Controversy has erupted again over the best location for the new national children's hospital, writes Theresa Judge.
The HSE has rejected a call by Our Lady's Hospital for Sick Children in Crumlin for a review of the decision to locate a new national children's hospital at the Mater hospital, and says one of the fundamental criticisms of the site raised in a report by Crumlin hospital is based on an incorrect assumption.
Insisting that the Mater site in the centre of Dublin is large enough to accommodate a world-class hospital, and dismissing concerns about access to it, Fionnuala Duffy of the HSE ruled out the possibility of any other site being considered.
The report by the board of Our Lady's Hospital for Sick Children in Crumlin, released last week to The Irish Times under the Freedom of Information Act, urged the HSE and Department of Health to consider a greenfield site to allow room for expansion and easier access.
Dublin's three existing children's hospitals are to be merged into the new hospital.
The report used independent experts and draws on experiences in children's hospitals in the US, Canada and Europe.
In recent days senior doctors at Crumlin hospital, who point out that they have accepted that their hospital is to close, say they do not believe the Mater site is in the best interest of sick children and their families.
Duffy, assistant national director of planning with the National Hospitals Office in the HSE, says the Crumlin report is incorrect in saying that the site size for the new children's hospital is 1.45 hectares.
She says the size of the Mater campus is 6.15 hectares, excluding existing buildings, and that the authors of the Crumlin report "may have made a simplistic assumption" about the area that will be allocated for the children's hospital.
Overall plans for the Mater include the redevelopment of the adult hospital and a new maternity hospital.
Duffy says the size of the site is still under discussion with the Mater hospital and they are "very close to having a definite area" for the children's hospital. She is "very confident" that "whatever we need will be made available for us".
Concerns raised by doctors at Crumlin that the new hospital is expected to have only 380 beds when there are currently some 450 beds in the three children's hospitals were also dismissed by Duffy.
She says the trend in children's medicine is moving away from keeping them in hospital overnight unless absolutely necessary and it is best practice to keep children as close to home as possible. This can be done in a variety of ways through satellite or day-care centres.
She says the HSE is "planning for this best model of care and delivery" and the number of beds provided will reflect this.
On the question of accessibility, she says the taskforce, set up to select a site, had commissioned researchers in Trinity College Dublin to study travel times to all the hospitals bidding for the children's hospital and they had concluded in favour of the Mater. A new metro is also to pass by the Mater.
Doctors at Crumlin say the majority of parents bringing children to hospital travel by car and that many have already driven long journeys from outside Dublin. Travel times from the outskirts to the city centre can be up to 90 minutes, they argue.
Arguments put forward by Duffy are unlikely to allay the concerns raised by doctors and board members of Crumlin hospital, or to quell opposition from those who wish to keep children's services at Tallaght hospital.
The leaders of the main Protestant churches have also urged the Government to base the hospital across two sites, including Tallaght.
Neither Tallaght hospital nor the Mater wished to make any comment for this article.
Political controversy over the decision to locate the new hospital, which is estimated to cost at least €500 million, in the Taoiseach's constituency is also likely to continue with both Fine Gael and Labour now calling for the decision to be reviewed.
However, any change at this stage would be a major U-turn for the Government. The Mater site was selected during the summer and approved by Cabinet.
Allegations of political interference were denied in the Dáil by Tánaiste Michael McDowell last week. He said the decision was "based on merits". On the report from Crumlin hospital, McDowell said: "It will be taken into account but the decision still stands."
McDowell's statement contrasted with comments made last week by Minister for Children Brian Lenihan when he said that if there were difficulties about the size of the site or access to it, then these would have to be addressed.
There was annoyance in Crumlin hospital over the HSE's initial public response to the report. In a brief statement, the HSE said it shared "the aspirations and vision for children" set out in the report and "is fully confident that they can be catered for within the site which has now been selected at the Mater hospital location".
Dr Fin Breatnach, a paediatric oncologist who has worked in Crumlin hospital for 25 years, says people feel their concerns are being ignored. "We have engaged with the HSE from the start but the problem now is that we find we haven't been listened to," he says. Specific concerns about the Mater site have to be addressed, he says.
Breatnach says people must "drop all their agendas" and focus solely on what is in the best interest of sick children and their families.
He says it is crucial "we get it right this time, because in the past the interests of children have not always been well served". As an example, he points to the fact that Crumlin is only now getting an MRI scanner.
"We said to the HSE you can have our hospital, that we don't mind losing our hospital as long as you give us something better for the children and their families."
Referring to bids from a number of hospitals for the new hospital, Breatnach says: "People saw it as a prize and nobody seems to be focusing on the important issue, the core issue for people in this hospital is what is best for children and their families and I wish people would drop all their other agendas and not see it as a prize for their institution."
He says the core issue is whether the hospital would be large enough to cater for all sick children now and into the future. He says Crumlin is now 40 per cent bigger than it was 15 years ago and a large children's hospital in Toronto told them major redevelopment was necessary every 10 years.
Population growth in Ireland is also a factor.
Another consultant at Crumlin hospital says observing the hospital planning process is "like watching a train crash slowly". While it is still possible that the HSE could come up with solutions to make the hospital fit on the Mater site, there is a "large credibility gap".
Oisín Quinn, a member of the board of Crumlin hospital and a Labour councillor, says: "If the Mater plan is debated on its merits, it will not stand up." Now that a detailed plan has to be drawn up, he believes "the problems will start to spill out" and he says the HSE will have to give a detailed response to the report.
Crumlin hospital fully backed a report by McKinsey & Co consultants earlier this year which concluded that there should be just one major children's hospital in the State. However, it says that a finding by McKinsey that the hospital should be co-located with an adult teaching hospital has been over-emphasised, leading to a narrowing of options.
Crumlin points out that adult specialisms such as neurosurgery or liver transplants are spread over a number of Dublin hospitals and this weakens the argument for co-location with an adult hospital.
It says the need to co-locate with a maternity hospital is more important to eliminate the need to move very premature babies from one hospital to another.
Duffy says the Mater plans include a maternity hospital and says she is "very surprised" that people in Crumlin feel their concerns are being ignored. Duffy says the plan for the children's hospital at the Mater has "factored in 20 per cent expansion" without the need to go into any nearby site.
The HSE/Department of Health transition group for the children's hospital is now tendering for consultants to draw up a design brief for the hospital and the Crumlin report has been formally included as one of the documents the consultants have to consider, Duffy says.