The real battle may only be starting, writes Eithne Donnellan, Health Correspondent
The news that there is to be just one children's hospital in Dublin was a surprise announcement yesterday.
That's because up to now there has been a debate about where to provide the most complex treatments, such as heart surgery for children, and it had certainly been argued that such services should be provided on one site only.
But the plan now to provide everything except local A&E services, with no overnight beds, for children on one site in the capital is significantly different.
Minister for Health Mary Harney herself must have been taken aback. She said last September that while she no longer wanted to see specialised treatment services for children spread across "a number of sites", this did not mean that three children's hospitals in Dublin were too many.
It seems the consultants engaged by the Health Service Executive to look at best practice in this area do not agree.
McKinsey and Co, having looked at best international practice in the provision of tertiary care for children, found the Republic with its four million population "can support only one world class tertiary [complex, multidisciplinary] care centre".
This was after looking at over 15 leading tertiary care centres in Australia, Canada, Scandinavia, the UK, US and New Zealand and speaking to staff in each.
They also conducted an extensive review of research published in medical journals and consulted with professional bodies such as the American Academy of Paediatrics.
All their research pointed to the fact that there are better outcomes when large volumes of patients are treated at one centre. They noted for example that the consolidation of paediatric heart surgery from four to two sites in Sweden in 1993 led to a dramatic reduction in mortality rates, despite an increase in complexity of cases.
The consultants also stressed there were huge benefits for a children's hospital to be "co-located" with an adult hospital. They defined co-location variously as "adjacent to an adult hospital" and "being within a practical walking distance" of the adult hospital. In such circumstances, they said, the hospitals could share specialists and equipment, but they recommended their budgets be kept separate.
Their recommendations spell huge changes, some of which are likely to meet with resistance. The children's hospitals in Dublin have been reluctant at times to co-operate in the past.
There were rows between them for years, for example, about where one replacement surgeon should be located. At the time, the dispute was branded a "turf war" by Prof Brendan Drumm, now head of the HSE, then a consultant paediatrician in Crumlin.
There is likely to be a war of words again between the different stakeholders about where the one national children's hospital should be located.
While most of them welcomed the plan for one hospital yesterday, they may not be as happy when the location for the new hospital is announced.
There are a number of possible locations. The experts say the new hospital should be adjacent to an adult hospital and be easily accessible.
Temple Street was already about to move to the Mater and work costing millions in preparation for the move had already been carried out at the Mater campus. Given the Mater's proximity to Mountjoy Prison, which is due to move out to north Dublin, this could be an option. There are also plans to run a metro through the area.
Then there is Tallaght Hospital, which already incorporates the National Children's Hospital. And it is on the Luas.
But other adult hospital sites cannot be ruled out, Prof Drumm indicated. Each hospital will be waging its own campaign. Even private hospitals might bid.
However, the real battle in moving the project forward will be a political one. If the new hospital were not to be at the Mater/Temple Street site, in Taoiseach Bertie Ahern's own constituency, he could be in for a bashing on the doorsteps in the run-up to the next election.
Already residents on Dublin's northside are expressing fears about having to travel, for example to Tallaght for secondary care, if the new hospital were to be based there. They seem to be forgetting that the new hospital is to be a national children's hospital and many parents will have to travel much farther - from all corners of the country - to have their children treated there.