Wednesday, 17 November 2010
National Paediatric Hospital: Statements
I am pleased to be here to speak about the national paediatric hospital.
The national paediatric hospital is a major priority project for the Government and notwithstanding the financial pressures the country is under, the capital funding for the project is protected in the four-year plan which will be submitted to the European Union in the next ten days or so. The reason it is protected is because the status quo as far as sick children are concerned is not an option.
In 2004, when I became Minister for Health and Children, the plan was to build a new hospital for Temple Street at the Mater hospital site and also to build a new hospital for Crumlin. Between them, they were to have approximately 700 beds and cost somewhere in the region of €600 million to €800 million. The view was taken by many paediatricians in the country that instead of building two new hospitals and also keeping Tallaght hospital, we should look at the prospect of bringing all of the children's hospitals in Dublin together to create a world-class tertiary children's hospital for the sick children of Ireland.
McKinsey was appointed to carry out a review of paediatric services in Ireland and to examine global experiences in this regard. It looked at 17 children's hospitals around the world and all of those hospitals were co-located with adult hospitals. McKinsey recommended, given the relatively small number of sick children in Ireland and given the requirement when it comes to complex care and sub-specialisation, which is a strong feature of medicine, that many of the clinicians that would work with very sick children would also have to work with adults and the new children's hospital should be co-located with an adult teaching hospital. In addition to the benefits from a clinical point of view in dealing with complex cases and sub-specialisation, there are significant synergies that come from a research perspective and, obviously, there are considerable savings from bringing all of those hospitals together. We estimate the bringing together of the three hospitals from a back-office point of view will save in the region of €25 million to €30 million a year alone in operating costs.
The Government endorsed the McKinsey report on the recommendation of the HSE and then a group was put together chaired by the OPW - the late Mr. David Byers, a highly respected architect in OPW. There were 12 persons on that group, including representatives of different Departments, those with architectural expertise and site expertise, to receive applications on where that hospital might be located.
When the McKinsey report recommended co-location with an adult hospital, the three hospitals in Dublin - Crumlin, Tallaght and Temple Street - all endorsed that very enthusiastically. I remember having many meetings with different paediatricians in the city and they felt this was the appropriate future for sick children. When, however, we came to deciding on the site it was a different matter.
A number of sites were advanced. Tallaght was advanced, St. Vincent's was advanced as a possibility, Blanchardstown made a case, and so did Beaumont, the Mater and St. James's hospitals. It came down to two sites, either St. James's hospital or the Mater hospital.
The St. James's hospital site had a number of difficulties with it. It was a site that had restrictions and there were issues around the preservation of buildings on that site. The Mater hospital site was an unencumbered site and, therefore, it was felt that it was appropriate.
In any event, some of these sub-specialists who will work with sick children will still be attached to Beaumont and they will travel to the Mater hospital site to treat sick children, and some of this expertise will be in St. James's hospital and they will travel to the Mater hospital site as well. At present, what happens is the children travel to the doctors from the different hospitals. When the new hospital is built, most of the expertise will be located within the hospital but some of the expertise, because it will work with adults, will be located in other hospitals that have national tertiary facilities in the city.
At that point a major controversy arose. This controversy is not unique to Ireland. Last week there was an event in Farmleigh for the Crumlin Foundation where a doctor from Manchester spoke. He stated that for 40 years there was much bickering among the three hospitals in Manchester. It took them nine years to decide where to locate the new hospital, but they are now together in one hospital and it has been a breathe of fresh air. He spoke as somebody who was sceptical of bringing the three hospitals together.
After the site was selected and the development board was put in place, RKW, a world expert on hospital planning, came to advise on the requirements of the hospital. It also looked at 17 different hospitals around the world. In fairness, many of the hospitals were similar to the ones at which McKinsey looked. Between the two, 25 different hospitals were examined. Twenty-four of the 25 hospitals are co-located with adult hospitals. Right around the world that is seen as the future for paediatric care, that one brings not only the children and the adults together, but also maternity, so that high-risk pregnancies can be dealt with in the site that deals with very sick children and where mothers can be dealt with as well in an adult facility. The new hospital will cost approximately €650 million. Of this, €450 million will be made available by the taxpayers. At present, €400 million is in the capital plan and there will be an extra €50 million in the capital plan next year. To date, €25 million has been spent on the planning phase and on the various expertise that has inputted into the requirements of the hospital. There is a shortfall of up to €200 million. Of that, €90 million will come from commercial sources such as car parking, retail space in the hospital and consultant rooms and €110 million will come from philanthropy. I know many people are sceptical about €110 million being raised from philanthropy over the next four years. In Canada the year before last, $98 million was raised through philanthropy for a children's hospital. Throughout the world, children's hospitals are the easiest to raise money for, but I am not stating that it will not be a challenge.
The new chairman of the board, John Gallagher, has a fantastic track record in philanthropy. He has much expertise and experience and at present the board is putting together the foundation that will raise this philanthropy. The hospital has received charitable status from the Revenue Commissioners. Recently, I visited New Zealand and saw the Starship Children's Hospital which raised a considerable amount of its funding from philanthropy. Tied to the philanthropy will be the research input. Pharmaceutical companies, medical device companies and companies which supply inputs to children's hospitals are always keen to provide philanthropy where it is tied in with research. A very central part of this new children's hospital will be the research dimension and we should not underestimate its significance.
All of the rooms in the hospital will be single rooms. These rooms will have parent accommodation and it will be the most modern hospital that this country can provide and afford. It will provide an environment not only for sick children but also for those who work with sick children that will be among the best in the world. I have had an opportunity to visit a number of children's hospitals in recent years. In Chicago, the children's hospital is being moved from the equivalent of Ballsbridge in Dublin to the equivalent of Grafton Street, just off Michigan Avenue. The reason it is being moved to the centre of the city is to be co-located with an adult hospital for all the reasons, synergies and benefits that have been recommended here.
When the parents of sick children came to see me in 2004 they stated they did not care where the new hospital would be, they just wanted me to make it happen. When McKinsey reported, the parent's group from Crumlin hospital commissioned Dr. Pollock, a very well-renowned paediatrician and well-known in Ireland because he has advised us on our cystic fibrosis strategy, to advise it on whether the new hospital would provide the environment necessary for sick children. The parents asked him one question, which was whether the new hospital on the proposed site could provide the international standards of excellence in tertiary health care for their children. His response was that it most certainly could. The synergy created by assembling some of the best clinical and research skills in the country on a single site would create the environment for Ireland to progress further in international standing with measurable benefits for children and adults. To this day, the parents of sick children at Crumlin hospital remain totally enthusiastic for this project.
It is the case that there has been controversy about the site and some people advance every single argument as to why it should not happen. I sometimes feel that if they wake up and hear a negative, it is music to their ears. I would understand the controversy if the Government was withdrawing funding and naturally it would be right that there should be controversy. I do not understand the controversy surrounding the site. I accept that there are access issues and they have to be rectified by Dublin City Council. As the Bristol inquiry stated, however, the issue of access must be secondary to the quality of clinical care for children. That was the outcome. There is no site in the country-----
The faculty of paediatrics in Ireland, which is the educational and professional arm of the institute for paediatrics attached to the Royal College of Physicians of Ireland, said in a recent statement that it strongly supports the proposed new national paediatric hospital and recommends that adequate funding be provided to equip and staff the hospital to the best international standards in child care. The faculty recommended that the project proceed as a matter of urgency and stated it is keen to advise in the ongoing discussions on the optimum delivery of care for children.
There are individuals, and I do not want to take away from this, who are not enthusiastic but in my view they are in a minority. A case has been advanced for a stand-alone site on the periphery of Dublin in my constituency. We have been told it would cost half as much. It would also be half the size. It would be a stand-alone facility, not co-located with an adult hospital or a maternity hospital. Not only are all the recommendations on paediatrics that there should be co-location with adult and maternity hospitals, the maternity review has recommended there should be no more stand-alone maternity hospitals. They are a thing of the past. Worldwide, stand-alone hospitals in any area are a thing of the past. The recommendation on maternity is that the Coombe Women's Hospital should move to Tallaght Hospital, Holles Street hospital should move to St. Vincent's Hospital and the Rotunda Hospital should move to the Mater Hospital site for many of the same reasons it is recommended paediatrics should be co-located with adult hospitals.
To return to a question asked by Senator Norris, the Bristol inquiry stated, "quality and safety should prevail over ease of access".
Quality and care. Many of our very sick children travel outside this jurisdiction. Many of us who have met the parents of very sick children know they would go anywhere in the world to have the best care for their children. We are speaking about tertiary facilities for children from the entire country. Many of them will arrive by helicopter and others will come by ambulance. They will come from other hospitals throughout the country. It will also provide secondary care for children in the Dublin region and it is estimated that 65% of the children attending the hospital will be from the Dublin region.
