The recent announcement that the new national childrens hospital will be sited at the Mater Hospital has raised controversy. St Jamess and AMNCH in Tallaght both strongly campaigned for the hospital to be sited at their campuses, but many also believe there was no need for the move to be made.

In the light of this, a very timely book on two previous hospital amalgamations has been released. Its author, consultant orthopaedic surgeon Mr David FitzPatrick, believes there is much to be learned from these experiences for the present day.

The book, The Feds: An Account of the Federated Dublin Voluntary Hospitals deals with the coming together of seven voluntary hospitals into what we now know as AMNCH and St Jamess hospitals.

There are contributions from 44 writers on the hospitals involved, the problems they faced, and the reasons the amalgamations took place.

Mr FitzPatrick has worked in the Irish health service for 40 years. He qualified in 1961, the year the Federation came into being. He worked in four of the Federation hospitals-Adelaide, Meath, National Childrens Hospital and Dr Steevens-and moved to Tallaght in 1998. Considering the amalgamation process was discussed first in 1961, some critics might ask why it took such a long time to come about. Mr FitzPatrick does not agree with this view. "It took less than 40 years, which is a very short time," he said. "Seven independent institutions agreed to work together, and by the early 1970s they had developed a central pathology lab. By the early 1980s, they had developed the new hospital at St Jamess and the hospital in Tallaght could have been started."

Mr FitzPatrick puts the delays on Tallaght down to "prevarication". One of the key questions, he said, was whether money would be provided and how big the hospital would be. He doesn't think it was an overly long process. "The willingness was there all the time-I don't think it was an unduly long period. Compare it to the new St Vincents hospital. It opened in 1969, but the foundations were laid in 1939."

Before the two hospitals were opened, there was progress on improving facilities, Mr FitzPatrick points out. "The first achievement of the federated group was the centralisation of the laboratory services in Trinity. Different hospitals then developed specialist areas. Adelaide with microbiology, haematology in the Meath and so on," he said.

The new childrens hospital cannot work alone in providing care for ill children, Mr FitzPatrick says. It must have support from other secondary care facilities, for one-off cases like appendicitis. "Suppose the plan as it is went forward, with Temple Street just beside the Mater. Then it would seem to be logical and imperative you should retain at least a secondary care unit in Tallaght, to take the pressure off. Ill children don't all need tertiary specialist care. You need to have secondary care facilities around the country together with primary care," he says.

As for the hospital plan itself, Mr FitzPatrick has his reservations. "It depends precisely what the objective is. My understanding originally was the idea was to put the National Childrens Hospital, Our Ladys and Temple St on the same campus, effectively to replace Crumlin," he says. "Crumlin, as a stand-alone paediatric hospital, has worked extremely well as a tertiary referral centre. There have been pressures for Crumlin to be rebuilt over the years. From that has developed the idea that the three hospitals in Dublin should come together to provide a tertiary service on the campus," says Mr FitzPatrick.

The idea is quite logical, he says. "The transition between late childhood and adulthood-there could be crossovers in expertise."

Having worked at Tallaght, Mr FitzPatrick admits he might be accused of bias in suggesting it as the location for the new childrens hospital. "There is a feeling that the facilities and the access and the space in Tallaght are ideal, that it is the best place. There is a strong argument to be made to establish [the new hospital] on the campus."

However, if the decision was made to site the new hospital at Tallaght, Mr FitzPatrick is quick to point out he'd make the same argument for secondary care facilities elsewhere.

"If Tallaght had been chosen, I would make the exact same argument for Temple Street. I see no reason why there shouldn't be a good secondary care facility. It would be intellectually dishonest not to make that argument."

Funding was one of the major issues for AMNCH at the very beginning. Mr FitzPatrick says there were some serious mistakes made in this respect.

The financial allocation was based on the allocation to the other base hospitals, the ones that were moving there. It wasn't recognised that a single modern institution as Tallaght, on a much bigger site, was going to be much more expensive in terms of running than the three base hospitals."

"An understandable error, perhaps. Well, understandable as you like to think."

Before the hospital opened, bed numbers were cut by a third. "Its hard to know why it happened. Possibly it was due to economic pressure at the time," he says.

Mr FitzPatrick says these cutbacks still have effects on the hospital. "With all the problems with A&E, it would have been appropriate to leave the numbers! Perhaps we wouldn't have patients on trolleys. It has caused problems in term of space per speciality."

"In terms of the hospital in Tallaght that has been a problem. There have been difficulties in getting units established. I cant speak for Jamess, but I'm sure they've had similar problems."

Mr FitzPatrick believes there are things to be learnt from the two amalgamations. Although they had setbacks, he believes it was imperative for this to happen.

"While there were obviously problems for patients in the new hospitals, there were problems in the old hospitals for patients, doctors and administrative staff. Those problems were greater than the problems that are existing now." Reported difficulties with the Protestant ethos of the Adelaide do not ring true with Mr FitzPatrick. He remembers being at a meeting around the time when the subject came up. "Someone from the Meath said, What is all this Protestant ethos? In the Meath, were Roman Catholic and we would subscribe to the ethos you're portraying. "I think the hospital in Tallaght stands for a liberal ethos that anybody can subscribe to."

Co-locating and amalgamation are two important issues for Irish hospitals. Mr FitzPatrick advises continued communication and respect for each others way of working in any such process. "The important things are to recognise the other institutions culture.

"Get people to appreciate the necessity of the amalgamation. As early as possible, establish communications between management and staff at all levels so when the new institution comes about, people aren't saying, We do it this way." He believes this is what happened in Tallaght. "The staff did talk to each other, there were joint appointments and people were involved in the development of the new institution. The better parts of the cultures of the three have been moulded into the new hospital."

Communication must not only be open, but correct. "Communication from the top down is important, but it needs to be accurate. Sometimes things are said which aren't implemented. Usually in the form of financial support being promised, and not living up to what it was."

The federation of Dublin hospitals came about following negative criticism of medical training in Dublin in the 1950s. The Hospitals Federation and Amalgamation Act became law in 1961, bringing together the original federation of seven Dublin hospitals (the Adelaide Hospital; the Meath Hospital; Mercers Hospital; the National Childrens Hospital, Harcourt St; the Royal City of Dublin Hospital, Baggot St; Sir Patrick Duns Hospital; and Dr Steevens Hospital). The Feds: An Account of the Federated Dublin Voluntary Hospitals, 1961-2005(FitzPatrick, 2006) traces the amalgamation of these seven hospitals for the purposes of improving medical training and enhancing the efficiency of clinical and related services. Further amalgamation took place, resulting in the closure of all seven hospitals and the development of St James Hospital at Mount Brown and of the Adelaide and Meath Hospital incorporating the National Childrens Hospital at Tallaght.

Readers of a certain vintage will recognise many of the names, places, union disputes and political manoeuvring referred to in this intriguing book. For some, the enjoyment will be derived from comparing past events with the current health service reform process. There is just one dedicated chapter on nursing services. Co-written by Sibéal Carolan, Mary T Moore and Anna Dolan, this chapter outlines developments in (pre-registration) training programmes in general nursing provided by the original member hospitals of the Federation. It also blends in factual accounts of and reflective pieces on rules and regulations governing nurses behaviour and dress in earlier times and is a salutary reminder of how far nursing has come.