It will provide for essential specialist services for all children of Ireland at a single location, co-located with an adult teaching hospital and future maternity hospital when the Coombe is relocated to the site.
I draw the witnesses' attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they give to the committee. If, however, they are directed by the committee to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or an entity by name or in such a way as to make him, her or it identifiable. Any submission or opening statement submitted to the committee may be published on its website after the meeting.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official, either by name or in such a way as to make him or her identifiable. I also remind members to switch off their mobile phones or put them in aircraft mode.
We will now listen to the opening submission.
Mr. John Pollock:
I thank the Chairman, Deputies and Senators for inviting the National Paediatric Hospital Development Board to attend their committee to provide an update on progress of the new children’s hospital on the shared campus with St. James’s Hospital. I am delighted to be able to share news of significant progress on this much needed and much wanted project.
Joining me this morning is Ms Eilísh Hardiman, the chief executive officer of the Children’s Hospital Group; Dr. Sharon Sheehan,Master of the Coombe hospital, Dr. Peter Greally, group clinical director of the Children’s Hospital Group board, and Ms Caitríona Sharkey, a parent who has had extensive interactions with paediatric services in Dublin.
Due to the scale and complexity of the project, we circulated some pre-reading materials to the members. I hope they have had the opportunity to review some of those materials.
This morning I will provide an update on the design and construction aspects of the project while my colleague, Ms Hardiman, will give an overview of the extensive progress that has been made on the integration of services across the three children’s hospitals at Crumlin, Temple Street and Tallaght.
Before I commence the progress update, I want to say that, like the Connolly for Kids Hospital group, we, too, want to do the best for our children. We also are parents and grandparents. We have children, and we want to do the best for them. We are also driven to make sure we provide the best facilities for all our children.
With regard to the progress update, commencing in September 2013, the role of the current National Paediatric Hospital Development Board is to plan, design, build and equip the new children’s hospital at the St. James’s Hospital campus in addition to two paediatric outpatient departments and urgent care centres - one at Tallaght hospital and one at Connolly Hospital - a 53-bed family accommodation unit and the children’s research and innovation centre on a shared campus with St. James’s Hospital.
Following two years of procurement and design work by an international team and thousands of hours of engagement with families, young people, staff, local communities and three local authorities, a planning application for the new children’s hospital and the associated developments was submitted to An Bord Pleanála in August 2015. The application included a master plan, which is an important point, for the overall campus development at St. James’s Hospital showing how up to three times the current area, including the relocated Coombe Women and Infants University Hospital, can be accommodated on this 50-acre site; a world-class children's hospital with 6,000 rooms, extensive gardens, including the rainbow garden which is the length of Croke Park; a hospital design and capacity based on measured activity currently in the hospitals, unmet clinical need and future projected demographics for the next 20 years. When we open this hospital it will not be operating at full capacity and it will be 20 years before it reaches its full capacity. Moreover, we submitted an environmental impact statement which comprehensively tested traffic and accessibility issues and concerns.
A ten-day public oral hearing was held in December 2015 which allowed those who are supportive of the project and those who have concerns about the location to air their views and have their questions answered. I am pleased to say that in April of this year, An Bord Pleanála granted planning permission for the new children's hospital and the various elements I have described. No changes were required to our design by An Bord Pleanála.
This major milestone for the most significant health care capital project ever undertaken by the State was welcomed broadly by families, young people, the staff of the three children’s hospitals and those who have campaigned for almost 20 years to deliver this much needed resource. Since planning permission was obtained, in August 2016 the development board appointed a contractor for the enabling works. Those works are currently under way, including site clearance and demolition works. Currently, we are in possession of approximately nine acres of land on the St. James's Hospital site. Early in the new year, the full 12 acres will be handed over to us. The Minister for Health, Deputy Simon Harris, together with children and young people who are current and former users of paediatric services, helped to get the digging under way in August.
With regard to the overall programme, tenders will be received by the end of this month. By tomorrow, we will have all construction tenders back for both the main children's hospital and the satellite centres. They will be evaluated before Christmas and we will bring a recommendation to Government in terms of our preferred contractor and to confirm the cost of the project, with a view to appointing a main contractor in January of next year. The urgent care centres at Tallaght and Connolly hospitals will be completed in 2018 and, two years later, the main children's hospital on the St. James's Hospital campus will be completed at the end of 2020.
The hospital is about much more than bricks and mortar. It is about the staff, children and young people who will deliver and receive world-class care within the new buildings. I ask Ms Hardiman to provide an update on progress from a paediatric services perspective.
Ms Eilísh Hardiman:
I thank the Chairman, Deputies and Senators for inviting us to present to the committee this morning. The Children’s Hospital Group consists of the three children’s hospitals at Crumlin, Temple Street and Tallaght, and we have been working for the past three years with the National Paediatric Hospital Development Board to develop a hospital that will meet the requirements of our sick children and the children whom we serve locally. It is a project that the staff in the three children's hospitals fully support. It is a badly-needed project that must be delivered in a timely manner.
As Mr. Pollock mentioned, the hospital is just one part of our plan for paediatric services in Ireland. This plan is called the new model of care for paediatrics, which has been developed over four years of extensive engagement with parent representative groups, general practitioners, doctors, nurses and health and social care professionals in every paediatric service unit on the island of Ireland. It is led by Professor Alf Nicholson and Professor John Murphy. It has concluded, but it has been working for the past four years and central to that work was the development of the new children's hospital.
The new children’s hospital at St. James’s Hospital and the paediatric outpatient department and urgent care centres at Tallaght and Connolly hospitals will provide services to children and young people to ensure that the right care is given by the right team at the right time. It is important for us to be clear about the primary functions of these new facilities. First, the vast majority of work we undertake, which is 78% of the inpatients currently in the three children's hospitals, comes from the greater Dublin area, that is, Dublin, Kildare, Wicklow and part of Meath. The future plan is to undertake those services through the hospital and the two satellite centres at Connolly and Tallaght hospitals.
Our second objective has the national remit, which is the highly specialist tertiary-quaternary care, for children across all of the island. Currently, that comprises 22% of the workload undertaken by the three children's hospitals. I fully support the previous group in its strong support for tri-location. We in the Children's Hospital Group and the three children’s hospitals fully believe that tri-location on this campus with St. James’s Hospital and the relocated Coombe Women and Infants University Hospital is the optimal configuration of services from a clinical perspective.
In terms of the three children's hospitals, the clinical directors, the medical boards and the nursing leaders believe it is best for us to co-locate with St. James's Hospital, which is the largest hospital and the leading adult teaching hospital, because it offers unparalleled opportunities for our paediatric services to be supported by the breadth and depth of sub-specialties that best support paediatrics. Also, as a campus, it fits in with our vision for research and innovation. Between its facilities already on the St. James's campus and the new children's research and innovation centre, it will drive advancements and treatments that will improve clinical outcomes for our children.
What we are about, however, is more than the building, albeit it is an important catalyst. I am glad to report that the Children’s Hospital Group and the three children's hospitals are working hard to integrate to ensure we become one before we move into these new facilities. We have a major programme ahead of us, which includes establishing a new single legal entity to run the services on the three children's hospitals and manage them, and the transition to the new facilities.
In discussing everything we are doing, we must stay focused on the importance of this new hospital in addressing some of our concerns. Currently, children, young people and their families are receiving treatment in buildings that are no longer fit for purpose. We have heroic, talented staff that we value highly. Despite their surroundings, they are doing great work but in sub-optimal conditions.
We support our colleagues, who have presented previously to the committee, in the absolute need for a new children's hospital. It is, however, broader than that. We also rely on multiple arrangements with several adult hospitals to support paediatrics and we need to move to position where that is much more co-ordinated with a large teaching hospital. The ability to work collaboratively across all of the clinical specialties in paediatrics is hampered and limited by the fact that the specialties are on different sites particularly between Our Lady's hospital in Crumlin and Temple Street Children's University Hospital. This means that our children and their families need to move across the city, our charts need to move across the city, our x-rays need to move across the city and it is not helping us in delivering optimal care. Tonight, parents will be sleeping on the floor of a children's hospital beside their sick child's bed because we do not have the facilities to accommodate them appropriately. There is limited car parking at Our Lady's hospital in Crumlin and there is none at Temple Street. Our children deserve more.