The will be an ambulatory care centre at Tallaght Hospital which will provide ambulatory care on a day case basis. I know Senator Fitzgerald will be interested in the Tallaght facility and I want to put on the record what will happen there. It will provide emergency and elective ambulatory care. Medical and surgical day care services will be provided through 28 day care beds, three operating theatres and two procedure rooms. Outpatient services will be provided through 26 consulting examination rooms. The urgent care centre will also provide emergency care services for the local population of children and this will be co-terminous. It will be done at the same time because it is an integral part of the project.
The new children's hospital will have 445 beds with 392 inpatient beds and 53 day beds. All inpatient rooms will be single with en suite facilities and overnight accommodation for parents. There will be 62 critical care beds divided into intensive care and high dependency. There will be 13 operating theatres and two procedure rooms. There will be an emergency department, a family resource centre, play areas, external gardens and courtyards, a therapy park with hydro pool and gym, a hospital school, 1,000 underground car parking spaces, family accommodation provided by the Ronald McDonald House charity, and undergraduate, postgraduate and continuing professional education facilities. The hospital will be 112,000 sq. m and will be 16 storeys high. In many debates that have taken place worldwide it has been suggested that vertical delivers better quality than horizontal. I have followed some of these debates and last week I read a very good article on this. Some advance that a vertical environment, where everyone is much closer to theatres, critical care, intensive care and access to car parks, has a very positive impact on the outcome of care rather than the traditional layout where one might walk not quite for miles but for long distances to get from A to B in a hospital.
I am happy we are having this debate in the House. It is important we all support the project as the parents do and as most paediatricians do. I accept it is not unanimous. The board of Crumlin hospital is represented on the development board, which is chaired by John Gallagher because a vacancy occurred in recent times. I urge everyone concerned about sick children in Ireland to come behind this project. If for any reason this project were not to proceed, we would not see a new children's hospital in our lifetime. Of this I have absolutely no doubt. The alternative to having this facility is the status quo and this is not acceptable. Neither Temple Street hospital nor Crumlin hospital are fit for purpose and anyone who has visited them recently will have seen the huge inadequacies in both of these hospitals. They are very old hospitals.
It would require major refurbishment but refurbishment is not possible because of the age of both hospitals. It would require significant capital investment to make those hospitals fit for purpose which, I suggest, is a sum of money in excess of the money to build this new hospital. It will be a great testimony to the will of the people of Ireland, notwithstanding the current financial circumstances, to continue with the project. The development board began discussions with An Bord Pleanála on 5 November as this is considered to be a strategic investment project. An Bord Pleanála has approximately three months to indicate whether the project qualifies as a strategic investment project - we believe it qualifies- and a formal application will then be made. The intention is that planning permission would be granted in the autumn of next year and that construction would begin at the end of 2011 and be completed at the end of 2014 with the hospital being commissioned at the start of 2015.
I thank the Minister for coming to the House to deal with this debate. She is one of the few Ministers who always attends the House for debates related to her Department and it is appreciated.
The development of the national paediatric hospital is a significant project for any country and it is a critical part of the infrastructure. Those of us familiar with the children's hospitals in Dublin know the appalling conditions and the very difficult circumstances with which they have struggled. It is clear there is a need for rationalisation. It is a shame that the development of this project has been so dogged by controversy and continues to be, even in recent weeks and despite the progress which the Minister outlined and the current state of the project.
I did not use a script. If the Senator requires any clarification I am happy to provide him with all my documents. I have about five files on this hospital in my office and I am happy to share them with the Senator.
The Minister in her contribution said she did not understand the controversy. The main concerns of the ordinary people of the country and the parents of sick children have been about access to the centre city site. This is fuelled by the fact that the outpatients' departments in Crumlin, Temple Street and Tallaght hospitals each deal with 30,000 children a year. The country also has a growing population with an increasing urban population. The concerns about access and the prospect of the closing of the other hospitals have been central. There are other concerns but these are the key concerns. I refer to the critical timeframe of 60 minutes within which to get a sick child to hospital, the so-called golden hour. There is a worry about accessing the Mater hospital site and whether there will be sufficient parking spaces. I acknowledge some children will be brought in for specialist treatment and the Minister referred to the use of helicopters. I do not know how feasible this will be or how many children such a service will affect. The key issue is about easy access for other children to the site. Public transport is difficult to use if one is bringing a sick child to hospital so the number of car parking spaces is critical if people are to feel safe when travelling to the hospital and are able to get there quickly.
The project has been dogged by controversy with regard to the site and access to it, with regard to the process and funding and with regard to a number of other issues. I accept the Minister's bona fides on her wish to do the very best for sick Irish children and I do not doubt her motivation. I believe she will be supported in her desire to achieve this. We all know about the existing facilities, the lack of rationalisation over many years and the resistance from professionals. These problems are evident in schools and hospitals and everywhere, even in the system that pertains in the Houses of the Oireachtas. None of it has been in the interests of children. It is a shame that such a key project has been so mired. I refer to the move of the Coombe hospital to Tallaght which will take place and which has been achieved by agreement. It has not attracted any of the kind of controversy that has dogged this project and this site.
I ask for information about some of the current concerns, if not today then in writing at a later date. The Minister referred to the ambulatory care centre in Tallaght. This is a key project, given the numbers of children attending the various hospitals. Is the funding in place for this project and will it be in place? There was discussion in this House previously about whether this would be an eight-hour, 12-hour or 24-hour facility. I assume it will be a 24-hour facility - it has been called a 23-hour facility because it is not intended to be an overnight facility. Will the Minister accept that, in effect, some children will inevitably need to stay overnight? A certain number of children will require anaesthesia or intervention and will too ill to be moved. There is no doubt that the facility will need to provide overnight care for some group of children.
I expect there will be substantial demand on that facility, given the numbers I have quoted and the fact that one accident and emergency department will not address the needs of the entire city, plus the children coming from around the country. My questions about this facility are about the timeframe. Can the Minister reassure the many parents whose children will be attending that facility from west Dublin and beyond that it will be available at the same time as the hospital on the Mater site? Are plans in train for the facility? What is the timeframe for funding? Will it provide 24-hour care? These are critical questions.
I refer to a recent survey of the public attitude to the Mater site for the hospital which showed it received very little national support. What is the Minister's view on the transport and access issues? What is the message to parents? It is clear the public need much more information if it is to be convinced of the merits of the site. People in general and parents in particular are worried that the Mater site is too centre-city and that parking will be too difficult.
Many people noted the recent disagreement between the Minister and the chair of the board, Mr. Philip Lynch, who resigned or, depending on whom one believes, was asked to resign by the Minister. He said he was not satisfied he would be able to raise questions he wished to raise and he was either forced to resign or resigned because he raised questions he believed should be addressed. The Minister has issued a statement on this matter but I ask her to take the opportunity today to address his concerns. The funding gap is clearly a key concern.
I have come from a briefing by the Jack and Jill Foundation. The Minister has said that philanthropy would hopefully supply a funding of €110 million. The Jack and Jill Foundation funds care for extremely ill children in their own homes. It states that over the past two years, donations are down by 25% while nursing bills are up by 40%. One would imagine philanthropic organisations willing to support sick children would be able to raise that kind of funding and one, therefore, wonders about the reality of the funding of €110 million at this time in Ireland. That is not to say it is not feasible to raise it but given the financial situation and the great demands on all charitable organisations and the drop in donations, is it realistic to think that within two years a total of €110 million will be available from those organisations? Where is the other €90 million? The proposed sum of €90 million to be raised by the coffee shop and parking charges seems like a lot of money.
Yes, but €90 million still seems a lot of money to raise from such sources. People still have concerns about the reality of the approach to the funding of this project at this time. I think the Minister will understand the reason for their concerns. Is it a viable project? The Minister seems to be saying she considers it a viable project even in the current situation. We have had the first indication this morning that the hospital will be part of the Government's four-year funding strategy. The Minister clearly received a guarantee, but can she assume it will be supported by our visitors from Frankfurt, Brussels and Washington? Can it be ring-fenced?
The Minister has been criticised for not putting in place the clinical and governance structures, but I assume work is ongoing in this regard. A considerable amount of work was required in agreeing on the governance structures at Tallaght hospital. Three entities will be brought together in the new paediatric hospital. What is the timeframe for developing governance structures and the Minister's thinking on them? People will hold different points of view on the moral and ethical questions that will undoubtedly arise. If one takes paediatric research, for example, genetic investigations will play a critical role. It is important, therefore, that the governance structures are clarified in advance, given the ethos at the location selected for the new hospital.
Let me interrupt the Senator briefly, as I can help her on that matter. As the site was donated to the State, in terms of governance, the hospital will not be the Mater Catholic Hospital. There is considerable misunderstanding on this issue.
The nuns donated the site to the Exchequer and it is now owned by the State. I held a number of meetings with the chairmen of the three hospitals on the issue of governance. We need to develop the right governance structures. Tallaght hospital is not a good example because, as the Hayes report revealed, serious governance issues have arisen there. I hope to reach agreement on the governance structures in the early part of next year.
That is very helpful because there is significant confusion. Representations were made to me on governance issues. I, therefore, welcome the Minister's clarification that the site was donated and that the governance structures will be different from what one might assume given the location.
