Eilish O'Regan: Hospital rivalry may yet be the toughest hurdle
There's no politics like medical politics. We can brace ourselves for more hospital rivalries and turf wars in coming years.
The planning green light for the long-awaited National Children's Hospital may have been given - but that guarantees only that there will be a building. It is very much a first step.
The three children's hospitals in Crumlin, Temple St and Tallaght will have to merge in more than name under the one roof.
History tells us that could yet be the toughest part.
There will have to be much surrendering of long-held and much-coveted powers, decision-making and ethos.
All three hospitals now support the move but it has been a long road to even reach that stage.
The board of Crumlin Hospital for a long time would not join the group planning the new facility.
When it was necessary to go back to the drawing board after An Bord Pleanala rejected the Mater site, a tough bidding war was mounted by different hospitals.
Their submissions revealed much of their attitudes to each other with much criticism of their rivals' ability to deliver the best care for children.
The most recent precedent for how three hospitals were merged but continued to be riven with divisions was Tallaght Hospital. It saw the Protestant-run Adelaide, the Meath and National Children's Hospital come together in 1998.
However, there followed a power struggle for make-up of the board and problems with governance and delegation of responsibility to management for years. It had a negative impact on the service.
Staying true to traditions and preserving heritages will be among the crucial battles to be fought.
Tied into all of these hospitals are fundraising arms which will find it difficult to relinquish donations and bursaries under a new regime.
There will also be the inevitable hurdles in bringing medical and other health teams together.
Where will a doctor who was head of department in the original hospital rank in the new set-up?
If efficiencies and streamlining of the new hospitals are to be met then there will have to be a review of old structures and systems.
There are four years to try to smooth some of this path and some progress is already made.
But the biggest sacrifices for the three existing hospitals are yet to come and some firm handling is needed.