Liam Twomey (Wexford, Fine Gael)
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Question 82: To ask the Minister for Health and Children if she is satisfied that the selection process for the new national tertiary children hospital was rigorous, transparent and equitable and in line with best international practice; and if she will make a statement on the matter. [35754/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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A review of tertiary paediatric services carried out by McKinsey & Company on behalf of the Health Service Executive, HSE, recommended the establishment of a single tertiary paediatric hospital in Dublin, co-located with a leading adult academic hospital. Subsequently, a joint HSE-Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital.

Based on this assessment, 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 task group's report and its recommendations were endorsed by the board of the HSE and by the Government, which mandated the HSE to move forward with the development of the new hospital and its associated urgent care centres and to explore any philanthropic proposition in respect of its development.

I am fully satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. The task group conducted a thorough assessment and consideration of criteria such as the breadth and depth of tertiary services necessary to complement the paediatric hospital, ease of access, governance and site suitability.

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 by the transition group 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 the new hospital. The group will consult with relevant stakeholders in the course of its work.

Liam Twomey (Wexford, Fine Gael)
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This is an extremely important issue. It is important that the selection process was transparent but the Minister's answer leaves me in some doubt as to whether it was rigorous and followed best international practice. I do not wish to make the charge that political interference occurred but this charge arises because people are unsure as to how this decision was reached. The Minister of State at the Department of Enterprise, Trade and Employment, Deputy Killeen, indicated in the Seanad that three hospitals were more or less immediately knocked out of this process because of the breadth and scope of their tertiary services. Given the Minister of State's assertion, the Minister should explain to the House the deficits in tertiary care that exist in St. Vincent's Hospital and the National Children's Hospital, Tallaght, which make them unsuitable sites for the new children's hospital.

If the Minister is insisting on closing down the National Children's Hospital, Tallaght, where does this leave all the other paediatric units across the country which are much smaller than the paediatric unit in Tallaght? Does the Minister also intend to rationalise the services in these units in the future when she examines the wider elements of paediatric care? These are extremely important questions. We need to find out how the Mater site was selected. Fine Gael has no difficulty with whatever hospital receives the new children's hospital but it has a considerable problem with how it is selected. The Minister has not made it sufficiently clear how the site was selected and her answers so far are not sufficiently transparent. She should also address the other questions. What is wrong with St. Vincent's Hospital and the National Children's Hospital, Tallaght, to render them unsuitable for tertiary paediatric services? What are the Minister's plans for paediatric units across the country which are smaller than the National Children's Hospital, Tallaght?

Mary Harney (Dublin Mid West, Progressive Democrats)
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A total of six hospitals were considered as part of the process undergone by the group. These hospitals included the National Children's Hospital, Tallaght, St. James's Hospital, James Connolly Memorial Hospital in Blanchardstown, Beaumont Hospital, St. Vincent's Hospital and the Mater Hospital. The group felt that only three of these hospitals — Beaumont Hospital, St. James's Hospital and the Mater Hospital — had the breadth and depth of speciality needed to complement the paediatric hospital.

I am not a clinician and am, therefore, not in a position to say what the particular issues were, except to say there are not many tertiary facilities in the National Children's Hospital, Tallaght. The vast majority of children from that hospital's catchment area who have tertiary-related issues are treated at Our Lady's Hospital for Sick Children in Crumlin. As Deputy Twomey is aware, very sick children, regardless of whether their conditions relate to cancer or cardiac matters, are treated in Our Lady's Hospital for Sick Children, rather than the National Children's Hospital, Tallaght.

I understand the group narrowed it down to the Mater Hospital, St. James's Hospital and Beaumont Hospital. As a result of a number of other factors, including speed of delivery, it was felt that the Mater Hospital was the most central site and could be developed more quickly than the other two facilities, Beaumont Hospital being located on the north side of the city.

There will be urgent care centres. For example, the National Children's Hospital, Tallaght, has a bed occupancy rate of less than 40%. Thankfully, the vast majority of children who attend hospital do so for relatively minor events, day surgery or ambulatory reasons and do not require the kind of intensive care that will be available at this national tertiary hospital. There will, of course, be children's hospital facilities around the country. The new hospital will be a national hospital for those children who require very specialised treatment.