In making progress, we have identified that there are 39 specialties within our existing services. These specialties have mapped out, over the last year, what they are going to do and undertake before they move to this new hospital. This is essential because while the building offers the opportunity to come together, fundamentally as a service we need to be working effectively before we transition to these new centres. There is extensive, daily collaboration between the three children's hospitals; between the nurse, the clinical and the management leaders, on optimally getting the best from a clinical and operational perspective in designing this hospital. We are on track for our programme and we will work with our colleagues in the development board to support this build. We are already making changes in how we are delivering paediatric services such as introducing new beds and new types of beds into children's hospitals. The new building will be a significant catalyst for positive change and it will afford us the vision that we want to deliver, as do all of us here, with what is right and best for our children.
I thank Mr. Pollock and Ms Hardiman for their opening statements. I am going to bank questions in groups of three, due to time constraints, and the witnesses may make notes of the questions. I invite Deputies O'Reilly, O'Connell and Kelleher.
Good morning, or good afternoon now, and I thank the witnesses for their presentations. A number of questions arise which are not specifically based on the presentations we have just heard, but are related to it. Obviously everyone supports tri-location. We all accept and believe that it is a good idea - but concerns were relayed to this committee. There was a degree of scepticism expressed about whether or not there will ever be a maternity hospital on the St. James's Hospital site. If a maternity hospital is to be put in to the St James's Hospital site further concern was expressed about whether or not it would be a full services maternity hospital or an urgent care only maternity hospital and I have to be honest that I would share some of this concern. That is my first question. If we all accept that there is not a huge benefit to be had from bi-location and that tri-location is the key, I would be interested to know if the board has an estimate on when we would actually see tri-location on the St James's Hospital site.
Reference was made to 78% of proposed inpatients coming from the Dublin area. Will the witnesses indicate where these figures came from because they have been disputed, on the basis of figures that have been publicly issued previously? We would all need to understand exactly who will be using the new hospital and where the figures came from. Perhaps Mr. Pollock and Ms Hardiman could give the committee a brief run through - it is in some of the documentation - on the car parking issues. Traffic is a serious problem. I lived in Dublin 12 for many years. I was born in St. James's Hospital and I am very familiar with it and I know that the traffic around that area is a nightmare. Parents have expressed concerns to this committee about driving through city centre traffic with a sick child in the back of the car. Anybody's heart would break listening to that so perhaps the witnesses could give the committee some idea of how traffic congestion will be dealt with because there is going to be traffic congestion.
I thank the witnesses very much for coming in to speak with us this afternoon. To follow on from Deputy O'Reilly's questions, I would like to speak about the tri-location model. Could the witnesses explain the reason why the maternity services from the Coombe Women and Infants University Hospital cannot be done in tandem with the new children's hospital? Is it just the money or an ambition thing? Is there any timeline for the start of the transfer of those services from the Coombe to the St. James's Hospital site? The committee has heard presentations from people - I should not say the opposing side because we are all on the one side here - who have had different viewpoints. Everyone has stated that the health and well-being of our children is priority and especially anyone with experience in dealing with the children's hospitals in this State. I had reason to be in Temple Street with my youngest child last Friday and I am actually shocked at how bad it is. I knew it was bad but if there was a fire in Temple Street people would be throwing children out from windows, it is that simple. It is terrible. My mother-in-law told me that the decor in Crumlin hospital is the same as when my husband had his tonsils taken out 35 years ago, as it was when I was there five years ago myself. There is nobody out there who does not think that a new children's hospital is absolutely essential for the health, well-being and maintenance of the welfare of our children.
Reference was made at this morning's session to the model of care having been decided after the location. Some people have claimed that. Could the witnesses elaborate on that process as one that people could perhaps find fault with. Many people seem to have issues with capacity, future proofing, expansion and demographics. Can we grow on the St. James's Hospital site to accommodate the demographics and advances in health care? Some of the people who have been in to the committee previously spoke about actual physical barriers - I believe it was the proton scanner or some other new machines - so could the witnesses talk us through any sort of barriers that they could see to development in the future.
I may have misinterpreted this but some of the clinical directors who have supported the St James's Hospital site - and I thought it was being implied - came on board and were in the process that was aligned to the St James's site. I do not wish to twist anyone's words but perhaps they were part of the St James's Hospital ideology anyway and maybe they are not the most objective. I may be twisting the words of previous presentations to the committee but I am trying to find out if that would be true to say.
I thank and welcome the witnesses. I cannot get out of my mind the image of the Minister for Health, Deputy Harris, on the St. James's Hospital site with a shovel helping to commence works. I hope there is more than the Minister down there with shovels; I hope there are a few JCBs or the deadline will certainly run longer than 2020.
There are a few issues and slight difficulties. The board is charged with the responsibility of developing the site as proposed on the St James's Hospital site. I am sure that if the Government had picked another site the board would be charged with the responsibility of developing that site. The board's view can only be expressed on the site that has been chosen from the Government's point of view and the board's responsibility is to bring together the three children's hospitals in the context of the National Children's Hospital group and also the physical construction. There are, however, issues that are very relevant with regard to the development of the site to which I would like some answers, on the physical aspects and with regard to the services that will be delivered when it is finally completed.
During the initial phases there has been a lot of concern about the actual physical construction of the hospital itself and the expense that will be incurred. Mr. Pollock has already relayed the fact that the site had to be cleared to get to the stage where building work can commence.
These are all additional costs but they have to be incurred because the St. James's Hospital site has been chosen. There is a 50 acre site overall and the National Paediatric Hospital Development Board will have approximately 12 or 13 acres available for the children's hospital.
Several issues have been raised. One relates to future proofing and further developments that may be required in the context of the children's hospital. This question is distinct from the maternity unit, which is separate. In terms of future proofing, when the hospital is fully developed is it completely locked in to the site for ever? Let us consider the amount of specialties in paediatrics. Within the concept, plans, design and construction, is there for flexibility or manoeuvre in terms of expansion of specialties in paediatrics? This arises because technologies and medical advances take place all the time.
This brings us back to the issue of relocating the Coombe Women and Infants University Hospital to St James's Hospital. Reference has been made to the fact that it is a tight site. How confident are the members of the hospital development board, bearing in mind that An Bord Pleanála does not always get every decision right? Either way, it is always the final arbitrator. Once An Bord Pleanála decides one way or the other, that is the end of it. How confident are the development board members that, in the context of the national maternity strategy, moving the Coombe to St James's Hospital can be done successfully when it comes to construction? Reference has been made to how we could end up in a situation where the Coombe could not be relocated, but that there could be a high-dependency maternity obstetric service, a service for complications, in other words. The view is that the Coombe cannot move in its entirety.
Another issue is parking. We had a passionate contribution from a parent of a sick child today. I have met several others in recent years while discussing this issue as well. The issues of parking and the ambience are critical for parents and families. Can the members of the development board elaborate on whether there is sufficient parking for staff, parents and family members who will be there for long periods as well as people who may wish to visit, such as siblings?
A related question is the issue of green space and open space arises. The development board representatives have made reference to the fact that there will be a garden the length of Croke Park on the rooftop. Can the representatives elaborate further on whether it will be a real park that will be available at all times for family and children? Emergency transfer by air and road is another question. The helicopter pad will be accessible on a 24-7 basis. The helicopter would be flying in to a heavily populated residential area. Transfers by road is another matter. Can the representatives clarify the position on those areas?
There is a broader issue. Ms Hardiman is charged with bringing the three hospitals together into one group. How much consultation has there been with clinicians and worker representatives? We have heard of cases, whether they are factual, of there being large numbers of staff leaving St. James's Hospital. These include senior clinicians as well as nursing and ancillary staff. Is this the case? Does Ms Hardiman have any concerns about ensuring that the staff in the three hospitals will fully co-operate and move seamlessly into the new children's hospital?
