Tuesday 28 February 2012

John Crown: Farcical saga of children's hospital has to end now

The saga of our severely botched attempt to develop a national children's hospital has now ascended from mere vaudevillian farce to an infernally authored metaphorical mini-series depicting all that is wrong in Irish public governance.

An Bord Pleanala's rejection of the Mater campus for the hospital had, by its own admission, nothing whatsoever to do with the interests of sick children, or with the ease with which it could be accessed, although these arguments have resurfaced all week. No, they objected to its aesthetic impact on the Dublin skyline and views, and on the incongruity of its architecture in the local area. They voiced particular concern about the view from O'Connell Street(!).

When my incandescent rage had cooled down to a level that was compatible with rational thought, I was reminded of the scene in Fawlty Towers where Basil verbally skewers a demanding guest who complained of the lack of a view from her hotel room, by asking what she expected to see in Torquay. "Sydney Opera House perhaps? The hanging gardens of Babylon? Herds of wildebeest sweeping majestically across the plain?"

Basil might well have asked what An Bord Pleanala expected to see from O'Connell Street. Was it the Taj Mahal, perhaps the Grand Canyon?

Instead of the visual assault that the burger joints, sex shops and slot emporia of this once grand boulevard imposes on the eyes of citizens and tourists, we could have had something to be proud of, a towering monument to excellence and compassion, a visually stunning symbol of hope rising from an area that once had the highest infant and child mortality in Europe.

What about the Dublin skyline? I have news for An Bord Fawlty-Planawlty. As Basil might have said, "nobody can see the bleedin' Dublin skyline". The Luddite opposition to high-rise buildings -- an opposition which runs directly counter to the needs of conservationism and environmentalism, means that we all spend our lives scurrying vast distances at ground level like ants, in a city with the most rudimentary of public transport systems. Only in Dublin can a four-storey apartment building be billed as offering panoramic views.

And the incongruous architecture? The neighbours of the Children's Hospital on three sides would have been two modern hospital buildings -- the Mater University Hospital and Private Hospital -- and Mountjoy Prison. On the fourth it would have been the Boulevard des Champs de Dorset Street.

While there was general agreement in the medical community that the paediatric needs of our Republic would best be met by a unitary national children's hospital, there was also agreement that achieving it would be fraught with gargantuan medico-political difficulty and internecine competition between the existing institutions.

Dublin had been historically and honourably served by four children's hospitals, shamefully understaffed and under-resourced institutions where dedicated nurses and doctors toiled. These were Our Ladies Hospital for Sick Children Crumlin; the Children's Hospital Temple Street; the National Children's Hospital, Harcourt Street, and St Ultan's in Portobello, which closed its doors in 1984. Harcourt Street moved to the new Tallaght Hospital in 1998. Bizarrely, Dublin also had (and has) three maternity hospitals with their own paediatric units for very young babies.

This fragmentation of services meant that no unit was providing truly comprehensive care, and furthermore Irish paediatric medical and surgical training was in danger of becoming derecognised internationally.

A consensus emerged that there should be a single unitary national children's centre, a place of excellence and compassion for sick children and a mecca for our brightest carers and researchers.

The problem was always going to be the location. The staff of Temple Street argued that it should be on the campus of a major adult hospital, and it just happened that they had one handy -- the Mater. To the staff of Crumlin, this may have felt like a Temple Street takeover, and a strong counter argument was launched which was basically "ABM -- anywhere but the Mater". Crumlin favoured developing its own institution -- for the record I favoured this -- or perhaps going to an alternative adult hospital or green-field site.

Further complicating the issue was the perception of an unusually close relationship between Fianna Fail and the Mater. If the Church of England is the Tory at prayer then the Mater Hospital is Fianna Fail with a chest pain, or so the thinking was. Former staff members included Taoiseach Bertie Ahern. There was a suspicion that the Mater held all the political cards.

The letters pages of the newspapers, the commentary in the airwaves filled up with passionate, well thought-out articulately presented arguments by eminent paediatricians which came to exactly contradictory conclusions about where the hospital should be.

It was obvious that international advice would be necessary and there was a grudging acceptance that the needs of children would best be met by ending the argument and rowing in behind whatever decision was ultimately made.

The international opinion was offered, and it was for the Mater. No site was ever going to be perfect, but concerns about the suitability of a city centre site -- most of the leading international paediatric hospitals are in city centres -- access, scope for development etc were ultimately subjugated to the desirability of having the adult co-location.

Most commentators now agreed that it was best to proceed. New Health Minister James Reilly commissioned a mini-review on assuming office and the decision was reinforced -- the Mater.

At least An Bord Plantation Mentality was honest and didn't misrepresent itself as having any concern for sick children or expertise in health policy.

That platter of self-delusion garnished with hubris and served with a Pamela Anderson level of artificial self-inflation must go to An Taisce, which not only objected but also decided that its paediatric expertise was superior to that of the international board of experts.

It offered its own advice as to how paediatric services should be developed before delivering the absurd Chamberlain-like edict: "The decision on the Children's Hospital by An Bord Pleanala will protect Dublin's future."

Well, like Whitney Houston, "I believe that children are our future".

An Bord Pleanala and an Taisce, on the other hand, are offering the future of the past.

Senator John Crown is a consultant oncologist

Follow John Crown on Twitter: @ProfJohnCrown

Read the article @ The Irish Independent


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