Questions were asked about the process of site selection with reference to the transport studies conducted. At least two of the international paediatricians involved in the process considered they had not been consulted to the extent they had expected. Philip Lynch raised other concerns. The bottom line is access. I accept the Minister's bona fides in wanting to provide the best treatment for sick children and concur with her points about rationalising services and the need for high standards. There is no question that parents will go to the ends of the earth to obtain the correct treatment for their children. It is unfortunate, therefore, that such a worthy project has been dogged by concerns. I thank the Minister for her clarification of governance issues and look forward to hearing further details on the outstanding question of funding.
In regard to Senator Fitzgerald's comment on the controversy about access, I would want my child to be treated in the best facility at the best location, as supported by the evidence. It is not edifying to see access being used as a political football. Hospitals are located cheek by jowl in every city in the world. The Government's priority is to provide the best standard of complex hospital care for children. To further this priority it is fully committed to the construction of the new national paediatric hospital on the Mater Hospital site. A paediatric hospitals operations group has been established to oversee ongoing network management and the enhanced integration of the three paediatric hospitals in advance of the transfer to the new national paediatric hospital. The report, Children's Health First, recommended that the new hospital be located alongside a leading academic teaching hospital in Dublin. The principle of locating it alongside a leading academic teaching hospital is in line with international best practice and enjoys widespread support.
The current estimated cost of construction of the entire project is €650 million, a significant reduction on earlier estimates. A total of €400 million will come from the taxpayer; €50 million from the HSE for the ambulatory and urgent care centre at Tallaght Hospital; €90 million from car park, research, education and other funding elements; and €110 million from philanthropy. While challenging, the philanthropic funding element is considered to be a realistic sum for a project of this size. The Minister investigated projects around the world which have been supported by philanthropic funding and I am sure this one will succeed if she puts her head to it. Construction of the new facility to merge the three children's hospitals on one site on Eccles Street, Dublin could start as early as next year and we are on target to admit the first patient in 2015.
Access and parking have emerged as the key issues because they are easy to speak about. The hysteria evident on the "Liveline" programme was over the top. Some have suggested the existing three hospitals should remain in place, but this would be a tragedy. The facilities at Our Lady's Children's Hospital in Crumlin and Temple Street Children's Hospital are desperately outdated and beyond improvement. Three years ago I had occasion to visit a child at Crumlin hospital. As an Irish person, I was embarrassed and shocked to see the state of the hospital. What was going on to allow the hospital to be run into the ground? I could have been in the Third World. As a country, we focused on economic development, with the result that we have beautiful state-of-the-art factories, but I will never forget the condition of Crumlin hospital. I do not know why previous Ministers for Health and Children did not realise there was a need for a new hospital many years ago. For that reason I am completely behind the Minister.
The debate must focus on the quality of care a tri-located hospital can provide for adults, children and maternity patients, the calibre of clinical staff it can attract and the ground-breaking cures its combined research facilities can unearth. The argument should not revolve solely around questions of access and parking. Dr. Eilish Hardiman, CEO of the National Paediatric Hospital Development Board, has stated that while total consensus among the medical community was never possible, the majority of paediatricians supported the project.
The new hospital will comprise 16 stories and cover 112,000 sq. m. The building will include 13 operating theatres for inpatient and day care cases, as well as two procedure rooms. All inpatient rooms will be en suite and contain facilities providing accommodation for parents. Family accommodation will also be made available adjacent to the Mater Hospital site by the Ronald McDonald House charity. The new hospital will include a therapy park, with hydro-pool and gym, play areas, a family resource centre and a hospital school.
I wish the Minister the best of luck in getting the facility up and running at the earliest opportunity for the sake of the children of Ireland.
I welcome the Minister, although she is leaving the Chamber. I am sure the Minister of State at the Department of Health and Children, Deputy Moloney, will communicate my views to her. It is a pity a script was not supplied because, even though I was present to hear most of the Minister's contribution, I had a difficulty in catching her more technical comments. Furthermore, I missed part of her contribution because I had to leave to take an urgent telephone call. To assist in the proper running of the House, there should be a requirement on Ministers to circulate copies of their speeches, especially on important matters such as this. The Minister is extremely competent. She is very good at dealing with matters on her feet and throwing out general and vague ideas. It is not enough for her to believe she is supported by a majority of consultants. We need to know how many hold the different opinions on this issue. If we know how they are divided, as parliamentarians, we can make a decision on the evidence presented. The Minister is highly driven. However, I do not always happen to believe in the ideological forces driving her. It is important, therefore, that we receive this information.
For a number of reasons I wish to speak briefly about the timeline for this development. A number of years have passed since I placed a motion on the Seanad Order Paper asking the Government to establish an international peer review of the hospital, particularly its location. At the time - three, four or five years ago - I was advised by senior professionals in the paediatric field that such a review was necessary. It was suggested it could be conducted expeditiously, perhaps within six weeks. It is a matter of concern that the proposal was not accepted by the Government. I have highlighted this point because I do not want it to be said I am a Johnny come lately who is raising objections at the last minute. I am not one of those colourfully referred to by the Minister as "rocking with delight" when they hear bad news in the morning. I do not have an appetite for bad news. I consider it necessary for a good, modern, national facility to be established in the interests of our children's welfare. If we are to make a proper and balanced decision on the matter, we need access to all of the information. I am not a Johnny come lately. I made a rational request for the matter to be reviewed. It would not have significantly impeded or delayed the development of the hospital. It would have cleared the air and made it absolutely obvious that there were no vested interests involved. It would have made it clear that the process of deciding on the location and development of the national children's hospital was proper, fair and judicious.
This has re-emerged as a central issue principally because of the resignation of Mr. Philip Lynch in recent months. This was an astonishing development. His departure was subject to obscurity because he said he had resigned but the Minister said she had pushed him. It is not clear whether he resigned or was pushed. He went in any case. He outlined the reasons for his departure in a statement:
There were fundamental differences between the Minister and myself on the need for open and informed discussion at Board level at all times on a range of substantive issues relating to the NPHDB. Amongst the issues outlined were:
The substantial funding gap
The development of the AMNCH at Tallaght
Clarity or absence of governance proposals for the new Hospital
Effectiveness of stakeholder communications
Planning and design challenges for the Mater site
The Minister dealt, to a certain extent, with the "clarity or absence of governance proposals" in response to Senator Fitzgerald. On the evening Mr. Lynch's resignation was announced, I happened to be in the company of a member of the board of the group. When I asked the person in question about the matter, I was astonished to be told the €110 million funding gap could be met by philanthropy. This is not the kind of economic climate in which we can anticipate such significant philanthropy. The Minister has mentioned that in Canada $98 million was raised through philanthropy. I remind her that the economic climate in Canada is completely different because its banks operated judiciously and prudently. It is in a wonderful position - it is not at all threatened. People in Canada who have money to spare can engage in these philanthropic exercises. I was not particularly thrilled to hear Ronald McDonald would be involved in the project. It seems we are relying on the sale of hamburgers to provide our children's hospital. Reference was also made to the philanthropic interests of the pharmaceutical industry. That is a new one on me. We know philanthropic companies are very efficient at squeezing the Government. They have squeezed the public dry in terms of prescription drugs and all the rest of it. I would be interested in probing a little further the idea that they are about to become philanthropic. What will they get out of the taxpayer in these circumstances?
There is a series of contradictions in this context. I was interested to read a recent article in The Irish Times by its former environmental correspondent, Mr. Frank McDonald. I think I can say he fully supported the hospital. The article was accompanied by a nice picture showing abstract art in it. Although Mr. McDonald was lyrical in his praise of such aspects of the project, he did not mention that access was one of the critical elements of the development. This difficulty was addressed by the Minister and others when they referred to the development of the metro north project. I remind the House that Mr. McDonald has devoted almost all of his entire journalistic career to trying to prevent the metro north project. This is another of the contradictions to which I refer.
I took the liberty of interrupting the Minister to ask her about the matter of access which is particularly important. It was being discussed when I was listening to the wireless one day - I am not sure whether it was on the Joe Duffy programme. If somebody is talking sense, it does not matter to me whether it is on "A Prayer at Bedtime" or the Joe Duffy programme. While there is a great deal of hot air and a lot of rubbish is spoken on the Joe Duffy programme, there is also a certain amount of sense from time to time. The programme to which I refer covered the story of a woman who had tried to drive her seriously ill child who was moving towards having peritonitis to the Mater Hospital. She was prevented from going down one street because there was a match in Croke Park, a factor we need to take into account in this context. After she had managed to get into the car park and park her car, she went through what she thought was the main entrance, only to be told it was not the proper entrance and that she needed to walk to a different entrance. Her child developed peritonitis when his appendix burst before it could be operated on, but, luckily, his life was saved. Such things can happen. That is why access is important. It is dangerous to say excellence in treatment is more important than access. There must be a balance between the two. I do not doubt that the boy in this case received excellent treatment, but if he had not been able to access the hospital in time, it would have been of no use. One can have a world-class facility, but one will have a real difficulty if people cannot gain access to it in critical circumstances.
