Seanad debates

Tuesday, 13 November 2012

National Children's Hospital: Statements

 

4:10 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I was delighted to announce that the Cabinet had accepted my recommendation to develop the new national children's hospital at the campus of St. James's Hospital in Dublin. The rejection by An Bord Pleanála earlier this year of the proposal to develop a children's hospital on the site of the Mater hospital was very disappointing, particularly given the many real strengths of that location. In response, I established a review group, chaired by Dr. Frank Dolphin, to advise me on the best way forward and the group presented its report to me in June. Unfortunately, after consideration and further detailed analysis, the Government decided it could not proceed with a site with such a significant planning risk. In identifying the new site we have carefully considered the report of the Dolphin group along with detailed supplementary information on cost, time and planning issues. I again express my thanks and praise to Dr. Dolphin and his group for the key role they played in helping us to reach our conclusion. I take the opportunity to say that not for the first time the good will of people towards this project was shown in abundance. On the previous occasion we asked four international experts to give us their opinion and they did quite a body of work gratis. Similarly, the Dolphin group also worked gratis.

The report of the group reiterates what all previous reports on the national children's hospital have stated, which is that any decision must be based first and foremost on clinical considerations. Both the Mater hospital and St. James's Hospital have the necessary clinical mass and both are at the cutting edge of Irish health care. However, the Dolphin report and subsequent work undertaken by members of that group made it very clear that the planning risks associated with the Mater hospital are still significant. The decision on where the new children's hospital should be situated was not an easy one. Over the summer officials in my Department and I looked closely at all the proposals submitted, each of which had its own particular strengths. I thank all the hospitals that took part in the review process for their hard work and dedicated enthusiasm. In the end, however, the decision had to be made. As Senators will know there can never be a perfect site, but as we said previously we cannot let perfection be the enemy of excellence.

This decision has been made in the best interests of children with clinical considerations being paramount. It is essential that the new children's hospital can deliver best clinical outcomes for our children. Co-location with an adult hospital has been deemed essential in the Dolphin report and in all previous reports on the issue, while tri-location with a maternity hospital is optimum. Co-location and ultimately tri-location with a maternity hospital on the St. James's campus will support the provision of excellence in clinical care that children deserve.

I now intend to move quickly to put in place all the necessary arrangements to enable the delivery of this project as quickly as possible and to the highest quality. The Government regards the building of the new national children's hospital as a key priority and no effort will be spared in expediting its completion. We must now get on with building this hospital to the highest quality with best value for money as quickly as possible so that we can continue to provide the best of care, but now in the best of environments.

Photo of Marc MacSharryMarc MacSharry (Fianna Fail)
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I welcome the Minister to the House and thank him for taking the time out of his busy schedule to always come himself to talk with us. On balance Fianna Fáil welcomes the progress on the national children's hospital. I wish to mention a number of issues and I have some personal reservations.

I know the process transcends a different Administration.

When one reads the objections to the Mater Hospital proposal - I am not a trained planner but a humble auctioneer with some common sense - one could have written them in advance as being issues which would be raised by An Taisce and the Irish Georgian Society. They were the main objections which carried the day with An Bord Pleanála. I hope this time all of the ducks can be put in a line very quickly and that the Minister, or those in the Department who will manage the project, will proactively engage with Ian Lumley, the chief executive of An Taisce, members of the Irish Georgian Society and other stakeholders. They may hold the view we should be able to retrofit Georgian buildings to facilitate all possible wishes with regard to hospitals, which is obviously not practical, workable or cost effective.

We need to move much more quickly than we have. The Dolphin report was available in June and if we believe what we read in the media, we have had a five month wait since then. The Tánaiste was checking out the process to ensure he was happy with it before we could move forward. Serious doubts about the site have been raised. We all agree we want the hospital, and if St. James's Hospital is the site then so be it, let us get on with it and build it as quickly as we can. The official zoning of the site is unclear because of the court ruling. Earlier today I looked at some maps and it is very much a brownfield site rather than a greenfield site and this raises all types of issues. It is notionally possible that some brownfield sites may have listed buildings. If this were the case all of a sudden we would have far more interest from An Taisce, the Irish Georgian Society and other interest groups which can hold up processes. People may wish to pursue an agenda rather than facilitate the overall ambition of getting the hospital built as quickly as possible to start delivering the outcomes for which all of us yearn. It is a potential problem if the site is not sufficiently zoned.

