David Norris (Independent)
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I welcome the Minister of State to the House, particularly because we have a good Laois man in charge of this debate.

Eugene Regan (Fine Gael)
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The Senator is winning already.

David Norris (Independent)
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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.

John Moloney (Laois-Offaly, Fianna Fail)
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Unfortunately, the Minister cannot attend this afternoon and she has instead asked me to take this Adjournment matter on her behalf. The development of the National Paediatric Hospital is a priority project for the Government and the project is proceeding as planned. The Children's Health First report commissioned by the Health Service Executive indicated that the population and projected demands in this country can support only one world class tertiary paediatric hospital. It recommended that the hospital should be in Dublin and should, ideally, be located with a leading adult academic hospital in order to optimise the outcomes for children. Following detailed consideration, it was decided the most appropriate location for the new National Paediatric Hospital is at the Mater Hospital.

The development is being overseen by the National Paediatric Hospital development board, which was established in May 2007. The board has 12 members appointed by the Minister as follows: a chairperson appointed directly by the Minister, three members appointed on the nomination of the chairperson, three members appointed to represent the interests of the general public, two members appointed on the nomination of the HSE and one member each appointed on the nominations of the Children's University Hospital, Temple Street, the National Children's Hospital, Tallaght and the Faculty of Paediatrics, Royal College of Physicians of Ireland. There is currently one vacancy on the board to be filled on the nomination of Our Lady's Children's Hospital, Crumlin.

The board has appointed a number of key personnel, including a chief officer, a medical director and a finance officer. A detailed design brief for the new hospital is due for completion during the second quarter of 2009. The design brief will be converted into an exemplar design, outlining the exact dimensions and specifications for the new hospital to allow the project proceed to tender for construction. A more accurate estimate of costs will be available at that stage. The project is scheduled for completion in 2014. The HSE has advised that €5.3 million has been expended on the project to date and the Minister looks forward to continuing progress on this important development.

David Norris (Independent)
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I thank the Minister of State for his reply and ask a few questions. He pointed out that the Children's Health First report recommended one centre of excellence but that does not answer the question about two upgraded accident and emergency units. This is recommended by the leading authority on the subject in the interest of what it describes as the safety of children. That is an important point.

My second point is that flexibility is provided by two documents such that the project can be changed in that minor way. I am no longer challenging the location of the hospital, although there are grave questions marks over it, but that matter is now history.

The Minister of State indicated there is one vacancy on the board.

John Moloney (Laois-Offaly, Fianna Fail)
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There is.

David Norris (Independent)
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It is a significant vacancy. It is one to be filled on the nomination of Our Lady's Children's Hospital, Crumlin, which has these exact reservations among others. That is a real problem.

I note the list of board members contains some distinguished people, including some friends of mine such as Harry Crosbie, who is a remarkable man. The sum of money the Minister of State indicates is being spent, that of €5.3 million, is considerable. An article appeared which indicated that €28.5 million had been approved for Project Management Limited — Beechams Solicitors to provide business services. That is a great deal of money.

Pat Moylan (Fianna Fail)
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The Senator has made his point.

Michael McCarthy (Labour)
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It is a long point.

Pat Moylan (Fianna Fail)
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Senator Norris has made his point well.

David Norris (Independent)
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There is flexibility in this regard and we need to examine it.

Pat Moylan (Fianna Fail)
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That is a long-winded question.

Michael McCarthy (Labour)
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It is.

David Norris (Independent)
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I would like the Minister of State to convey the points I have made to the Minister.

John Moloney (Laois-Offaly, Fianna Fail)
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I certainly will. On a point of clarification, the debate on this project has moved on and settlement has been reached on the location. I welcome the fact that the Senator also accepts that point.

I am not sure as to the reason the board vacancy to be nominated by Our Lady's Children Hospital, Crumlin has not been filled. That information is not available to me. It has not been indicated that the hospital will not fill it. Apparently, it will fill it but the nomination has not yet been submitted.

Regarding the Senator's concerns about there being two accident and emergency departments, that is a matter for the board, which has now been put in place. I am not sure what the final decision on that will be as that matter has not been concluded. I will ask the Minister to correspond directly with the Senator on that specific point.

David Norris (Independent)
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I thank the Minister of State for that.