Dáil debates
Tuesday, 5 December 2006
Priority Questions
Hospitals Building Programme.
3:00 pm
Liz McManus (Wicklow, Labour)
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Question 46: To ask the Minister for Health and Children her views on a new report from the board of Our Lady's Hospital for Sick Children in Crumlin, which called for a review of the decision to locate the new national children's hospital, following reservations from Tallaght Hospital: if she will provide the full list of objections from these sources and address each; her further views on the fact that the Taoiseach appears to have given a commitment that the hospital would be located in his constituency prior to the decision-making process having been completed; and if she will make a statement on the matter. [41732/06]
John Gormley (Dublin South East, Green Party)
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Question 47: To ask the Minister for Health and Children if she has read the report from the board of Our Lady's Hospital for Sick Children, Crumlin, on the proposal for a new national children's hospital; her views on the conclusions; and if, in view of this expert advice, she will reconsider the decision to move the children's hospital from Crumlin to the Mater Hospital site. [41668/06]
Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 46 and 47 together.
The objective of the Government is to ensure the provision of a world-class hospital to serve the children of this country. It was for this reason, and no other, that the Government strongly endorsed the recommendation of the joint task force group and the decision of the board of the Health Service Executive to locate the new national paediatric hospital on a site to be made available by the Mater Hospital. The decision was taken in the best interests of children.
The McKinsey report, commissioned by the HSE at my request, provided the original basis for the decision to co-locate adult and paediatric hospital services. The report is very clear. It demonstrates that best outcomes for children are achieved by having the necessary breadth and depth of services on a single site. Co-location of paediatric services with adult services and, in due course, with maternity services is in line with best international practice and this was widely accepted by stakeholders when the McKinsey report was published.
The collaboration of adult and paediatric specialists is of critical importance. It creates the necessary platform for sub-specialisation and improved outcomes. The optimum delivery of complex paediatric surgical services can best be achieved by creating teams of specialists covering both adult and paediatric patients. Co-location also offers the benefits of providing transitional care for children with complex illnesses who are now surviving well into adult life.
I am fully satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. It is true that the site chosen for the new national paediatric hospital is in the Taoiseach's constituency. It is being suggested that the Mater Hospital, an internationally renowned adult teaching hospital, should have been disregarded as a possible site for the new paediatric hospital simply because of its location. Comments by the chairperson of the Mater and Children's University Hospital Limited at a public function a number of months ago were reported out of context. They related to the Taoiseach's long-standing support for the redevelopment of the Children's University Hospital, Temple Street, on the Mater site, which at the time was at an advanced stage of planning. This has now been overtaken by the Government decision to develop a national paediatric hospital.
It is perhaps understandable, in circumstances where services provided at three hospitals are to move, that the decision has not met with universal approval. However, some of the public comment has been misinformed. Not all paediatric services are moving to the new hospital. As is the case internationally, the new national paediatric hospital will be supported by a strategically-located urgent care service. The transition group will be advising early in the new year on the recommended scope and location of this service. The group is working to ensure that the widest possible range of services will be provided through the urgent care service.
The report commissioned by Our Lady's Hospital for Sick Children in Crumlin was submitted to the joint HSE-departmental transition group some weeks ago and has already been the subject of discussions with the hospital. I also received the report and met with hospital representatives to discuss their concerns. The transition group is overseeing the preparation of a high level framework brief to inform decisions in respect of the range of services to be provided at the new hospital and the specific site to be ceded by the Mater Hospital. I understand that the transition group is satisfied that the new hospital can be fully accommodated on the Mater site. The transition group has assured the Crumlin Hospital authorities that their report will be taken into consideration in the preparation of the framework brief.
To date, no decision has been taken in respect of the range of services to be provided at the National Children's Hospital in Tallaght in the context of the development of the national paediatric hospital and the associated urgent care service. The Taoiseach has given an assurance to Tallaght Hospital that the Government wishes to see it thrive on a sustainable basis as a particular focal point for the involvement of the minority tradition in the health care system and as a key health provider to an expanding local population.
