Alan Shatter (Dublin South, Fine Gael)
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Question 68: To ask the Minister for Health and Children her plans with regard to Tallaght Children's Hospital; and if all medical and surgical services presently provided by the hospital will continue to be so provided. [17483/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I recently signed an order establishing the National Paediatric Hospital Development Board on a statutory basis. The development board held its inaugural meeting last Monday.

The principal functions of the board will be to plan, design, build, furnish and equip the new National Paediatric Hospital in accordance with a brief to be approved by the Health Service Executive. The brief will set out the preferred model of care, the core services to be delivered at the new hospital, and the additional range of services to be provided in an urgent and ambulatory care setting, taking account of international best practice.

The HSE is being advised in this context by Rawlinson Kelly & Whittlestone Ltd., RKW, an established UK-based health care planning company. In finalising its work RKW, together with a panel of international advisers, has arranged a series of meetings later this week with key stakeholders, including the three paediatric hospitals.

I am aware that the position on the provision of paediatric services at Tallaght has been a matter of concern for the hospital and the local community. I was therefore pleased to confirm recently, that a major ambulatory care centre at Tallaght will be advanced as part of the initial phase of the new paediatric hospital's development. The ambulatory care centre at Tallaght will offer a comprehensive and wide range of services to children, including an urgent care service, a major expansion in outpatient services and a significantly increased day surgery service.

This followed an analysis of the current location of major paediatric populations in the catchment area for the new hospital and the need to minimise the travel time for children requiring access to such services. Most attendees at the existing children's accident and emergency unit at Tallaght do not require admission and will continue to access their care at the ambulatory care centre.

Alan Shatter (Dublin South, Fine Gael)
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I congratulate Deputy Brendan Howlin on his new position.

Will the Minister tell the House what paediatric services currently provided in Tallaght Hospital will be removed from the hospital? Is she aware that the widespread concern across the community about her plans to close down Tallaght as a paediatric hospital derives from serious concerns about the inaccessibility of the Mater site, and this Government's breach of faith with the original board of Harcourt Street Children's Hospital, to whom it said that a paediatric hospital would be maintained indefinitely in Tallaght? Will she indicate the time frame for transferring paediatric services from Tallaght to the projected new hospital on the Mater site?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The board's remit is to put the new hospital in place to have it operational in 2012. I was happy to hear from the chairman and the board members, whom I met on Monday, that they believe that ambitious deadline can be met. Among the functions of the board is to work on the transfer from the three existing hospitals. No tertiary facilities exist at Tallaght. Those that were there moved to Crumlin Hospital some time ago. I understand that between 80% and 85% of the patients treated in Tallaght will continue to be treated there. The facility will operate from 8 a.m. to midnight. There will also be an ambulance service to transfer patients who need to be transferred to the tertiary facility at the Mater. The volume of activity in Tallaght will increase substantially depending on whether there are one or two additional centres on the south side and maybe the west of Dublin but that has not been determined yet. I am happy to furnish the Deputy with a copy of the list of the activities envisaged in the ambulatory care centre in Tallaght Hospital.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome the Minister's colleagues, Deputies Brendan Smith and Jimmy Devins, and commend and congratulate them on their respective appointments and wish them the very best in their areas of responsibility. I am sorry to say I cannot give the same welcome to the Minister with the health portfolio because her approach to health care and the needs of our people do not meet at all.

Does the Minister accept that the board of Tallaght Hospital maintains that the loss of its paediatric services would be in breach of the charter which established the hospital and which was passed by the Houses of the Oireachtas? Does she also accept that it would clearly be in breach of a personal promise, made by the Taoiseach in 2006, to the leaders of the various Protestant denominations who are represented on the board? Does the Minister further agree that, given the growth in population in south Dublin and Leinster, served by Tallaght Hospital, the loss of paediatric services would present an unacceptable danger whereby the safety, wellbeing and perhaps even the lives of young children would be put at risk?

Finally, does the Minister agree it was a disgrace for the HSE effectively to threaten the board of Tallaght Hospital that if it did not accept a co-location private hospital on its site it would not receive funding for the additional public hospital beds it required?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am well aware of the Deputy's views on myself as they were well publicised in the aftermath of the election. I am, however, delighted to see him back in good health and I say so genuinely.

As I understand, the board of the National Children's Hospital, Tallaght and certainly the paediatricians in the hospital generally support the move to a single tertiary hospital for sick children. I have not met all the paediatricians but have met many from all over the country and I have yet to meet one who does not support what we are doing, which represents best practice internationally to get the best possible state-of-the-art hospital for very sick children. Most clinicians in the area, whether nurses or doctors, would strongly favour that.

I am not an expert on the charter but do not believe any charter would put patients' safety second to anything else. For those with serious organ failure and serious illnesses there can only be one tertiary level centre with the expertise required in a country such as ours, with a population of 4.3 million, or even on the island of Ireland. That centre must be co-located with the national hospital because even with sick children we will not have sufficient numbers in the different specialties for sub-specialists to be able to deal only with children. I do not accept that the decision that has been made in any way undermines Tallaght Hospital.

