The publication of the report "Children's Health First", by consultants McKinsey and Co, is an important step forward in the development of paediatric hospital services. The study found that the Republic, based on its population size, is in need of a single world-class tertiary paediatric centre and that this should be located in Dublin.
Paediatric tertiary care is the provision of specialised and highly complex medical services to patients under the age of 16. Typically, it involves looking after children with cancers, blood disorders, complex respiratory problems and cardiac conditions. Care for kidney, neurological and metabolic disorders must also be available, along with highly specialised paediatric surgery and intensive care facilities. A key element of a tertiary paediatric facility is that it be driven by a minimum volume of complex cases, thus ensuring high-quality care.
In making their recommendations, the consultants looked at best international practice in more than 15 leading paediatric care centres in Australia, Canada, Scandinavia, the UK, US and New Zealand. They noted, for example, that the consolidation of paediatric heart surgery from four to two sites in Sweden led to a dramatic reduction in mortality rates.
The evidence for provision of a single tertiary paediatric centre in the State is strong. The report's recommendation that the new hospital be easily accessible and be close to a leading adult teaching hospital is reasonable. Such co-location would ensure ease of access to specialities which are split between adult and paediatric patients and would allow for the sharing of specialised equipment. The new hospital must liaise closely with paediatric units in the regions and provide them with outreach facilities. And it is an opportunity to develop a comprehensive paediatric intensive-care retrieval service, ensuring the safe transfer of critically-ill children.
With a task force due to choose the site for the paediatric hospital within the next two months, much has been made of a potential conflict between the three existing children's hospitals in Dublin in the run-up to the decision. Yet two of the three have welcomed the McKinsey report. If there is a weakness in the report, it is the proposal that secondary care paediatric facilities for the capital should also be located in the new hospital. There is a danger that its highly specialised services will be overrun by the need to admit children with less complex illnesses. The task force should consider leaving open two of the three existing paediatric units in Dublin as secondary care facilities, allowing the new tertiary hospital to focus on specialist care.