I am satisfied that the development, as planned, is consistent with international best practice. For example, I recently had the opportunity to visit the Children's Memorial Hospital in Chicago, which is an established secondary and tertiary paediatric centre. The hospital, which operates as a stand-alone facility, will transfer to a city centre site where it will be tri-located with an existing adult teaching hospital and a new maternity hospital. The hospital authorities considered other options, including a move to a greenfield site, but ultimately decided the clinical and other benefits of the tri-location model far outweighed any other considerations and would allow for the provision of an enhanced level and quality of care for children.
Liz McManus (Wicklow, Labour)
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Does the Minister for Health and Children accept that the goodwill present at the start of the process has evaporated and that the Government decision to locate the paediatric hospital on the Mater site has now effectively been rubbished by Crumlin Hospital's report, which clearly states that it is too small? Perhaps the Minister might deal with those issues, both of which featured in my question. If Crumlin Hospital says that the site is too small for four hospitals to relocate there, how does the Minister address that? Her Minister of State has said that those issues will be addressed. How will she deal with the site that is too small? How will she answer the criticism that access is too difficult? What is her answer to the claim that there are too few beds, with 100 fewer than at present?
Those specific and very serious charges have been levelled regarding a Government decision about which doubts have been raised. However, she can deal with that political charge only if she can justify it and reply to the questions raised by Crumlin Hospital. Its chairman pointed out in an article in The Irish Times today that there is now real fear that care will be compromised and fragmented. Does the Minister accept that it is a very serious charge?
She seems now to have jettisoned a recommendation in the McKinsey report on urgent care units. The recommendation was that they simply be short-term facilities providing urgent care and that no child should be there for longer than 24 hours. The intention would be to stabilise the child and direct it to the tertiary hospital. Is the Minister not clearly stating that the part of the McKinsey report in question has been jettisoned? Is that also for the sake of political expediency?
Mary Harney (Dublin Mid West, Progressive Democrats)
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If this were a matter of political expediency, we would continue building a new hospital in Crumlin and another in Temple Street. The original plan was for approximately 700 beds. McKinsey and Company examined 17 of the top tertiary children's hospitals in the world, on which basis it recommended a 380-bed hospital in the context of Irish demography. There will be fewer beds than at present because ever more children's services are being provided on a day-case basis.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The Chicago site will be 6,500sq. m.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy may laugh.
Liz McManus (Wicklow, Labour)
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I can laugh, since I hope the traffic moves in Chicago; it certainly does not move in Dublin.
Séamus Pattison (Carlow-Kilkenny, Labour)
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Please allow the Minister to speak without interruption.
Mary Harney (Dublin Mid West, Progressive Democrats)
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We should learn from what is happening elsewhere, instead of trying to——
Liz McManus (Wicklow, Labour)
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They have seen it in America, so it must work.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Does the Deputy favour a single hospital?
Liz McManus (Wicklow, Labour)
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The McKinsey report could have been decided in a way that deals with the serious criticisms raised by those in Crumlin.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The reality is that the Deputy is on everyone's side.
John Gormley (Dublin South East, Green Party)
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The Minister is not yet in Opposition; we ask the questions.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The Mater site is 20,000 sq. ft. Before the decision on the location, every paediatrician in Dublin, including Dr. Doherty, with whom I had many discussions, said that it was fantastic. I remember him telling me that co-location with an adult hospital would be fantastic; there is no doubt about it.
Issues have arisen regarding parking and access. One must remember that the hospital is for the entire country, since 48% of the children will come from outside the Dublin area. It was generally thought that a city-centre site, with many children arriving by public transport, would be best. The metro station will be adjacent to the site. Their parents may have to stay for a long period, with other relatives visiting. It was thought that it would be more accessible than picking a site on either side of the city. Experts were involved regarding traffic and choice of site.
