Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move amendment No. 2:

To delete all words after “Dáil Éireann” and substitute the following:“notes:

— the urgent need to develop an appropriately sited, world class facility to care for children and young people from all over Ireland who are in need of specialist and complex care;

— that clinical considerations were paramount in the decision by the Government in 2012 to co-locate the new National Children’s Hospital with St. James’s Hospital, in line with independent reviews affirming the importance of co-location with a major adult academic teaching hospital;

— that the Government decision to proceed with the construction of the new National Children’s Hospital on the St. James’s Hospital campus was endorsed by the Dáil in 2012;

— the Government decision to re-develop the Coombe Women and Infants University Hospital on the St. James’s Hospital campus, in the context of achieving tri-location of adult, paediatric and maternity services on that campus as the optimum configuration to best support paediatrics, highly complex foetal and high risk maternal medicine, and chronic disease management in young people;

— the capacity of the site at St. James’s Hospital to accommodate the new National Children’s Hospital and maternity hospital, and the incorporation into the design of the National Children’s Hospital of the required operational links with both maternity and adult hospitals on the St. James’s Hospital campus;

— that St. James’s is the hospital best served by public transport in the country, including easy access to the M50 and Heuston Station, and that safe underground car parking for 1,000 cars, including 675 dedicated to patients and families and 31 drop-off emergency spaces, will be provided and be commercially funded;

— the Government decision to develop satellite centres on the campuses of Tallaght Hospital and Connolly Hospital which will be easily accessible to local populations for the management of minor illness and injuries, and attendance at outpatient and chronic disease clinics;

— that planning permission, unanimously granted by An Bord Pleanála in April 2016, supported the development of the hospital on the St. James’s Hospital site and the satellite centres at Tallaght Hospital and Connolly Hospital; and

— the vision of the new National Children’s Hospital as a research-intensive, academic healthcare institution and the potential to attract and retain specialised nursing and medical staff and health and social care professionals;

acknowledges:

— the commitments given in the Programme for a Partnership Government to develop a world class children’s hospital;

— the desire of all political parties, groups and members to improve and prioritise medical outcomes for the nation’s sick children;

— the significant financial commitments given by the Minister for Health and the Government to progress the National Children’s Hospital project, including the availability of €650 million Exchequer funding earmarked for the core construction costs of the hospital and associated satellite centres;

— the progress made to date as the first phase of construction (site clearing works) on the site of the new hospital will be substantially completed within a matter of weeks;

— that the new National Children’s Hospital accommodation is being designed to ensure that children and young people receive their care in the best organised and most clinically suitable setting, with facilities for parents to comfortably stay overnight;

— the link between the hospital and local and regional paediatric units, through an integrated national clinical network aimed at delivering services to children as close to home as possible;

— the robust governance arrangements in place to manage and oversee the new National Children’s Hospital project;

— the adherence to the Public Spending Code requirements at all stages of the project;

— the Minister for Health’s intention to bring a Memorandum to Government shortly on the new National Children’s Hospital, setting out full details of the project costs; and

— the Minister for Health’s intention to bring a General Scheme to Government shortly, seeking permission to draft legislation establishing the new National Children’s Hospital as a statutory body to take over the services provided by the three existing Dublin paediatric hospitals; and

supports the Government priority to make progress on the new hospital on the St. James’s Hospital campus and satellite centres at Connolly Hospital and Tallaght Hospital as soon as possible, to support best clinical outcomes for children and young people in Ireland.”

I very much welcome the opportunity to address the House on the new children's hospital. I thank Deputy Mattie McGrath and the Rural Independent Group for tabling their motion and for the opportunity it provides to the Dáil to debate a very important issue. I am quite sure the Deputy did not mean to refer to some doctors and nurses and the like who work to care for our children and who came to the audio-visual room as being in any way hired to be there. I am sure he will clarify that statement. They are certainly not hired guns. I accept the bona fides of his views but I would not like a slur to be made on their bona fides and their views in looking after our sick children. I am not in a position to accept the Deputy's motion and I am moving the Government's counter-motion on the development of the new children's hospital and satellite centres.