The McKinsey & Company report recommended co-location. In particular, there are considerable benefits when many hospital facilities are co-located. We can see these benefits even in large countries like the US. Given that Ireland has a population of only 4 million, the report argued very strongly that in certain specialties, it would be impossible to produce sufficient numbers of people to solely carry out paediatric work because the country simply does not contain enough children, given its small population base.

I was in the Children's Memorial Hospital in Chicago in the past two days. It is located about three miles out of the city but will move to a downtown city site to co-locate with an adult teaching hospital and a maternity hospital for much the same reasons that we are seeking to do that here. It has about 300 paediatrician consultants on its staff. It is operating on a scale much greater than anything we could have, yet it considers enormous benefits can be gained from co-location.

Liam Twomey (Wexford, Fine Gael)
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The question has not been answered. Will the Minister release the information that resulted in these hospitals being discounted so quickly? What is the breadth and depth of it? I understand the Minister is not a clinician but many people would like to know why the Mater Hospital was picked as opposed to any of the other hospitals. All they are looking for is the information on why the decision was reached. Concerns exist that it may not have been as clear-cut as the Minister has implied. The information should be released so that people know exactly why they were not selected. It should be made crystal clear why the HSE considered St. Vincent's Hospital and Tallaght Hospital unsuitable for a tertiary children's hospital.

If the Minister is still intent on closing the National Children's Hospital in Tallaght she should be aware it will have a significant impact on the many other paediatric units across the country. There are supposed to be joined-up policies in all aspects of the health service. What is the thinking of the HSE in this regard, as it will have a profound impact on aspects of the health service around the country? There is a need for the Minister to be honest with people about what she intends to do and why this decision was reached.

The Minister stated that the reason she wants to close the National Children's Hospital in Tallaght and Crumlin Hospital and amalgamate them on to one site was that the outcomes for children's cancer are the only ones in keeping with the EU average. That is an important fact. The Minister only got McKinsey & Company to look at paediatric services across the country. No attempt was made to examine tertiary services for adults across the country. Is there any request from McKinsey & Company to do exactly the same for adult services because that would impact on the future delivery of services? That is an aside and I do not wish to get into a discussion on the matter at present. The HSE should make known how it reached its decision and what its plans are for the future, not just for Tallaght Hospital but for all paediatric units around the country. The Minister should not hide behind the kind of answer we have been getting in recent months.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not hiding behind anything. We proceeded on the basis that we would build a new hospital in Crumlin with 400 beds and a new hospital in Temple Street with in excess of 200 beds, in addition to the facility in Tallaght. When the analysis was done the reason we came to this position in the first place was that many of the paediatricians in Dublin said to me that such an approach was crazy and that we should have brought services together years ago. This was not something I had ever reflected upon. That is how we came to the position of examining what we would do before it was too late and we had spent a great deal of money.

The same applies to adults but, unfortunately, there are more sick adults than sick children. Thankfully, there are relatively few sick children because children generally are healthy. With a population just in excess of 4 million, we are not justified in having more than one tertiary facility. In the case of adult treatments, we have to provide some tertiary facilities and they can only be provided on a single site basis. What we want to do on the adult sites is to develop regional facilities where people can be treated based on quality assurance, safety protocols etc. That is particularly important in the area of cancer care.

In the end, the decision came down to either the Mater Hospital site or St. James's Hospital. St. James's Hospital has the largest range of adult specialties. The Mater Hospital's advantage was that many of the paediatricians in Temple Street Hospital are also on the staff of the Mater Hospital. The site there could also be available more quickly because of the work that had been done on the redevelopment of both facilities. We want also to make arrangements for a maternity hospital because many of the children who will be treated there are neonates. It was for all those reasons that the decision was made. I assure Deputy Twomey that there is no question of closing Tallaght Hospital. The issue for that hospital is whether it will become an urgent care centre.

I asked the group to examine as a matter of priority where urgent care centres in Dublin should be situated and what should be their scope. Those matters must be agreed quickly. Anaesthetists and others will be required to perform day procedures. I cannot be certain, but, given the experience of the hospital in Tallaght, I would be surprised if the group did not designate it an urgent care centre.