I accept that when one does not choose the preferred site of certain individuals, people may oppose it. However, it reassures me greatly that parents of sick children in Crumlin have said it is great and that I should implement the plan without delay. That is the greatest reassurance of all, and those are the words that I like to hear.
Urgent care centres have not been compromised. Of the 25,500 child visits to Tallaght Hospital last year, for example, 19,500 were dealt with the same day, with no overnight stay. Thankfully, the vast bulk of sick children who require to attend a hospital are treated as day cases and do not require hospitalisation.
The new hospital will cater for very ill children with rare cancers and serious illnesses, many of whom will be in hospital for a considerable time. In the past, many such children would not have survived for more than a few days after their birth. That has changed, which is why co-location with maternity facilities, where high-risk pregnancies will be dealt with, was an important feature of the decision.
John Gormley (Dublin South East, Green Party)
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I do not know which parents of sick children the Minister consulted, but I have spoken to a fair number in my constituency, and I have yet to meet one who is happy with this decision.
I wish to return to certain points. Dr. Pat Doherty has been mentioned, and he is quite clear that no meaningful input or consultation with the paediatric community took place. That is his major problem, and perhaps the Minister might respond to that very serious charge. She says that she has held discussions, but he says that experts have had no meaningful input.
At first they welcomed the idea of a single hospital, but they now have serious reservations regarding access. Many parents have raised that question with me. The hospital may be too small but cannot expand, since there is no open space. The Minister seems oblivious to the litany of complaints. Perhaps she might answer this. The McKinsey report states very clearly that co-location with an adult hospital, while perhaps desirable, is not essential. However, certain criteria are absolute, and those concern the hospital's future expansion and accessibility by road and public transport. I hope that the Minister agrees that we ought to listen to the experts in this matter.
Mary Harney (Dublin Mid West, Progressive Democrats)
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It depends how one defines experts. Dr. Doherty is the chairman of the medical board in Crumlin. He is an anaesthetist of considerable experience. I am not a clinician and therefore unable to question his clinical judgment. However, I spoke to Dr. Doherty when he was informed of the decision at a meeting organised by the HSE on the outcome of the McKinsey report. Like all others to whom I spoke, he was extremely enthusiastic. Dr. Doherty's preferred location was St. James's Hospital, but the decision to locate it at the Mater was taken for several reasons.
It is not true that there is no room for expansion. In addition to what I described, 10,000 sq. ft. will be made available at Temple Street, so the hospital can be expanded. We must stop thinking in narrow engineering terms as if we were construction experts. I am now being advised that it cannot physically fit on the site, but the experts assure me that it can. I am told that we should facilitate those coming by car, but the vast majority of cars at current children's hospitals are those of staff members. I hope that improved public transport in this city will lead to a reduced need for staff to use cars, particularly when the metro is to be located there.
Deputy Gormley asked me what parents I had consulted. It was the parents' group in Crumlin that told me to act and not let anything delay implementation. Above all those people, to whom we must listen, want a state-of-the-art facility for their sick children, believing that current facilities leave much to be desired. The original plan was to build a new hospital in Crumlin and another in Temple Street. However, we would not achieve good clinical outcomes, subspecialisation or the kind of hospital that we deserve if we split it over two or three sites. World expertise points to that.
John Gormley (Dublin South East, Green Party)
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Why was the paediatric community excluded, as Dr. Doherty states in today's The Irish Times article?
Mary Harney (Dublin Mid West, Progressive Democrats)
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The paediatric community was consulted after the publication of the McKinsey review and was enthusiastic about its findings. Difficulties arose with some members of the paediatric community when the site was chosen. It is inevitable some people will be upset when one hospital must be chosen from among several. I understand that people have preferred locations. What is important, however, is that for the first time, we will have a world-class, state-of-the-art tertiary facility for sick children, collocated with an adult teaching hospital and, subsequently, a maternity hospital that will deal with high-risk pregnancies. This will be a major step forward in the treatment of sick children and it will be welcomed by the vast majority of people, notwithstanding the reservations of some that a particular site was chosen in preference to some others.