In recent days the media reported the OPW highlighted in advance of the selection that serious challenges from a planning perspective and that the zoning was no longer clear. This puts a serious doubt over the timeframe. Presumably the project will go directly to An Bord Pleanála, which will be guided by the zoning of the day. Assuming Dublin City Council zones it appropriately to facilitate the building of the hospital as quickly as possible it may be open to challenge because the court judgment states it must go to public consultation. While the application will go directly to An Bord Pleanála it will consider it in line with the development plan of the day. If the development plan is amended to apply the relevant zoning, while it will not involve the planning authorities in Dublin City Council they will be cognisant of the development plan. The density to plot ratio of the project would be 4.5:1, but this is in contravention of the development plan for the area. Any potential objectors will have significant ammunition to shoot it down before we even start.

In putting his ducks in a line the Minister may not be able to consider the zoning issue only. He may also have to examine the possibility of Dublin City Council adjusting the density in the development plan for the area to progress the project. Otherwise it could be delayed for a significant period.

Building costs have changed in recent years. I have anecdotal evidence that the starting place for the HSE, when it considers the cost of building, is ¤200 per sq. ft. but from an auctioneering point of view, and my untrained view, it ought to be about ¤120 per sq. ft. Costs may be higher for a specialist build such as a hospital but it should not be 120% higher. Perhaps the Minister will reflect on the points that I have made. I wish him well in making a decision as quickly as possible.

Obviously leaving the maternity hospital on the never, never is not good enough. As the Minister has said, trilocation was mooted 19 years ago. If we put the maternity hospital on the never, never then my children will be grown by the time we realise the ambitions that the Minister and his predecessors have for the hospital.

4:20 pm

Photo of Imelda HenryImelda Henry (Fine Gael)
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Senator Colm Burke wishes to share time with Senator Eamonn Coghlan. Is that agreed? Agreed.

Photo of Colm BurkeColm Burke (Fine Gael)
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I welcome the Minister to the House and thank him for making a decision on the matter. It is welcome. The McKinsey report dates back to 2006. At present three hospitals in Dublin provide child care. It is important that we make the necessary changes because children require specialist treatment. In 2006 the report accepted that one children's hospital would look after children from the greater Dublin area and provide specialist care for children from around the country. It is important that we provide the best facility for children and at the earliest possible date.

It is interesting how medicine has improved in the past ten years and the specialist work that is now carried out in hospitals. It is important that children do not have to leave the State for medical treatment. There have been a number of reports since the McKinsey report and it is unfortunate that the original Mater project was unable to proceed. As recently as 15 May 2012, An Bord Pleanála responded to a suggestion to scale down the Mater project by stating:

In the case of this pre-application consultation, whilst the information before the Board is of an outline nature, the Board notes that a reduction in the height of the proposed building from 16 to 9 storeys plus plant is proposed. Whilst such a reduction in height is likely to reduce the visual prominence on the city skyline the Board advises that the reduction may, however, have other significant impacts in respect of the design, massing, bulk and functionality of the proposed hospital building and have the potential for consequent planning impacts which, together with the issue of visual impact, will be important considerations for the Board in determining any future application.
An Bord Pleanála made it quite clear, no matter what new application came forward about the Mater Hospital, that there was still going to be difficulties even with a reduction in height.

The site at St. James's Hospital is good. It will be a trilocation and will provide an adult facility. The Coombe Hospital is quite close plus we will have a new facility. We will be able to provide a comprehensive service when they are all working together.