I am familiar with a document that criticised the work of the location task group because "no study of ambulance transport times or traffic impact on Emergency Access" from the proposed new "enlarged catchment area", the entire greater Dublin area, to Dublin hospitals was undertaken. The document continued:
It is essential that ambulance access times to the Mater ... from the outreaches of the catchment area should have been studied. Life-threatening emergencies do not respect gridlock from rush hour, All-Ireland finals, events at the O2 or the RDS, city centre marches etc. The absence of these two studies ... is a gaping and dangerous defect in the Task Group's report.
The task group's report was produced four years ago, probably around the time I proposed that a peer review be undertaken. Such issues should have been covered in the examination of the suitability of the site, but that did not happen. God knows, I am not against the location from a personal point of view. It is located right next door to me and I would like the infrastructure of the north inner city to be built up. As the principal proponent of the metro north project, I would be pleased to see it going ahead. However, I cannot blind myself to these questions.
I wish to give another example of the continuing series of contradictions in this regard. On 7 March 2006 the HSE website carried the following announcement on the children's hospital site:
The outcome process has not been predetermined ... It is open and objective to the point where the outcome may even be a decision to locate somewhere other than an existing hospital site ... Any suggestion that this group has prejudged anything is completely misplaced.
It appears the situation had altered by 29 March 2006, however, as a message on the same website announced:
This process is to recommend only where the hospital is to be sited ... The prime consideration in making this decision on site location will depend on co-location to an adult teaching academic hospital and adult national centres of treatment.
That decision had been made in principle, so there is a contradiction there. That is regrettable and could have been obviated.
In regard to the rigorous, robust and independent process about which the Minister spoke, in a press statement on 11 January she said the task force engaged in extensive consultation with the three existing paediatric hospitals, the three maternity hospitals and external experts in arriving at its recommendations. There were no hospital site visits. There was one meeting with each of the three children's hospitals and they were all held on the same day, 26 May.
As far as the external experts are concerned, one of them, who has been extensively quoted by the Minister and the Department, Sir Alan Craft, a past president of the Royal College of Paediatrics and Child Health in the United Kingdom, said in a letter to The Irish Times, because he was concerned by the impression being given by the officials, that the extensive consultation referred to consisted of a telephone conversation with a member of the task force to discuss the parameters against which a decision regarding location could be made and which other specialties should ideally be co-located. He said he did not see the report nor was he involved in making the decisions. There is a whole raft of contradictions and I would like to refer to one or two more.
The RKW report states:
This brief ... takes as given:
The McKinsey recommendation that all Dublin secondary inpatient beds should be co-located with the tertiary services.
The decision of the Task Group endorsed by the HSE that the hospital should be located at the Mater site.
RKW, the consultants, were not allowed to examine a situation as fundamental as the matter of the site. They referred to issues regarding environmental quality which relate to the density of building on the site but were not able to deal with it.
I mention car parking. As a matter of policy, car parking is limited by Dublin City Council in the city centre. We were told 800 spaces would be provided. Proportionately, that is fewer than the current number in Our Lady's Hospital for Sick Children. In an emergency, how many people are going to use the metro? I am a big fan of the metro but will people use it? Will it go ahead? It may well not go ahead.
It appears a certain amount of academic and inter-hospital politicking was going on. In the interests of the children of this country, we need to ensure the best possible thing is done. I do not want to impede the development of the national paediatric hospital. I am not a johnny-come-lately; I have raised these real questions consistently and they cannot be answered by bluster. I regret the Minister did not have a speech and that-----
I welcome the Minister of State, Deputy Moloney. I thought I was taking part in a debate on the national paediatric hospital only to find I am taking part in a debate on metro north and the transport situation in Dublin. I always find it quite amusing that when people talk about access to national facilities, such as the proposed national paediatric hospital, they talk about it very much in a Dublin context. We are talking about a national, world class, tertiary care facility, which we do not have. We are talking about a major improvement in facilities for sick children in this country.
I listened carefully to the Minister's speech. She quoted what parents have said to her. She said they do not care where the hospital is located and that she should just make it happen. That is a crucial point.
I do not know the ins and outs of whether people can park beside the Mater hospital or whether they will not be able to park there in the future when this hospital is built. The key point is that we need a proper mobility plan and to ensure the hospital is as accessible as possible. We also need to ensure there is a hospital to access. That is a crucial point. There is no point having a hypothetical debate about access to a hospital which does not exist. If we do not get on with this project, we will not have a hospital.
The Minister said the hospital will provide secondary care for local children and that it is estimated 65% of the children attending will be from the Dublin region. I believe that means the remaining 35% will be from around the country and will attend for tertiary care. People said half an hour is crucial for a child. We are talking about tertiary care. We are not talking accident and emergency or primary care but about serious world class health care for children with serious difficulties.
The key issue is not necessarily the fact everyone must go to Dublin if faced with an accident and emergency situation but that children who are very sick have the best facilities in the world available on their door step. Ten minutes here or there will not make a difference in that regard. In an accident and emergency situation, it obviously would make a difference. In many tertiary care cases, ten minutes would not be crucial. If someone is coming from Donegal, he or she will not be able to get to the hospital ten minutes more quickly because of where it located.
People have suggested that the hospital should be based in Athlone because it is the most central place in the country. There is merit in that idea but we have gone down a particular route. Other people have suggested that the national paediatric hospital should be based in Galway, which I would like. I would like to see any national institution being based in Galway. There is more than land in Merlin Park, although I do not know the economics of such a proposal. Only recently people have suggested that given the difficulties faced by the developer, Bernard McNamara, it should be located at St. Vincent's Hospital where he owns facilities. Perhaps that is an opportunity. The key point is that we need to plough ahead with this project and not talk in hypothetical terms. We need these world class facilities.
I refer to a quote in the executive summary of the RKW report from the French philosopher and poet, Gaston Bachelard, who stated: "Even a minor event in the life of a child is an event of that child's world and thus a world event." I agree fully with that. In many ways, nothing is more important than how we cope with those who are most vulnerable in our society. It is up to our society to provide the best possible primary, secondary and tertiary care. As a father who has children in Galway, I am aware there are various facilities at primary and secondary care level in Galway which need to be improved as well, but the tertiary care facility, which is what we are talking about in this debate, not the 65% seeking secondary care, is to my mind the crucial part of this situation. I urge the Minister of State to give a guarantee that the tertiary care element of this hospital can proceed with as much haste as possible.
It is important not to consider this issue from the point of view of Dublin alone. With the great difficulties we are facing in terms of the budget, it must not be the case in the future that the standard of care and facilities for our children in place in other parts of the country are sacrificed to provide the best quality care facility in Dublin. We need to ensure we provide the best possible care in a very balanced way throughout the country. It should not be the case that if a child gets sick in Donegal or Kerry, he or she would be disadvantaged. We need to ensure the primary care facilities, which are being rolled out throughout the country, are very much linked to the secondary and tertiary care facilities.
There are seven key principles in the founding of the Green Party, one of which is that it is most important that everything is done at the lowest effective level. The key word there is "effective", that things are done effectively and properly. Primary care facilities can cater for many of the things that are being catered for in secondary care institutions. As is said, all boats rise together. It is important, therefore, that we ensure there is proper linkage among the various primary care teams which are being set up now and the secondary care facilities on a regional basis and, ultimately, with the tertiary care institution we are talking about, the national paediatric hospital, which it appears will only be 35% of the particular project.
The Minister said that €25 million to €30 million per year in operational savings would be made by putting this facility in place. It is crucial we proceed with it because we are in a very difficult budgetary situation. We have managed to build projects such as the Aviva Stadium and to redevelop Croke Park, we have various motorways around the country and there have been improvements in infrastructure in general, but in many ways there is nothing more crucial than this project. It is one of the last great projects that was mooted in the Celtic tiger era. It is crucial we follow through on it no matter what the financial situation is in the coming years. This facility should be number one among all facilities in this country. It is a prize worth fighting for and it is a project we should all get behind. If there are issues about access and transport, we need to work together to solve those and not get our knickers in a twist and say it should be here, there and everywhere and use the transport issue either as a means to beat the Minister or the Government over the head or as a political football. We need to resolve all the issues to ensure there is the best possible access for parents and children. Particular recognition should be given to those who travel from far away to ensure they are catered for and that parents and families are not left trying to find a parking spot and are delayed getting their sick child into the hospital. We need to address those issues but, more importantly, we need to proceed with this project.
I listened carefully to what has been said in this debate and I am glad to have this opportunity to contribute to it. The criticism of Crumlin hospital as a facility is perhaps justified but the staff, ranging from the porters to medical and nursing staff, and the care that is given to children in emergencies and to those in need of tertiary care is without question of the highest standard. The staff do a terrific job under very difficult circumstances. There were opportunities during the boom times to make good improvements there but that did not happen.