Finally, the HSE did not bully, harass or threaten Tallaght Hospital. It told Tallaght Hospital to make up its mind and asked if it wanted to proceed with co-location or not. That was not unreasonable and I am pleased to say the board unanimously agreed to go ahead.

Brian Hayes (Dublin South West, Fine Gael)
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With a gun to their heads.

Alan Shatter (Dublin South, Fine Gael)
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I am surprised the Minister has made this decision without reading the Tallaght Hospital charter. I suggest she does so because what is now proposed is contrary to the charter and amounts to a serious breach of faith on the part of the State towards those involved in Tallaght, and particularly those involved in the move of the National Children's Hospital from Harcourt Street to Tallaght.

Will the Minister acknowledge that, while paediatricians rightly favour the provision of one tertiary centre of excellence, they have major reservations about the Mater Hospital site? It is untrue to suggest they support it. Does the Minister acknowledge the proposed ambulatory centre will have no accident and emergency facility, no inpatient beds and will not be open after midnight? Does the Minister accept that, given the current needs of the population catchment currently served by the paediatric section in Tallaght Hospital, there will be a grossly inadequate service? Can she also confirm to the House the point she appeared to make in her response that, while 80% of the procedures currently provided by the National Children's Hospital, Tallaght will continue, 20% will not continue? Am I wrong or is she unable to identify that 20% to the House? Can she clarify the 20% of services currently provided which will be discontinued in Tallaght Hospital?

Brendan Howlin (Wexford, Labour)
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We are well over time on this question but a number of Deputies wish to come in so I will ask the Minister to be as brief as she can and I will allow two more brief supplementaries.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I fully accept that not everybody is in favour of the Mater Hospital site. If the impression was created that everybody was happy then it was wrong. Of course they are not, but I do not believe that there is any site in the country to be co-located with an adult hospital that would have met all the requirements.

I said that 84% of the children that attend the accident and emergency department in Tallaght Hospital do not get admitted. The children's hospital in Tallaght has a 40% bed occupancy, so 84% of children who present there are dealt with and go home. We believe this will continue to be the case in an 8 a.m to midnight facility. There will be ambulance facilities in the hospital and very few children get transported to hospital between midnight and 8 a.m. Having a single facility in the city that will take children between those times is not unreasonable. Given the level of care that will be provided there, it will be much more reassuring for the parents of sick children, many of whom I have met. The message they have given me, whether they are parents of children in Tallaght, Crumlin or Temple Street, is to get on with it and give them the hospital they deserve.

The Deputy is right to say there will not be inpatient beds, as it will consist of day procedures and activity in the accident and emergency departments. I am not in a position to say what is appropriate in 2012 on a day basis and what requires inpatient facilities. That will be a matter for clinical decisions and not for me.

Liz McManus (Wicklow, Labour)
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I thank the Minister for clarifying her statement because she accepts that there is deep anxiety among many paediatricians who have given their working lives to the care of children and have expressed very strong concerns about her policy on this hospital. Does she accept we do not live in an ideal city? Transport congestion is a serious block to children accessing care. Rather than seeing it as a question of one site, a hospital could be provided on two sites north and south of the Liffey. She has completely dismissed that option.

Brian Hayes (Dublin South West, Fine Gael)
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When does the Minister envisage the publication of the RKW report? If the report comes to the conclusion that the existing site is not sufficient for the kind of development of a world class tertiary hospital in Ireland, will she reconsider it?

Where did the Minister get the information that there is a 40% bed occupancy for the National Children's Hospital in Tallaght? I can tell her that it is wrong.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I got it from my Department and from the HSE.

Brian Hayes (Dublin South West, Fine Gael)
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Maybe she should ask them again.

Mary Harney (Dublin Mid West, Progressive Democrats)
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If the Deputy gives me the correct figures, I will be happy. I have quoted that for the last year and it is yet to be contradicted. It may have increased in the last few weeks, but I am referring to the period 2003-06.

Brian Hayes (Dublin South West, Fine Gael)
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She should speak to some of the paediatricians.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have spoken to many of them and I think the Deputy is aware of that. We are following the advice of what happens in the best children's hospitals in the world. Most of those hospitals are downtown in the centre of the city, co-located with research facilities, adult teaching hospitals and so on. When the consultants were appointed to look at 17 different children's hospitals, they came to a strong recommendation that this was the way forward for our population base. I do not think a good model of care is provided if experts have to travel from one site to another. It is better that all the expertise is together.

The development board must develop a hospital. It must appoint a CEO and take the design that will be given to it by the HSE. None of that will happen until we get the RKW report. After the consultation this week with the stakeholders, my understanding is that RKW intends finalising the report in a matter of weeks.

Brian Hayes (Dublin South West, Fine Gael)
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So the Minister has been tipped off.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have not been tipped off. It is in the ambulatory care centre. Does the Deputy not want it in Tallaght?