I probably have a little more to say. Will we have an opportunity to come back in?
My final question is for Mr. Pollock. In the previous session Dr. Jimmy Sheehan referred to the construction. However, I did not need him to reference it, because it is something that continues to bother me a good deal. We are very good at building but we are very slow. Let us consider this street. We have been digging up the street for the Luas. The stretch is not 500 m but we are a long time at it. While we have great expertise in the area of design and so on, I take the view that build management is an area where we let ourselves down from time to time. Has the development board carried out forward planning in terms of the exact type of equipment that will be going in, and all that flows from that? Such planning is essential, rather than carrying out the construction first and then assembling the parts of the hospital to fit equipment and so on. That has been the case in some of our major projects in previous times. We have not always covered ourselves in glory. Has the development board seamlessly planned right through to the end? Will the hospital be fitted out as it is built? Will it all be done in time and on budget?
I welcome the members of the hospital development board and thank them for coming before the committee today. I feel a particular responsibility to vindicate the right of people, such as those in the group before the committee earlier, to raise questions about public safety, safety of children and public money. That is my sole interest in asking the questions that I believe need to be asked. I know some questions will overlap with what others have asked.
While it is true to say that we are all on the same side, in that we do not want the status quoto continue, it is clear from the earlier presentation that serious concern has arisen among eminent people and people of goodwill. These people have declared to us that they have no vested interest. They are not happy about the way they have been treated by Government in terms of consultation. They are not happy with some of the claims which, they maintain, the hospital development board has made. That has to be put out today and a response sought from the members of the development board.
Earlier, representatives of the Connolly for Kids hospital group alleged false and misleading statements were made to counter what they describe as their valid criticisms and the major shortcomings of the site. For example, they say that in dispatches the hospital development board has claimed that one of the reasons the St. James's Hospital site is needed relates to the availability of a pet scanning facility. They have pointed out that there is such a facility in Connolly Hospital. Does this mean that the development board was wrong? Was there something misleading in the response that the development board has provided to the Connolly for Kids group directly or indirectly?
The group makes serious and concerning claims to the effect that deaths will occur as a result of the choice that has been made. Are these concerns not well founded? I have in mind all the concerns about access, parking and future expansion. We heard from a young doctor who talked about being shuttled to the children's hospital in the back of a car and feeling nauseous. He was describing real life. One could conclude that there was a real lack of empathy in the decision that has been taken. Does the development board believe those concerns are ultimately not well founded?
Individually and without prejudice to the role that the development board members now have to play, does each member of the board believe that the St James's Hospital site is superior to the Connolly Hospital option from the point of view of the welfare of children and having regard to all the concerns expressed? Would it have been the choice of each member of the development board, prescinding from the role they now have to play? Would they have chosen St. James's Hospital over Connolly Hospital?
The development board representatives referred to thinking 20 years ahead. Is 20 years too conservative? Is that enough of a time within which to consider whether the right amount of thought has been given to expansion in future? Can the development board justify its recommendations around space for expansion? Has the board costed a facility on a greenfield site as opposed to the St. James's Hospital option? What do the development board representatives think of the claims that €200 million is the difference? The claim of Connolly for Kids seems to rest on the idea that stalling the diggers now and starting again in Connolly would cost €200 million less. That is an astonishing claim. Does the development board believe it? Are those making the claim right? Are they misguided? I do not think anyone wants to suggest that anyone else is acting in bad faith, but that is an extraordinary claim.
Their claim essentially rests on two issues, namely, welfare of children - they allege future deaths if this choice is proceeded with - and an alleged massive waste of public resources. "Allegation" is the wrong word. "Prediction" is the correct word.
Ms Hardiman stated that the staff of the children's hospitals fully support the choice that has been made. How can I reconcile that with the Connolly for Kids Hospital representatives' claim that a staff survey in Crumlin hospital in November 2015 showed that 84% thought St. James's was not the best site for the children's hospital? Who am I to believe? Can both statements be true? I would be grateful for the NPHDB's opinion on that. In the presentation this morning, reference was made to the three children's hospitals believing that St. James's hospital, as the largest and leading adult teaching hospital, is the best adult co-location partner for the new children's hospital. With respect, is that really the issue? The presentation made by the representatives of Connolly for Kids Hospital argued that adult co-location is not the primary lens through which this issue should be viewed. Ms Hardiman said the NPHDB agrees with them about tri-location. The essential point made by Connolly for Kids Hospital, if I understood it correctly, is that maternity hospital facilities need to be beside children's hospital facilities and that this is the core issue. They claim that, through that lens, Connolly is the better option because of its greater potential. The statement that these hospitals might believe that the best adult co-location partner is St. James's might be perfectly true, but is that the most important issue?
The Connolly for Kids Hospital representatives were sharply critical of what the former Minister, Senator James Reilly, had to say when he said that the primary clinical driver for the decision was that children with very rare diseases could be treated by St. James's adult hospital consultants and not have to travel abroad. They state that was a false and nonsensical claim by the former Minister. Are they right? I would like to hear the views of the NPHDB on that. Was that a competent statement by the former Minister?
What is or are the biggest weakness or weaknesses of the Connolly location in the view of the NPHDB? I ask that in connection with my question as to whether the NPHDB has engaged, intellectually or otherwise, in a comparative cost analysis between a greenfield site and the St. James's option. Those are my questions. I apologise that the list is a little bit long.
Mr. John Pollock:
There are quite a few questions there. I will start with the St. James's campus. There is a big vision for the St. James's campus that people probably do not always fully understand. It has come out of all reports that were written for Government on which the ultimate decision to co-locate was made. Fundamentally, having co-location is the optimal solution. That comes out clearly in all of the reports, whether it is the McKinsey report, the Dolphin report or the Clear and Martin report. Co-location is fundamental. What St. James's has as a campus is specialties and sub-specialties. What does that mean for people who come to the hospital? It means it has radiation treatment services. Obviously, Connolly does not have a radiation treatment service so we would have to duplicate a service like that out in Connolly. St. James's has access to the blood transfusion service. Again, that is obviously a service that paediatrics requires. I will ask my medical colleagues to elaborate on why these specialties are so important.
St. James's has 50 acres of land in the middle of the city centre. It is going to undergo a radical change over the next number of years. I invite the committee to come and visit the site. It is currently made up of many single and two-storey buildings. The development plan now permits the building of six and seven-storey buildings. The children's hospital construction works are now under way. Adults are already there. It has blood transfusion services. On the issue of maternity services and the Coombe, I will ask Dr. Sharon Sheehan to talk about her support for the site from the maternity side of things. The Coombe will be delivered in the next number of years. On this campus, there will be services from cradle to grave: there will be maternity services, children' services and adult services. St. James's recently opened the Mercer's institute for successful ageing, MISA, building for the aged. There are services for maternity, children, adults and the aged. We also have access to radiation oncology services. There are the blood transfusion services. There is research carried out there. There is the institute for molecular medicines and the Wellcome institute. We are going to put the children's research centre right beside that. They will share a mass spectrometer. Buildings will be physically linked and staff will move from building to building. They will share their research. People ask, "Why is research important?". Research is important because it is the future of treatment. The research we do today is the treatment of tomorrow.
There is a big vision piece happening on this campus. Out of that, we will get a campus that will rival anything in Europe. It will be one of the great health care campuses and will compete with any in Europe. What we get from that is the best staff and the best people wanting to work on this campus. People automatically think of Great Ormond Street Hospital and they want to work there. This is what we are creating: a health care campus across cradle to grave that people want to come to and have access to research in. If we get the best people and staff, we get the best treatment for our children. That is the big vision piece that might not always be communicated on our behalf. I will ask Dr. Peter Greally to talk about why St. James's is so suitable from the clinical perspective.