I am disappointed the Minister, Deputy Harney, has left the Chamber because I want to pick up on something she said. All the Dublin hospitals endorsed the idea of having a co-located hospital on a general hospital site, as set out in the McKinsey report. The Minister said there would be no more stand-alone hospitals, including maternity hospitals. If there are to be no more stand-alone hospitals, facilities that exist in hospitals such as the acute psychiatric unit in South Tipperary General Hospital, in which the Minister of State, Deputy Moloney will be interested, should not be relocated to Kilkenny because it will remove vital services in that area. As we have seen from recent events, we were never more in need of acute psychiatric services. This is not the subject under the discussion but I availed of this opportunity to make that point on foot of what the Minister said. I would be happy to be hopeful that this decision might be reversed.
On the issue of a location in Dublin being the site for the hospital, I agree that density of population is a key issue. Therefore, I would not see a location in Athlone as being an ideal site for it. Even though access to such a location in Athlone might be easier, the hospital should be located where there is a density of population and the highest density of population is in Dublin.
There are misgivings about the site. As a health care professional who has travelled on many occasions with a flying squad - we did not fly but travelled on the roads - when children were born with, say, an exaomphalos or a diaphragmatic hernia and we had to travel from south Tipperary with a very ill neonate to Dublin, there was no problem. Parents and anyone present in this Chamber, whether he or she is a parent, a health care professional or a care giver in any capacity, would say that he or she would travel anywhere to ensure his or her child would get the best care.
These are not my points but points that were made to me. There are misgivings about the Mater hospital site being the location of the new children's hospital. The late Dr. Maurice Neligan, God rest him, withdrew his support for the Mater site because he said crucial decisions were made on limited or selective criteria and without honest debate. I would like to think that the debate we are having is honest and not only one that assumes that this is the decision and nothing can be changed. Some valid contributions and opinions can be given. I am not necessarily reflecting my opinion but opinions that have been put to me. Some people would say the location was selected as another Bertie vanity project for his own constituency but I will not go into that debate.
Philip Lynch's resignation as the chairman of the board seemed to indicate there was a problem. Was the issue that he had lost confidence in the Mater site for the building of this new 440-bed hospital? We do not know that and the issue around it is not clear, but his resignation says something about it. I am aware he met the developer, Noel Smyth, in the summer to discuss alternative sites and I am not suggesting support for Noel Smyth, although he has become the focus and a rallying point around which an alterative view is being articulated.
The advent of NAMA creates new possibilities for finding a site, but the argument for a site close to the M50 is strong while the argument for the Mater site is weak. This morning it took me only 42 minutes to reach the point where the building of the new extension is going ahead, but that was without taking account of the time involved in trying to find a car parking space. Car parking is a big issue, which has been articulated by other contributors to this debate. There are 1,000 underground parking spaces for members of the public and for 1,500 staff. I am not suggesting that every member of staff has a car and that every member of the public accessing the facility will have a car but if they do, it will be tough. The access to a site close to the M50 appears to be more convenient for people outside Dublin and the Dublin suburbs, which is what the M50 is for, in effect.
Mr. Smyth believed that a site close to the M50 would be €150 million to €250 million cheaper and he offered to build on a not-for-profit basis. While I appreciate the contribution by the nuns of a site on the Mater campus is a generous one, we must have open minds on this matter. Everyone wants to have a world class hospital but the issue of access is vital. Mr. Smyth believes that because the planning application for the Mater Hospital site is before An Bord Pleanála, the Government is obliged to consider alternatives such as his proposed site. I ask the Minister of State to respond and, if he is unable to do so today, he could do so when replying to a letter I wrote to him following last week's debate on mental health.
The Health Service Executive refused to hear Mr. Smyth's presentation on the basis that the new hospital must be located at an adult teaching hospital. He has also offered to build a new hospital at any location chosen by the Government. The location Mr. Smyth proposes at Newlands Cross is one mile from Tallaght Hospital, which is part of the National Children's Hospital. I trained as a midwife in Whipps Cross maternity hospital, part of the general campus of Whipps Cross Hospital. The campus has a corridor that is one mile in length and is used for many purposes besides transporting patients. I refer to this to highlight that it is not beyond the realms of possibility to have a facility that is one mile long.
Under the current plan, a funding shortfall of €110 million will need to be raised through fund-raising efforts and philanthropy. I am concerned that it will not be possible to achieve this target in the current economic climate. Other contributors have voiced similar concerns.
The €650 million estimated cost of building a new hospital at the Mater Hospital site does not include information and communications technology costs, which are estimated at more than €100 million. As this money will to be provided from HSE funding, this additional cost will have implications for the health service and the project. In light of other cutbacks in the health budget, the overall deficit will amount to more than €200 million.
I am also concerned about other cutbacks. At the weekend, I saw a proposal to cut the budget for mental health in HSE west by €5 million. It is a matter of grave concern that such proposals are being made when a project to develop a new national paediatric hospital will reduce the overall health budget by €1 billion. This concern must be addressed by the Minister of State, whose presence I welcome, and his boss, the Minister, who has left the Chamber, unfortunately.
The board of Crumlin hospital and the nurses employed there want the new hospital built on a site near the M50. They are most familiar with the experiences of patients and children. As I indicated, the travel time from the M50 at Blanchardstown to the proposed new site at the Mater Hospital is not less than 30 minutes and can be more than one hour, depending on the time of day, traffic volumes, etc. In most cases, one can expect the journey to take between 30 minutes and one hour. Moreover, contrary to what the Health Service Executive claims, the Mater Hospital is not close to train links. It takes 30 minutes to walk to the Mater Hospital from Connolly Station and the nearest Luas stop.
While I welcome the proposal to have a roof garden at the new hospital, I would be nervous about visiting a garden at the top of a 16-storey structure. A Dublin city centre location will not offer great opportunities to avail of fresh air.
The benefits of the M50 include an abundance of low cost hotels in the vicinity, easier access for those living outside Dublin and the possibility of accommodating expansion of the new hospital and the Coombe Hospital. It has been argued that postponing development at the Mater Hospital site would delay the project. Given that the new hospital is not due for completion until 2015, three years later than originally planned, a greenfield or brownfield site could be developed quickly because to do so would not create as much disruption as a the project at the Mater Hospital site.
Some 1,800 children are on waiting lists while wards lie idle at Tallaght Hospital, Crumlin hospital and Temple Street hospital. I await with interest the response of the Minister of State on the issues raised. As I noted, I wrote to him last week seeking clarification when he was unable to answer questions in a debate on the effects of the recession on mental health. If he is unable to give answers to specific questions, I would be grateful if he could do so in his reply to my letter.
I am grateful to the Leader for arranging this debate and to those Senators who proposed that the House discuss the matter. I am becoming increasingly angry as I listen to this debate. Given our fixation with doom and gloom, it was nice to have a Minister giving the House a good news story. How has it been received? We have heard only that the Minister has taken the wrong course of action. Despite the fact that a world class facility for children, one that is unique in Europe, is about to be provided, all I have heard are complaints about its location. We have lost the run of ourselves.
Senator Prendergast referred to Noel Smyth. Since when has Mr. Smyth been an expert on hospital location? Why does the Senator give him such credence? I cannot believe the nonsense I have heard. I presume Mr. Smyth would like to enjoy the advantages of having a large hospital located beside the site he owns. Senators should cop on. Are Members of this House and the other House fools?
On the resignation of Mr. Philip Lynch, the Minister would have been perfectly entitled to sack Mr. Lynch. Politicians, specifically the Government, are castigated time and again for failing to make decisions. The decision on the location of the new children's hospital has been made and we must live with it and move on. The national broadcaster has been giving air time to taxi drivers to tell us what a stupid decision has been made. Since when have taxi drivers been experts on hospital location?
I was thoroughly disappointed by the decision of the Opposition spokesperson on children in the other House, Deputy Fergus O'Dowd, to jump on the bandwagon and seek to score a quick political point against a somewhat beleaguered Government. Rather than looking at the bigger picture, the Deputy decided to score a goal against an easy target. We must accept that a decision has been made to invest in a world class facility for children.
Deputy Gilmore was hoist with his own petard last week when, having stated that the Labour Party would not support the budget, he added that his party would not reverse any of the decisions made in the budget. Similarly, the next Government will not waste the millions of euro spent on the decision to locate the new children's hospital at the Mater Hospital site.
The opinions I value most on this issue are those of consultants, that is, the medical experts, and the parents of sick children. As one recent letter to The Irish Times noted, access does not matter when one has a child. While I am not a parent, I imagine that parents of a sick child would not care where they had to go provided the best possible medical attention was available.
The Minister has not sold the message that the highest possible standards will be available in the new hospital. I understand equivalent standards are available in only two other hospitals in the United States and that they may not be available elsewhere in Europe. Why is everyone not rallying behind the proposal and welcoming this good news? We are proceeding with the project because it is what children need and what parents want.
During my time serving on the Joint Committee on Health and Children, of which the Minister of State and Acting Chairman, Senator Feeney, were also members, I came to realise that being competitive is part of human nature, especially in an adversarial political system. Conventional politics, however, does not hold a candle to medical politics. During a discussion with a delegation, members of the joint committee discovered that a position of consultant in paediatric care, for which the Government had provided funding, remained vacant for ten years because the three hospitals concerned could not agree on where the new post should be located.
