JOINT COMMITTEE ON HEALTH AND CHILDREN díospóireacht -
Thursday, 11 May 2006

Tertiary Hospital for Children: Presentations.

Vice Chairman

We are back in public session for a discussion with officials from the Department of Health and Children and the HSE on the new tertiary hospital for children. I welcome Ms Laverne McGuinness, national director, national shared services and chairperson of the joint HSE-Department of Health and Children task group to advise on the optimum location of the new paediatric hospital, Dr. Fenton Howell, population health directorate, Health Service Executive, Mr. Paul Barron, assistant secretary, Department of Health and Children and Dr. Philip Crowley, deputy CMO, Department of Health and Children.

Before asking the representatives to make their presentation, I draw their attention to the fact that members of the committee have absolute privilege, but the same privilege does not apply to witnesses appearing before the committee. I will now ask Ms McGuinness to commence her presentation and I thank her for coming. Perhaps she will try to be as brief as possible because this is the second presentation. Unfortunately, the Health (Nursing Homes) (Amendment) Bill is being taken in the Dáil today to which some members will have to contribute.

Ms Laverne McGuinness

I am pleased to have an opportunity to make this opening statement. The letter of invitation asked me to discuss the new tertiary hospital for children. In late 2005, the Health Service Executive, at the request of the Tánaiste, initiated a review of tertiary paediatric services for Ireland. Following a procurement process, McKinsey and Company was engaged to provide a written report recommending the strategic organisation of tertiary paediatric services for Ireland, in the best interests of children. As part of the brief, McKinsey and Company was instructed that the report and its recommendations should be evidentially based, fully documented and informed by international best practice, working models in the delivery of paediatric care, current and projected demographics in Ireland, the inter-relationship between secondary and tertiary care provision for children, the requirement to provide paediatric secondary care and accident and emergency services for children in the greater Dublin area, emerging clinical trends and technological developments. Specifically the report was to identify whether tertiary paediatric services should in future be provided at one or more locations, the facilities required to meet tertiary paediatric needs, that is, beds, be they in-patient, day, ICU, theatres, diagnostic facilities, radiology, pathology and out-patient facilities and appropriate facilities required to meet secondary paediatric service needs in Dublin.

The report, Children's Health First, was completed by McKinsey and Company, accepted by the board of the Health Service Executive and presented to the Tánaiste in February 2006. Its main findings and recommendations are as follows. The population and projected demands of Ireland could support only one world class tertiary centre. The centre would require the following attributes to deliver international best practice in tertiary paediatric services: breadth and depth of services; accessibility; ability to recruit and retain high quality staff; strong academic and research capability and efficient use of resources. The centre would be located in Dublin. Ideally, it would be co-located with a leading adult academic hospital. It would have space for future expansion, including education and research facilities. It would be easily accessible through public transport and the road network. The centre would be at the nexus of an integrated paediatric service comprising important outreach capabilities at key non-Dublin hospitals, adequate geographic spread of accident and emergency facilities, including two to three of these in Dublin, and treatment at urgent care centres is another option. These centres would be either stand-alone or attached to an adult facility with no inpatient children's beds. The centre would also provide care for all the secondary needs of the greater Dublin area.

Following publication of Children's Health First, a joint Health Service Executive and Department of Health and Children task group was established in February to progress matters and, in particular, to advise on the optimum location of the proposed new hospital. The task group also includes representation from the Office of Public Works. The task group has been working intensively since its establishment. The joint task group embarked on an extensive information-gathering process to inform the decision-making process. They drew up evaluation criteria in line with the proposed assessment criteria in Children's Health First. They consulted with the patient advocacy groups on important factors which should be considered in choosing the location of the new hospital and requested information from, met with and undertook site visits to the Dublin academic teaching hospitals.

