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.