Q.(Mr McFarland) The timing of the decision by the Royal College of Paediatricians to withdraw paediatric cover from the Belfast City Hospital (BCH), given the imminent Ministerial decision on maternity provision, is somewhat surprising, and could be construed as a pre-emptive strike against the Assembly. Can you comment? There are already car-parking problems at the Royal Maternity Hospital (RMH): how would it cope access-wise therefore with double its current maternity numbers?

A.The decision by the Royal College was not a rushed one; it first wrote to the Chief Executive of BCH Trust in August 1997 to express concern that there was not
middle-grade cover at all times in the hospital. A whole raft of legislation relating to the training of junior doctors is now in place and the staffing rosters have become impossible.

The problem of car-parking is acknowledged, but the panel feels that the RMH's accessibility is slightly better than that of the BCH. There is also scope to increase car-parking spaces at the RMH.

Q.(Mr Berry) Does the panel have figures of the number of high-risk babies transported from BCH to RMH each year, and related mortality figures?

A.Transportation is never good for babies in such circumstances, but that is not the only issue. The RMH has two high-risk births per day and can call upon full-time expertise from consultants who can carry out simple neo-natal procedures on the spot.

Q.(Mrs Carson) We hear so much about "temporary" proposals: what do you understand by "temporary"? Can the RMH cope with the maternity influx from the BCH, and if a new hospital is needed, how will it be financed?

A.The "interim" proposal for maternity provision is our understanding of "temporary" and a refurbished RMH to cope with the immediate increase in demand seems supported by the BCH's clinicians. As a temporary arrangement a 16-bed ward has been opened and 20 additional cots are available. The question of new build in the long term is a substantive issue, but we could, for example, look to Europe and the US as potential sponsors of a new "Peace" Hospital.

Q.(Ms McWilliams) Are you suggesting keeping acute specialities together? Are high numbers of births with complications known beforehand? What proportion are emergencies?

A.Our suggestion would be for obstetrics to come over now and that gynaecology transfer later with the new build. We dislike the principle of split-sites but accept that the siting of future provision of gynaecological oncology is a matter for debate. About 60% of congenital defect cases are known beforehand; around 40% of premature births are predictable. The RMH manages 60% of Northern Ireland's new-borns weighing under 1000 grammes.

Q.(Ms Hanna) What percentage of babies at RMH is born before 28 weeks? What percentage of new-borns needs paediatric intervention immediately? How many need to be urgently transferred to the Royal Belfast Hospital for Sick Children (RBHSC)? Are you implying that, at the Trauma centre is moving to the Royal Victoria Hospital, gynaecology should also transfer from the BCH?

A.About 1% of babies are born before 28 weeks. About 3% congenital and 1% depressed cases need immediate paediatric help. Most cases are stabilised and treated immediately by the paediatrician at birth. In the long term, gynaecological services, which are acute, should be provided on the same site as the A&E Department.

Q.(Mrs Robinson) Can you explain what McKenna missed in his report? In one survey, carried out on women in relation to future maternity provision, 6 out of 10 said that hey would not go to the RMH because of its location: comment? In terms of attracting PFI funding (which is not a preferred option) which site would be best?

A.The McKenna report's remit was acute hospital review generally and he refused to have an input of expert opinion from those who provide the maternity service. The Donaldson report was more focused and in-depth on maternity provision. Of the 55 consultant paediatricians we spoke with, none believed that perinatal services should be moved further away.

Our overall responsibility is to provide the best possible care for mothers and their babies. As regards where patients are prepared to go for the best care, the panel's experience is that the location of a hospital is not a consideration for patients as set against a concern for their best clinical treatment. Questionnaires can produce different results depending on how the questions are phrased.

Q.(Mr McFarland) The RMH's argument seems to be based on its proximity to the RBHSC: but my understanding is that neonatologists (who are all paediatricians) can stabilise new-borns, where necessary, and the babies can then be moved safely to the RBHSC in an incubator. Where is the problem with this?

A.Once the baby has been stabilised, a specialist needs to be on hand. He will have to come over from the RMH to the BCH and may have competing commitments. A recent study in California showed that the mortality rate for newborns was 33% higher in hospitals where there were only neo-natologists compared with those that also had paediatric consultants.

Q.(Mr Berry) Is the transportation of sick babies a real issue here given that whatever site is chosen as the regional maternity hospital will have referrals from all over Northern Ireland: the distances travelled by many will far exceed the relatively short distance from the BCH to the RMH made by sick babies at present.

A.A significant proportion of defects in babies are detected before birth and these cases are transferred to the RMH for special care in advance of the birth.

Q.(Dr Hendron) Is intensive care provision for mothers included in the plans for the new build if the RMH is the agreed site?

A.Only a small number of women require intensive care facilities. The plans for a new hospital on a site at the Royal Victoria Hospital would include a high dependency unit.