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Duty of care

• Co-location is one of the key concepts being flung around (or rubbished) in the debate following the refusal of the children's hospital planning permission by An Bord Pleanala.

Its merits do not depend on a statistical headcount of how many leading children's hospitals outside this island have or do not have co-location. Many of those were established and/or built many decades ago so they should not be cited (on this issue) in this debate.

The argument for co-location is based on common sense. Many conditions to which the infant is subject can now be identified and addressed before birth. But some require treatment or procedures after birth -- and these should be available immediately after birth.

Some conditions continue well into childhood, adolescence or adulthood. Hence it makes the plainest of common sense that care should be seamless and available on the same overall campus. The clinical personnel to whom the child is transferred should be in touch with each other from the start.

Access to the medical records should also be seamless and easy, with all the latest information technology.

Dr Finn Breathnach has been one of the saner voices in this debate for some years but his view is not entirely helpful on the issue of co-location. If we are going to get this right at long last, co-location is essential.

I have never made any secret of my partisanship with regard to Tallaght but if it can be shown that there is a better solution -- in the interests of children -- I will accept it.

Not only does Tallaght have space on its own campus but it has a promise of more land from South Dublin County Council. Directly opposite the gate of the hospital are acres of multi-storey Nama buildings, which are lying empty and will rot away.

They could be converted for some of those ancillary buildings, which do not need to be custom-built for paediatric care. The Luas runs beside the hospital, connecting with Heuston and Connolly mainline rail. There is a bus terminal in the Square. Access to the M7 and M50 is minutes away.

There is already an existing children's hospital on the campus (working very successfully within the broad gambit of the adult hospital).

Current plans envisage the re-location of the Coombe Maternity Hospital on the site. There have, in the past, been exploratory talks between Crumlin and Tallaght. In any case, many of the paediatric clinical staff work in all three existing hospitals.

One of the issues arising out of the current proposals for the national paediatric hospital is the northside-southside problem. The RKW consultancy was explicitly precluded from expressing any opinion whatsoever on the Mater site, or indeed the geographical configuration of the national paediatric hospital facilities.

But RKW nevertheless managed to sneak in an opinion of its own, that the single first aid/triage ambulatory unit proposed to be built at a cost of €30m -- beside the closed-down Tallaght children's hospital, opened within the last 15 years -- would not be sufficient to meet the demands of the southside -- and south of the country -- for elementary hospital care.

The current proposal was made at a time when money was no problem and when massive capital expenditure was envisaged for Dublin's traffic engineering. We live in different times. But, as any ambulance person will tell you, time is of the essence in A&E cases.

There is therefore a need for serious hospital facilities for children on both sides of the gravely traffic-wise challenged city. So why not indeed rebuild Temple Street on the Mater site as part of a single institution but with the main centre at Tallaght?

Can we set aside vested interests, turf-wars, trophy-hunting, electoral populism and consider the problem as if we were clinical -- and, above all, mature -- adults?

Maurice O'Connell
Tralee, Co Kerry

Irish Independent