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Desmond O’Neill: The location of Ireland’s new national children’s hospital

9 Nov, 12 | by BMJ

Desmond O'NeillOne of the hottest topics in Irish medical politics finally came to a head this week with the announcement of the location of the new national childrens’ hospital, amalgamating the three Dublin paediatric hospitals on the site of an adult hospital. For the host institution, this was a step of the utmost importance, as its future role as the leading adult hospital in the country would almost certainly thereby be assured.

Until recently, it had all seemed signed, sealed, and delivered to the Mater Hospital, affiliated to University College Dublin and in the gritty north inner city of Dublin, following the deliberation of an international panel of experts. However, following a sustained and divisive campaign by those in hospitals which did not win and on foot of an unhappy refusal of the first design of the Mater site by the national planning board, a further panel—this time without international input—was asked to review the site of the hospital again.

What followed was an extraordinary free-all and flurry of activity on and below the radar by a huge range of hospitals and developers, including a surprising greenfield site in the constituency of the Minister for Health which was widely regarded as splitting the focus of one of Dublin’s three medical schools, the Royal College of Surgeons in Ireland, between it and another site.

In view of what was at stake, the louder each of the parties proclaimed that it was the interests of children which came first, the more I was reminded of Emerson’s quote that “the more he proclaimed his honour, the faster we counted the spoons.”

The deliberations of the panel went to Cabinet for a widely leaked decision to site the hopsital at St James’s Hospital, the largest teaching hospital in the state, one of the two teaching hospitals of Trinity College Dublin. As a geriatrician, working at the other teaching hospital of Trinity whose bid few would have seen as a contender (a long story, which as my children would say, is a short story which I really don’t want to tell you), I had no involvement in the process, and so watched with fascination and a little distance.

Given that €40 million euro has already been spent on the Mater project, of which little can be recovered at a time of great national financial distress, it was of note that the new site is also an inner city hospital with a crowded physical footprint and tortuous local access roads: like the Mater, it is close to a large maternity hospital. Unsurprisingly, a delay is certain beyond the planned completion date of the original hospital of 2016.

The dynamics prompting the change and review will make interesting reading for future historians who will eventually have access to more information than most of the rest of us have. And fascinating it will be, in a small country where medical and national politics often intertwine: indeed, the current Minister for Health and the Minister for Transport are both GPs.

One strand may well be to analyze the association, if any, of the perceptions of the choice of the Mater site and the subsequent change of direction with the legacy of Bertie Ahern, the former Irish prime minister: not only did it lie in his former constituency when originally selected, but he had also been a member of the staff of its accounts department for some considerable time. His style of government was the object of great antipathy to the incoming government, elected into office in 2011, with his substantial and effective work for peace in Northern Ireland overshadowed for many by the findings of an official tribunal over his financial dealings.

Once announced, there is a sense that, barring those who will hold out like Japanese soldiers on isolated desert islands many years after the war’s end, there appears to be a general agreement to get on with it, fuelled to a certain extent by weariness and recognition that no site would prove perfect.

Whether by design or accident, it also probably helps that no cabinet minister has a seat in the constituency of the chosen site: during the campaign it was clear that some ministers were acutely aware of the kudos of attracting the project to a location in their patch. As the hard grind of sourcing the several hundred millions of euros in funding, redesigning, gaining planning permission and building this major project evolves, cabinet ministers may welcome this aspect more than they might ever have imagined.

George Bernard Shaw’s dictum that there are two tragedies in life, one to lose your heart’s desire and the other to gain it, remains as potent as ever.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and director of the National Programme Office for Traffic Medicine in the RCPI: the views stated are personal.

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