It is important to have a maternity hospital close by. A lot of difficulties can be identified before a baby is born and a pregnant woman can be transferred to the new facility once her baby is born. Tri-location is crucial and I thank the Minister for making the proposal.

I agree with Senator MacSharry that it is important that the planning and consultation processes be expedited and that we build at the earliest possible date.

4:25 pm

Photo of Eamonn CoghlanEamonn Coghlan (Independent)
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I welcome the Minister to the House. Last week, 6 November was a great day when the announcement was made that the new national paediatric hospital would, at last, go ahead. Whichever site was chosen, there were always going to be disagreements as to the right location. The hospital in Crumlin was designed in 1936 and opened, eventually, 20 years later. It took 18 years from the time Tallaght hospital was designed until it opened. This debate has been going on for ten years. I hope it will not take another eight or ten years before the hospital is finally constructed.

A few moments ago, we heard how the children's rights referendum took 20 years to get this far and that there are lessons to be learned from what happened last weekend. Let us hope the lessons we have learned to date can be applied to what is going to happen in the new paediatric hospital on the St. James's Hopsital site and that we get it right this time.

The McKinsey report indicated that it was important for the paediatric hospital to be co-located with an adult hospital. From my experience as a fund-raiser for Our Lady's Children's Hospital in Crumlin for more than 20 years, I can emphasise that it is more important to have a maternity hospital located with a children's hospital. More than 500 emergencies go by ambulance from the maternity hospitals to Crumlin and Temple Street hospitals every year. A direct physical link from a maternity hospital to the children's hospital is most important to deal with these emergencies.

With regard to planning permission, is a maternity hospital included in the planning application? If not, will it be included in phase 2? I hope it is not left until phase 2, because no construction included in phase 2 of a hospital plan has ever been built. Planning permission for this hospital must include permission for a maternity hospital at exactly the same time in order that we know exactly where we stand now, not 20 years down the road.

Photo of Aideen HaydenAideen Hayden (Labour)
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With the permission of the House, I will share my time with Senator Marie Moloney.

I take some credit for my own party in saying the national children's hospital was a key Labour Party commitment in the general election and in the programme for Government. Funding for the project has been ring-fenced by the Government and it will represent the single biggest piece of infrastructure to be given the green light in the lifetime of the Government. It is a very important development.

As a parent, I welcome the development. I have had reason to use two of the three hospitals concerned, and irrespective of how wonderful the staff are, the hospitals are not fit for purpose. I welcome the decision, on foot of the Dolphin report, to proceed with the national children's hospital.

I know there are many who are dissatisfied with the decision. Spokespeople for the Mater Hospital, for example, have said its proposed changes would now satisfy the planning requirements. The Children's Hospital Alliance accepts the decision but considers the choice of St. James's Hospital to be a poor one. The alliance favours the greenfield site at Connolly Hospital and wants the Minister to mothball that site for future development. The Minister might bear that in mind.

The McKinsey report, which supported trilocation, has been dealt with by other colleagues. As I presume the Minister will deal with this matter in his reply, I will not go into it. I am concerned, however, that the Minister has indicated that the 2016 deadline for the construction of the hospital will not be met. I ask him to pull out all the stops to ensure it is. In the late 1990s, the Bacon report on housing indicated that it might be possible to expedite the planning process. It is shocking that it took five years from the initial choice of the Mater site to the submission of a planning application. That must not happen on this occasion. The McKinsey report was issued in 2006.

There were many debates before the McKinsey report was issued on a national paediatric hospital. For the sake of argument, I am thinking of when childhood leukaemia services were moved from Tallaght hospital to Crumlin hospital. That resulted in a very significant national debate. It is important we learn from what can only be described as a debacle in the past few years and ensure it does not happen again.

I am concerned about what will happen in the meantime to the existing children's hospitals, namely, Our Lady's Hospital for Sick Children in Crumlin, Temple Street hospital and Tallaght hospital. It is critical the services in these hospitals are maintained in the interim. There is always a temptation, even if it is unintentional, to downgrade services when it is known that a service will be moved to another site. In fact, I think a certain amount of downgrading has gone on over the past number of years in anticipation of the building of a national children's hospital.

