Department of Health fears that Tallaght Hospital was seeking to build up certain paediatric services to rival Our Lady's Hospital for Sick Children in Crumlin prompted its decision to move the diagnosing of all childhood leukaemias to Crumlin, this newspaper has learned.
This decision is controversial - it means one of the services traditionally provided by the National Children's Hospital, formerly of Harcourt Street, Dublin, but now part of the Tallaght complex, is to be removed from it. Provision was made for a new multi-million pound specialist unit in Tallaght for this specific service.
According to sources close to Tallaght Hospital board, this breaches the charter of the Adelaide, Meath and National Children's hospitals, which make up the new hospital.
One source said: "We believed that when the charter went through both Houses of the Oireachtas we could trust these people. Clearly we can't. The implications are enormous - the whole charter is being dumped."
The charter of the amalgamated hospitals says the objects of the new hospital include "the activities carried on by the Adelaide Hospital, Dublin, the Meath Hospital and the National Children's Hospital immediately before the . . . `transfer day'."
For the National Children's Hospital, these are "to provide and develop paediatric medicine and surgery in the State by developing the work heretofore carried out by the National Children's Hospital and to associate all paediatric services with the name of the National Children's Hospital."
A Department document, headed Briefing Note and drawn up for the Minister for Health, Mr Cowen, which has been seen by The Irish Times, acknowledges that a case exists for transferring paediatric haematology services (blood disorders) to Tallaght on the basis of existing specialist expertise and the charter commitment.
But, it continues: "The real concern is that there is an obvious attempt to build up tertiary level haematology services to rival Crumlin Hospital. The AMiNCH group [Adelaide, Meath, incorporating NCH] claims to have had a specific Ministerial commitment (from Mr Howlin) that all services and specialties available in the National Children's Hospital would be transferred to Tallaght."
The briefing note goes on to argue why this should not be the case with acute paediatric haematology, mainly in order to avoid duplication. Therefore, it says, all cancers, including leukaemia, should be referred to Crumlin, which already treats other childhood cancers, for initial diagnostic work-up and treatment planning.
Sources close to the Tallaght board are concerned that this is part of a general down-grading of the hospital.
Medical sources are concerned at the clinical implications. Since the early 1970s all children diagnosed in the National Children's Hospital with leukaemia have been part of international clinical trials, with their progress monitored worldwide. The majority of leukaemia-sufferers in Crumlin have not been entered in such trials.
Dr Ian Hann, a consultant haematologist in Great Ormond Street Hospital in London and one of the leading British experts on the disease, considers involvement in such trials to be vital.