Madam, - Darach Crimmins, consultant paediatric neurosurgeon at Leeds General Infirmary (July 1st), raises a range of issues which deserve a considered response.
1. Did "Children's Health First" (the McKinsey report) consider how paediatric services should be actually configured in Dublin? The answer is no. The report states: "We were not briefed to consult with experts and practitioners in Ireland and did not have access to detailed hospital specific data on the nature and quality of care".
McKinsey, asked to give a "pure" and clear view based on the international literature and best practice, said that one hospital providing all the secondary care needs of Greater Dublin would be best, but added, very significantly, "subject to the obvious and significant step of translating this into a workable plan - which we have not looked at" (page 59).
The real issue now is developing a "workable plan" that will maximise the benefits for all children requiring tertiary and secondary hospital care. It is entirely appropriate that such should be provided on both the northside and southside of greater Dublin (not least because of traffic gridlock) but governed by a single board. Children in the catchment area of Temple Street and the Mater also deserve the finest care.
We note that in Leeds the Teaching Hospitals NHS Trust, of which Leeds General is one of eight hospital sites delivering services to over 1 million people (according to its website), has plans to build a new children's and maternity hospital by 2012, to provide better services nearer to where children and their families live. This is precisely what was proposed by Tallaght Hospital in its submission on the paediatric review.
Currently there are at least two hospitals - Leeds General Infirmary and St James's University Hospital - providing paediatric services. It is disingenuous of Mr Crimmins to give the impression that he has all services for 5.9 million people under one roof.
2. There is no "ludicrous" suggestion of "scuppering this whole project by splitting it up on religious, ethical, cultural, secular or sectarian grounds", as asserted by Mr Crimmins. The fact is that there is a very modern National Children's Hospital opened in 1998 and co-located in Tallaght Hospital. The Government has decided to build a new tertiary paediatric hospital on the Mater Hospital site as both Temple Street and Crumlin hospitals require new facilities. It has also decided that this new hospital should be governed on a "multi-denominational and pluralist basis" as is already the case in respect of the National Children's Hospital.
The Protestant Church leaders, on healthcare grounds, have requested the Government to develop both children's hospitals equitably and to pursue a single governance arrangement for them. To our knowledge no country in the world has ever reversed international trends by stripping paediatric services from the part of the country with the largest number of children and women of child-bearing age (Tallaght, Crumlin and much of Leinster) and placed them all in an inner-city site with great access difficulties.
Surely Mr Crimmins owes our church leaders an apology for accusing them of using the health of children "as a political/ideological football".
3. The case for developing paediatric services fully in Tallaght rests upon the healthcare needs of a rapidly growing population and upon governance arrangements which are inclusive and most likely to attract patients from both northside and southside to the new hospital, giving it the 5 million population base McKinsey indicated it would require. We have read enough about the NHS to realise that political/ideological argument concerning healthcare is perhaps even more pronounced in the UK than in the Republic. In contrast to the UK, it is Government policy here to support great Catholic teaching hospitals like St Vincent's University Hospital and the Mater and in that context it is appropriate that one teaching hospital would be a focus for the Protestant contribution within a multi-denominational and inclusive charter.
Uniquely the charter provides a statutory guarantee to protect the privacy of the doctor-patient relationship. We believe this is what the majority of Irish citizens would desire for the care of their families. We are pleased that the Taoiseach confirmed to the church leaders the Government's absolute commitment to honour the Charter of the hospital at Tallaght, which includes the National Children's Hospital, and to examine positively a "framework for development" for the Hospital at Tallaght over the next decade.
A single "National Children's University Hospital", on two adult teaching hospital sites, under its own board and with its own consultant staff and effective air and ambulance links, best fits the needs of all children in the Irish context and represents a further natural evolution of the steps so far taken by the Government. - Yours, etc,
Prof IAN GRAHAM, President, Dr FERGUS O'FERRALL, Director, The Adelaide Hospital Society, Adelaide & Meath Hospital, Tallaght, Dublin 24.