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.