Madam, - It appears that decisions are soon to be made concerning the deployment of specialist paediatric medical services in the Dublin area.
However, there appears to be little open debate on the subject. It is reported that there is a consensus view that tertiary (highly specialised) referral centres should be grouped in a single hospital on a single site within the Dublin area but not in Crumlin.
We await the report of the McKinsey Group consultants, who have been commissioned to make recommendations for the deployment of specialist services and on the interaction between existing paediatric centres. However, it appears they will not be making recommendations on the location of any new tertiary care paediatric hospital.
Meanwhile, development of both the Mater and the Children's Hospital (Temple Street), as well as the advancement of specialist paediatric services to the country, have been stopped.
There are two options for relocating of specialist paediatric services from Crumlin: either to relocate to a "stand-alone" facility on a greenfield site or to the campus of an acute adult general hospital. Evidence from abroad weighs heavily in favour of the latter.
For instance, in the United States there are two ranking indices for paediatric (and other) medical institutions. These are the ranking lists produced by Child magazine and by US News and World Report. While league tables have their critics, these assessments have taken place over a five-year period and are based on research, patient care and patient safety.
Many of the best children's hospitals share top-10 rankings in both lists. And the vast majority in both lists share a common campus with an acute general hospital and the remainder (most of which are older hospitals) lie within a block of such a facility.
There is no comparable league table in the UK but current practice points to a similar policy. Some excellent paediatric institutions, particularly Great Ormond Street, Alderhay and Birmingham Children's Hospitals have "stood alone" since the first half of the last century or earlier and Yorkhill Hospital in Glasgow was also built some time ago. However, recent practice has been to build only on general hospital campuses. Examples include the relocation of the Guy's Children's Unit to St Thomas's Hospital, of the two Manchester paediatric hospitals to the Manchester Royal Infirmary, the Bristol paediatric unit to the Bristol Royal Infirmary and the Children's Unit at the Radcliffe in Oxford. There is a similar policy within the Scottish and Welsh offices as well as in the European Community.
These data strongly support the view that international best practice mandates the building of any new tertiary paediatric institution on a campus with an acute general hospital. The decision as to where to locate such an institution is to be made by the Health Services Executive. Quite apart from demographic and transport issues, plans have been completed, planning permission obtained and money set aside under the National Development Plan.
Some €46 million euro has already been spent on the joint Mater/Temple Street project. The recent action by the HSE in stopping this joint development is completely unacceptable. - Yours, etc,
RICHARD G FIRTH, Consultant Physician/ Endocrinologist, Mater Misericordiae University Hospital, Dublin 7.