David Norris (Independent)

It refers to the question of the provision of treatment facilities and services for the children in our community. In referring to our community, I mean the national rather than Dublin community. In the old days there were at least three principal centres for such matters, the Temple Street Hospital on the north side of the city, Crumlin in the west and the National Children's Hospital on Harcourt Street for those in the south. I remember that very well because I went to school quite close to it and people with broken legs were referred up there.

There was a series of reorganisation procedures and as part of that, the National Children's Hospital was incorporated into the hospital in Tallaght, although with certain substantial undertakings. Its identity was to be retained and the provision of facilities was to be funded. This has not happened. The brief given to the consultants was too restrictive and their hands were tied.

There is the question of access when all these services are concentrated in one area. I have been a great proponent of the metro and I noted the Minister speaking about the proposed service in my neighbourhood near the Mater Hospital. We hope the metro will run past that location, although there is a question mark over this because of financial constraints, but in any case people with sick children may not find it an appropriate method of transport. That should be borne in mind.

I have had a series of meetings with people representing the hospital in Tallaght. These were not the elite consultants and so on, although they would be supportive. They included the nursing staff, parents and technical staff. These people came here to meet with myself and Senator Déirdre de Búrca, who was also very much on side.

There is a certain degree of flexibility provided for at this stage with regard to the closure of the paediatric accident and emergency department at Tallaght Hospital, although this would remove a very important facility. This plan will result in the closure of all overnight beds in Tallaght and only day case beds will be present on site to deal with minor surgical cases. Once the reconfiguration of paediatric hospitals is complete, the urgent care centre will deal with minor scrapes, bumps, bruises, coughs and minor illnesses. All seriously ill children will face being transported across an increasingly congested city centre, involving delay and anxiety. In addition, people may come to the accident and emergency department and hang around to go through the initial stages before being told to go across to the other facility to start the process again. That is unsatisfactory.

These observations are highlighted in two documents, the RKW planning report and the statutory instrument that established the development board. In the planning report published in 2007, RKW indicated it was unable to consider the option of having two fully functional facilities — one on the north side and the other on the south side — to cater for the range of possibilities. That was recommended by the Irish Association of Emergency Medicine. The reason it could not consider the matter is because it was outside its remit. The consultants who prepared this report state that the concept of legitimate variation must be explored during the final planning stages.

The second document on which I am relying is S.I. No. 246 of May 2007, which established the development board for the new paediatric hospital at the Mater. Under section 5, it states with regard to board functions:

(a) to plan, design, build, furnish and equip a national paediatric hospital ("the hospital") in accordance with a brief approved by the Executive with the prior consent of the Minister, and subject to any subsequent variations to this brief as may be determined by the Executive in consultation with the Board, and with the prior consent of the Minister;

The important term is "subject to any subsequent variations to this brief as may be determined by the Executive in consultation with the Board, and with the prior consent of the Minister".

Although there is general support for the concept of a centre of excellence to deal with tertiary care for sick children, it should be noted that 18% of all hospital care comes under this category, leaving an overwhelming preponderance of sick children requiring easy and rapid access to secondary and tertiary care. One could argue that a large proportion of tertiary care in any case could be classified as elective, chosen or planned events. For example, there are specialised services, oncology and the diagnosis of serious illness. Some admissions will be emergency admissions but many accident and emergency admissions would come under a non-tertiary scenario.

Approximately 80% of the children in both Temple Street and the National Children's Hospital are admitted via the accident and emergency department, with the length of stay in the National Children's Hospital being 2.9 days. Emergency admissions are by their nature those which require speedy access to medical attention.

The Irish Association of Emergency Medicine has expressed serious concerns about the plan as formulated at the moment. For example, it has put the view forward that two fully functioning accident and emergency departments, with the back-up of overnight beds, would provide the "safest care" for sick children, which is a very important phrase. It has also indicated that urgent care centres as envisaged cannot replace the requirement for comprehensive emergency department care. That is a very serious case to be made.

A number of points and difficulties have been raised and it would be very helpful if the Minister could indicate that the flexibility that exists could be employed in the interests of the children of our country.