John Gormley (Dublin South East, Green Party)
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It is turning into a debacle.
Liz McManus (Wicklow, Labour)
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One might wonder why Progressive Democrats Ministers in the Department of Health and Children are quick to make allegations and innuendoes about those who disagree with them.
Mary Harney (Dublin Mid West, Progressive Democrats)
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What allegations have I made?
Liz McManus (Wicklow, Labour)
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The Minister of State who is seated beside the Minister made a serious allegation, which he was unable to substantiate, on national television last night.
The Minister is correct in her observation that there was goodwill towards the McKinsey report among the paediatric community. Does she accept that Our Lady's Hospital for Sick Children in Crumlin has no vested interest in this matter? The notion that staff in that hospital are engaging in some type of obstruction is not convincing given the hospital itself will not exist in the future. Four hospitals will be crammed onto the site of the Mater Hospital, including that hospital's adult and private facilities, the children's hospital and a maternity hospital.
Does the Minister accept this is one of several serious flaws that have emerged from this decision of the Government? Will she consider an independent view of the plan? Let us all be proved wrong. If an independent review concludes that this is the best site for a children's hospital, I will have no problem admitting to the House that the Minister was correct and I was wrong. Until that happens, grave doubts will persist. If the Minister does not have the goodwill of those working in paediatrics, including those working in Our Lady's Hospital for Sick Children in Crumlin, it will be difficult to make this proposal work.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept the facilities will be crammed onto the site. I could list many hospitals elsewhere in the world where the space is substantially less than what is being provided here. I am neither a construction expert nor a clinician. It is clear to me, however, that once the site was identified, some people were not as pleased as they might have been if another location was chosen. The merging of hospitals has not been done often in the past and it is not always a happy experience. It can take a long time for all types of reasons. Difficulties arose when St. Luke's Hospital was being amalgamated with St. James's Hospital, for instance, but the merged facilities are widely accepted as offering the best care for cancer patients. Some of these decisions are not easy for staff or patients and their families. If they are made on the basis of sound clinical advice, however, the vast majority of people will accept them.
I am often criticised for arranging too many reviews but now there are calls for another. I do not accept the need for such a review. We must move on. I will shortly announce the appointment of the team to oversee the development of the new children's hospital. The Mater Hospital was selected from among three contenders, the others being Beaumont Hospital and St. James's Hospital, and was recommended as the preferred site for several reasons. It was understandable there would be a certain degree of disappointment that other hospitals were not chosen.
To suggest, however, that this decision was motivated by anything other than the best interests of children is incorrect and unfair. No allegations are being made against anyone. I have spoken to everyone who wished to raise the matter with me. I made clear to the board of Our Lady's Hospital for Sick Children in Crumlin that, where possible, the issues raised in their report will be addressed but that the decision on location is final unless something arises of which neither I nor the advisory group is aware. If we are to allow further delays because of uncertainty over the site, we will simply delay the provision of this state-of-the-art facility. It was the unit in Trinity College which provided advice on transport, location and access.
John Gormley (Dublin South East, Green Party)
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The Minister and Professor Drumm always repeat this mantra about how we will deal with the capacity problem. In view of the major increase in the child population, however, it is clear we should increase the numbers of beds in paediatric services rather than decrease them from 480 to 380. How will the services cope with this reduction? I ask the Minister not to pass my question off by saying more patients will be treated as day cases. Does she recognise there will be a serious capacity problem if she proceeds in this way?
Mary Harney (Dublin Mid West, Progressive Democrats)
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No, I do not. Tallaght Hospital, for example, has a current occupancy rate of 40%, which means 60% of the beds are not in use.
John Gormley (Dublin South East, Green Party)
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Is it that simple?
Mary Harney (Dublin Mid West, Progressive Democrats)
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No, the McKinsey report advised that this site can take a further 200 beds.
John Gormley (Dublin South East, Green Party)
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The Minister is blithely dismissing the problem.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I am advised it can be further expanded to provide 580 beds.