John Browne (Wexford, Fianna Fail)

I thank both Deputy Mitchell and Deputy Rabbitte. I see that Deputy O'Connor is also present and has an interest in the issue. I apologise for the absence of the Minister for Health and Children, Deputy Harney.

In late 2005, the Health Service Executive, HSE, at the Minister's request, undertook a review of tertiary paediatric services. McKinsey and Company were engaged by the HSE and its report, which was presented to the HSE in February, included a number of key recommendations, namely, the population and projected demands in this country can support only one world-class tertiary paediatric hospital; the hospital should be in Dublin, and should ideally be co-located with a leading adult academic hospital, that is, it should be within a practical walking distance of such a hospital; and the hospital should also provide all the secondary, that is, less complex, hospital needs of children in the greater Dublin area and these secondary services should be supported by strategically located urgent care centres. The HSE welcomed the report as providing a clear outline of how to provide the best hospital care for children throughout the country, in line with best practice.

It is worthwhile at this point to explain why the principle of co-location of the paediatric hospital with the adult hospital is so important. The McKinsey report emphasised that best outcomes for children are critically dependent on having breadth and depth in sub-specialist services, that is, a critical mass. To achieve such a critical mass, it is considered that tertiary centres should serve a population which is large enough to support a full complement of paediatric sub-specialists, co-located with an adult teaching hospital. The collaboration of adult and paediatric specialists creates a larger critical mass of specialists in a particular area, which in turn creates the platform for improved outcomes.

Arising from the McKinsey report, a joint HSE and Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital. Each of the six major adult academic hospitals in Dublin, including Tallaght Hospital, made a detailed submission to the task group. The task group concluded that each of the sites adequately demonstrated the feasibility of accommodating the proposed new paediatric hospital and a new maternity hospital.

However, the task group considered that three of the hospitals, the Connolly Hospital, St. Vincent's University Hospital and Tallaght Hospital, did not offer the necessary breadth and depth of tertiary services to complement the paediatric hospital and on this ground those three sites were ruled out as co-location options. Following assessment of the remaining sites, the group concluded that Beaumont Hospital was significantly less suitable, in terms of ease of access, than either the Mater Hospital or St. James's Hospital, particularly for the children of the greater Dublin area who will use the hospital for all of their hospital care. The task group found that both the Mater Hospital and St. James's Hospital demonstrated their ability to meet all of the assessment criteria set by the group and, on the basis of these criteria, it was not possible for the group to recommend one location on a basis that rendered it clearly distinguishable from the other. The group decided the selected location would have to develop clear cross-site, team-working arrangements with the corresponding adult specialist teams based at the other adult hospitals.

In the context of the current configuration of adult specialties, the group considered the Mater Hospital to be in a better geographical position than St. James's Hospital to facilitate a clinical network of critical adult and paediatric specialties. Accordingly, the task group recommended that the new national tertiary paediatric hospital should be built on a site to be made available by the Mater Hospital. The board of the HSE and the Government endorsed the task group's report and its recommendations. The Government mandated the HSE to move forward with the development of the new hospital and its associated urgent care centres, and to explore any philanthropic proposals connected with its development. The governance arrangements that will arise in the context of the amalgamation of the three children's hospitals will also be pursued, in particular the measures needed to ensure the new hospital is multi-denominational and pluralist in character.

The Minister is fully satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. The task group consulted widely in arriving at its recommendations, and gave detailed consideration to the key issues of access, governance, clinical values and site suitability. Each of the three existing paediatric hospitals expressed strong support for the development of a single paediatric hospital, and emphasised the need for decisions on the new hospital to be taken urgently. Paediatric consultant representatives expressed their willingness to move to the new hospital regardless of its location.

A joint HSE-Department of Health and Children transition group has since been established to advance the development of the new hospital. Among the key items to be addressed are the definition of a high level framework brief for the new hospital and the determination of the range of services and location of the associated urgent care centres required to support it. The group will have consultations with relevant stakeholders, which will include representatives of the National Children's Hospital at Tallaght. To date, no decision has been taken on the range of services to be provided at the National Children's Hospital at Tallaght in the context of the development of the national paediatric hospital and the associated urgent care centres.

The Taoiseach, the Minister and the chief executive officer of the Health Service Executive met with representatives of the Adelaide Hospital Society, including Archbishop Eames, in June to discuss issues relating to Tallaght Hospital. The hospital representatives expressed concern at the implications for the National Children's Hospital at Tallaght of the Government decision to endorse the development of a single national tertiary paediatric hospital at the Mater Hospital. They also discussed several other matters relating to the provision of hospital services at Tallaght. Development proposals submitted by the delegation, which have significant resource implications, have been forwarded to the Health Service Executive for consideration.

In a letter to Archbishop Eames following the meeting, the Taoiseach gave an assurance that the Government wishes the hospital to thrive on a sustainable basis as a focal point for the involvement of the minority tradition in the healthcare system and as a key health provider to an expanding local population. These objectives will be pursued in tandem with other compelling objectives, including the achievement of an effective and efficient hospital care system, which will deliver the highest possible standards of care within a framework designed to respond to the needs of patients at national, regional and local level. Arising from the meeting, it has also been decided that a review will be conducted of decisions taken with regard to the funding and development of the hospital. The arrangements for this review are being finalised.

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