If this is not medical politics at its worst, I do not know what is. It was an outrage and this was when I lost faith in people who agreed on having a hospital but not on deciding on a location or on who would win or lose out as a result. In those circumstances, one must stop listening to them. This is the reason I am somewhat disgusted with those who continue to listen to this point because it is only medical politics that is getting in the way of driving forward this project. I wish it could be put to one side and the fact embraced that people who know about such matters have decided on a location for the facility. The most important thing is to get on and to build it.
In conclusion, I was somewhat disappointed by Senator Norris's contribution. Although he is someone who usually has a can-do attitude, I refer to his complete defeatism on the grounds that the project's budget has determined that €110 million must be raised through philanthropy. As for not going ahead with it because it might be difficult in these straitened times, I have never heard the like from him and was most disappointed by his attitude. Had we such an attitude, we would not get on with anything and nothing would get built. However, people who have associations or connections with Ireland time and again have put their hands in their pockets to support educational and many other ventures and I have no doubt but they will do so again. The Minister highlighted how the research budget will work as part of that philanthropic effort and again, this is about the commercialisation of research that I absolutely applaud and which should be pursued. The Minister was extremely transparent at all times and has invited someone such as Senator Norris to examine her files on the matter of what is going on at present. I am in agreement with Senator Fitzgerald that it is as clear as day that the Minister wants to build this project. All I ask of Members is to get behind it. As this decision has now been made, we should move forward and build the thing.
Opposition Members often are criticised by Senator Mary White when they do not listen to her wonderful contributions in this House every now and again. I do not believe she was listening to Senator Fitzgerald's earlier comments when she described the latter's contribution as unedifying. I thought Senator Fitzgerald was quite conciliatory in her approach and that in general she was highly supportive of what the Minister is setting out to do in this regard.
The construction of a new state-of-the-art children's hospital would be a most welcome development in health care in Ireland. We have a long and proud tradition of providing excellent health care for children in our existing children's hospitals despite the fact that the staff operating in those hospitals do so in what often are highly difficult conditions. However, that collective knowledge and experience amassed over decades would allow us to scale new heights of excellence and that is the primary thinking behind this new hospital plan. International best practice requires that for a country of our size and population, there should be one facility, and one facility only, for the treatment of seriously ill children with cancer, cardiac problems, diabetes, cystic fibrosis and other serious conditions.
This is the reason I was somewhat mystified earlier by Senator Norris's contribution in which he cited a discussion he heard on radio regarding a lady who rushed her child, who had a threatened ruptured appendix, to hospital in Dublin city centre. I cannot discern how that anecdote plays into this debate. The primary aim of setting out to construct this hospital is to provide world-class tertiary care for seriously ill children. A child with a ruptured appendix from Galway, Donegal or Kerry will not be placed in a car and driven to the Mater hospital. Consequently, this argument simply does not stand up to scrutiny. On that basis, all Members must be highly supportive of this concept.
Until quite recently, I and others were reasonably content that plans for the new hospital were moving ahead quite well until the unexpected resignation of Mr. Philip Lynch, who was chairman of the-----
However, the chairman's resignation reignited the debate about the location and funding structure of the new national paediatric hospital. The debate is centred around two key aspects of the development, namely, its location and its funding. I am somewhat mystified as to the reason the decision was made to build a multi-million euro state-of-the-art hospital right in the heart of Dublin city. However, I must bow to the wisdom of the members of the paediatric hospital development board on that matter. I am not an expert in paediatrics and certainly do not claim to have any superior knowledge to those involved in choosing the site. I refer in particular to the comments of the chief executive officer of that body who stated it was important to remember what was best for children and that a co-located hospital, unlike a greenfield site, had the collective expertise amassed on a single site, as well as the economies of scale associated with being next to an existing hospital. Members also should reflect on the words of a board member of the Faculty of Paediatrics of the Royal College of Physicians of Ireland, who recently stated "the vast majority of paediatricians countrywide [were] behind this project". In fact, the dean of that faculty called an emergency meeting of its board on the morning of 12 October, five days after the resignation of the aforementioned chairperson. That board went on formally to endorse the national paediatric hospital in advance of issuing a statement confirming the faculty's strong support for the project. Members also should reflect on the words of a parent of two children with cystic fibrosis, as quoted in the national press some days ago, who stated "we [now] have an opportunity to build a world-class facility for our children, so let's get on with it and get it built".
All Members' focus must lie on simply getting on with the project and reassuring parents and children that they are deadly serious about providing a world-class children's hospital. My concerns do not centre on the hospital's location but rather on the resources required to build it. Latest estimates put the cost of construction at approximately €650 million. To date, the Government has committed €400 million and I was heartened to hear the Minister for Health and Children, Deputy Harney, state earlier that this would be increased next year to €450 million. The board of the hospital expects to raise €90 million through the private operation of the car park, retail units and research facilities in the hospital. Following that, this is the point about which I am deeply concerned, at least €110 million in funding must be raised through philanthropy, that is, through a combination of corporate fund-raising and private donations.
In her contribution, the Minister, Deputy Harney, mentioned that Canada recently had succeeded in raising €98 million for a similar facility there. However, Canada is a country of 33 million people, approximately ten times the population of Ireland. Canada is not going through the deep economic crisis that Ireland is suffering. It was telling to listen to Senator Fitzgerald's observations on the report from the Jack and Jill Foundation to the effect that its fund-raising is down by 25% this year. Moreover, the ISPCC, a children's charity, is unable to raise sufficient money itself to ensure that all calls to Childline are answered on a daily basis. Consequently, I have concerns that this figure of €110 million is not realistic in the current climate. The Minister stated there will be a commitment in the four-year budgetary strategy towards ensuring that the aforementioned €450 million in funding will remain in place for the hospital. It is most important that this commitment be reiterated in the Budget Statement, whenever that might take place, because unless such a commitment is forthcoming, one must question whether Ireland has the resources to continue or whether the Government is serious about so doing.
It also is important to get some clarity and transparency and to apply some scrutiny to the claims of the board of the new hospital that it can raise the other €90 million through commercial activity within the hospital, including as the Minister noted the renting of rooms to consultants on a private basis, as well as through the car park facilities and other commercial activities within the site. Perhaps €90 million can be achieved but more clarity is required in this regard. I am utterly and completely supportive of the concept and it is past time to end the discussion on the location. The issue is about providing such world-class tertiary care for seriously ill children in a suitable location. I do not subscribe to the argument that one needs to be within an hour's drive from this facility. That is not the kind of care it sets out to provide.
Can we have clarity from the Government that the €450 million is sacrosanct, untouchable and will remain in place irrespective of the comings and goings of the next weeks and months? We need to hear that commitment made in the budget speech. If it transpires that the €110 million simply cannot be raised through philanthropy, the Government may have to step in at some point and make up the shortfall. Making that commitment now may not be the right thing to do because it might discourage a comprehensive effort on the part of the fund-raisers. The Government must realise, however, that it may have to step in at some point in the very near future and supplement the €450 million already committed. This project needs to be completed quickly. I am very supportive of the concept.
I join colleagues in welcoming the Minister of State to the Chamber. I concur with Senator O'Malley's comment that this is a very exciting project. It provides us with a golden opportunity to create one of the world's greatest children's hospital, to which clinicians, educationalists and researchers from around the world will be attracted. I welcome Senator Cannon's contribution, his enthusiasm and his recognition of the importance of this project.
Donald Berwick has been quoted in the Royal College of Paediatrics and Child Health document, Guide to Understanding Pathways and Centralising Networks, as saying,
Great health professionals do not make great health care. Great health care professionals interacting well with all the other elements of the health care system make great health care.
That is what we are aiming to do with the establishment of this new hospital. By merging the three existing children's hospitals we will be pooling the expertise of some of the country's most prominent child health care experts in an effort to provide a world class paediatric service. It should be recognised that Ireland has a world class record in paediatric services, especially in paediatric oncology.
It is universally accepted within the paediatric health care community that the sickest children requiring access to highly specialist professionals, equipment and facilities can only be accommodated in one children's hospital. There is also unanimous agreement that the child population and projected health care demands of Ireland can support only one national tertiary hospital and that there is an urgent need for capital investment in children's health care services. The McKinsey report also found that international studies show that hospitals that treat higher numbers of cases with a critical mass in the depth and breadth of speciality services deliver significantly improved outcomes and experiences for children. That is something we have seen throughout all aspects of health care. Where we can achieve specialist centres and provide clinicians with the opportunity to hone their expertise, there are much better outcomes for patients. This has to be a driving factor behind the establishment of a national children's hospital. We want the best possible service for the children of our country. That is the only thing driving this development.
I was delighted to hear that the development board is making good progress in planning and developing the new hospital, that it has formally asked An Bord Pleanála for the project to be considered under the strategic infrastructure legislation and that it has had an initial meeting with An Bord Pleanála.
Colleagues have raised the issue of the location of the hospital and controversy and debate has surrounded the issue. I can only imagine what we would be hearing today if the Government had gone against the recommendation of an expert group. It was an expert group that recommended this location. The group was given a job to do, with terms and references. It did the job, brought back a recommendation and the Government accepted it. If the Government had not accepted that recommendation and gone with an alternative location, we would be hearing much more vociferous contributions today.
