Ms Eilísh Hardiman:

Certainly. I will start and my colleague, Dr. Curtis, might wish to chip in. It is important to note that there is a national model of paediatric healthcare. It sets out the grand scheme plan for 25% of the citizens of Ireland. It is an integrated plan, which means that it takes into account community and acute services.

We have to work in an integrated way, which I am aware the committee supports, and as has been outlined in Sláintecare. In that plan we have identified the priority issues for the next five years that help to address the challenges facing children's healthcare. This involves us working collaboratively with our colleagues in the community - GPs, public health nurses and others - to look at implementing Healthy Ireland and other plans that have a significant element focusing on children. The Government's First 5 programme is a very important plan that identifies getting a child started in the right direction around their health and healthcare outcomes and has significant benefits to the healthcare system and to the health and wealth of a country into the future. There is much planning and integration work. There is great collaboration among the paediatric community and the acute system, which work together on the priorities. We know that everything cannot be invested in during the first year and collectively we have identified the priority areas where we need to focus. We work with some of the national leads with regard to the plans to roll this out.

From our perspective, this year we have identified the regional units in Cork, Limerick and Galway in particular and they have received almost €5 million in investment to build services there. We are working in such a way that the new children's hospital is about a network of services rather than just one bricks and mortar building. We work collaboratively with our colleagues in these services to ensure as many of the services as possible are delivered locally. Some of our clinicians will do outreach clinics in the regional hospitals in specific areas that we have all agreed.

It is a ten year plan and currently we are looking at every year over the next five years for the children's hospital to see how we can invest to add to the existing resources in children's healthcare and to work in a more integrated way with our colleagues, between community, mental health and the acute services especially. We are looking at how to change the delivery of services to get a better outcome.

I am glad to report, and Dr. Curtis will concur, that obesity has started to plateau. There are some positive signs around that. Unfortunately, chronic diseases are still on the increase but I am glad we are getting our second allergist starting, along with a dermatologist and a rheumatologist, which is important. These are areas in which we have new investments this year in Children's Health Ireland that will transform how we address some of those chronic diseases. The plan is not to get down on the numbers of super specialties - we definitely have a need and requirement for some of those - but we plan to build a very strong bedrock and foundation of general paediatrics and to support them with tertiary specialty services. We are glad to say that there has been an increase in general paediatricians with six joining us on the whole team at Children's Health Ireland. Already they are bringing in expertise around adolescent care and transition care and we also have a general paediatrician with a special interest in dermatology.

We are interested in doing things a bit differently whereby the GPs do not have to wait to refer to the specialist who might have a long waiting list. Our general paediatricians are taking on board those referrals on a single waiting list that is jointly shared across Children's Health Ireland and it goes to whoever has the next available clinic. It is about more efficient use of our existing services. We are working with our colleagues to triage to see what could go to the specialist and so better use their time, and to see what can and should be managed with our general paediatricians. In using them and engaging much more closely with our GPs in the community we aim to manage those chronic diseases in that way. It is about supporting them to work a bit differently.

All of the elements mentioned in Sláintecare are the new ways of working that we are embedding into the paediatric outpatient and urgent care centre at Connolly Hospital, for example, with clinical triage of referrals. Our general paediatricians are doing a triage clinic where they clinically triage the referrals and then phone the GP, which is very important. They have managed to divert some 30% of the referrals by engaging with the GP and supporting them to care for the child, as opposed to the child having to come in for a referral. We are also bringing in general nurse specialists in general paediatrics who can deal with some of the chronic elements in paediatrics such as constipation, some of the rashes and so on. These nurses can work with the families as opposed to the child having to see a consultant. All of these new ways of working are how we are trying to transform the services. The new facilities at Connolly Hospital Blanchardstown allow for that. We have not had paediatrics in north county Dublin and its environs previously. I am glad to report that the GPs and our community colleagues in CHO 9 in that area are looking at this and working collaboratively to try to use this as a new opportunity to transform, not do the same old same old, and to implement new ways of working, especially around managing chronic disease as much as possible in the community.

Perhaps Dr. Curtis would like to add to that.