Dr. Peter Greally:
It is great to have the opportunity to present the vision for the new children's hospital. As a bit of background, I started my training in paediatrics in 1985. I have worked in various capacities in each of the Dublin hospitals over the last four decades. I observed a system in which we had really good, highly-trained people working in conditions that are not fit for purpose delivering very good clinical outcomes. The system is not conducive to producing the best clinical outcomes. There is a fragmentation of services. There is a duplication and triplication of some services. We have children who have quite complex needs needing to visit two or three sites to have their medical needs catered for. We all agree that concentrating the medical expertise with increased volumes of activity into centres of excellence is a good thing. As the group clinical director, I encounter that fragmentation and lack of integration every day when I am trying to deal with the medical problems that arise from the current system. I firmly believe that this hospital needs to be built, built now and built on the St. James's campus.
I am a respiratory clinician by training. I look after chronically ill patients with respiratory disease and cystic fibrosis in particular. I became involved in clinical directorates because I saw how dysfunctional the system was. Rather than just complain, I decided to get in there and try to do something about it. In 2009, I became clinical director for paediatric services in Tallaght, where I hold one of my appointments. Last year, in 2015, I became the group clinical director. I was appointed in open competition. I was involved in the appointment of the other three clinical directors. These are the site clinical directors for Temple Street, Tallaght and Crumlin. One of them is a specialist in neonatology and is very much an intensive care doctor. Two of them are emergency department consultants. That involves front-of-house, very acute medicine. These are not people who are hiding from the coalface. They see the problems that arise in trying to provide services for children in the current set-up on a daily basis. These people were appointed in open competition and on the merits of their experience and training. I just want to clarify that.
This project has received the wholehearted support of the medical boards of the three children's hospitals, as well as the boards of management of the three children's hospitals, the Coombe Women and Infants University Hospital and the faculty of paediatrics.
Therefore, people whose main interest is the best care for children all endorse this project and location because we recognise that an integrated, tri-located campus has the capacity to care for the sickest of newborn children, older children, very ill mothers and adolescents with chronic diseases who will need to transition to adult care. As Mr. Pollock mentioned, it is an academic campus that has the capacity to care for people from cradle to grave. We therefore have great ambitions for this campus, and I envisage that the children's hospital, over time, will become a magnet hospital where the scale of our activities becomes such that we will attract medical and nursing trainees from all over the world who will want to work in our institution. We will become a flagship hospital of international renown and will be a rival to hospitals such as Great Ormond Street Hospital.
I will say a few words on the evidence for tri-location. I think we have all agreed that tri-location is a good thing. The lack of evidence does not mean that there is a lack of benefit. The lack of evidence means that no one has done a clinical trial or a trial that examines the outcomes of patients who have been treated in one system versus another, so that argument does not hold. Many clinical interventions in medicine have occurred which have not been scrutinised by clinical trials but which we know to be beneficial to patients. The modern trend, when building a new children's hospital, is to tri-locate it on a campus with maternity services and an adult academic centre. These days, new builds of stand-alone hospitals are rare. We have heard about Alder Hey but, in fact, Alder Hey wanted to tri-locate with the relevant hospitals in Liverpool but they were unable to cater for the scale of activity that Alder Hey was providing on a suitable campus. I can give the committee plenty of examples of tri-located hospitals in the UK and elsewhere. The most analogous to our proposal in the UK is in Manchester, but Glasgow Children's Hospital is also tri-located, as will be the soon-to-be-completed Edinburgh children's hospital. The Lady Cilento Children's Hospital in Brisbane is also tri-located on an adult campus, so the evidence is that international best practice is tri-location.
Why St. James's Hospital? The authors of the Dolphin report were asked to carry out an appraisal of the Dublin academic teaching hospitals. They chose St. James's Hospital on its clinical and academic strengths, which I will go into in a moment, but it was also chosen because it has excellent public transport links. Six bus routes serve it, there are three Luas stops near it, it is adjacent to Heuston Station and is closely adjacent to the N4 and M50. No other hospital has such links. The medical sub-specialisms available there, as we have heard, include blood transfusion, radiation oncology and PET scanning. It is also the national or regional centre for haematology and coagulation disorders and oncology and provides craniofacial and maxillofacial surgery, immunology, vascular surgery, orthopaedics, plastic surgery and burns treatment, cardiology, respiratory treatment, renal treatment - the list goes on. Unfortunately, none of the other sites had such a breadth of specialties. These specialties are important because many children who are regular users of our service will require care in adulthood, and while not all of them will be catered for on the adult site, many can be. I am not involved in defining strategy over the next 50 years, but I imagine that national centres will relocate to the St. James's Hospital site to facilitate that transitional care to adulthood.
A particular example of the importance of the transition to adult care is children who survive childhood cancer. They are at risk of developing new cancers because of the chemotherapy used to treat their primary cancers. Some children will have received radiation therapy, particularly to the brain area, and are therefore at risk of pituitary growth-type problems. Children who have undergone palliative treatment for complex congenital heart disease require long-term follow-up and often follow-up procedures in adulthood. Children who have chronic conditions of the kidney or joints will also require long-term follow-up.
An academic environment is extremely important as well. I hold an academic appointment in Trinity. Teaching and research is very important. It should be remembered that today's medical and nursing students are tomorrow's clinical leaders and that current research leads to tomorrow's cures.
Mr. John Pollock:
One of the concerns of the members of the committee is the capacity of the site for maternity services. I will ask Dr. Sharon Sheehan in a minute to talk about the relocation of the Coombe, but one thing that demonstrates how we handle maternity services is that as part of our planning application to An Bord Pleanála, we did not lodge a planning application for maternity services. That was not what we were asked to do by the Government. That decision was only made in May of 2015, and we lodged our planning application in August of 2015. However, what we did do is produce a master plan for the campus. The people who know this campus best of all are now us. We were told we would not deliver a children's hospital in this campus and that it was too cramped and too small. We delivered a planning application and An Bord Pleanála adjudicated on it and made no changes to it. We understand this site. We understand how we need to stay within the Dublin City Council development guidelines regarding height and access to the sites. We understand all the planning issues about overlooking and protecting residents. We applied the same strategy as we applied for the children's hospital to do an outline design of the maternity hospital. We have identified the site. It is three acres. Much of it is made up of a car park, which is the outpatients department of St. James's Hospital. The other portion is a single-storey building, the outpatients department, which would need to be demolished. That building was erected in the 1970s. That three-acre site will be a full maternity hospital, and we have physically plotted all the connections, whether underground, for servicing it and for materials, or corridor links above ground for moving patients and staff from the maternity hospital to the children's hospital. I am therefore extremely confident that we will deliver a maternity hospital on the site. What our site capacity plan demonstrated is the 50 acres of land we have on St. James's Hospital site, and because of the fact that heights will go up as permitted under the Dublin City Council development plan, our building will be seven stories. There will be more seven-storey buildings in St. James's Hospital. Our outline master plan demonstrated that we can have the St. James's adult campus and the children's and the maternity hospitals, and on top of that we could build another children's hospital, so we could triple the development on the 50 acres at St. James's Hospital. That is while protecting the listed building and the residents. This campus of 50 acres can therefore triple in capacity, so we will comfortably deliver the maternity hospital. Would Dr. Sharon Sheehan like to talk about why it is so important from her perspective?
Before Dr. Sheehan begins, will the witnesses specifically address the issue of timing? My understanding is - and I ask the witnesses to correct me if I am wrong about this - that planning permission has not yet been received for the maternity hospital.
I ask the witnesses to factor in an assumption of planning permission. We are all speaking about tri-location, but what is being proposed in the short to medium term, from what I can see as a layperson, is co-location, which we all agree is not ideal. I apologise for the interruption but I must go and I want to be very specific about this.
Dr. Sharon Sheehan:
I thank the committee for giving us an opportunity to speak. I am here at the master of the Coombe Women and Infants University Hospital. I am also a consultant obstetrician and gynaecologist. Like Dr. Greally, I have worked the three Dublin maternity hospitals as well as in Limerick and in the UK. I bring a range of perspectives to this.