Arising from the deliberations of the joint task group, a number of important issues, not included in the original terms of reference, arose. In particular, the issue of co-location with maternity services, especially for high-risk obstetric and neonatal services, emerged as requiring consideration. The decision was taken to extend the working time for the task group in order to allow for expanded terms of reference and further consultations, including consultations with the three maternity hospitals in Dublin. The Dublin maternity hospitals were invited to provide written submissions outlining their views on the appropriate model, scope and scale for a maternity-neonatal service that could be accommodated as part of the new paediatric hospital and the consequential implications for maternity services in the city.

Meetings have been held with two of the three Dublin maternity hospitals and I can confirm that a meeting with the third, scheduled for yesterday, also took place. Meetings have also been held with representatives of private companies that have submitted unsolicited proposals to the joint task group expressing an interest in building this hospital. The work of the joint task group is due to be completed at the end of May and it is intended that the report of the group will be considered by the board of the Health Service Executive at its meeting on 1 June.

Vice Chairman

I thank Ms McGuinness for her succinct and comprehensive presentation. We will take the first tranche of questions from Deputies Twomey, McManus and O'Connor.

Deputy Twomey

One of the biggest problems for people is that it takes so long to get a decision. The national health strategy reviewed paediatric services and when the McKinsey consultants were appointed in December 2005 they reached a conclusion quickly. Where do these reports fit and how did we get to where we are now? The Mater Hospital redevelopment plan was to move Temple Street Hospital into the grounds of the Mater Hospital and if we went down to Eccles Street, we could see a nice chipboard model of what we could look forward to in that regard. However, all these plans have been thrown out and changed radically. How long is it since the Mater redevelopment plan was drawn up and why were these considerations not taken into place then?

Since the publication of the McKinsey report the maternity service has been thrown into the mix. It seems the sands are shifting under this proposal every second day. I am concerned about this as it reminds me of what happened with the radiation oncology report. A commission set up in 2000 to report on oncology services produced its report in 2003. As a result of this report it remained Government policy to have three major oncology centres — Dublin, Cork and Galway — until 2005. However, in 2005 we reverted to what was proposed in the year 2000. Now we are told that nothing will happen with regard to implementation of that 2000 policy until at least 2011. It seems the same will happen with regard to the national tertiary hospital for paediatric services.

Let us suppose we made a decision and the proposed tertiary and paediatric facility was to be established in Tallaght. If that was the case, would there be justification for a secondary care paediatric service and an accident and emergency service to be provided in the new Mater Hospital development to look after 90% of the cases within the Mater hinterland, a significant population of at least 500,000? Tertiary paediatric services could still be provided in Tallaght.

Let us nail Tallaght as the place. It has co-location, existing paediatric services and road, rail and air infrastructure. People suggest that Mr. O'Brien, the CEO of St. James's, might want this new hospital on the grounds of his hospital. I would have no problem with St. James's as it fulfils most of the criteria, but people feel it will be used to develop tertiary adult services and therefore there is no need for it to get the paediatric service because of its future plans.

It could also be suggested that Beaumont should be the site of the new hospital. It has tertiary services for neuro-surgery and neurology which are grossly underdeveloped and as a result the consultants there are threatening to resign. Although Beaumont could fulfil the criteria for a national tertiary hospital in paediatrics, we can rule it out because it will develop its own adult specialist services. Therefore, the Mater, Beaumont and St. James's are ruled out and St. Vincent's ruled itself out. This leaves us with Tallaght. However, we are still adding more into the mix by suggesting the new hospital should provide maternity services and by suggesting a private developer might be interested in building the hospital. The private developers are not an important consideration as they have made it clear that they do not care where the hospital will be built as they will build on whichever site is selected.

Therefore, what is slowing the decision is the addition of provision for maternity services for the greater Dublin region. We have three large maternity hospitals in the city, all of which have excellent records and which in the past had plans for some form of amalgamation. Will all the talk about amalgamating paediatrics and maternity services and co-locating them with other hospitals now delay the process further? Would we not be better off making a decision?

