The great need to rationalise Irish hospital services in order to improve the quality of care and reduce costs, has been apparent for at least 50 years. The first serious recommendations on how this might be achieved came in the early 1960s with the publication of the Fitzgerald Commission report. It produced a national plan whereby there would be fewer larger hospitals in which the most specialised services would be available, supported by a series of smaller hospitals in which more general care could be provided. While some steps have been taken towards implementing Fitzgerald's sensible proposals, the overall plan is far from complete because of local resistance and political inaction.
Saturday's editions of this newspaper highlighted the controversy which has arisen over the specialist treatment of childhood leukaemia. The EU's specialist committee on the treatment of childhood cancer has recommended that there should, throughout Europe, be one specialist paediatric oncology unit per five million of the whole population and that such units should be responsible for the management of both solid cancers and leukaemia.
At present in Dublin (never mind the State as a whole) there are two separate units handling these cases, one in Crumlin Children's hospital and the other in the new Tallaght hospital. This particular issue has been complicated by the recent transfer to Tallaght of the National Children's hospital (NCH) to join the Meath and Adelaide hospitals on the new campus. The charter of the new hospital includes an undertaking that services already being provided in the three hospitals before the merger should continue in Tallaght and the recent and current financial crises besetting the Tallaght Hospital (by no means all the fault of the new hospital) will have created an understandable defensiveness there.
There can be little doubt that the health professionals involved in the treatment of these children want the best possible outcomes from their therapy of their young patients. And there is every reason to believe that one of the best ways of ensuring that the quality of care is optimal is to establish a children's cancer unit which brings together the best of clinical skills and experience in the country.
There are, currently, different skills and experiences in the two Dublin units. The unit at Harcourt Street was very usefully and actively involved in ongoing London-based international trials which included peer-review analyses of the effectiveness of both diagnostic techniques and treatment protocols here and at other specialist centres overseas. The Crumlin unit has followed the protocols of a German-based international survey but has been more passively than actively involved. There is reason to believe that closer linkages would further benefit the patients in both units.
Talks have already started, facilitated by Miriam Hederman O'Brien, between the chairpersons of the three Dublin children's hospitals on increased co-operation between Temple Street, Crumlin and Harcourt Street (now Tallaght) to improve the care of children. These talks should continue, and the clinical staff who care for children should be drawn into them. The potential to benefit the primary clients - sick Irish children - is considerable. The best care is provided by way of collaboration rather than competition.