IVAN YATES: Is saving face more important than saving children’s lives?

THE decision by An Bord Pleanála to refuse permission for the National Children’s Hospital at Eccles Street, Dublin 1, has come as a bolt out of the blue to the development board of the National Paediatric Hospital, government ministers, the HSE and the Department of Health. I don’t like saying “I told you so.”

My Irish Examiner column of Oct 21, 2010, on the NCH: “The arguments in relation to traffic congestion and inaccessibility could prove deadly for the 5% of emergency cases that are time-critical. If Metro North is deferred or axed, additional problems will be encountered by parents with seriously ill kids. Bord Pleanála may yet determine that a city-centre location, with limited parking and crowded adjacent Croke Park events, is not optimal for such a facility. The limited size of the site prevents future capacity expansion and requires extra cost, due to deep, underground development and its vertical height. Funny money and best-practice urban development could scupper the scheme.”

In that article, I cited the five reasons given by Philip Lynch in relation to his resignation as chairman of that board, after three years of service. Mary Harney refused to listen. From the get-go, she blindly supported Bertie Ahern’s insistence that the Mater site be chosen. Bertie worked as an accountant at the Mater Hospital, prior to being a politician. The hospital campus is in the heart of his former Dublin Central constituency. In the Dáil, Pat Rabbitte, as Labour leader, revealed correspondence between Bertie and Des Lamont (Mater chairman) in which the Taoiseach was thanked for pledging their site — many months before the “independent” group indicated their selection.

One year on from momentous electoral change, Fine Gael/Labour more resemble their predecessors with every passing week. Instead of change, they copper-fasten the errors of the last, calamitous administration. The Government’s first review of the NCH site was a token exercise. The terms of reference precluded consideration of a new green-field option. It’s possible to pre-determine reviews, by selection of personnel and criteria to shape the result. Frank Dolphin is chair of the latest “expert” reconsideration. Who is he? A former member of the Mater board and HSE chairman who was most associated with Temple Street children’s hospital — long-term cheerleaders for the existing site. Enough said.

Catch-calls by elite insiders to the planning board’s decision have been predictable and contemptible. They blithely dismiss reasons for refusal. They misrepresent arguments about the skyline and aesthetics as abstract academic theorising in the context of urgent care for sick children. Failure to accept that this site is too small, resulting in overdevelopment, is typical of their arrogance. The limited scope of the campus means huge extra cost in digging underground car parking, and 16 stories of towering height (74m into the sky). There is only provision for 13% staff car-parking. Motorists know how inaccessible and congested this city-centre location can be. Common sense never gets in the way of our superiors.

Instead of accepting the outcome of due process, advocates of the present shambles insist that Bord Pleanála reconsider. Consultations are proposed to coerce them into submission. This means downsizing the building by a few floors, resubmitting the project and proceeding on the same site. The central argument for the NCH was to have a singular site on which there would be paediatric medicine, care, training and education. It would be co-located with maternity services and an adult-teaching hospital. If this requires a 392-bedroom hospital as designed, why should the scale and size be reduced? Adhering to this location means undermining the core proposition. Saving face can be more important than saving children’s lives.

Reducing the physical capacity of the building means either eliminating clinical specialties (eg oncological, cardiac or other faculty), or removing educational/training components. Take your pick. There is never a wrong time to make the right decision. Blind folly has resulted in €36.6m of technical expenditure and a decade of delay. Why perpetuate an initial wrong choice? The original cost, of circa €340m, in 2002, has exploded exponentially into current estimates of €650m, which probably don’t take full account of additional equipment and staffing liabilities.

Remember, design of the NCH took place during the Celtic Tiger era of other trophy projects, such as Metro North and West, Terminal 2 at Dublin Airport, the Thornton Hall phantom prison and the Bertie Bowl at Abbotstown.

The troika team needs to assess this plan. The entire capital budget of the Department of Health this year is €443m. The NCH is the biggest single building work in the history of the State. Financing of the scheme has been extremely dubious. A key part of Mr Lynch’s critique, at the time of his resignation, was lack of credibility in ensuring proper finance. A black hole of €200m was apparent. Unrealisable, overambitious targets of charitable donations amounted to funny money. The Cabinet sought to rectify this with their own creative solution. The license to award the operation of the National Lottery is to be raided. An Post, Camelot or any franchisee that is chosen will be asked to stump up €200m in advance. In return, taxpayers will pledge them €50m each year for up to 30 years of the licence period. God only knows what changes in gambling patterns will occur in the decades ahead. Irrespective of unpredictable revenue scenarios or losses, we must repay.

It’s time for the Cabinet to face the painful reality that the NCH will not be operational in the lifetime of this government. The immediate problems at our Lady’s Hospital for sick children in Crumlin, Temple Street and Tallaght need to be urgently addressed.

A sevenfold increase in trolleys is unacceptable. Even under the present NCH plan, 30% of day treatments were due to take place in Tallaght as an ambulatory clinical centre. Co-location has many meanings: bringing these three hospitals together; the Jul, 2005 Mary Harney version of public and private medicine; maternity and paediatric adjacent facilities; adult and children’s co-occupation on campus. Vested interests lurk beneath every option — just read Brendan Drumm’s book Challenge of Change. Dr James Reilly has an horrendous (impossible) in-tray: cumulative cuts of €2.5bn; more than 4,000 retirements; abolition of the HSE; promised, dim-distant dream of Dutch universal health insurance; assurances of hospital treatment within one year — all in the context of him taking personal responsibility for health-care delivery, through the Special Delivery Unit. Reilly’s appetite is admirable, if politically naive.

We are not a banana republic. We must respect planning law. From the outset, the NCH location plan was flawed. It’s a square peg in a round hole. It’s time for the cabinet to cop on and consider an alternative, more accessible, cheaper site. If they were in opposition, that’s what they’d do. They won’t. They are subservient to the permanent power brokers.


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