Politics, not patients, the key influence in choosing hospital site


Dr James Reilly has hardly been a model of impartiality in the past over healthcare locations so why should the National Children’s Hospital be any different?

You really have to wonder about the nature of democracy and democratic accountability when all you get to choose is the difference between a Fianna Fail and Fine Gael politician, and decisions that affect something so basic as children’s health — ie the location of the new children’s hospital — are effectively made by one minister with a dubious record in choosing healthcare locations.

If you spend any time at all in the sector, you will hear the phrase ‘patient-centred’ all the time.

The idea is that health institutions/practitioners develop and use methods and practices designed with the patient in mind, instead of ones that serve the doctors and bureaucracies.

But in the case of the children’s hospital, it would seem the focus has been entirely on choosing a location that suits the needs of medicine and politics, rather than patients.

When the Mater site was chosen, there were many who suspected its location had more to do with the proximity of then local TD, Bertie Ahern.

There were many who had doubts about the Mater site — not so much because it was so inferior to any other potential location, but because there was suspicion about why it was chosen.

Those suspicions were confirmed when the small size of the site pushed the hospital so far skywards that An Bord Planala had to refuse planning permission for it.

The question which remains is: if the Mater was the best site a few years ago, and if it was refused planning permission for one building, wouldn’t it remain the best site?

Wouldn’t new permission for a different building be sought?

No; it turns out that the Dolphin report took a different view and recommended the St James’s site.

All that seems to prove to a suspicious public is that reports can recommend dramatically different things — presumably Fungie the Dolphin would have recommended Dingle as the location.

The decision effectively passed to the Minister for Health, James Reilly, a busted flush in terms of impartiality in choosing healthcare locations.

It is perhaps unfortunate for him that his most recent fame comes from the resignation of Junior Minister Roisin Shortall over the allocation of Primary Care Centres (PCCs) to Swords and Balbriggan in his constituency after they hadn’t been recommended by a review.

Of course, Reilly claimed that he used ‘other criteria’ than the ones used previously which would have not allocated PCCs to Swords and Balbriggan. The problem there being that many people suspected that his criteria included the fact that both locations were in his constituency, and it was this factor above all others which influenced the decision.

As Bob Dylan once remarked: “You don’t need a weatherman to know which way the wind blows.”

Yet, despite this, Reilly was effectively given the decision to make. His presentation to the Cabinet could not have been countered unless there was a very strong and obvious argument against it, and even if there was, his position as deputy leader of Fine Gael meant he was in a strong position to force it through, even if there had been strong opposition.

So we are left with the St James’s site, and at this stage, the need to proceed and finally build a hospital, after so much delay, will probably ensure it is built there.

But it is curious that the needs of sick children (and their parents) don’t appear to have featured as the main driver of the location. The debate has centred on co-location and tri-location and things many people don’t understand, rather than something they do understand; when I need to use it, if I need to use it, how far away is it?

The answer, if you live outside Dublin, is: it’s co-located, possibly tri-located, but located a long way from you.

In fairness, the medics and nurses who work in paediatrics in Ireland are generally of the highest international standards, and the care here is impressive, but when something so fundamental as the way paediatric care will be structured is on the table, we’d all like to have an input — if only to make sure incompetence, political interference and vanity don’t skew the process of site selection.

This hospital will be a key determinant of how and where sick children are treated over the next 50 years. One would have thought it important enough that the whole country should have a say on where it’s located and to make sure that the interests of children are properly served.

It certainly seems every bit as important as the referendum on children’s rights — but, now that I think of it, the Government also tried to skew that decision while giving the impression of impartiality.

There are, of course, many sick children who need expert care, and a big hospital with many different specialities is the way to give that care.

But when you’re planning such a major and expensive project aimed at improving the care of sick children, should all the money go into one location built in the heart of Dublin?

If a family in Donegal or west Cork have a sick child that needs ongoing care, would it be more equitable to ensure the major Dublin hospital is supplemented by regional hubs that can do some of that care — thereby giving the family more time and support at home in dealing with their child’s illness?

Shouldn’t that be the subject of debate — how do we best serve the needs of sick children and their families — rather than reducing the argument to a simple one of where the hospital will be?

Still, it is obvious that, as the retired consultant paediatric oncologist, Dr Fin Breathnach, has pointed out, with 60 per cent of the children coming from outside Dublin, a greenfield site (possibly in west Dublin) outside the capital would make the most sense for the most people.

Even at this stage, it would be nice to see some kind of thought-out policy on how the hospital will serve all the children in Ireland as equally as possible.

The children’s hospital was decided like the old Kerryman joke: “If I was going there I wouldn’t start from here”.

Similarly, though the location is now chosen, the very relevant subject of how to provide equal access to the hospital for every child in the country is still to be planned and discussed.

If only such a group all lived in the same Dail constituency and had a Minister for Health representing it, we could all be assured that their needs would be met.

This article was originally published in the Sunday Independent here

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