Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the opportunity to contribute to this debate. Although the Government's motion is somewhat self-congratulatory in its wording, the decision on the development of a national paediatric hospital is welcome. There is a broad consensus that this development is required urgently in the context of a debate that been ongoing for a long time. The McKinsey report in 2006 recommended that construction of a national paediatric tertiary hospital should commence as quickly as possible. Since then, public discourse has featured a range of competing views on the precise location of the facility. This debate was sometimes divisive not only at a political level, but also within the medical professions and among the various hospitals in the city which already provide excellent care under very difficult circumstances. Given that tri-location is a feature of international best practice, the different hospitals were bound to have a view on which would offer the best location.

My party welcomes the fact that a decision has now been made on foot of the Dolphin report. The focus now must be on ensuring there is strong co-operation between all of those involved, most particularly the amalgamating hospitals at Temple Street, Tallaght and Crumlin, in the further development of paediatric services. In tandem with the construction of the facility, it is crucial that there be sufficient preparation in terms of the provision of paediatric specialties and the structures of governance in order to ensure a smooth transition to the operation of the new facility. That is the challenge to individual hospitals and those with the expertise in paediatric care. The focus of the process from now on must be to expedite the construction, support it through the Estimates and ensure there is an upgrading of specialties in paediatric care.

The question does arise as to what will happen in the interim. We are all aware of the straitened circumstances in which the Government is operating. My concern in this context is that there might be a natural inclination to reduce funding for the existing hospitals that are providing paediatric care. I am not saying it will happen, but there might be a tendency to downgrade those facilities in anticipation of the opening of the new hospital in 2017 or 2018. If such a downgrade is permitted, it will be very difficult to enhance the provision of the sub-specialties that are required in the area of paediatric care. Some specialties remain dependent on the expertise of the adult teaching hospitals. There must be a clear focus on building up capacity between the three existing hospitals to ensure there is sufficient expertise and specialisation to operate the new facility effectively. I am not seeking to inject negativity into the discourse in raising this issue, but it is a concern that has been expressed to me by management at the various hospitals. The danger is that officials in the Department of Finance who are looking at the budgetary position might conclude that in advance of the provision of the new hospital in 2018, they can scalp a little here and there in the three existing paediatric hospitals. This, however, could have a detrimental impact on the increased capacity and specialty-building that is required for a national paediatric hospital.

Many people had views on the suitability of the Mater site, which was independently assessed by medical peers internationally. Of the two reports on the Mater option, one was commissioned by the previous Government and the second by the Minister, Deputy James Reilly. The latter stated that all things being equal in terms of medical care, the provision of an adult teaching hospital, maternity and paediatric hospital in a tri-located site was the best option from a medical point of view. The authors of the report acknowledged the difficulty of identifying any site which would fit all of the criteria. The bottom line is that if An Bord Pleanála had made a different decision, we would now be proceeding with the Mater site. The decision An Bord Pleanála actually did make led to a delay in the process and that uncertainty is now concluded with the identification of the St. James's site as a suitable alternative. The latter does not fit the best international practice requirement of a tri-located facility with maternity, paediatrics and an adult teaching hospital located on the one site, but that is something we simply must accept. The report states that there is potential to develop a maternity hospital on the St. James's site. If planning permission is granted for the proposed facility and construction proceeds as envisaged, the next obvious step would be to develop maternity facilities on the campus in order to comply with best international standards not only in terms of paediatrics, but also in the treatment of women who experience complications during pregnancy and after childbirth. All of the international reports suggest this is the optimum type of facility.

As we are all aware, children in this State sometimes have to be transferred to Great Ormond Street Hospital and elsewhere for highly specialised treatment. While our objective should clearly be to provide as broad a range of specialties as possible in our own national paediatric hospital, we should nevertheless seek to enhance co-operation in this area on an all-island basis and between Britain and Ireland. In the case of very high-level specialties, no single hospital might have an absolute capability in delivering a particular service simply because it does not have the capacity or throughput. As well as focusing on the governance structures required to operate the new hospital at optimum capability, we should also consider how the services provided there can be complemented through co-operation with children's hospitals in the North and in Britain, including Great Ormond Street and Newcastle.

