The Health Service Executive (HSE) has proposed major new reforms for paediatric services in Dublin to be carried out in advance of the development of the planned new national children's hospital.
The Irish Times understands that the HSE is looking at the development of a joint paediatric surgical service across the three children's hospitals in Dublin: Our Lady's in Crumlin, Temple Street and Tallaght.
According to some hospital sources, the HSE proposals could see specialist paediatric surgical services for very young children being centralised at Our Lady's hospital.
It is understood that the HSE has also suggested that paediatric neurosurgical services could be developed at Temple Street.
At present neonatal surgery services are carried out at Our Lady's and at Temple Street.
Neurosurgery services in Dublin are carried out at Beaumont hospital.
However, according to some sources, there is a view that such surgery involving children should be performed in a paediatric hospital.
The proposal to bring surgical services for children into one department across a number of sites is broadly in keeping with plans drawn up by the HSE for medical services in other parts of the country.
The HSE in other areas such as cancer care has adopted the approach that a single department would have more expertise in dealing with complex cases and thus reduce risk and maximise outcomes for patients.
A HSE spokesman yesterday declined to comment on the specifics of the new proposals to reform paediatric services.
The HSE said it had been in discussions with the three children's hospitals in Dublin regarding paediatric services in general and paediatric specialist surgery in particular.
"Following these meetings [ via the Council for Children's Hospital Care] the HSE sought submissions from the hospitals regarding paediatric surgical services with a view to developing a joint paediatric surgical service across the sites.
"The HSE has received the submissions in the last few days and we are currently considering them," it stated.
Proposals in one form or another to concentrate specialist surgical services for children in Crumlin have been around for nearly a decade.
However, these have been strongly opposed by Temple Street.
In 1998, following the failure of the three Dublin paediatric hospitals to agree on the nature and structure of a consultant post which had arisen at Crumlin, a committee of the then Comhairle na nOspidéal was established to examine this whole area.
Comhairle recommended the concentration of a very small number of specialist paediatric and neonatal surgical operations in Our Lady's hospital with all three paediatric hospitals continuing to provide non-specialist paediatric surgery and less complex urology services.
Comhairle maintained that a very small percentage of the children undergoing paediatric surgical procedures at Temple Street would require access to the specialist surgical services under consideration.
However, strong concerns were raised from within Temple Street in relation to the proposal to transfer some services to Crumlin.
In 2002 the then minister for health, Micheál Martin, announced a further review of the issue following talks with Comhairle and the then Eastern Regional Health Authority. He said at the time that he wanted to explore the possibility of developing some highly specialised services for children on an all-island basis.
It is understood that recently the Council for Children's Hospital Care has also submitted new proposals to resolve the difficulties in relation to the future of paediatric surgical services.
Last year the Government agreed that all paediatric services in Dublin should be centralised in a new children's facility to be developed on the site of the Mater hospital, a move which again prompted disagreement among hospitals in Dublin.
However, the development of the planned new national children's hospital is expected to take at least five or six years to deliver.