Look where we are coming from on this. The Mater Hospital redevelopment programme started before the health strategy was published and these were followed by the McKinsey review. We are getting nowhere. All we are getting are reports. Can somebody not just make the decision to build the hospital in Tallaght? We need to wake up on this. The situation is extremely frustrating for people outside of the House and the general health service as they cannot understand what is going on. They feel the whole decision making process is paralysed. We just cannot seem to reach a decision to do something and do it.

We committed to building this new tertiary hospital for children. First we were going to build a new Crumlin hospital on either a greenfield site or on the grounds of the old Crumlin hospital, but that plan changed last year. I do not want to bore people silly with the history of this, but the situation is absolutely chaotic. I am also afraid that ——

Vice Chairman

Perhaps the Deputy could ask his questions.

Deputy Twomey

I am on a rant.

Senator Feeney

The Deputy is politicising. He should move on. Fine Gael has had its Ard-Fheis.

Deputy Twomey

This is not a party political matter because we are talking about making a decision about where to build a tertiary hospital. We should not be issuing more reports or throwing more things into the mix. The decision has been made at least three times in the past. It was made for a new Crumlin hospital on the site of the old one, then for greenfield site followed by the decision to develop the Mater Hospital. It was then decided to go for co-location and now we are throwing the maternity services into it. All I am asking is that somebody should make up his or her mind on this as the people who need the service are losing patience.

Deputy McManus

I have much sympathy with what Deputy Twomey said. There is a problem about ad hoc planning for a paediatric hospital. There is a cost involved, both in terms of people working in poor accommodation like in Our Lady’s Hospital in Crumlin and the €42 million that went down the drain in terms of preparing the Temple Street project. We are paying a price for this kind of poor ad hoc planning.

I must take issue with regard to the minor but interesting point that there was consultation with patient advocate groups. We are elected by patients and probably know more about their needs in terms of community services than anybody because of the work we do. I represent County Wicklow and part of Carlow. One of the key problems people with sick children have is access. I am not sure what patient advocacy groups the members of the group met, but they certainly do not know what it is like to take a sick child from Carnew in the middle of the night to Loughlinstown hospital. Loughlinstown hospital does not provide paediatric services, but yet we have a situation where some 5,000 children are seen in it each year. This is because people are so desperate they go to the first hospital they can find, which happens to be St. Columcille's in Loughlinstown.

It is very important this matter is dealt with in a way that will meet the needs on the ground. This leads me to my first question. How many beds are there are in the current system and how many beds will the new hospital provide? My impression is that there will be a reduction of beds. In a growing population, with a large child population, it does not make sense to have fewer beds for sick children. We can all have great aspirations about community services and better general practitioner services and more care close to home, but the reality is the community services are not available. People must still get in their cars, if they are lucky enough to have one, and try to access a hospital bed.

Is co-location a key factor? The McKinsey report was published over Christmas when people had other things on their mind. People involved in running paediatric hospitals in the city accepted the report because it stated that co-location was a key factor and I note it is now becoming the ideal. Grangegorman is being suggested as a site and — I mean no disrespect to them — private developers are talking about sites that have no connection with any adult hospital. Will co-location be a criterion? This needs to be stated because the situation has already become confused.

I would like some feedback from the delegation on the two or three accident and emergency departments. I have already been seeking out some kind of way of promoting the cause of St. Columcille's Hospital, Loughlinstown to be the site of one of these accident and emergency departments. The service is being provided there anyway. They do not have the resources or the manpower to provide for children but it is an important hospital for a very large area of both south Dublin and the entire County Wicklow. Surely it is the case that beds will need to be attached to those accident and emergency departments? Where will children who need to be stabilised over 24 hours, for instance, be cared for if there are no beds for them? Will these accident and emergency units have beds available?

I refer to the rheumatology presentation. A total of 5,000 children are suffering from rheumatology disorders or conditions. How will they be provided for in this hospital?

