Madam, - Fintan O'Toole (Opinion, March 20th) makes a series of criticisms of the process for selecting the Mater Hospital site for the new national children's hospital.
What most of the debate on the children's hospital has not made clear is that the model set out in the McKinsey report, which set out the criteria for the site decision, would place four major hospital paediatric services on one site - tertiary, secondary and accident and emergency, with obstetrics to be added.
The McKinsey report is clear on tertiary care, defines it well and makes a good case for it to be on a single site. It is simply at sea on the rationale for having secondary care on the same site and it makes no case for having an accident and emergency service on the same site as tertiary care. Adult hospitals, in Dublin particularly, are in such a mess partly because our public hospitals are trying to do tertiary, secondary and emergency care on their sites.
The result is that A&E is driving the bulk of inpatient care and driving out planned elective and tertiary care. McKinsey proposes a failing model for a new children's hospital.
McKinsey examined centres in the UK, US, Canada, New Zealand and Scandinavia. It consulted 29 leading experts, of whom 14 were from North America and 19 were in hospital management. It is hardly surprising that the report favours a big, centralised, North American management solution.
Fintan O'Toole points out that parents, children, paediatricians and welfare organisations were not consulted. Similarly, there is no recognition in the McKinsey report that the majority of healthcare provided to children in Ireland is in primary care by dedicated public health nurses, practice nurses, general practitioners and area medical officers. I cannot find a reference to any consultation being carried out with any of us in primary care, yet another current review of paediatrics by another consultancy firm RKW is for paediatricians only.
It is simply unwise to ignore the national resource that is primary care in favour of a North American, centralised institution that gives no recognition to the part of our health system that works well for our society. Like many GPs, I am concerned that secondary care will be centralised and the proposed urgent care centres will end up replicating what we are doing now. The end result will be to de-skill primary care and reduce its capacity to provide cost-effective, commonsense care to the majority of children in Ireland.
The next job in paediatrics is to develop good secondary care with A&E departments attached separately from tertiary care. This would spare our children inheriting the mess that is the adult hospital model and that McKinsey recommends. - Yours, etc,
Prof TOM O'DOWD, Public Health and Primary Care, Trinity College, Dublin 2.