Children's hospital fiasco
Bertie Ahern has reneged on promises made to Protestant church leaders on the National Children's Hospital and he lobbied secretly for the Mater site in 2002. By Frank Connolly and Justine McCarthy
A leading Church of Ireland official and board member of Tallaght Hospital has accused the HSE of reneging on a promise made by Bertie Ahern to the three most senior members of the Anglican, Methodist and Presbyterian churches at a meeting last summer. The churchman, retired Dublin archdeacon Dr Gordon Linney, has condemned the planned withdrawal of the national children's hospital from Tallaght as “an absolute betrayal”.
Meanwhile, Bertie Ahern's own role in the decision to locate the new national children's hospital at Tallaght has come under scrutiny. On 15 January (while on a visit to Riyadh in Saudi Arabia), he said he previously had expressed “misgivings” about citing the new €500m children's hospital on the site of the Mater hospital in Dublin. “Like a lot of things in life, people wanted a national children's hospital,” he said. “Personally, I saw that as an issue that would delay the development of the Mater hospital... It certainly wasn't something that I welcomed at the time because I saw it as a delay. I was afraid it would delay the Mater hospital [redevelopment].”
But this assertion is directly contradicted by a letter he himself sent to the then Minister for Health and Children, Micheál Martin, on 27 September 2002. This letter arose from representations to him by the medical board of Temple Street who were concerned at a possible downgrading of services in their hospital. Both Temple Street and the Mater are in the heart of Bertie Ahern's Dublin Central constituency.
Bertie Ahern wrote: “Given that the intention is to move Temple Street onto the Mater campus and to provide a state-of-the-art children's hospital for North Dublin and indeed the country, any further downgrading or deskilling of Temple Street would not be in anybody's interest. I would be grateful if, through your office, a solution could be arrived at which would guarantee the equal distribution of paediatric surgeon posts between Temple Street and Crumlin hospitals and the continued maintenance of the services in Temple Street."
His intervention on behalf of Temple Street followed an instruction by Comhairle na nOspidéal, an advisory body to the Minister for Health, that the hospital reduce, transfer and downgrade its specialist surgery services. An Comhairle had recommended that all paediatric and neonatal surgery be conducted at Our Lady's Hospital, Crumlin, a view vigorously opposed by the board of Temple Street. An Comhairle had refused to ratify a much-needed replacement consultant surgeon post unless Temple Street acceded to its directive.
While there had been discussion at the time on the transfer of Temple Street Hospital to the nearby Mater site, there were no formal plans to develop a national children's hospital combining the three existing Dublin facilities at that time and providing tertiary services or complex surgical procedures.
In a follow-up letter to Micheál Martin on 16 October 2002, Bertie Ahern wrote: “I would be grateful if you could meet with representatives of the hospital to discuss the issues of concern as a matter of urgency and if you could let me know the position please.”
This correspondence followed the receipt by Bertie Ahern of a letter from Michael O'Keefe, a consultant ophthalmic surgeon in the National Children's Eye Centre at Temple Street. In his letter on 9 October 2002, Michael O'Keefe referred to a meeting with the Taoiseach in Bertie Ahern's constituency office St Luke's, Drumcondra, a month earlier.
“I met with you in your office in Drumcondra about one month ago. At the time I highlighted the problems of Temple Street Hospital and the ongoing attempts to downgrade it; you are aware of them yourself. To rub salt in our wounds, An Comhairle rejected our application for an additional A/E consultant and approved Crumlin Hospital's... I realize [sic] you are dealing with important and urgent issues at the moment. Temple Street Hospital is important to a lot of people in your constituency and elsewhere in the country. Perhaps you would ask Mr Martin to at least meet with representatives of the hospital to clarify these issues.”
The correspondence from the Taoiseach on 16 October 2002 to the Minister for Health prompted a reply from Micheál Martin on 12 November 2002 in which he said that he hoped to resolve the difficulties in relation to the provision of specialist paediatric and neonatal services. “In the wider context I will also be progressing a national review of paediatric services. The review will focus on the future organisation and delivery of hospital services for children.”