Deputy O’Connor

I welcome the members of the delegation and wish them well. I have had a difficulty getting my head around this issue and I have been very careful in the manner of my public statements. I live in Tallaght and I represent Dublin South-West and even if this was not the case I would still be of the view that the case made by Tallaght Hospital in regard to all the criteria is very strong. I am pleased Deputy McManus said that Tallaght Hospital, which was founded in 1998, not only covers Tallaght which is the third largest population centre in the country but its catchment extends through counties Kildare and Wicklow all the way to Carnew. Tallaght Hospital has made the headlines overnight because of the remarks of the Archbishop of Dublin, Dr. John Neill. In that regard is Ms McGuinness in a position to tell the committee whether any direct contact has been made with the archbishop who is the president of the hospital?

I have been somewhat frustrated and unhappy with the delay. I note that the Tánaiste last week in the Dáil confirmed to Deputy McManus the schedule being followed. There has been a delay and the Tánaiste has explained this by referring to the involvement of the maternity issue as being a delaying factor. I do not wish to be insensitive to Ms McGuinness but I am aware that the issue of the chairmanship of the task force was also an issue and there has been a change in that regard. Has this caused any conflict? I stated publicly that the involvement of the previous chairman created a situation in which I believed St. James's Hospital was not being considered in any form. I wonder about the internal politics within the HSE that may exist with regard to that issue. I do not wish to be insensitive to Ms McGuinness's position but I am concerned about the matter.

This process has been delayed and it is time a decision was made. I have made my position clear on the case for Tallaght Hospital. There are all sorts of rumours and talk about other sites. Once the decision is made there will be an issue as to the schedule to be followed, the services that will be provided to the children of Ireland and the future role of the other hospitals. I am not sure whether this meeting this morning will impact on the decision and it might have been better to have held this meeting earlier. The HSE has a lot to do in calming public disquiet about the process. I am not just giving Archbishop Neill the credit for exposing that position but he has certainly helped. I hope the delegation can give us guarantees that the decision will now be taken and announced. I wish the delegation well.

Ms McGuinness

The nub of Deputy Twomey's question was the delay in the overall process and the reason it has taken so long to make a decision. The terms of reference have been expanded. Part of the process was consultation with the wider groups, with the Dublin teaching hospitals. We also asked for and received information from the paediatric hospitals. During the course of those deliberations it arose that maternity services are a key issue and the benefits that could accrue from tri-locating or at least having a maternity service in close proximity to the new children's hospital. I assure the committee that the overall thrust and task of this group is to come up with the optimum location for the children's hospital and to decide what will best serve the children of the country. We can give a commitment that the work of this group will be concluded by the end of May. The overall objective is to send a report to the board of the Health Service Executive on 1 June 2006, following which the board will make its observations and comments. The report will then go back to the Tánaiste and Minister for Health and Children.

We are in the middle of the process and the decision has not yet been made. We have been meeting the maternity hospitals and met with one of them as recently as yesterday. The process is ongoing. The site of the hospital is not dependent on a bidding process; the decision will be based on what will be the best hospital for services for children. We are gathering together all the information in order to inform that decision-making process. Some of the key criteria used are based on the information available in the McKinsey report. The four areas of consideration are the planning and development considerations, the governance issues, and the key issues of access and the overall area of co-location values. The McKinsey report has shown the benefits of co-location values, based on international best practice.

Dr. Philip Crowley

I will answer some of the other questions. The timescale may appear protracted but being involved in the committee has been a very pressurised experience. We have been criticised by some for acting with undue haste. We have studied the literature on best practice and we have been in contact with international experts. We studied transit times both nationally and across Dublin. We have been meeting interested groups and visited sites. We will take care in making our final decision.