In terms of the design of the new national children's hospital, I would like the Minister to take two specific things into account. There should be adequate accommodation for parents of children who require hospitalisation. Children do better when their parents are around but, more importantly, it is assumed in the medical services that family will be there to take over part of the care of children. The second point I would like to make is that there must be adequate parking. The parking charges in some of our hospitals are a disgrace and many parents and others are paying exorbitant amounts of money in parking fees which they cannot afford.

Senator Coghlan mentioned that Tallaght hospital took 18 years from initiation to construction even though in 2007 we built 98,000 housing units in this country. Many of our current hospitals are not really fit for purpose. I was in St. Vincent's Hospital recently and the Minister might turn his attention to some of the other hospitals in the country. If it is going to take this amount of time to build a national children's hospital, we should start to move on some of the other hospitals.

4:30 pm

Photo of Marie MoloneyMarie Moloney (Labour)
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I welcome the Minister. I will be very brief because Senator Hayden touched on the subject I was going to speak about. In the wake of the children's rights referendum last Saturday, it is paramount that we protect the welfare and well-being of every child in this State and a world class national children's hospital is key to that. In the development of the new site, as Senator Hayden said, I hope the families of sick children will be considered and catered for because it is a very traumatic time for families when they have a very sick child. As a rural Senator coming all the way from Kerry, I know many families struggle financially to afford accommodation in Dublin. The Ronald McDonald House in Crumlin is an invaluable and affordable service for families having to travel to Dublin with sick children. Have negotiations taken place with the Ronald McDonald service in regard to the new site? In the development of a world class hospital, we must cater for the needs of families as well as children.

Photo of John CrownJohn Crown (Independent)
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I welcome an Aire. I begin by saying, unambiguously, well done and congratulations to the Minister. It was a good decision. In a country with six medical schools for 4.5 million people - twice the European average and three times the North American average - it was pretty obvious that people were going to be unhappy no matter which affiliated institution was chosen for this. There really was a necessity to pick the best place. There were a number of good places but this clearly was one of the best ones. St. James's Hospital, in the Irish context, is a very fine hospital and it has a full range of support and high quality services and high quality academic connections, again in the Irish context, and I have no doubt it will make a very fine fist of it.

There were a number of arguments to be made in favour of alternative sites and the Minister may still hear some of the disgruntled adherents of other sites still making arguments at this stage. I beg and beseech for ciúnas among my colleagues, regardless of their institutional affiliation at this stage. The decision has been made and let us support it.

There is still the hurdle of what I have, rather uncharitably, termed "An Bord Faulty Pleanálty" to overcome. We should not give any ammunition to any argument from a group that feels there is still a viable alternative. Any other decision at this stage will just cause delays, and as there are no manifestly superior sites, we should proceed with this one.

I draw the Minister's attention to two problems. There will inevitably be a tendency for a freeze to occur on much-needed first aid measures in the existing children's hospitals with a mantra of waiting until the new place is built. There will be deficiencies affecting the health of living children and the services must formulate creative ways to deal with the issue. We understand that it would not be wise to make major infrastructural investments in any of the existing institutions that will close but we must ensure that some of the appalling waiting list issues in children's medical and surgical services are not just put on the long finger until the arrival of the nirvana of the opening of the new national children's hospital.

There may be some apparently regrettable duplicate investments in the short term to ensure waiting lists are dealt with. I am sure the Government is considering whether, in the short term, certain specialist surgical services with unacceptable waiting lists can be outsourced from the country temporarily until the new hospital is built.

Concentration facilitates quality but does not ensure it. The fundamental reform of the health system and how the hospital system is paid for will have a much bigger effect on the quality of health care in this country than any reorganisation of either hospital networks or integration into solitary specialist hospitals. I urge the Minister to ensure he keeps his eye very firmly on that prize because until we get fundamental reform of the way we pay and finance the health service, our system will be mediocre, and there is no other interpretation in that regard.