A comment made by Brendan Drumm, chief executive of the then newly formed Health Services Executive (HSE), on 24 November 2005, suggests that the decision to locate the new children's hospital on the Mater site may have been a fait accomplis at the time, before independent consultants were invited to make a recommendation. He said at the Oireachtas joint committee on health and children that he preferred the Mater site as the location for a national tertiary care centre for children. “There is the possibility that the national tertiary unit would be on the Mater site. The contending arguments involved have not been fully thought through... While I cannot make a determination in advance of a detailed planning process, the centre should ideally be in the city centre or close to the Mater site. The implications will be more significant for people on the Crumlin site than for those in the Mater or Temple Street hospitals.”
In December 2005, McKinsey Consultants were commissioned by the Department of Health and Children and the HSE to make a recommendation on the development of paediatric services to serve the country's 1.5 million children. In January 2005, McKinsey recommended that there should be one major children's hospital in the state to avoid years of fragmentation in the tertiary paediatric services. McKinsey said that the new hospital should be in Dublin and adjacent to an adult hospital. It also stated that the chosen site should be easily accessible by road and public transport. It said that there should be sufficient space on the chosen campus for parent accommodation, green space and for the expansion of relevant research and training units.
A Department of Health/HSE joint task force was established to consider where the new hospital should be located and received submissions from six Dublin teaching hospitals including Tallaght, St James's, the Mater and Beaumont hospitals. It eventually short-listed the Mater and St James's as the most suitable sites.
In June 2006, the task force announced that it had recommended the Mater site as the preferred location for the new children's hospital. Among the reasons for its decision was the view that the Mater could be developed more rapidly than the best alternative site, at St James's Hospital in Dublin. The task force believed that the Mater and St James's best met the criteria set down by McKinsey. It said it was unable to draw clear distinctions between the two sites. However it decided on the Mater for reasons based mainly on accessibility, building space and development costs. It said that the Mater site could be completed more quickly as significant work had already been done on the north inner city campus in preparation for the planned move by Temple Street to the site.
The task force also recommended that the new paediatric hospital should have its own board of management, separate budget and identity. The 48-page task-force report was received unsympathetically by St James's, Tallaght and Crumlin, in particular.
The board of St James's argued that the Mater campus was too small for the services required, and was more inaccessible by car and other transport than St James's.
Tom Mitchell, chairman of the board of St James's, wrote a critical appraisal of the task force's conclusions within weeks of their publication. “With regard to site considerations, the task force stated that both sites could provide the required space for the paediatric and maternity hospitals but noted the greater capacity of the St James's site to allow expansion, in fact an almost fourfold difference (24.3 hectares v 6.15 hectares). It fails, however, to pursue the implications of this difference, a critical consideration and a critical omission in the final determination of the outcome. But it is with regard to the criterion relating to the breadth and depth of clinical and academic services and facilities that the task force most clearly and egregiously failed in its task,” wrote Mitchell. “This criterion was arguably the most critical since the whole concept of co-location is founded on the widely-held international view that the best quality of care for children is provided where there is the greatest range of specialties available to it. Surely in that case it had a duty to seek it and to engage expert help to conduct a more detailed study.”
Mitchell said that the task force assumption that the Mater could be built more quickly and was better suited to developing cross-site cooperation with other tertiary hospitals was unsupported by any detailed investigation or reliable evidence. “Surely it is unacceptable that so far-reaching a decision affecting so deeply the well-being of children should be decided on such superficial and untested assumptions.”
His comments were echoed by consultants and other staff at Crumlin and Tallaght who claimed that the task force did not adequately consult with paediatricians in their deliberations. One of those who was consulted, Alan Craft, professor of child health at the University of Newcastle, said that his involvement had been “minimal” and dealt with in a short telephone call from a member of the task force.
“My involvement in the process to find a new children's hospital for Dublin has been minimal. In April [2006] I was rung to ask if I could offer advice on important linkages which should be considered in determining where a new children's hospital should be. I offered advice [based] on my experience across the UK. That was the limit of my involvement and I have heard nothing since. I was not paid for my advice,” Professor Craft said on 9 June 2006 in correspondence seen by Village.
The board of Crumlin hospital, which had not tendered for the project but which was prepared to move to an agreed location, firmly rejected the choice of the Mater. It cited the traffic problems in accessing central Dublin notwithstanding plans to build a Metro station under the Mater site.
