Other countries have debated the issue long and hard and have managed to produce world-class facilities However, these countries recognised that access isn't the holy grail of tertiary services. Is there any chance we can come around to the same thinking?

In its report advising on a tertiary paediatric service in Ireland, the McKinsey group examined 16 leading international children's hospitals in Australia, Canada, the US, Britain, Scandinavia and New Zealand.

They looked at hospitals that were managed or designed nationally and focused on populations or catchment areas similar to Ireland. They interviewed over 25 leading physicians and administrators in these centres.

All of the hospitals studied were in city-centre locations but the McKinsey report did not go into the pros and cons of such a decision.

Instead it reported that, "for tertiary services, access should no longer be judged in terms of patient convenience."

It quoted the Bristol inquiry, which was set up in Britain to investigate high mortality rates for paediatric heart surgery. This inquiry, when looking at a tertiary service, found that "quality and safety should prevail over ease of access, " and this is what the McKinsey report concentrated on.

Instead of access for all, a tertiary service should have outreach clinics for both routine and A&E visits, and an emergency retrieval service by land and air for life-threatening cases.

This, it found, did not present a significant risk to the lives of patients, but in fact increased their chance of survival because of the top-class services to which they were being brought.

On examination of some of the hospitals covered, the Sunday Tribune found, that as well as being in the centre of busy cities, many of the hospitals were at some distance from public transport.

For instance, the Hospital for Sick Children in Toronto can be reached by car or subway, but the nearest subway stop is a two-block walk away from the hospital.

Great Ormond Street Hospital in London is worse. Its nearest underground station is at walking distance from the hospital, and the nearest bus stop is a 15-minute walk away. Parents bringing children in by car have to face the notorious London traffic system, and have to pay a fee to enter the centre of the city.

The Children's Hospital of Philadelphia sounds more like what the HSE has envisaged for the Mater site, in that it includes an underground station directly underneath the hospital. But really, the underground is for staff and visitors, not emergency cases.

Location aside, the McKinsey report suggested several elements fundamental to a world-class children's hospital. For a start, each provides a minimum of 25 subspecialities including cardiology, oncology, haematology, neurology and neonatology.

Keeping all tertiary services in one place was deemed the most important factor in providing the best possible care for patients. The report stated unequivocally that spreading a world-class hospital over two locations does not work and leads to services being stretched.

All of the 16 hospitals studied are on a single site.

Education for the patients and any siblings who may have to stay at the hospital with their parents was found to be a huge factor in giving children the best care.

For example, Cincinnati Children's Hospital has a family unit next door to its neonatal intensive care unit, allowing parents to care for their child in a simulated home environment. This was found to make the transfer home less traumatic for everyone involved.

Fourteen of the 16 hospitals studied have overnight accommodation for the family and many have pulldown beds next to children for both parents. Others have 'hospital hotels' where children who are not ill enough to require 24-hour nursing can stay with their families.

Co-location with an adult hospital was a major issue in the McKinsey report. All but one of the hospitals studied are co-located and this is internationally considered to be best practice. Co-location with an adult hospital means staff can be shared in areas where a children-only service does not apply - for example in transplant surgery. It allows for a good transition from paediatric care to adult care, especially in cases like cystic fibrosis, where patients find it notoriously difficult to get similar treatment in Ireland once they are over 18.

Having a paediatric hospital beside an adult one also offers more opportunities for collaboration in medical research and training. Great Ormond Street Hospital is the only one of the hospitals studied that is not co-located with an adult hospital, and this is mainly because it is an older establishment.

For a population of up to five million, then, the McKinsey report recommended that there should be a single tertiary centre which is colocated with an adult hospital.

Access is important, but not as important as quality of care. Fourteen of the 16 hospitals have this, and those who don't admitted that this situation was the ideal.

This is what the international experts say. Presumably, it's what Ireland should be looking for.