I am a little newer to the political arena than the Minister but I am a fast learner. While he is in the House, I will shamelessly tack on some questions for his consideration. Ireland will assume a senior role in Europe in January as the country takes on the European Union Presidency and I hope the Minister will use the opportunity to seriously advance some anti-smoking initiatives that we are considering. Our legislation banning smoking in cars in which children are present appears to be stuck between Departments. In the health committee on Thursday we will introduce a motion that Leinster House, in its entirety both inside and out, will be made a smoke-free zone like HSE hospitals.

In the past week we have begun a major initiative targeted at Europe and the Government to get the European Commission and the European Parliament to agree to the notion that by 2030, it would be illegal to do any commerce in tobacco in the European Union. With 17 years to lead into this process, this quixotic ideal is possible.

Will the Minister determine if appropriate inquiries are being made into the circumstances of the resignation of the former Commissioner Dalli? I attended the European Parliament last week wearing my European oncology hat rather than my Seanad hat and there is substantial speculation that Mr. Dalli, who had a very firm anti-tobacco agenda in his position, found himself in rather surprising circumstances being forced to step down. It has been suggested, although we do not know if there is a basis to the claim, that he may have been the victim of dirty tricks by those with a vested interest in opposing attempts to rein in the tobacco industry.

I congratulate the Minister on the decision made on the national children's hospital and look forward to a very productive six months when the Minister is in charge of Europe's health initiatives.

4:35 pm

Photo of David CullinaneDavid Cullinane (Sinn Fein)
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I learned today that the Minister is not in favour of shotgun or forced marriages and I agree with him on the site chosen and that we should get on with building the hospital, which we all want. It is a welcome development that the site has finally been chosen and we will now see the building of a new top quality national children's hospital, which will be an enormous addition to the health care infrastructure on this island.

I commend the Minister for the review carried out by him when he took up office and on the confirmation that the Mater Hospital site was the appropriate choice before the refusal of planning permission by An Bord Pleanála in February 2012. It seems clear that this process and the delay it caused in delivering a key project was less than ideal at the time. We have moved on and we now have a new site. The genuine question people have relates to the ring-fencing of capital funding for the project to ensure there is no issue about funding going forward. We all accept there has been too much delay. We can continue to engage in the blame game or we can move on and work together to ensure the hospital is built. In that context, the Minister will have my party's support to ensure that happens. I seek an assurance that the funding will be ring-fenced.

4:40 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank all the Senators for their comments and support. There is unanimity in the House that this project is worthy of a modern State. Many countries are judged by how they treat their most vulnerable and sick children fall into that category. Senator MacSharry alluded to a parallel process being run. There was no parallel process. There was a clear sequential process in that we had the Dolphin group report, then we had a member of the group do a further report on the relative costings because all the bidders put their best foot forward and in their enthusiasm some of the information might not have been as accurate as they believed and this had to be verified. There was a planning exercise given the risks and what had happened previously, where the focus was on the clinical primacy needs of co-location. This is the benefit we are seeking to achieve. A small country of 4.6 million people does not have the cohort of children to support the specialties that a country such as the UK does with a population of 60 million. Members have referred to Great Ormond Street as a stand-alone hospital. It can justify that because there is such a huge cohort of children. The hospital's chief executive officer was a member of the international group who kindly gave of her time freely and even she agreed unanimously with the other three members that co-location was by far the most preferable way to go.

I have walked the site and the planning issues have been mitigated considerably because it is much bigger than the Mater site. It is in excess of 6 hectares, which is much bigger than the 2.4 hectare site originally offered by St. James's Hospital.

This also provides a wonderful opportunity to rejuvenate part of old Dublin and lift that area of the city with the possibility of a new medical quarter in the city to rival the best in the world. Meetings have been held since the decision was made on the hospital regarding governance issues. I attended a meeting in this regard before I attended the Chamber with members of the national paediatric hospital board.