It claimed that the Mater site was too small, and could lead to a further fragmentation of services which the new hospital was intended to avoid. It said that there was insufficient car parking on the Mater campus while most sick children travel to hospital by car. It said that there would not be sufficient space for single rooms or for families to stay with their sick children, huge numbers of whom will travel from outside the capital for treatment. It also had insufficient room for expansion or to develop the necessary training and research facilities.
The Mater Hospital is located in Bertie Ahern's Dublin Central constituency. The Taoiseach has long associations with the Mater, having worked there before he entered politics and won his Dáil seat in the mid-1970s.
Dr Gordon Linney, a member of the board of Tallaght Hospital, described the decision to locate a new national children's hospital at the Mater as “an absolute betrayal” by the government of the hospital's charter, a legal document that was approved by the Oireachtas. The charter established Tallaght as the umbrella under which the Adelaide, the Meath and the National Children's Hospital at Harcourt Street would be amalgamated. Removing the children's hospital to the Mater with its different ethos is a breach of the charter, he said.
“Mary Harney, who seems unable to listen to people, says that Tallaght doesn't have the specialties that would be needed but we don't have them because they have not been given to us, or they have been taken from us. We have been asset-stripped.” When the Health Service Executive was established it inherited a seat on the board of Tallaght Hospital from the outgoing health board. No HSE representative has ever attended a hospital board meeting in Tallaght and it is even unclear if the HSE has nominated anybody to take the seat, Dr Linney said.
He added that the leaders of the Church of Ireland, Methodist and Presbyterian churches travelled to Dublin from Northern Ireland in June 2006 to meet the Taoiseach about the proposed new children's hospital. The message from Dr Robin Eames and his colleagues was that the government was breaking its commitment to Tallaght.
“As recently as last summer, the Taoiseach personally promised the church leaders that the charter would be honoured,” according to Linney. “That includes keeping the National Children's Hospital in Tallaght. While I would be very surprised if the Taoiseach wasn't a man of his word, there isn't one shred of evidence that the HSE recognises that commitment to the charter.”
“I was centrally involved in the negotiations in the 1980s and 1990s to set up Tallaght,” he continued. “Why I feel personally let down by the government is that I was one of the younger people then who persuaded those who were reluctant to go with it. I did so because I was a participant in the New Ireland Forum where everybody was talking about inclusiveness.
“We've been caused trouble continually by the Department of Health and the health board from day one,” he claimed. “There is a huge anti-Tallaght attitude. By not retaining a paediatric service at the Tallaght site, the government is walking away from a solemn commitment made by the entire Oireachtas.”
Also speaking on behalf of Tallaght Hospital, the Church of Ireland Archbishop of Dublin, John Neill, said that the infrastructure and transport facilities were not in place at the Mater site. He also raised issues pertaining to medical ethics, such as embryo treatment and genetics, that have been simmering through the wider debate about the chosen location.
“I'm very seriously concerned about what is good for children. The space is not there for the infrastructure and transport is not in place. I'm also concerned that the variety provided by the various hospitals and traditions (in Tallaght) is going to be lost and the ethos as it's reflected by the ethical approach of the hospital, and more liberal approaches described as Protestant. There would be some difference, for instance, in genetic research,” he said.
The hospital boards of both St James's and Crumlin called for an independent peer review of the controversial decision, a call which was rejected by the HSE. Consultants at both hospitals privately claimed that there was political interference in the selection process and threatened not to co-operate with the development of the new national paediatric hospital.
The suspicion of political interference was further fueled by comments by the chairman of the board of the Mater, Des Lamont, to the effect that he had been given an assurance by Bertie Ahern, in September 2005, that a new paediatric hospital would be developed at the Mater. He made his comments by way of thanking the Taoiseach for fulfilling his promise at a function in the Mater in early-September 2006.
On Monday 15 January 2007, Alan Gillis, the chairman of the board of the National Children's Hospital in Tallaght, said that the hospital would not co-operate with the plan for the Mater unless it was changed. The boards of both Crumlin and Tallaght are to meet within a week to discuss their future strategies. At high-ranking meetings between the two hospitals in recent months, an invitation by Tallaght for Crumlin to join it in developing the Tallaght hospital was discussed. This proposition seems to have floundered however, as the board of Crumlin agrees with the McKinsey recommendation that there should be a single hospital on one site whereas Tallaght is proposing two locations, one northside and one southside in Dublin, under the aegis of one hospital. On Tuesday 16 January the board of Crumlin indicated that it was considering the construction of a new children's hospital, incorporating a maternity unit, on its existing site or on a green-field site. This followed separate meetings of consultants and nursing staff at the hospital at which there was unanimous opposition to moving to the Mater.