I take the opportunity of the Minister of State's presence to raise some specific issues. The National Rehabilitation Hospital in Rochestown, Dún Laoghaire, caters for adults and children with brain or physical injuries acquired as a result of accidents or medical events. Will there be a dedicated unit within the national children's hospital for children with brain or spinal injuries or other serious physical disabilities acquired as a result of a catastrophic event? There is a great opportunity here. Treating adults and children in the same setting is not ideal. It has long been the goal, even in the proposed redevelopment of the National Rehabilitation Hospital, to have a specialist centre for children. Within the confines of what is proposed for the national paediatric hospital, there may be an opportunity to meet that need. The establishment of the national paediatric hospital is also an opportunity to provide world class training and educational services. That is to be welcomed. It will be a much-utilised resource of benefit to all children.
I note it is intended to commence construction in the last quarter of 2011 and that it is hoped to complete the project by 2014. This would be very welcome. It is a very exciting project and I concur with colleagues who have said the sooner we can get on with building the hospital and putting it in place, the better it will be for our health services.
I welcome the Minister of State. I acknowledge the contributions of Senators Corrigan and Cannon. Politics will change as a result of the desperately difficult times in which we find ourselves and I was struck by the nuanced and constructive approach both my colleagues took to his matter. Care was taken to try to understand the issue and both speakers made informed contributions that left aside the kind of politics and sectional interest that so often riddle our country when we make major decisions. There has been much discussion today about what our sovereignty will look like when the events of the coming weeks are out of the way. One of the things that deeply frustrates me about how we use the sovereignty we have currently, and will have in the future, is that every time a Government, of any complexion, makes a major decision, the interests involved who are disappointed by the decision do what they can to have the decision unpicked. Many of these interest groups, and in the case of the national children's hospital, all of these groups, are driven by what they believe are the best interests of children and by genuine interests. We are getting to the point, however, where any time a major decision is taken, the journey between making and implementing the decision becomes longer. This is at the cost of the country and every Member.
This is a decision about which I feel strongly, for reasons I will explain. Once a decision has been made and the Opposition in the House and stakeholders outside it have expressed constructive views thereon and have done what they can within the system to have their points of view heard and their proposals implemented, progress should follow. Despite some of the opposition that is now evident, I am glad a planning application has been sought for the project. I am glad to see the project moving ahead and that, within Leinster House, the questions being raised by colleagues such as Senator Cannon and Fitzgerald are legitimate in respect of which we all want answers. We all want to ensure funding is in place and that it is adequate for the project.
One common perception that has not been touched upon but which is a source of uncertainty is that the decision to locate the hospital on the site in question was made because it is in the constituency of the former Taoiseach. We should address this. I want to raise the matter because I live in the constituency in question and hope to represent it in the Dáil some day. I walk by the new site twice per day. I have brought my children to Temple Street hospital and the Mater hospital and have used their facilities very much, and I will use those that are put in their place very much. An issue that has riddled our politics and which is riddling the paediatric hospital project is the perception that decisions made in the national interest are too often influenced by constituency or sectional interests. I want to outline my view and then make a statement on those who make the final decision.
I will be glad to see the project completed, irrespective of whether the hospital, which is to meet the needs of chronically sick children, is located on the Mater site or in another part of Dublin or another part of the country. Where we live and where we represent must not influence the decision. I have confidence that two people will make the right decision in this regard, namely, the current Minister for Health and Children, whom I believe is motivated by the national interest, and a person who might be Minister for Health and Children in the future, Deputy James Reilly, if he is privileged enough to hold that post and if Fine Gael is lucky enough to get into government. Both are motivated by what is right for children and will make the right decision regardless of the location and the concerns that arise.
As Senator Cannon stated, we must ensure there is sufficient funding to ensure the hospital is built and built well. As I was acquainting myself with the background to the project, I took the time to read the McKinsey report and the reports that followed it, which laid down the criteria for the hospital's location. Colleagues have already touched upon them. The reports are very clear and state a country of our size should have a national centre and that, in order to deliver the best possible facility, it should be co-located "with an adult teaching hospital to access specialities that generally split between adults and children to facilitate clinical and academic cross-fertilisation and to attract the top staff". From talking to people who work in this field, I learned that the only two hospitals that would meet the criteria are the Mater hospital and St. James's hospital.
The Government, with the advice of experts in this area, made the decision to opt for the Mater hospital site. As planning permission is being considered for the project, the Government should do all it can to provide transparency regarding how the legitimate issues being raised by many are dealt with. Concerns arise regarding how the money will be found. Let us provide answers in this regard. We now have a crucial window that will allow the question to be answered. When a decision is made to meet the needs of citizens, particularly children, let us unite in respect thereof and implement it. Let us leave aside the various interests, which in many cases may be motivated by good intentions, and ensure a positive outcome.
Let me refer to an opinion piece in The Irish Times on this subject by Mr. Karl Anderson, former chairman of the New Crumlin Hospital Group. In the interest of openness, he was supportive of the decision made but concluded with a point that should appeal to everybody, regardless of what side of the debate one is on. He stated:
If the prospect of a new children's hospital becomes a distant memory smothered in reviews and endless circular debates (which it will because there is no perfect location), those who are most vocal against the current plan will be silent. Those who are actually responsible for providing services will be held accountable.
That is the tone we need to adopt in making a decision and implementing it. We must put the right facility in place and answer legitimate questions that have in mind the best interest of the children who will be using the services at the hospital when built.
I welcome the Minister of State, Deputy Moloney. The Minister, Deputy Harney, was present this morning. When I saw last Thursday that we were to have statements on the new national children's hospital, I had sense of déjÀ vu. I have been present on at least two occasions discussing the hospital. I was rather surprised, but mainly disappointed, when the issue raised its head again a month ago and the controversy started.
I am very encouraged by the remarks of Senators Cannon and Donohoe, bearing in mind that there were very negative contributions this morning from a Member from the Labour Party and an Independent Member. I appreciate the views of the last two speakers for Fine Gael, and also those of Senator Fitzgerald, who suggested that we get on with the project. It is not about Dublin or about a sick child with appendicitis who had to come from Connolly Station and whose mother had to feed the meter and leave him or her with somebody. It is a question of accommodating the needs very sick children from Inishowen to the Beara Peninsula, and from the most westerly point in Connemara to the most easterly point in Monaghan.
I was particularly taken by the remarks of Senator Donohoe and often quote him. We may not always agree but I am taken by much of what he says. I agreed with his remark that it is not a question of where we live or represent and that it should never be. It should be a question of legislation, and the planning of institutions should be done on the basis of what is best for the country. This would resonate with the Minister of State because I remember an occasion on which he got into terrible trouble for going against local opinion requesting that a cancer unit be located in his own area. He concurred with the views of those who knew where it should be placed. Its location was determined by Government policy at the time. It would have been so much easier for the Minister of State to support the locating of the centre in County Laois. That is just part of what goes on.
The Minister said this morning that stand-alone facilities are a thing of the past and must never be considered in the future. One need only read the McKinsey report in this regard. It refers to children being treated by specialists who are at the same time treating adult patients. I do not believe there are medical disciplines that pertain only to adults or only to children. In children's medicine, one cannot have a specialist in every area and one needs to share with adult patients.
I am prompted to wonder what it must be like for the top-class medical professionals we are trying to attract to work in the proposed new national paediatric hospital when they listen to a debate such as this and realise we cannot even agree on where the hospital should be located. We want to attract the best experts to work at the new facility. As Senator O'Malley stated, it will be one of the few national paediatric hospitals in Europe, a fact of which we should be so proud. If we continue to sit on the fence and refuse to decide where the new facility should be located, who will want to work there?
The Minister briefly outlined the legal difficulty that arose in respect of St. James's Hospital and then indicated that the Mater Hospital had ticked all the right boxes. I accept that the Mater Hospital site might be confined. However, there are other hospitals throughout the world which also operate on such sites. I refer, for example, to the Sloan-Kettering cancer treatment centre in New York which, as a member of the Joint Committee on Health and Children, I had the privilege to visit and Great Ormond Street Hospital for Children, with which I am not familiar. These facilities are located in cities that never sleep and where people do not seem to stop to draw breath but both are world renowned. In Ireland we worry about whether it would be better to locate the new national paediatric hospital near the M50 or whether it would be more appropriate to provide more than 1,000 car parking spaces. We have shilly-shallied for long enough. People should stop talking nonsense and delaying the project. In the interests of sick children, we should progress it.
I agree with previous speakers on the shortfall of €110 million. I hope there will not be such a shortfall, particularly as the Minister indicated more funding will be available next year. In view of the fact that we are financially strapped, I hope the project will be given priority ahead of everything else. If money must be raised, we must put our shoulders to the wheel and do everything possible to ensure the new national paediatric hospital is built.