Is it possible that with close co-operation, children from Britain and Northern Ireland could equally be coming to our national paediatric hospital for high end, specialist interventions? Rather than having a duplication that may not provide the highest level of specialties, we would have co-operation. The Department officials might examine that in discussions with their colleagues in the UK. It is something most people would welcome.

We have an uncanny knack of spending more on construction than we have budgeted for. Due to the downturn in construction costs, there is now a key opportunity to be imaginative concerning the national children's hospital we aim to create. I know there are financial constraints, but €200 million has been set aside from the sale of the national lottery and a capital envelope will be available in addition to philanthropic support. I do not know how much funding support there is from the business sector and the broader community. Some form of tax relief could be made available through the Finance Act to people who make a donation towards the construction of the national children's hospital. I do not know whether that idea has been considered or discussed. If people wished to make such a contribution, that tax relief might encourage those with resources to assist this iconic flagship development for the children of Ireland.

The timeline has slipped somewhat and reference has been made to 2016, which will mark the 100th anniversary of the 1916 Rising. The 1916 Proclamation referred to "cherishing all the children of the nation equally". In this context therefore, the Government should at least bring forward some proposal in the Finance Act whereby people who wish to provide any amount of money for the development of the national children's hospital could offset it against tax. It would be an inducement to encourage people to contribute. I ask the Minister of State to examine this idea, although there may be a downside to it. None the less it might stimulate a bit more interest if people were encouraged in this way.

As regards the Dolphin report, I wish to put on record my party's appreciation of the efforts of Mr. Dolphin and that group in assessing the sites. We welcome the report's findings and broad recommendations. Overall there has been strong political support for the St. James's site but I acknowledge the contrary views. I wish to raise one point, however, that I raised the other day on the Order of Business. The Cabinet made a decision, yet within minutes we were informed by the media that there had been a massive row at Cabinet. We were told that two Ministers, Deputy Leo Varadkar and Deputy Joan Burton, were adamant that the Blanchardstown Connolly Hospital site should have been the location. I have no difficulty with views being expressed around the Cabinet table. I assume that is how Cabinets work, although I was never there. There is meant to be Cabinet confidentiality, however, and a collegial decision. Despite this, we had the unsightly scene of Ministers falling over themselves to get out of the Cabinet meeting as quickly as possible to tell the media locally that they fought tooth and nail for Blanchardstown or other areas. That undermines what we all are trying to achieve here, which is to have this project embraced nationally in order that it will be seen as a flagship project without dissent or division. What happened was unsightly and inappropriate to say the very least. I know that everyone plays to their constituencies, but obviously commitments were made that they would raise this issue. None the less it was grubby.

We now need to see a strong commitment from the Government to ensure a financial stream is available for the development, involving the planning process and including drafting and drawings. There should be no delay in getting approval from the Department of Finance. The sale of the national lottery licence has been mentioned with €200 million being provided. The national children's hospital project will cost €500 million, which is a capital stimulus in itself. It will provide a lot of employment in the short and medium term, both in drafting and construction, which will benefit the locality as well. This national hospital will be for all the children of Ireland. Proper facilities must be put in place outside the capital city for the transfer of children who may need specialist treatment in the national paediatric hospital. Helipads, ambulance and other transportation services must be available as part of the overall package so that this is seen as a national children's hospital for the island of Ireland.

I wish the project, and those who are overseeing it, well. The Department should put expertise to the fore to observe the continual development of the project, to ensure it is on time and within budget and that any complications that could arise will be ironed out in advance. Funding is critical. Once the drafting, design and planning is out of the way, a stream of funding must be made available for the continual development of the building until such time as it is completed. In tandem with that, there must be a smooth transfer to the new location of the three hospitals currently providing paediatric services. On behalf of the latter hospitals, I will be watching to see that there is no downgrading or penny-pinching in the new facilities, or any lack of support for the development of the sub-specialties that are urgently needed. As we develop the national children's hospital, those sub-specialties must be in place in order that a smooth transition can take place from the existing hospitals to the new one.

This is an opportunity for all those providing paediatric services, including consultants and medical teams, to embrace this project and ensure we have an excellent facility for the children of this country in the years ahead.

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