Complicating the current debate is an underlying suspicion among board members and consultants in Crumlin and Tallaght that there is hostility among key decision-makers, including Bertie Ahern, and senior figures in the Department of Health and the HSE to the idea of locating the new combined children's hospital on a site associated with a perceived Protestant ethos such as Tallaght.
They are also concerned that there is similar opposition to locating it on a hospital site such as St James's which is a training hospital for Trinity College with its more liberal traditions. In contrast, the Mater is closely linked to University College Dublin which historically is perceived as a promoter of a more Catholic ethos.
Crumlin board tried to remove Diarmuid Martin
The Roman Catholic archbishop of Dublin, Dr Diarmuid Martin, successfully resisted an attempt last year to remove him from the board of Our Lady's Hospital in Crumlin.A Deloitte & Touche report commissioned by the hospital to improve its governance recommended that the archbishop, who is the chairman of the board, be removed and given a titular position such as president of the hospital, equal to the Church of Ireland archbishop, John Neill's position in Tallaght Hospital. The report took cognisance of the fact that Dr Martin only attends one board meeting a year on average.
After the Crumlin board issued a press statement on 11 January 2007 announcing its disengagement from the HSE's transition group for a new children's hospital at the Mater, Dr Martin issued a statement of his own expressing surprise that such a decision was taken in his absence.
Crumlin hospital was founded as a local children's hospital by archbishop John McQuaid in the 1950s and remains in the possession of the archdiocese. The Catholic Church also runs the Mater Hospital and nearby Temple Street children's hospital, where the archbishop sits on both boards.
Simmering worries about a religious-denominational conflict over medical ethics at the proposed new children's hospital have been heightened by a controversial decision taken by the Mater's ethics committee in 2005. It ruled that women cancer patients could not avail of a new trial drug because it would have necessitated them taking the contraceptive pill. One Dublin oncology consultant condemned the decision as “ultimately sectarian”.
The controversy resurrected the dormant debate about the dominance of Catholic-run hospitals in the Republic. With both Crumlin and Tallaght hospitals now proposing to provide their own maternity services, conflicting ethical stances on issues such as assisted reproduction, abortion and embryo research are likely causes of contention between the churches.
Tallaght Hospital, which incorporates the old Protestant-run Adelaide Hospital, contains a clause in its charter stating that all medical procedures that are lawful within the State must be provided by the hospital and that the conscientious objection of any patient or staff member must be respected.
“There's a view among consultants that Diarmuid Martin has a major conflict of interest given his involvement in Crumlin as well as in the Mater and Temple Street,” says a senior medical consultant in Crumlin. “There's also a feeling that certain people would never allow the new children's hospital to go on a site associated with Trinity College, as are Tallaght and St James, and that has a perceived Protestant ethos.”
Hospital politics
Several prominent political personalities have become main players in the controversy over the national children's hospital.
The chairman of the board of Tallaght Hospital is former IFA president and Leinster MEP, Alan Gillis, who will be a Fine Gael candidate in Kildare South for the general election. He joined the hospital board in 1999 and has been its chairman since 2002.
Over in Our Lady's Hospital, Crumlin, the two board seats traditionally reserved for nominees of the Lord Mayor of Dublin are occupied by Dublin City Council members Oisín Quinn (Labour) and Charlie Ardagh (Fianna Fail) from nearby Walkinstown. Quinn has been selected to contest the general election on the Labour ticket in Dun Laoghaire.
The chairman of Crumlin Hospital is Archbishop Diarmuid Martin and the deputy chairman is the retired Dublin City manager, Frank Feely. Another board member is Ciara Byrne, the wife of a Kerry-born property developer who was a close friend of Charles Haughey.Among the board members of the HSE, which is overseeing the development of a new national children's hospital, is Niamh Brennan, UCD accountancy professor, author of the health service's seminal Brennan Report and wife of justice minister Michael McDowell.
Asked if party politics ever intruded on board deliberations at Crumlin Hospital, Oisín Quinn replied: “No, not for me and not for Charlie (Ardagh) either.”