Tri-location is absolutely essential. It is really simple as to why we should tri-locate. It improves outcomes and efficiencies across our services. What is very important, and I would like to take this opportunity to dispel many of the myths circulating, is we are not talking about moving a high-risk maternity unit onto the campus. We are talking about bringing the full breadth and depth of women and infant services that operate in the Coombe Women and Infants University Hospital onto the St. James's Hospital campus site to tri-locate with St. James's Hospital and the new children's hospital. Any misconceptions about a high-risk maternity unit are ill-founded. It is very important that it is the full breadth and depth. For us, in our hospital, it is about looking after maternity services. It is also very important to remember how much gynaecology service we deliver in our hospital. It is essential this is catered for on the St. James's Hospital campus and this has been allowed for.
The full breadth and depth of women and infant services is very important and it has been raised previously regarding the national maternity strategy. I had the great pleasure and privilege of sitting on the national steering group for this strategy. It fully endorsed the tri-located model, which is very important. Yes, it endorsed co-location but it fully endorsed tri-location, which is entirely consistent with Ireland's first and only national maternity strategy. This is very important.
Another very important issue to take into account is that we are not just talking about moving to any hospital. We are talking about moving to the St. James's Hospital campus. It is important to remember that St. James's Hospital is the largest and leading adult acute service in the entire country. It has the greatest number of national specialties and the greatest number of acute specialties. This is not just moving to any adult service, it is moving to the leading service for clinical specialties and research and innovation on the St. James's Hospital campus.
When we look at tri-location, and it has been raised previously, we speak about the transition for mothers and their babies to paediatric services, but we must also think about the transition for mothers and women to adult services. It is not just about children moving from paediatrics to adult care, it is about mothers moving across in a seamless transition to adult services. We are not just talking about buildings, and this is very important. Ms Hardiman mentioned this in her statement. Much work has already taken place, so we are in a position where we can state we are virtually tri-locating. This is not just waiting for a new shiny building and expecting our services to transition patients seamlessly across them. This is all about the collaboration that happens long before any planning permission applications are sought or a sod is turned in the ground. This is going on.
If I can speak about what is going on in the Coombe hospital at present with regard to maternal medicine, we operate one of the largest maternal medicine and comprehensive services for women with complicated medical histories during their pregnancies. Consultation is provided across our experts in the Coombe hospital and experts in St. James's Hospital and Tallaght hospital. This is already happening. We offer mothers who come in with complex maternal medicine cases the absolute optimum of care.
With regard to location with the children's hospital, extensive collaboration is going on regarding our services and paediatric services. An example of this is the all-Ireland fetal cardiac clinic. This is being led by Dr. Orla Franklin, who is a consultant cardiologist in Our Lady's children's hospital in Crumlin and Dr. Caoimhe Lynch, consultant obstetrician and gynaecologist and fetal medicine specialist in the Coombe hospital. This clinic looks after women from all 32 counties in Ireland. No other fetal service in the country is doing this. Mothers diagnosed with congenital cardiac anomalies in their babies in the womb are transferred and referred the Coombe hospital. They meet experts in our hospital and in Crumlin hospital, where their care is mapped out as is a plan for their labour and delivery and for what happens to the baby once it is born. This is happening right now.
This is the type of collaboration we need to have well-established before we think a shiny building will better enable it. We already know the service we offer for those mothers whose babies have been diagnosed with this condition in utero means the outcomes for those babies has improved. We are able to say this right now. Tri-locating only enhances this in terms of the physical space. So much work is already going on. Understanding the importance of tri-location across maternity services for women, paediatrics and adult services is very important. It is essential we do not lose sight of why we are moving onto the St. James's Hospital campus. It is because of the benefits the hospital will be able to deliver for us and the benefits the new children's hospital will bring. The benefits of tri-location are really simple. It will improve outcomes for our women and their families and it will improve efficiencies across our services.
I apologise for not being here for the start of the presentation. Unfortunately I had business in the Seanad I had to attend to. I was moving a Private Member's Bill. I have looked all the documentation on this. With regard to the presentation made earlier this morning, I raised in particular the issue that An Bord Pleanála looked at the Mater hospital site and decided it was not the appropriate place for the children's hospital. I asked whether all the issues regarding traffic management and parking were dealt with by An Bord Pleanála when the application went in for the hospital on the St James's Hospital site but I did not get an answer to this. There is very much a myth out there about transport access to St. James's Hospital. The witnesses have outlined the Luas line, Heuston train station and bus services. However, genuine concerns were raised by other witnesses who appeared before the committee this morning. Are the witnesses before us satisfied we can meet these concerns and that we will not be here in ten years' time stating the location was a huge mistake with regard to access?
There is much focus at present on the size of the site and that it is not adequate. The witnesses referred to the fact the site is 50 acres. This is not in the public domain. Many people have the view it is a two or three acre site. A message needs to be sent out on this because it is a problem. I have visited the site and I know where it is. There are a number of issues in the public domain. We receive many e-mails from people who have a firm belief it is the wrong site. What needs to be done to send out a positive message about the project?
Another issue is the timescale. As I understand it, the site is being cleared at present and much work has been done. When is building likely to occur? The witnesses may have already gone over this, and I apologise if I am asking a question which has already been covered, but what is the timing from the start of building to actual completion to actual fit out to actual commissioning? Will the witnesses give us some guidelines on the timing?
Are we anywhere closer to making a planning submission for the maternity unit? If it goes through, has any indication been given by the Department on the likelihood of funding being provided? What timescale does the Department have for funding a new maternity unit?
I accept that what has happened in the maternity units in Dublin is wrong in that they have grown at a phenomenal rate. All of the hospitals have moved from a figure of approximately 6,000 to 9,000 deliveries in a short timeframe and been able to deal with the challenge, but that will not continue forever. Have the delegates been given any indication about the availability of funding in the short and the long term and the timescale about which we are talking for maternity units?
Mr. John Pollock:
Deputy Louise Reilly's question was linked with this issue. In terms of timelines, we are further on than the Rotunda Hospital in moving to Connolly Hospital because we have done two things. First, we have a master plan in place. We have physically identified the location of the site. Second, we have future-proofed our services within the children's hospital. For instance, in the case of the energy centre, clinical sterilisation servuce and facilities management, FM, logistics, we have built in spare capacity for when the maternity unit will come on line. That will help to bring down costs. The Rotunda Hospital is not as far advanced. A master plan for the site has not been completed.
I am not aware of when the Government will commit funding, but I estimate that it will take approximately two years from when the funding is committed to develop the brief, lodge the planning application with An Bord Pleanála and receive planning permission for the St. James's hospital site. Thereafter, it will probably take two years to buiild the hospital. If the Government was to commit funding, that would be the timeframe involved, but it is a matter for the Government to decide.
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.
Ms Eilísh Hardiman:
Particular futuristic treatments were mentioned. To be clear, the national cancer programme has led the way in planning proton therapy which only three to five children need. It is more for adults. We access such facilities in London. Something of that nature, a highly specialised treatment, would have to be developed with paediatric and adult services in mind. St. James's Hospital is the largest provider of cancer services in the State. It is also the provider of radiation oncology services. There will be future expansion of radiation oncology services for both paediatric and adult services.
I heard mention of a PET-CT scanner. No, we do not have a PET-CT scanner and will not in the children's hospital because such small numbers use it. We will access the one that is already in St. James's Hospital. Yes, we have developed a workforce plan. We engaged with the directors of nursing, the clinical directors, the health and social care professionals and the management of the three children's hospitals. The plan outlines our staffing requirements for the next five years to open up both the paediatric and outpatient urgent care centres at Connolly hospital and Tallaght hospital and the new children's hospital. We have also identified that the majority of the staffing increase is in the nursing area. In planning for that we have a workforce planner specifically for nursing looking at the supply of children’s health nursing over the next five years in a planned way, as opposed to getting to the point where we realise we need to train more such nurses. We have a systematic process identified of what our requirements are and a plan put in place over the next five years to look at how we can supply. There is a global shortage of some specialties but we are also looking at whether there are new and different roles that can be introduced to alleviate some of the pressures that have been well established in other jurisdictions in particular areas.