The issue of maternity services may seem to have come out of left field, but international best practice shows the importance of the care of very precarious and very small newborns, in particular newborns requiring surgery who are often identified before birth. It would have been remiss of us to make recommendations on the paediatric co-location decision without at least acknowledging the fact that in the future some other form of links with the maternity services would be best practice. That is why we have done that. The evidence is very strong for co-location with an adult site, on which we are working. That is one of the primary criteria used when examining sites and taking information in for all kinds of reasons. There are specific adult specialties that provide care to children and there are others where co-locating adult and child services for the same type of care helps with the transition of care from childhood to adulthood. There are all kinds of clinical supports that can happen across teams in that kind of scenario and it is bound to create a centre that will be even better than a single tertiary centre would be, because there would be added academic expertise on which to draw, and academic activity from which to feed. All paediatric facilities throughout the country are co-located so Dublin is unusual in that regard. We have had a strong steer in that direction.

Deputy Twomey

I need to leave as legislation is being taken in the Dáil. I apologise for leaving in the middle of the presentation.

Vice Chairman

I suggest that the committee might write to the Whip's Office. This is the second or third time that legislation has been taken in the Chamber at the same time as the meeting of this committee.

Dr. Fenton Howell

Some of the points raised by Deputies Twomey and McManus need to be answered. We are considering all the proposals made to us whether solicited or unsolicited. We must give all of that due process and that is ongoing. Obviously, it is impossible to comment on that until the decisions are made. I believe everybody appreciates the situation in which we find ourselves. We cannot stop anybody from making proposals to us which we need to consider.

Deputy Twomey mentioned that moving Temple Street Hospital to the Mater was about to go ahead and asked what we would do with Our Lady's Hospital for Sick Children in Crumlin. There is recognition among the paediatric community in Dublin and in the country as a whole that we have been delivering care at a sub-optimal level and that there was a need to try to have one tertiary paediatric service in the country.

The faculty of paediatrics, which represents all the paediatricians in the country, has had documentation outlining that for some time. Many paediatricians were frustrated that we were going down separate routes and would never get sufficient volume to create what is best for children. This is about providing the best care to a high international standard for children. When the report was published, all the people we met so far, including the three maternity hospitals, and any correspondence we have had from the paediatric hospitals have warmly welcomed and supported the idea of a single unit dealing with tertiary and secondary care services for Dublin.

Deputy McManus asked about bed numbers. The existing bed complement between the three paediatric hospitals is approximately 405. The McKinsey report recommended a range of beds. It would range from 380 in one scenario regarding population and economies of scale, up to 585 depending on the same economies of scale and population. The range outlined is quite broad and when we make a recommendation and a decision is made on the location of the facility and when people sit down to plan it, we will be able to take into account the recent 2006 census and feed that data into the model to determine the optimal number of beds.

We know there will be a shift in the technologies available resulting in reduced need for inpatient care. New technologies will mean that people can be treated on an outpatient basis rather than an inpatient basis. The linkages that will be established with hospitals throughout the country will facilitate that change. The range is quite large and there is no diminution in overall bed numbers.

Deputy O’Connor

Did what I said make any impact?

Senator Feeney

Deputy O'Connor would like the witness to indicate they would like to move to Tallaght.

Mr. Paul Barron

I was going to respond to Deputy O'Connor's question about contact with Tallaght Hospital. We invited all the Dublin academic teaching hospitals, including Tallaght Hospital, to make submissions. We received very fine submissions from all the hospitals and we followed them up with detailed meetings with representatives of each of the hospitals, including Tallaght. The representatives of Tallaght Hospital made a very strong case, as did other hospitals. It is our intention before we conclude to invite the paediatric hospitals, which would include Tallaght Hospital, for any further observations before we take our decision, which will wrap up the process.

Deputy O’Connor

I apologise for raising this matter again. It is an important issue.

Vice Chairman

Other members wish to contribute.

Deputy O’Connor

I understand that. The committee was faced with a situation — almost a crisis — where the chairman needed to be changed. I wonder whether that caused any problems.