I highlighted in the other Chamber a number of issues that could not be addressed until the site was chosen and they primarily related to governance, information technology, which was a big miss in the planning process for the Mater Hospital site, and the ambulatory urgent care centres. Clearly until the site was chosen, I could not adjudicate on how many of these centres might be needed and I believe we need more than one.

Several Senators mentioned the need to maintain a safe environment in the interim while the hospital is under construction and I am acutely aware of this. This is a recurring theme. When I served on the Eastern Health Board years ago, I witnessed what happened at St. Ita's Hospital, Portrane, while we awaited the new psychiatric admission unit in Beaumont Hospital, which only opened a year ago. Reference was made to waiting 20 years for the children's hospital but we waited even longer for the unit in the Beaumount Hospital. Dreadful conditions pertained in the admission unit in St. Ita's Hospital for both the patents and the staff, which I highlighted in the past.

I am grateful we are moving ahead. Unfortunately, we do not have a capital budget that allows us to build all the hospitals we would like. I am acutely aware of the situation in our maternity hospitals and the difficulties there. We are looking at innovative ways to allow us to increase our capital fund to address the issues.

I refer to the issues raised by Senator Hayden in respect of parental accommodation and parking. These issues will be addressed. I thank Senator Crown for his support. I have some positive news in respect of children. This year, there are 800 fewer children on the list awaiting inpatient treatment than last year. Too many people are awaiting treatment still but we are moving close to achieving our goal of ensuring everyone in the childhood population is looked after within 20 weeks.

With regard to tobacco legislation, I share the concerns expressed by Senators Crown and Eamonn Coghlan. I have spoken to John Dalli directly to offer my personal support. I have spoken to several of the ministers in Europe and the interim Commissioner about the need to ensure the tobacco directive is progressed. It is a key part of our EU Presidency and we want to move it on. Everyone knows my view on tobacco, it robs children of a full life and the industry seeks to make addicts of young children. That is to be discouraged at every opportunity. Many people in Europe are very concerned at the manner of the Commissioner's resignation. In due course, I hope he gets to clear his good name. He was a great champion of tobacco control.

With regard to the point raised by Senator Cullinane, who has just left the Chamber, I assure Members that capital funding is secure for this project. Lottery funding of ¤200 million has been made available to us and the remainder is available in the capital budget. I have been very slow to say how much the hospital will cost because we are going to tender and the last thing I want to do is give those who will submit a tender the opportunity to take advantage of the information. Everyone knows that if there is a certain amount to be spent and we let people know the amount, that is what it will cost. We are looking for value for money.

Senator Eamonn Coghlan referred to the maternity hospital, as did others. The reports are quite clear that the optimal is bi-location if we can manage it but the most important thing is co-location with an adult hospital. Tri-location is our plan and the site will accommodate it. This is an important point when referring to the site at St. James's Hospital. It is large enough to accommodate not only the new national paediatric hospital but also a new maternity hospital and other developments. I hope I am not talking out of turn but I am given to understand that, in respect of education and research facilities, another area on the site is acceptable to Our Lady's Children's Hospital, Crumlin. That may remove the need for one floor in the new hospital, which mitigates further planning issues. St. James's Hospital has a long history in Dublin and has good relationships with its neighbours. It is part of the community and people feel it is their hospital. I went out to walk the site and meet management and I was at pains to point out that the local community should be engaged with to ensure there was full information in order that the plans did not intrude on local people too much. Obviously there will be some inconvenience during construction but I have absolute faith in the hospital's ability to do this in a manner that will minimise inconvenience.

I thank Senators for their support and assure them this will receive my serious attention. I expect to be given weekly updates and have monthly meetings to ensure this is expedited. We are looking at every legal and proper way to cut through red tape with regard to EU tendering, which causes so many delays. We will run as many matters as we can in parallel in order to avoid delays.

We need to be realistic - it could be late in 2017 or early in 2018. However, nothing would please me more than to surprise people by coming in much earlier and obviously well within budget.