I am pleased that people picked up on the fact that it is really important that while the building is a catalyst, there is strong consensus across the staff of the three children’s hospitals. We have had more than 1,000 hours of engagement. Currently, we have 200 of our staff working in planning the rooms. We have 6,000 rooms that are being designed. They are attending meetings on planning. I reassure the committee that the staff within the three children’s hospitals are actively engaged in designing the hospital and, more important, they are actively engaged in how we are going to work together as a single legal entity by 2018, before we move into the new hospital. Before I came here my previous role was CEO of Tallaght hospital, which was a merger of three hospitals. It is really important that the building works because we are the hospital that will be providing services to the children of the greater Dublin area and all of the national services but it is really when people come to get treated by doctors, nurses and health care professionals that we will get the integration right. We have some great fundamentals driving that, because no other hospitals in the adult system or even in the maternity system, work in an integrated way as do the three children’s hospitals. Every day we have staff going between the three children’s hospitals. Every day we have patients and families going between the three hospitals so we work already in that manner.
I heard reference to a staff survey. I wish to clarify that is not an official survey. It was not endorsed by the management and leadership of Crumlin hospital. It was a SurveyMonkey survey that one puts up on a web page. I completed it myself ten times so I question the validity of the outcomes of the survey.
I was asked whether I personally believe that St. James’s Hospital is the right site. Absolutely, yes. I come very much from a personal position. I have spent 25 years in management. I am a nurse by background and I was a director of nursing in St. James’s Hospital for five years, the deputy CEO there for almost four years and the CEO of Tallaght hospital for three years. In all of those years of experience, I recall the time when a very sick mother with twins from the Coombe had to come to St. James’s Hospital to deliver them in our theatre because she needed critical post-operative access to ICU. That was the toughest day of my medical and management history, whereby we had to deal with a woman who was critically ill and almost at the stage of barely surviving and two very tiny babies. We had to organise incubators to come over from Crumlin hospital and all of the special requirements for the mother from the Coombe. I am pleased to say we worked on that but it took a significant amount of effort for all three of them to survive, and they did survive. Our vision for the future is driven by those experiences, whereby we will have a corridor length to travel if the mother is at high risk and needs to get into the adult ICU and when babies and neonates require neonatal intensive care. I am very much personally driven by that most harrowing experience of my career.
In terms of weaknesses in Connolly hospital, we work with the management and staff in that hospital because we are planning an urgent paediatric care and outpatient centre. We have very good relationships with the hospital in regard to that. People in the area are very pleased to have paediatrics on the site of that hospital. Families are already attending the emergency department there because of their adult requirements and they look forward to the day when they will be able to attend for all of their requirements, not just adult but paediatrics. We have had engagement with the GPs locally who see this as a good development, as opposed to going into the inner city to get those treatments. Having said that, if I was to outline some of the examples of where the benefits are between Connolly hospital and St. James’s Hospital, it has to lie-----
Ms Eilísh Hardiman:
Yes, I am going to do that. For example, we have 300 children with cancer and a lot of them have leukaemia. We are rated fourth in the world for outcomes for paediatric leukaemia. Some children require bone marrow transplant. At the moment if a relative such as the mother or father is the donor, he or she has to have bone marrow extracted in St. James’s Hospital, while at the same time the child is in a theatre in Crumlin hospital. The bone marrow is brought over and has to be donated there. That service is not moving from St. James’s, which has been well established as a leading national service for adults. We want a situation whereby the mother and child are on the same campus at this very traumatic time when the bone marrow is donated and is also transplanted.
Radiation oncology is already on the site. St. Luke’s has moved its services to St. James’s Hospital. We have children with cancer who require full body radiation and at the moment they travel to St. Luke’s. Our intention is to move that to St. James’s so that there is a corridor length involved when they attend for radiation oncology as opposed to having to travel from another campus for the service.
A total of 25% of consultants within the three children’s hospitals have adult-based specialties with a special interest in paediatrics. All of our cardiac surgeons are also adult cardiac surgeons. All of our neurosurgeons are also adult neurosurgeons and that will not change. None of those are at Connolly hospital.
At the moment, within the three children’s hospitals we have to engage with our colleagues in the adult hospitals to support us in some very specific areas. For example, we do not have vascular surgeons in paediatrics. We have a very early stage development of interventional radiology where imaging radiologists go through veins instead of using open surgery to get to the organs they need to get to. That is much more established in the adult services. Those types of consultants are very competent in dealing with highly complex situations around bleeding. Sometimes when we have children that need very complex surgery we invite those surgeons to attend and be in the theatre at the same time so that they can help the paediatric surgeons. Those are the types of specialists who are in St. James’s Hospital and who are not in other hospitals and who really help us at times of crisis and when we have really sick patients.
In regard to rare diseases, we definitely are working-----
Ms Eilísh Hardiman:
Yes. St. James’s Hospital’s laboratory services already support the three children’s hospitals so they help us in the diagnosis of some illnesses and conditions. The new challenge with the children’s hospitals is that we are getting successful at treating some very rare diseases and children are now surviving into adulthood. One example of that is intestinal dysfunction. It is where a small number of young children do not have any small intestine and they end up not being able to absorb some key nutritions and they have to have them delivered intravenously. That is done in the children’s hospitals. Those children are now surviving into adolescence and we are now working with St. James’s Hospital, which has the greatest gastroenterology unit, in order for those children to move from Crumlin hospital to St. James’s Hospital.
Last year, in the case of haematology, which is the blood diseases, we transferred some of the sickle cell anemia cases. Sickle cell anemia is a very rare condition. Due to the inward migration, particularly from sub-Saharan Africa where there is a high prevalence of the disease, it was evident in the children in Crumlin. We have successfully treated those children to adolescent stage and they are now transferring to the haematology services at St. James's Hospital. For the first time on this campus-----
Was he correct in saying that the primary clinical driver for the decision was that children with very rare diseases could be treated by St. James's Hospital's adult hospital consultants? The group we met this morning said that was false. I seek an answer to that.
Ms Eilísh Hardiman:
Yes. The co-location with St. James's Hospital is about supporting the 22% of the really complex work we do. Our other core objective is meeting the local requirements of the local children, given that 48% of them live in the area within the M50.
If I may continue with the example, we are very successful in our paediatric cancer services. We are approximately fourth in the world with some of our outcomes. However, we have concerns with regard to adolescent cancer, because it is an area that falls between the adult and the paediatric services. The new cancer strategy has identified that as a key area for significant investment and improvement so we can save lives. Some of the adolescent children require paediatric chemotherapy regimens, which are very well understood by oncologists in the paediatric service, but because some of their cancers are adult type cancers such as sarcomas they need to be based with colleagues who deal with those in the adult service. In the future it is about co-working between paediatrics and adult services to get the best people together on these types of rare conditions. Internationally, that has been demonstrated to lead to better outcomes, which means more survivors and less mortality from these rare diseases. St. James's Hospital provides us with the opportunity to do that.
I have a few questions. When Dr. Finn Breathnach and several other members of the delegation from Connolly for Kids appeared before the committee they were quite definite that co-locating with an adult teaching hospital brought no additional benefits to children. You have referred to some of the benefits that will arise, so how can experienced paediatricians be so diametrically different on that point?
Ms Eilísh Hardiman:
We are going to differ on this because we have very experienced paediatricians currently delivering the most specialist services to our children and they fundamentally believe that co-location will add benefit. If you speak to Professor Smith or Professor Capra about oncology, they believe and strongly advocate that being on this campus will result in better survivorship for children with complex conditions. Dr. Peter Greally might wish to add to that.