We are closer today than we have ever been to providing Ireland with a state-of-the-art children's hospital that it badly needs and deserves, following not just years but decades of discussions and debates about paediatric acute services and sites for such services. Throughout those years, we have been well served, it is fair to say, by the dedicated staff of the three children's hospitals in Dublin. However, let us not forget that Temple Street Children's University Hospital is housed in a 19th century building and Our Lady's Children's Hospital Crumlin was built in 1956. Both hospitals have infrastructural deficits and challenges in delivering paediatric health care services to the standard warranted by a 21st century society. Most children and young people are cared for in multi-occupancy rooms and, across the children's hospitals, parents - indeed, many of the parents here tonight - regularly sleep on the floor or in a chair beside them at night. I think we can agree that this is not right. The truth is that the infrastructure of these children's hospitals is simply not fit for purpose to deliver the best possible service for children and young people in Ireland, who do after all represent 23% of our population. The patients and their families know it, hospital staff know it and we in the Dáil know it.

Furthermore, the historic development of services across three separate hospitals has resulted in an inefficient approach to paediatric service delivery, with fragmentation, duplication and, on occasion, triplication of some clinical services within a 14 km distance in one city. Again, this is not right. There is an imperative clinical and societal need to deliver a single children's hospital in one location with suitable infrastructure to meet the standards of care that are warranted. I trust we can all agree on that.

We are now at a point at which a world-class design, with child-friendly, high spec, modern interiors and acres of outdoor space, has been completed and has received planning permission following a robust planning application process. It is important to note that there was a planning application process. The announcement 11 months ago that planning approval had been secured was a huge and very welcome milestone for this important project. We now have an extraordinary opportunity to enhance health care services for children. I do not believe anyone would argue - indeed, I do not hear anyone arguing - with the need now to create a world-class facility to provide specialist and complex care for children and young people from all over Ireland.

I know that some people have different points of view about where to site the hospital, and questions about whether we as a country can afford it. There are sincere differences of opinion, and I am respectful of this. People hold genuinely different opinions on the best site, and Deputy Harty correctly said there will be strengths and weaknesses to nearly any site chosen. It should be remembered that we had the Mater project first, and now we have this site. It has been a long gestation. I wish to try to address some of the concerns I have heard. I will begin with the sites chosen. We are building the main hospital on the St. James's Hospital campus. We are building an outpatient and urgent care centre on the grounds of Tallaght hospital. We are building an outpatient and urgent care centre on the grounds of Connolly Hospital. I will talk first about the satellite centres as they will be built and commissioned first.

I understand there are some concerns that every child in the Dublin area needing acute care will have to go to the St. James's campus. This is not the case. It is important to recognise that an integral part of the new children's hospital project is the development of the two satellite centres at Tallaght and Connolly hospitals. These satellite centres will be easily accessible locally for many families in the Dublin area, but also in Meath, Kildare and Wicklow. Each centre is projected to deal with 25,000 urgent care attendances per annum, with urgent care delivered by consultants and staff of the new children's hospital. The satellite centres will also provide general community and paediatric clinics, including developmental paediatrics, multidisciplinary care for children with chronic stable conditions and other outpatient services catering for a minimum of 15,000 outpatient attendances per annum. This will reduce emergency department and outpatient attendance at the main site. Children in need of urgent care do not all have to travel to the city centre site. The satellite centres will also meet the needs of general practitioners for access to specialist opinion in the general paediatric rapid access clinics. Their strategic location in Tallaght on the south side of Dublin and Connolly in the north west is based on the projected population of families with children in the greater Dublin area. In each case, co-locating with an adult hospital facilitates the sharing of clinical and non-clinical support services, such as pathology, pharmacy, sterile services, biomedical engineering, facilities management and diagnostics. Connolly, for the information of the House, is scheduled to open at the end of 2018 and Tallaght at the beginning of 2019.

The main hospital will provide national services of the kind that can only be provided in a centre with the required scale of services and critical mass of clinical sub-specialist expertise and highly specialised health care facilities. The Government decision in 2012 to locate the hospital on the St. James's Hospital campus was made in the best interests of children. It is important to note, as others have, that Dáil Éireann endorsed this decision by a vote in this House in November 2012, so the Dáil took a decision on this site. St. James's has the broadest range of national specialties of all our acute hospitals, making it the hospital that best meets the criteria to enable the children's hospital to achieve our vision of excellence in modern paediatric practice.