I am glad this debate has taken place. On Thursday last I did not know where we were going on this matter. The debate has been extremely positive in nature. Since he entered the Chamber, the Minister of State, Deputy Moloney, has been repeatedly informed by Members that it is time progress was made on the issue. I look forward to the commencement of construction in 2011 and the completion of the new hospital in 2014. When the ribbon is cut at the official opening, we can all take a bow and say, "Job well done." Senator Donohoe is laughing, but he may be the person charged with cutting the ribbon. Regardless of who is afforded that privilege, let us ensure the project proceeds.
John Moloney (Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Justice, Equality and Law Reform; Laois-Offaly, Fianna Fail)
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The Minister, Deputy Harney, wanted to be present to reply to the debate, but, unfortunately, she is obliged to be elsewhere. I have had the privilege to be present for the past 60 minutes and, notwithstanding the criticism outside the House, it is obvious that many Senators couched their contributions in the national interest and have indicated that they want to try to deal with the various issues that arise.
Senator Cannon posed an extremely pertinent question with regard to the €400 million required for the project. It is only right and proper that a definite commitment to provide this funding should be contained in the Budget Statement. The Minister has referred to this commitment on numerous occasions. Senator Donohoe indicated that he fully recognised the commitment and integrity of both the Minister and Deputy James Reilly in the matter.
For a long period the integrity of the process relating to the selection of the site for the new national paediatric hospital was challenged or questioned, particularly in view of the fact that the site eventually chosen was located in the former Taoiseach's constituency. This has led to the waters being muddied to a degree, despite the fact that all of the evidence indicates that the site was selected on an independent basis. As Senator Feeney indicated, where there is competition between sites, the debate often becomes sidetracked. This is because there is a clear understanding that, regardless of which site is selected, certain benefits will flow to the political process and also the medical regime. As previous speakers stated, however, the debate must focus on the patient who must come first at all times. I am not an expert, but I have some experience of site selection processes. In that context, I am concerned that if we decided to re-examine the position on the site for the new national paediatric hospital, we could eventually find ourselves in a position where we would not be able to make financial provision for the development of such a hospital. It is important, therefore, that we proceed along the current path.
I recall what occurred when another independent report on the issue of cancer services in the midlands was published. When it emerged, the then Minister for Health and Children, Deputy Cowen, now Taoiseach, happened to live in Tullamore. There were suggestions at the time that he had interfered with the site selection process and dictated that the hospital to serve the four counties of Laois, Offaly, Longford and Westmeath should be located in Tullamore. When all of this was happening, with a number of colleagues from the midlands, I travelled to Dublin to meet the then chairman of the National Cancer Forum, Professor James Fennelly, to argue the case for locating the new facility in County Laois. Having been presented with evidence relating to the independent decision made to provide the service from Tullamore, I returned home with a different attitude. The assessment outlined the position on the likely throughput of patients and indicated that there would be a need to upskill consultants and other medical staff at one location. I stress that the decision of the National Cancer Forum on the matter was made on an independent basis. For some four years after the decision was made, people continued to argue the Taoiseach had been involved in influencing the site selection process. The actual position was somewhat different. I have always given credit to the Taoiseach's predecessor as Minister for Health, Deputy Noonan, who established the independent review group which selected Tullamore as the location from which cancer services in the midlands should be provided. My net point is that we ended up with a fragmented service and Senators will be aware of the awful difficulties which arose in the provision of cancer services for women at Portlaoise Hospital afterwards. There is a lesson to be learned in this regard. When an independent decision is made, it should be respected. People should not automatically assume independent bodies are influenced or dictated to by the Government.
Reference was made to the number of car parking spaces to be provided at the new national paediatric hospital. Some 800 car parking spaces at the new facility will be reserved for parents and staff will not be permitted to use the parents' car park. The Mater Hospital has already won awards for encouraging staff to use other modes of transport in getting to work. It is important to keep repeating this information, particularly in view of the fact that people seem to believe the number of car parking spaces to be provided will not be adequate.
Senator Prendergast raised a number of issues relating to mental health. I gave a commitment to her in respect of these issues last week. I will respond to her concerns in the next week or so and clarify the position on services in Clonmel.
I reiterate what the Minister, Deputy Harney, stated, that the Government's priority is to provide the best standard of complex hospital care for children in Ireland. To further this priority, it is fully committed to the construction of the new national paediatric hospital on the Mater Hospital site and providing the associated ambulatory and urgent care centre at Tallaght hospital. It is well known that in late 2005 McKinsey and Company was engaged by the HSE to advise on the future strategic organisation of tertiary paediatric services.
It was good to hear Senators refer to what constituted a tertiary hospital. Often the argument goes out that persons in a emergency would have to traverse the city. That is not the issue, and that has been so properly pointed out by Senators Donohoe, Feeney and Cannon a while ago. They make that point not to confuse what a tertiary hospital is about, and the Minister, Deputy Harney, has often tried to explain that.
The resulting report on a children's hospital first recommended that a new paediatric unit should be located alongside a leading academic teaching hospital in Dublin. I still believe the principle of location alongside a leading academic teaching hospital, in line with widespread international best practice, enjoys widespread support.
The joint taskforce, representative of the Department of Health and Children, the Office of Public Works and the HSE, was established in February 2006. The taskforce carried out extensive consultation with various stakeholders, including the three existing paediatric hospitals, the three maternity hospitals and the external expert. I reiterate there were extensive consultations with the three existing paediatric hospitals. Following these consultations, the taskforce recommended that the new children's hospital should be located adjacent to the Mater university hospital on Eccles Street.
The high-level framework brief for the new hospital prepared by Rawlinson Kelly and Whittlestone Limited was completed in October 2008. The report was informed by clinical and architectural experts from major children's hospitals in Toronto, Philadelphia and Manchester. The report included the detailed assessment of capacity, and concludes that the site adjoining the Mater hospital can accommodate all the requirements of the new hospital and will still allow expansion of capacity beyond 2021. The designs for the new children's hospital demonstrated that the site at the Mater campus meets the requirements for children, young people and their families.
The Government decision to locate the new hospital on the Mater site is, therefore, based on very best possible expert advice and, indeed, on internationally established best practice. The decision has been widely welcomed and has been supported recently by the faculty of paediatrics at the Royal College of Physicians of Ireland.
The new children's hospital will play a central role in the integrated network of paediatric services across Ireland. The merging of the three Dublin paediatric hospitals in a single hospital structure will ensure a critical mass of specialised skills to provide highly complex treatment and care of sick children. It will also provide additional benefits for sub-specialisation and the development of campus-wide support services. Dr. Ronnie Pollack of MPA Healthcare London stated that a synergy created by assembling some of the best clinical and research skills in the country in a single site will create the environment for children to progress further in international standing with measurable benefits for children and adults.
While the debate on the location has been reopened in recent weeks, Senator Feeney wondered whether this would delay the delivery of a new hospital. I dare say it will not, certainly going on what I heard here today. Whereas it might be possible to build a new hospital somewhere more cheaply on a greenfield site, and this had been mentioned, it is important to state that this once-off saving would be offset by higher running costs every year. The Mater hospital site offers economies of scale and scope for shared services that cannot be achieved in such an undeveloped location. The HSE has estimated the cost of building a hospital to the same specification on a greenfield site would be in the region of €549 million whereas the cost of construction on the Mater site is in the region of €600 million. Both amounts exclude the cost of an ambulance and urgent care centre at Tallaght, however it must be borne in mind that the project amount of €51 million would be a once-off saving and the savings derived each year from the efficiencies delivered by shared services and economies of scale which would be available at the Mater site would not be available on a stand-alone site.
In addition, it is estimated that the decision to move to a greenfield site would further delay the development by up to two years. It is so important to make the point that parents continue to ask when the hospital will be ready. If anyone talked about a hospital on a greenfield site two years down the road there would be suspicions about the commitment to building a hospital. The point was made by Senator O'Malley. The Government and so many others are committed to this project, and there is no one trying to find an escape clause here given the economic downturn. The commitment is alive and well. It is real. I think further commitment will be given to that in the budget speech. There is also no good reason for changing a decision which has been carefully reached. It would risk delaying the project considerably. There would be serious disadvantages if the hospital was built on a stand-alone site.
The development board will now press ahead with work on the development. The board is making good progress in planning and developing the new hospital on the Mater site and has formally asked An Bord Pleanála for the project to be considered under the strategic infrastructural legislation. It had an initial meeting with An Bord Pleanála on 5 November.
Subject to planning permission being granted, construction of the new hospital is scheduled to commence in the fourth quarter of 2011. Completion of the construction phase is scheduled for the end of 2014. The Minister has asked the HSE to ensure that the fit-out and commissioning of the hospital takes place as soon as possible after this.
The current estimate of construction costs for the entire project is €650 million. This is a significant reduction on earlier estimates. Of the total costs, €400 million is committed by the Exchequer and is reflected in the HSE's capital plan this year. It is important to emphasise that time and again. This will be increased to €450 million in the HSE's capital plan for 2011. The balance, as said by the Minister, will be from initiatives estimated at €110 million and €90 million from commercial and other sources of some, including car park, commercial units, research funding, private donations etc.
The Minister is confident that we will meet our objective of providing a world-class paediatric service for our children in the new paediatric hospital. I thank the Cathaoirleach and Senators.