Dr. Peter Greally:
I can base it on my own experience. In addition to being a respiratory paediatrician I cover the acute and general on-call roster, so it is unselected patients coming in with any number of disorders. I am based in Tallaght Hospital where we are co-located with adult services. Over the last year I have had three cases of adolescent patients who have presented with conditions that are relatively rare in children, and there was not necessarily the expertise within paediatrics to deal with them, where we called in the relevant specialists in the adult services to help us. That was just my experience and other colleagues in Tallaght would have had the same experience. Sometimes it can work the other way. Again, these are rare situations but it is one piece of a jigsaw. It is not just one thing that dictates whether co-location or tri-location is important, it is the totality. Sometimes adult physicians encounter rare disorders which are more commonly seen in children, so it works the other way. We are occasionally consulted to give our opinion on those disorders. It is part of the overall picture. It is not necessarily the key driver, but it is an important contributor.
Dr. Peter Greally:
As I said earlier, I do not think anybody has ever done a clinical trial or reviewed the outcomes in care by comparing one system to another. Ethically, I do not believe it would be possible to do it. However, I point to the fact that newly built children's hospitals are rarely stand-alone now. The tri-location model is the norm. Stand-alone new builds for children's hospitals are the exception.
Dr. Peter Greally:
Alder Hey Children's Hospital is the hospital he mentioned. As I understand it, Alder Hey as an institution wanted to tri-locate but because of spatial issues in Liverpool and the scale of the Alder Hey clinical operation there was not the capacity to accommodate it. With regard to Melbourne, which historically has been a stand-alone children's hospital, it is adjacent to Flemington Road and, if memory serves, there is an adult hospital and maternity services 2 km to 3 km up Flemington Road. Although it is stand-alone, those services are adjacent.
Ms Eilísh Hardiman:
If I may add to that, it is important to point out that the chief executive of Alder Hey was on the Dolphin group and fully supports tri-location. That was what Alder Hey was trying to do, but it was not viable. Previous reports of CEOs of major children's hospitals, which are often referred to, all support tri-location, including the CEO of Great Ormond Street Hospital.
Dr. Sharon Sheehan:
I remind everybody that the Connolly for Kids group also proposes a tri-located model. It is not proposing that we build a stand-alone hospital. We are saying the same thing as the group that appeared before the committee before us. Tri-location has been shown to be a better model, and we are all saying that. We are showing with our proposal that tri-locating on the St. James's Hospital site is the best option. However, there is no dispute among ourselves or any other group that tri-location is the preferential model.
Access is a very emotive issue for mothers, who believe they will be travelling long distances and will encounter huge traffic problems. I experienced that when I went to visit the site. How can you allay the fears of people who think they will not get to the hospital in a timely manner?
Ms Caitríona Sharkey:
To give the committee a little background, I am here as a parent representative. I have a long history of attending Temple Street Children's University Hospital as a parent. During my time there I have become involved in the Temple Street family advisory committee, which is an active group of parents and members of advocacy groups. I am also a parent representative on the governance, quality and patient safety committee in Temple Street, so I hear at first hand the impact the hospital infrastructure has on the ability to deliver a quality and safe service.
We all agree that is what we want.
My son was born 11 years ago with a very serious condition that required multiple surgeries and stays in hospital and many visits over the years. I am one of many parents who have spent nights on roll-away beds and chairs in wards with six or eight patients. I have spent a great deal of time in children's hospitals and the level of care given by clinical staff is exemplary and has been fantastic in our case. Staff, parents and children are inevitably challenged by the infrastructure and conditions in which they are working.
I will address some of the issues that have been raised, including parking. When my son first visited Temple Street Children's University Hospital 11 years ago, the walls were lined with plans for the Mater Hospital. Eleven years later, we still do not have a new, world class children's hospital for all of the children of the country. I accepted the decision of the experts and planning experts that the Mater Hospital was not the right location for the new children's hospital. I also accepted, based on trust, the decision of expert planners to grant planning permission for the James Street site and the Government decision that this site was the best location. For me and many of the parents with whom I interact, the issue is one of delivering a world class hospital and children's health care system from which everybody in the country will benefit. My primary concern and priority is delivery of the new hospital in the earliest possible timeframe.
Mr. Pollock or Ms Hardiman may elaborate a little on some of the traffic management aspects of delivering the new hospital. Temple Street children's hospital is located in the heart of Dublin city. As I stated, I have spent years visiting the hospital and traffic at different times of the day is like traffic elsewhere in the city centre. One issue that has not been mentioned is the stress caused to parents when they do not know if they will secure a parking space. Arriving at Temple Street with a sick child in the back of the car, I have been unable to find a parking space at times because the hospital does not have allocated parking.
The new hospital will have parking and will offer a new and innovative facility of pre-booking a parking space. This will remove an enormous amount of stress from parents travelling to the hospital. Integrated public transport services will also be available, in my case to my child's grandparents who visit from Derry and County Clare. The integrated public transport service will enable people to reach the hospital, which is a major step forward.
As a parent of a child who is in hospital, my needs are very basic. At times, I need privacy to have a private conversation, which is certainly not possible in Temple Street children's hospital. This is not the fault of the hospital but the result of the infrastructure at the hospital. I also need to be able to sleep, find something to eat and get some fresh air. People have spoken about outside space. I have looked at the plans for the new hospital. From my experience with Temple Street hospital, the outside space in the new hospital will be fantastic. Sick children do not need a space the size of Croke Park but a place where they can spend some time with siblings and other family members and get some fresh air. From what I have seen in the plans for the new children's hospital, they will deliver this.
Mr. John Pollock:
Yes. We have always been conscious that parents coming to the hospital with a sick child will drive and we have never suggested they take a bus or Luas. That was never our plan. From the outset, we have prioritised the car parking spaces for families and parents coming to the hospital. A total of 675 car parking spaces have been ring-fenced for parents. An Bord Pleanála has confirmed this and made the number of spaces a planning condition. This means we could not change it, even we wanted to do so.
As Ms Sharkey indicated, one of the anxieties parents have when coming to the hospital is whether they will find a car parking space. Parents will be able to pre-book parking using a facility similar to what available to visitors to Dublin Airport where people can pre-book a space and when they arrive at the car park their car registration is recognised. The barrier is then lifted and the driver parks in an assigned parking space. The new pre-booking facility at the hospital will remove an anxiety faced by parents.
We also recognised that some parents will arrive at the hospital in highly distressed circumstances and will obviously not have the luxury of pre-booking a parking space. The accident and emergency department will have 27 car parking spaces. A parent who arrives at the accident and emergency department with a child in an emergency will find a concierge service. The parent will hand the car keys to the concierge and enter the hospital and the car will be parked for him or her. The St. James's hospital campus caters for everybody, those who need to drive to the hospital and those who prefer to use public transport. As Ms Sharkey stated, grandparents who do not drive may wish to visit their grandchildren at the weekend. They will be able to take a train to Connolly Station or Heuston Station or a bus to Busáras and travel straight to the hospital. The green and red Luas lines will connect next year, making the site even more accessible.
We also recognise the need to look after staff and a further 325 car parking spaces have been provided for staff. These spaces will be prioritised, for example, members of staff living 1 mile from the hospital do not need to drive to the hospital. This is the way cities have evolved.
I am sorry Senator Rónán Mullen has left the meeting. He asked what is the significant weakness of the Connolly Memorial Hospital site. We know a great deal about Connolly hospital. In lodging an application for planning permission for a 5,000 sq. m. site, we had to comply with local, regional and national transportation policies. The An Bord Pleanála inspector, in his report ruling on granting us planning permission, stated:
There is a flaw, in my opinion, in the argument put forward by some of those who advocate a greenfield site adjacent the M50. They appear to assume that unfettered access off the national and primary route and unfettered access to on-site car parking can be accommodated. The same national, regional and local transportation policies are equally applicable at that location as they are at the application site and do not support such a strategy.
What the inspector was very much calling out in these remarks is that if one chooses a greenfield site without access to public transport, only one mode of transport, namely, the private car, is available to access the site and this means providing car parking. This does not align with transportation policies. The idea that thousands of car parking spaces would be provided at the Connolly hospital site is, therefore, a myth.