Why is co-location important for this project? It is because close access to the right kind of support from adult-based services will allow for better clinical care for our children. For example, co-location facilitates the joint management by adult specialists and paediatricians of conditions in children and young people which are more common in adults. This is particularly true in respect of specialist care for adolescents and our young adults and specialist surgery, where such cases are often managed by surgical specialists who work across the adult-child age range and are based in St. James's. The new children's hospital will be the national paediatric oncology centre. As St. James's Hospital is the largest adult cancer facility in this country, there is already a radiotherapy centre on the campus which will facilitate easy on-site access for children and young people who require radiation for their cancer treatment. They will not have to travel from one hospital to the next. Practising clinicians have expressed their support for the St. James's site, including the clinical directors and directors of nursing of all three children's hospitals. By bringing together the full spectrum of sub-specialties in paediatrics and neonatology on a single campus, supported by adult services sub-specialties, a degree of scale and critical mass can be attained which will support better outcomes from the most complex treatment and care for the sickest children and young people in this country.

In addition, the new children's hospital will also be a research-intensive academic health care institution, aided by its co-location. Why is this important? It is important because St. James's has a strong, well-established education infrastructure and a strong research platform in areas such as cancer, infection and immunity and neurosciences.

On the issue of trilocation and maternity services, I believe we are all convinced of the benefits of close proximity of maternity services to children's and adult services. The benefits of trilocation are maximised where the adult hospital provides the broadest possible range of clinical sub-specialties and expertise. At its most basic level, trilocation will facilitate the transfer of sick newborns from the maternity hospital into the children's hospital and the transfer of critically ill mothers from the maternity hospital to St. James's. Again, the depth of clinical services and research on site will enhance the potential to drive the best clinical outcomes for mothers, babies and children. Government policy is for the trilocation of paediatric, adult and maternity services on the St. James's campus.

The national maternity strategy published last year reaffirms this commitment. A site for the proposed maternity hospital is identified in the site master plan for the campus at St. James's Hospital. The new children's hospital design incorporates the required links with maternity and adult hospitals. While the construction of the new maternity hospital on the campus will not commence until the new children's hospital is complete, I met last week with the chief executive officer of St. James's Hospital and the Master of the Coombe and we expressed our shared commitment and desire to move forward. I have asked that a design team be put in place to move ahead with the project brief for that maternity hospital.

Recently I had the opportunity to visit the site at St. James's to see the clearance works that began last summer and will be completed in the next few weeks. When one sees the site cleared one appreciates the area available for the children's hospital and the proposed maternity hospital. It is exciting to finally see visible progress being made on this project. The hospital has been designed to meet the demands of projected child population growth. Beyond the current building footprint, a further 20% expansion capacity has been identified as part of the planning process.

I know there are some people who continue to advocate for a greenfield site as a means of building a cheaper hospital more speedily. However, I assure them that building on this campus is the right decision. Reviews since 2006 have affirmed and reaffirmed the importance of co-location of the children's hospital with a major adult academic teaching hospital. We have a well advanced plan for the St. James's site. There is no plan to build anywhere else. That would mean starting from scratch. The Government supports the need to develop this hospital as quickly as possible and that is what we have been working towards.

There has been much speculation about the cost of building this hospital. A total of €650 million of Exchequer funding was approved in 2014 but this was always - as anyone in Cabinet at the time would say and I was not there - for the core construction of the new children's hospital and the core construction of two satellite centres, when construction inflation was running at 3%. Construction inflation is now running at over 9%. The pricing proposed by the tenderers in the recently concluded tendering process for the main construction works took account of that higher figure, as well as the extended project timeline. The core construction costs at that time did not include other services we are providing including commercial spaces, higher education facilities, the Children's Research and Innovation Centre and equipment. The final project brief is now with the Department and I intend to go to Government on this shortly. As Deputy Harty said, when this brief and the Government's decision can be published people will see the true figures and the rationale behind them.

I know the project has the support of many Members of the House and many members of the public who share the desire to improve health outcomes for children and they want to see this hospital built as soon as possible. The decision to create a new children's hospital was taken by Government over ten years ago. I want us to get on with it but I also want us to make sure we engage with and address the genuine views and concerns of parents and other organisations as we work together to deliver world class paediatric facilities.

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