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.