Ms McGuinness

It was due to the continued candidacy of St. James's that John O'Brien stepped down and I took over as chair. The Deputy asked whether there was any internal dispute in the HSE. There is absolutely no dispute or conflict. I have taken over the role as chair. We will go through a transparent process and we will continue with the deliberations in hand. We are still in the process of information gathering.

Dr. Crowley

Deputy Twomey asked whether we were now in the territory of amalgamating maternity hospitals. Everybody knows that the Dublin maternity hospitals are very large institutions already with more than 7,000 births annually in all three of them. I do not believe there is any intention to amalgamate them, as they would be very large institutions at that stage. Deputy McManus raised the issue of access, which is one of the key criteria we are using in analysing the options.

Dr. Howell

All the maternity hospitals have clearly indicated to us, based on international best practice, that they should co-locate at a minimum with an adult hospital and preferably also with a paediatric hospital. This is the direction of international best practice. Other than in Limerick, every other maternity hospital in the country is co-located with an adult hospital or is about to be.

Regarding the point Deputy O'Connor made about the chairman, I was on the committee from the outset. Mr. O'Brien indicated at the start that in case there was a potential conflict of interest he would step down. Across the board, to a person the committee felt there was not a conflict of interest in the first stage. However, he took that honourable decision to ensure there was absolutely no conflict that anybody else might see. He conducted himself in a very honourable fashion throughout.

Deputy O’Connor

I have no problem with that.

Vice Chairman

Dr. Howell stated that best international practice is having a maternity, paediatric and general hospital together. Where does that leave the group's deliberations now, if it proposed to have a paediatric hospital co-located with a general hospital but without a maternity hospital? Is it building a maternity hospital into its deliberations?

Dr. Howell

That is the very reason the terms of reference were extended. It was done so we could consider that aspect and that wherever is selected could also take on board a maternity hospital. Everybody within the medical sphere recognises this is best practice. We are trying to achieve what is best for children with special needs and their parents.

Deputy Cooper-Flynn

What exactly are the options if all three are to be co-located?

Dr. Howell

We are in that process. We are considering all the options and we will have the report by 1 June when we give the outcome of those deliberations to our board.

Vice Chairman

Deputy Connolly has been waiting very patiently and is due to go to the Chamber.

Deputy Connolly

I thank the group for its report. The health service is famous for its reports. It is almost a mini-industry. Often we see no action. This was one occasion when I felt an early decision had been made. However, I now see it has gone back to the drawing board, which is rather frustrating. Dr. Howell mentioned that he cannot stop people making proposals. We need to reach a cut-off point at some stage, when we say that all proposals have been considered and a decision must be made.

Another issue that concerns me is the fact that every time I look at the newspapers it comes across as a Dublin issue and the question is who it will suit in Dublin to have the unit in a particular area. It almost appears to be like a trophy for some hospitals to have this unit attached to them. Being from a rural constituency it is frustrating that the issue is perceived as being an in-house fight in Dublin rather than the service being a national one. We should get on with it. I would welcome comments on this issue.

The hospital is an all-Ireland one. Recently it has been indicated that this hospital would also cater for people from Northern Ireland. I heard that they would be willing to accept services from it. Is it envisaged that it would be an all-island hospital, as such, and are people from Northern Ireland being consulted on the planning stage? Do they have any input into the planning process or in terms of finance?

As we hear a great deal about hospitals and taxpayer's money, it was a surprise to hear of private consortia coming forward announcing they would build a hospital. Are any strings attached to these offers? Taxpayers would want to know how genuine these offers are, or if they are a publicity stunt. If it is for real, why is it not being given serious consideration? If somebody were to come forward with the promise of building a hospital, with no strings attached, I would be keen to listen to what he or she would have to say and to tease out the issues with him or her.

Co-location of a maternity hospital is the issue now. It would have made sense to have a number of maternity beds in whatever facility is built. We have ways and means of identifying high-risk births. It would make sense for a facility to be available to identify high-risk people and to have a number of beds set aside for them. It would get around the issue of co-location and other outstanding issues.

