Pat Rabbitte (Dublin South West, Labour)
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I thank the Leas-Cheann Comhairle for calling me on this important subject.

There was a public protest in my constituency in Tallaght last Saturday, organised by the mayor of the county and the Labour Party, at which 4,000 people were present. It is only an indicator of the scale of public concern in the greater Tallaght region about the implications of the Government decision on a new national children's hospital, and the apparent implication of it for the retention and development of paediatric services at Tallaght Hospital. There are also implications arising from this decision on the downgrading of Tallaght Hospital itself.

Somebody was quoted as saying — I believe it was Mayor Eamonn Moloney — that 30,000 children were treated at Tallaght Hospital last year and that was 30,000 good reasons for ensuring the National Children's Hospital continues at Tallaght. There is no exaggerating the concern among parents and members of the public in the most densely populated area of the prospect of paediatric services being scaled down at Tallaght.

The situation would appear to be that following the development of a new national children's hospital, we may get what is termed as an urgent care centre at Tallaght. We do not know this because we cannot get clear answers from the Government. Although we do not know this, we would expect that if urgent care centres mean anything, one is likely to go to Tallaght.

From the perspective of the people of Tallaght, some of whom spent 20 years campaigning for the hospital at Tallaght, an urgent care centre is no more than a glorified clinic. It certainly does not meet the needs of people in the area, where there are so many people at the family formation stage and where all the modern day arguments about traffic, congestion, accessibility, communications, etc, apply.

The Government tends to indicate that the McKinsey consultants made this decision. The Government made this decision. The McKinsey consultants were brought in to advise on the ideal provision of paediatric services for a population of about 5 million. They were expressly prevented in the terms of reference from having regard to the current configuration of services and from deciding on a site. That was a Government decision.

I see much merit in the recommendation put forward by Archbishop Eames. It suggests that the best arrangement for Ireland is a single governance structure with two campuses, one northside and one southside at Tallaght. That does not mean the complex tertiary requirements would all have to be done in both locations. However, that would allow for the retention and development of paediatric services on a southside campus, in this case Tallaght, which would be accessible not just to the immensely populous region of the hinterland, but to people who travel from Cork, Mayo and Galway, etc. It is as much a struggle to get from Portlaoise to Newlands Cross as it is to get from Newlands Cross to the Mater Hospital.

The difficulty is that we cannot get any clarity from Government. The rather extraordinary procedures that were pursued in the making of this decision, and on which I have spoken on other occasions, have added to the concern and worry in my constituency. In submitting its tender, in the short timeframe allowed, the board of Tallaght Hospital drew attention to the nine McKinsey criteria, which included space, services, co-location, access, efficiency, people, teaching and research, financial stability and full project plan. They concluded that no other location met those nine requirements as well as Tallaght Hospital, and that conclusion has never been challenged. It has co-location with a major teaching hospital, ample space on the campus and offers the required services with a proven track record of expertise. It is accessible from all parts of the country, is efficient and has the necessary staff.

We do not know what the future holds for Tallaght Hospital. It is the conviction of the leadership of the hospital that if, as seems to be the import of the Government decision, all paediatric and tertiary services are transferred out of Tallaght and Crumlin to the Mater Hospital, it will not just be a blow to parents looking for services for their sick children but will impact on the stature of Tallaght Hospital itself, downgrading it when we should be planning for its continued development with the provision of maternity services and the retention and development of the paediatric services that are currently offered. I hope the Minister of State will be able to throw some light on the Government decision during this debate.

Olivia Mitchell (Dublin South, Fine Gael)
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I wish to raise precisely the same issue as my colleague, Deputy Rabbitte. Senator Brian Hayes raised the matter in the Seanad, with particular reference to the method used to select the tertiary hospital. That certainly needs explaining because, in terms of accessibility alone, it is difficult to think of anywhere less accessible than the Mater Hospital.

My concern is over the decision that the tertiary hospital, wherever it is located, is to be the only hospital providing paediatric services to children in Dublin. It makes absolutely no sense to run down or eliminate existing services which work very well and with which the public is absolutely satisfied. Many of us have known the writing has been on the wall for Crumlin Hospital for a long time, because it is a single specialty hospital, but it makes no sense to also run down and eliminate the services in the National Children's Hospital in Tallaght, leaving most of the children in the Dublin region with access to only one hospital where they will have to go even for ordinary paediatric services for the most common illnesses, rather than complex, tertiary services. Most childhood admissions to hospitals are for ordinary illnesses, often overnight. The idea of blocking expensive beds in a tertiary hospital for that kind of use is absolute nonsense and cannot be justified on expense grounds alone. Those beds will be so limited that Dublin children will not have access to hospital beds in the way the rest of the country might.

Parents understand that everybody cannot have a local hospital but do not understand how the rest of the country can have the services of a secondary hospital for the more common illnesses in addition to a tertiary hospital, while Dublin parents will only have access to the limited beds available in the national tertiary hospital.

I fully support the concept of having specialist services in one national tertiary hospital. To remove from a large swathe of the population vital, accessible children's services, and to abandon all the expertise and experience that has been painstakingly built up in the National Children's Hospital, Tallaght, over the years is economic, demographic and medical folly.

I do not know which bright spark decided that, uniquely for children in Dublin, the national tertiary hospital should also be their local hospital. Why is this arrangement being made for children but not for adults? Tertiary hospitals are required for all specialties but no one suggests we close all the adult hospitals in Dublin to provide the critical mass necessary to provide a tertiary service to the rest of the country. If anybody suggested the closure of five of the six major Dublin hospitals they would be laughed off the stage so why are we suggesting it for children? Just under 40% of the population live in the greater Dublin area. What on earth made anybody think one tertiary hospital would meet all the paediatric needs of the Dublin area?

I ask the Minister of State to heed what we say. I am not an alarmist but this is absolute nonsense. It is dangerous nonsense and has to be stopped.

John Browne (Wexford, Fianna Fail)
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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.