The inspector went further in his report when he stated:
In that regard, it is interesting to note that in its written submission to the Board, Transport Infrastructure Ireland (TII) placed strong emphasis on the applicant delivering upon its MMP to reduce the generation of car commuter traffic, especially in relation to the satellite centre sites at Tallaght and Connolly hospitals to protect the national road network in the vicinity of those sites... If the TII was concerned about the relatively small satellite centre of c. 5,000 sq.m. proposed under the current application at Connolly hospital, it may not be unreasonable here to suggest that they might have greater concerns if the NCH/CRIC/FAU of c. 125,000 sq.m. was proposed there instead.
He is pointing out that if the TII had concerns about a 5,000 sq. m., what would be its concerns in respect of a site of 125,000 sq. m. The inspector's report continues:
Furthermore, there is no guarantee that locating the NCH on a greenfield site adjacent the M50 will avoid the congestion some fear will be encountered accessing the St. James’s site. The upgraded M50, as referred to by some at the Hearing, is experiencing congestion too.
On this day last week there was major congestion on the M50 where even the hard shoulder was closed. That is a recurring theme. It is a myth to think that the M50 does not have problems because it does have problems. An Bord Pleanála, in its wisdom, looked at all of these issues and called out very strongly that it has concerns. I think that is a fundamental weakness.
The inspector also referenced the other major weakness in his report. He said there are many people who are not in favour of the St. James's Hospital site and on that point they are in agreement. After that they are not in agreement because some favour Tallaght, the Coombe, Connolly hospital or a greenfield site in the middle of the country. There will never be a site that everybody rallies around because there is no perfect site. There is the best site and that is what we have got.
Mr. John Pollock:
There is no security issue that I am aware of. I have heard some people opposed to the site run down the Dublin 8 area, which I think is inappropriate. I would describe it as a diverse community. We discovered that as part of a study on the impact of the hospital. The people living in the community range from people with low levels of educational attainment to people with the highest levels and PhDs. One of the ambitions we have set ourselves and with which we have engaged with Dublin City Council is the opportunity for a project like this to support the regeneration of an area. This opportunity cannot be missed and the docklands is an example. Regeneration can take place with proper planning. The big vision piece that I spoke about for the campus will attract other industries that want to locate in close proximity to us. The opportunity for regeneration of the area is huge. Within our construction contracts we have embedded community clauses. It means the contractor has a contractual obligation to employ staff from the area. We have gone into schools and sold the ambition of having a career in hospitals. Some people have said people should just think about careers in catering and cleaning. We wanted to set a bigger ambition and for children to say, "Why can't I be a nurse or doctor and this is the campus I want to work in."
Our offices are on the site, as the Chairman is aware. We have experienced no issues with security. We have a drop-in centre at the Rialto bridge where residents have been invited to visit the site. Residents support the project on a 10:1 ratio. Our offices on the site have models and images of what the hospital will look like. We have encountered no issues at the location, so we are welcome in the area.
I want to deal with an issue that was raised in the presentation made by the previous group of witnesses. They expressed the view that the Minister should intervene and locate the hospital the Connolly Hospital site. The last paragraph reads: "If the Minister fails to do so he should know with certainty that he will be responsible for the deaths of many children and the avoidable anguish of countless parents." It has been implied in the submission that the location at St. James's Hospital will cause deaths. It is a serious suggestion that needs a response.
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.
I apologise for arriving late but I had to attend a funeral in Tipperary and hence my absence.
I want to be assured that the easiest and fastest access to a children's hospital is the optimum, particularly at rush hour or peak traffic times. At other times it does not make a difference as it is easy to reach the required destination. As has been mentioned, the M50 is always extremely overcrowded at peak times and sometimes it is virtually impassable. Some people even refer to it as a carpark in the morning and evening peak times. If anything goes wrong, the M50 gets blocked for quite a while.
We must aim to provide the highest quality and most extensive services at the one location, in so far as is possible, in order to ensure there is a service available to patients and their families.
To some extent, yes. That is a major issue, but Mr. Pollock might elaborate on another matter. Has there been any mention of families and accommodation facilities? It is an issue that has come up. I remember many years ago having to contact people in Dublin who were building houses to consider allowing a family to use a house for a period of time. We are down to this. Has any thought been given to families and accommodation facilities and the broader issues involved in construction?
Ms Eilísh Hardiman:
We assure the committee that we have involved parents to a great extent in designing the hospital. We had a family forum which was made up of family representatives. Many of those who have presented to the committee as members of the Connolly for Kids Hospital Group actually sat with us in designing the hospital. As such, we have engaged in meeting the requirements of families. From a family perspective, there are single rooms which will contain a bed for a parent to sleep comfortably with a child. In addition, there will be a family lounge within what we call "dressing gown distance" of the critical care units, including ICU and the neo-natal intensive care unit, which, because they tend to work on a 24/7 basis, can be noisy, particularly because there are ventilated patients. The family lounge will include 28 bedrooms, as well as a seating area, a kitchen area and showers in order that predominantly mothers but parents can stay within dressing gown distance of critically ill children. The planning application also included a 53-bed family accommodation unit adjacent to the front door of the children's hospital. That is where the Ronald McDonald House will be located. Ronald McDonald House has long experience in Dublin at Crumlin hospitaL, as well as internationally, in accommodating families who stay overnight or must travel long distances. Currently, there are 16 such beds available; therefore, 53 beds represents a significant increase. We receive requests for accommodation in Dublin in the children's hospitals and have matched that demand and planned for it. We intend to deliver these services.
One of the things at which we are looking in collaboration with Dublin City Council is what the accommodation around the hospital needs to be like more generally. There should be accommodation for key workers. I have worked in London and the USA where one was able to find an apartment near a hospital. We have not previously looked at this issue in the design of cities to support really big developments such as the planned campus at St. James's Hospital. We are looking at general accommodation needs which require to be met to support a campus of this size.
Mr. John Pollock:
Our board is probably unique. As our remit is to design, build and equip the hospital, the skill set on the board reflects this. We have Mr. Tom Costello who was CEO of Sisk, the largest builder in the country; procurement expertise from the Office of Government Procurement; an architect from Northern Ireland, Mr. John Cole, who was the chief architect for the Northern Ireland health service; and financial services, contracts and legal expertise. It is very much a board that was assembled with a fixed remit to deliver a hospital from start to finish. We were asked if we had looked at equipping the hospital. We absolutely have. We have appointed a dedicated team of four people and have lists of all the equipment that will be provided in the hospital - from desks, beds, imaging and theatre equipment to X-ray machines. It is on our procurement list and we are advancing with these plans. They have been put out to tender.
We were asked to elaborate on the provision of green spaces. We have four acres of green space in total on the campus. There are multiple gardens. From the point of view of parents and children, it is within that oval, a garden that is longer than Croke Park, in the middle of which we have what we call a biome in order that, even on a wet day, one will be able to sit in that space and look out on the garden. It is very sheltered because the in-patient wards will surround it. Staff, families and patients will be able to go there and it is big enough to be segregated. Children who are immuno-suppressed and cannot go out with the other children will be able to use the segregated areas. At ground level, we will have what we call our "meadow garden" which will be open to everybody, including the public and local residents, and which will be over an acre in size. On the southern boundary where the Luas line runs, there will be a linear park which are creating as part of the development. The Luas stop at Rialto is 30 m from the front door of the hospital and there will be another garden located there. The three-storey finger buildings out towards the South Circular Road will feature internal courtyards. We are very conscious of our neighbours across the road, which is why the buildings will not be too high. The courtyards will be accessible to out-patients who want some fresh air and to get out of the hospital environment. On the third floors of the buildings, there will be break-out spaces for staff. If one needs a break from the hospital, one will have a quiet space where one will be able to take a cup of coffee and sit. In total, four acres of green space will be provided on the campus.
I thank Mr. Pollock, Ms Hardiman, Dr. Greally, Dr. Sheehan and, of course, Ms Sharkey for attending and giving us their views and updating us on how the hospital will develop. I propose that we send a transcript of the hearing to the Minister and the Department for Health and ask for their comments when the Minister and his officials meet us on 10 November. Is that agreed? Agreed.