Senator Glynn

I will be brief as most of what I want to say has already been said. It is important to remember that this is a once-off opportunity and we must get it right. I do not think we should sacrifice accuracy for speed. It makes eminent sense that the unit would be located in a multidisciplinary campus.

Thankfully we have a paediatrics unit in Mullingar Regional Hospital but there have been difficulties in recruiting specialised paediatric nurses. We only have 50% of the number we require. Do the witnesses have any information in this regard?

Dr. Howell satisfied my concerns when he stated that everything was being considered and that nothing has been ruled out. That is important. The report is due on 1 June which is only a few weeks away. Let us wait and see what happens.

Senator Henry

I welcome the delegation and the presentation. It must be most frustrating for the committee the way the brief appears to have changed as matters progressed. It is most alarming for us and the general public.

Dr. Howell stated that best international practice would appear to be to have an adult, paediatric and maternity unit on the same site. If one does not have that in the new hospital, it will look as if we are not following best international practice. Therefore, that has already tied them down into a box.

Dr. Devins and I visited the Vall d'Hebron hospital in Barcelona at the end of last year, which has such a complex. It appeared to be an extremely efficient and well organised place. If we do not aim for something like that, people will think they are not getting whatever is best practice and that it rules out many places. The situation regarding the most recently built of the maternity hospitals, the Coombe, is that it is falling down. The Georgian Rotunda is in better shape. We are in the difficult situation of trying to get the best value for money from every side.

It is desperately important that wherever the tertiary paediatric unit is put, it is emphasised to whatever other paediatric units set up that they are to be first class secondary units because it is not fair for people to think that if they cannot get into this tertiary unit they somehow will not be getting the very best care for their children. It is most important that whatever money is needed for these secondary units will be supplied by the Health Service Executive because otherwise people will feel they have been short-changed.

Deputy Fitzpatrick

What it boils down to is wherever this tertiary facility is placed one will need the widest and deepest range of medical, nursing and paramedical skill sets. That limits one immediately to Dublin. One then has to decide between a northside or southside campus. I declare an interest in that I have been looking after the northside.

Vice Chairman

We have already had Deputy O'Connor speaking on behalf of the southside. The Deputy is more than welcome to state his case.

Deputy Fitzpatrick

: On the northside, one has the Rotunda, Temple Street, the Mater and a ready-to-go site. On the southside one has a choice of Tallaght, Our Lady's and the Coombe or Our Lady's, the Coombe and St. James's together. We are talking about finding a site for the facility now. The fact is that I think a decision has been made to go ahead with it anyway. It is imperative that the facility goes ahead. We will be looking at the fine print in the committee report as to which site is chosen.

Vice Chairman

Deputy Fitzpatrick made the case well.

Ms McGuinness

With regard to Deputy Connolly's question on the issue of private consortia, we have had a number of unsolicited proposals from a number of private companies, some of them property developers. In some cases, sites only have been offered while in other cases offers have been made to build the facility. We have met with all of these people at this stage in terms of the information gathering process. We have asked them the questions to which the Deputy alluded. However, that must form part of the overall report and we still have to evaluate them against the four key criteria we are using, namely, the co-location value, access, the governance arrangements, and the planning and site considerations.

We met the people concerned to hear what they had to say and that will form part of the report but the overall evaluation criteria are key and they are to decide what is the optimal location for the new children's hospital and what is in the best interests of children — one of the key criteria being the co-location values.

Dr. Crowley

With regard to Deputy Connolly's question about it appearing very Dublin-centric, I can see how many things often appear that way and that is also the case here, in that the decision has been taken to site the tertiary centre in Dublin. It is fair to say that the committee has been extremely aware of national access to this unit and that has been a key consideration in terms of both public and private transport to this unit. Also in terms of access, there has been a requirement that all sites would make provision for a helicopter pad. We would hope that a model would emerge. Much of the thinking about how this institution will work needs to be done after this decision is made and that, in a way, is more important.

