Children want best hospital possible — it must be St James’s

Calls for Connolly to house the National Children’s Hospital are ill-informed. It is far from the best site that some imagine, writes Jonathan Hourihane

I am writing this in response to the article “Location of children’s hospital is not child’s play” (5/12/16) by Dr Fin Breatnach, who was writing on behalf of the Connolly for Kids Hospital Group.

I had no vested interest in which site the Cabinet would select when I was in the Dolphin group, which dispassionately evaluated all candidate sites, but I insist on now putting the views of those whose expertise and efforts presented the Government with a relatively simple choice, after reviewing all options, including Connolly.

The egregiously incorrect views propounded by Dr Breatnach and his allies gain traction with the public when their views are not expertly countered by facts but by polite silence.

The National Paediatric Hospital PR machine (if it has one) should be challenging all this misinformation, every time they appear, because such misleading statements must be refuted.

Dr Breatnach stated: “[St James… was chosen] with no justification whatsoever” and “without a single report ever recommending it”.

Has he even read the Dolphin report, published in 2012? The Dolphin group, on its own initiative, visited every candidate site.

Children want best hospital possible — it must be St James’s

The only reason Dolphin did not recommend the St James’s campus was because it could not, by its terms of reference, make a recommendation to Cabinet.

Any reader of the report could see the balance of judgement would have to fall for the St James’s site. Dolphin concluded that the St James’s campus had more going for it than all other bidding sites, including Connolly, which itself has definitely never been recommended by any report.

The only other hospital campus ever recommended was the Mater, also in inner-city Dublin, but that site was too small and remains too small. The St James’s campus was already big enough in 2012 and more space has been made available.

Dr Breatnach also stated: A “full- service maternity hospital [how is that defined, exactly?] cannot be accommodated” at St James’s?

Incorrect. It is planned to follow the children’s hospital at St James’s campus, with the Coombe Maternity Hospital moving on site. Why on earth does Dr Breatnach want to put an urgent care centre on the same site as the National Paediatric Hospital?

Has he not understood what the urgent care centres are meant to do: Keep most mild or simple cases out of the National Paediatric Hospital/ St James’s site (isn’t that what he wants after all?). So they have to be elsewhere. He should be happy with that.

The Dolphin group heard from children themselves as well as parents’ groups, including the Jack and Jill Foundation (loud critics since). The children told us they didn’t care if they couldn’t see “trees and deer” while in hospital — they wanted the best hospital Ireland could build, wherever. Children fighting for their lives in ICU and their parents don’t care about views either.

Next, I’ll address the issue of car parking. Crumlin has very little bespoke parking, just commandeered space. Its neighbourhood is choked by parked cars and Temple Street has no dedicated car parking either.

I’m not aware of any other inner-city (or suburban or rural) tertiary childrens’ hospital that has more than 1,000 reserved parking spaces and a tram running actually alongside the site, that connects the hospital with the two biggest national network train stations in the city (in this case Heuston Station and coincidentally Connolly Station).

Great Ormond Street Hospital in London has no reserved parking and families arrive from all over Britain and abroad by public transport of a much lower comfort specification than the Luas. They then have to cross two busy roads.

Children want best hospital possible — it must be St James’s

Boston Children’s Hospital has parking nearby but not underneath and has a tram service nearby. Our country’s new hospital has underground integrated parking and the Luas is closer than the T in Boston.

I admit that on occasions critically ill children will be brought by parents by car but the Paediatric National Model of Care and existing paediatric retrieval services will be bringing the overwhelming majority of critically ill children from the regional centres, including Cork, and from the Dublin area by ambulance, receiving medical care en route (which parents cannot do).

The Dolphin group heard from the National Ambulance Service that their service will bring any child to any (selected) site safely and better than any other option and that road congestion does not significantly affect delivery of this emergency service, including for sick, premature, newborns who require transfer.

I would like to hear Dr Breatnach’s evidence that there is “corner-cutting going on to an unacceptable degree” at National Paediatric Hospital. None that I know of.

The views of a property developer who builds for-profit private hospitals, as put forward by Dr Breatnach, are irrelevant. His views from the private sector have no basis, except to show he could build a private hospital at Connolly.

So could I, but it would be the wrong type of hospital in the wrong place because Connolly itself does not have the complimentary medical skill mix to match that of St James’s Hospital, which has the highest number of national specialties services in the country, while Connolly has one of the lowest in Dublin.

It was estimated in Dolphin that it may take 30 years of investment to get Connolly to the level and breadth of medical services that are already available at St James’s. By any measure that is a “meaningful disadvantage” of Connolly.

Could Dr Breatnach’s group wait 30 years? Which part of the health service would he propose we starved of funds for 30 years to fund that? His own field of oncology or the Jack and Jill Foundation?

Until recently the history of Irish paediatrics was marred by a shameful lack of inter-hospital co-operation, lack of resource maximisation, and fierce protection of personal fiefdoms.

The imminent implementation of a joint board for the three Dublin hospitals has been one of the big pluses of the final decision to go to the St James’s campus and for all three Dublin children’s hospitals to merge there.

The opinions of paediatricians who are retired must be respected, but only if they are based on correct analysis of available evidence and if they will forward the cause of childrens’ health in Ireland.

I judge Dr Breatnach’s analysis to be incorrect and I believe none of his views would manage the latter, either.

He should leave the field to the current players, who are getting done what was never even imaginable under the on-field and off-field leadership of former staff.

The delivery of this hospital has been long delayed and the project surely is not “child’s play”. We agree on that, at least.

Jonathan Hourihane is a professor of paediatrics and child health at UCC since 2005. He was the lead author of the report about research in the new National Paediatric Hospital, the Hourihane report (2009), a member of the Dolphin group (2012), and the Academic Advisory Working Group reporting to NPH Board 2014-15. He has not worked in any of the three children’s hospitals in Dublin

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