We would like to see the existing links between tertiary centres in Dublin and outside strengthened in this new institution, and to have clear outreach and regional links. There is already a flow of referrals from regional to central links. Those referrals will benefit from the fact that all paediatric services will be in one institution and it will truly be a centre of excellence for patient referral. The committee has taken that on board.

Reference was made to maternity beds. That is an interesting question because we put that to the maternity hospitals. A simpler model might be to develop a small neo-natal unit with a couple of maternity beds for those who have been identified in advance. Obviously, not all high-risk deliveries are identified in advance. Neither the international practitioners nor the three maternity hospitals in Dublin supported the idea of separating those who need surgery or those who are extremely premature from the slightly less acute deliveries because it would be difficult to maintain staffing and expertise in such a small unit. Seriously ill neo-nates will continue to be cared for in three maternity sites in Dublin regardless of what emerges from this plan. A full maternity unit with that element included would be better.

Mr. Barron

We are anxious to develop the all-Ireland dimension. Our first job is to advise on the site. Once that is developed the next stage is to begin the planning process, developing briefs and so on. The McKinsey report touches on this issue. For some of the critical specialties the population mass required is approximately 5 million. There is a good case for developing cross-Border links. We will take that into account when planning the hospital.

Our Lady's Hospital in Crumlin is in discussions with the Northern authorities about the possibility of children from the North using the cardiac surgery facilities here. The hospital has been asked to bid for this, as have some hospitals in the United Kingdom.

Senator Glynn is right to say we have a problem with children's nursing which stems from the long lead-in time to become a children's nurse. One must train and qualify as a general nurse and then study paediatric nursing. The Minister for Health and Children, however, has introduced new arrangements to commence in September under which it will be possible to train directly as a paediatric nurse which will considerably shorten the time required.

Vice Chairman

Paediatric nurses used to train separately.

Deputy Connolly

After they have gained their initial qualification they train as paediatric nurses.

Vice Chairman

Was it not the situation some years ago that they trained separately? I thought there was a paediatric training school in Our Lady of Lourdes Hospital.

Mr. Barron

That was the case in the 1940s and 1950s but not recently.

Senator Glynn

That was the registered sick children's nurse course.

Mr. Barron

Our Lady's nursing degree combined paediatric and general nursing in a three-year course.

Senator Glynn

Are the paediatric nurses required for a baby care unit specialised beyond their paediatric qualifications?

Mr. Barron

Yes, they would require——

Senator Glynn

That is the problem.

Dr. Howell

Senator Henry said the issue was frustrating but to the contrary, we find this incredibly exciting and rewarding. We raised the issue of taking on board maternity services, based on our consultations. That has been a rewarding experience because we have dealt with patients' associations, such as Children in Hospital Ireland, Heart Children Ireland, the Cystic Fibrosis Association Ireland, Crumlin Hospital Action Group, the centre for children's hospital care and Crumlin Childrens Research, all of which have warmly welcomed the idea of trying to build in Ireland a world-class tertiary and secondary paediatric hospital for children, and co-located maternity services. Practically all of them made that point to us. It is rewarding to partake in that decision-making process to build something world-class. That is our goal, and when it is achieved it will be welcomed.

Vice Chairman

Is the group still on course to present the report to the HSE at the end of this month?

Ms McGuinness

Yes, we are on course to present it on 1 June.

Vice Chairman

If the report is accepted what is the envisaged timescale until this hospital is operational? Will it be three, five or ten years?

Ms McGuinness

We do not have that information.

Vice Chairman

On behalf of the committee I thank the group for coming here today. Its deliberations are important and I presume it does not wish to even hint at where it might be going but we look forward to reading its report.

The joint committee adjourned at 11.35 a.m. until 9.30 a.m. on Thursday, 18 May 2006.