[Amtmann]

There's an opinion piece in today's paper that's useful to get a thread on this rolling here:

OPINION: Populist fixation on parking and access at the Mater site misses out on its clinical merits, writes KARL ANDERSON

THE PUBLIC debates that frequently surround healthcare decisions in this country are important but they can strangle progress.

In the past they have forced important decisions to be shelved or watered down to the point where the right decision is traded for what is acceptable to those who are most vocal. Think Hanly 2003.

We must not allow this to happen to one of the most important and exciting healthcare projects this country has ever embarked on: the new national children’s hospital.

Dr David Vaughan, consultant general and respiratory paediatrician, reminded us last week that the expert who many years ago suggested rationalising cancer services in the midlands needed a Garda escort, such was the level of public objection to his proposal. Ultimately the desire for consensus and compromise prevailed ahead of quality. It took the unfortunate cancer misdiagnosis in the midlands that came to light in 2007 for us to accept that if we want quality we have to compromise convenience and if we want convenience we have to compromise quality. We all can’t have both.

While the contributors to the current debate on the location for the new children’s hospital are well-intentioned, what is absent since the Eccles Street site was selected in 2006 is a viable alternative. Why? Because there is none.

The current objections can be distilled down to access and parking. It shouldn’t be so. There were no public debates on the construction of the new Mater hospital, which is now reaching skyward, on the basis of access or parking.

Nobody has ever said that Temple Street children’s hospital should be moved because of the access or parking problems. Access and parking did not deter the sale in 2007 of a majority share in the Mater Private Hospital on Eccles Street, which valued it at €350 million.

Access and parking have emerged as the key objections because they are communicable – while the clinical merits of tri-location are difficult to communicate yet are far more important.

Last week, I spoke to parents from Limerick, Clare and Waterford who attend Temple Street hospital regularly and parking and access issues are simply irrelevant to them in the scheme of things.

Worryingly, what has emerged through this debate is an Abes (Anywhere But Eccles Street) movement, confirmed by the array of alternatives being put forward.

Some suggest that the existing three hospitals should remain in place. That would be a tragedy. The facilities at Our Lady’s children’s hospital, Crumlin and Temple Street are desperately outdated and beyond improvement.

Because paediatric expertise and facilities are spread across three locations, they are not as efficient as they could be and, as a result, children are waiting longer for treatment than they should, given the €200 million-plus invested each year.

Keeping three hospitals operating independently of each other a few miles apart when there is, for the first time, an unequivocal Government commitment to build one of the best children’s hospitals in the world is impossible to justify.

Breda O’Brien (The Irish Times, October 23rd) opined that it would make more sense to locate the new hospital on a greenfield site along with a maternity hospital, and build an adult facility later.

However, she is silent on the fact that Dublin does not need another adult hospital and does not suggest which one should close. It is unrealistic to suggest we could have a tri-located facility (paediatric, adult and maternity) on a greenfield site. It is simply not going to happen in our lifetimes.

Dr Róisín Healy, a leading figure in the New Children’s Hospital Alliance, does not believe the hospital should be built on Eccles Street but does not have a view on where it should be built. Dr Healy is willing to take her case to Europe to stop the planned hospital being built.

Dr Finn Breathnach, one of the leading advocates for the new hospital to be built on an alternative site close to the M50, presented a new option on Joe Duffy’s Liveline show last week (October 18th).

When questioned about the fact that, under his preferred option, there would be no children’s hospital on the north side of Dublin, Dr Breathnach said a solution would be to move Temple Street hospital to the Mater.

Clearly with this two-hospital approach the status quo could be maintained. It would mean that Crumlin’s position as Ireland’s largest paediatric hospital would be secure; it would remain independent and continue to have the largest budget (€125 million in 2010).

This suggestion is, however, diametrically at odds with the undisputed finding of the McKinsey report, with which all three children’s hospitals agreed: because of the small size of our population, to provide quality paediatric care we should have only one national children’s hospital (national tertiary and local secondary).

The new paediatric hospital debate must be about the quality of care that a tri-located hospital (children, adult and maternity) can provide, the calibre of clinical staff it can attract and the ground-breaking cures its combined research facility could unearth. It should not be about access and parking.

If the need for consensus and compromise is again put ahead of quality, we will repeat the mistakes of the past.

The unacceptable status quo will remain. Our political leaders will invest their energy in alternative projects that attract less controversy but are equally worthy.

If the prospect of a new children’s hospital becomes a distant memory smothered in reviews and endless circular debates (which it will because there is no perfect location), those who are most vocal against the current plan will be silent. Those who are actually responsible for providing services will be held accountable.

Karl Anderson is a former chairman of the New Crumlin Hospital Group (2002-2005) and former adviser to former chief executive of the Health Service Executive Prof Brendan Drumm

http://www.irishtimes.com/newspaper/...282315052.html

[Pete_Cavan]

The last paragraph of the article says it all really.

[SeanW]

I tend to agree with some of the negativity and feel that the current site is a mistake.

The only benefit I can see to the proposed Mater site for the NCH is that it will be served by Metro North, if that project goes ahead.

As I understand it, a good NATIONAL children's hospital will have not only enough parking for parents who will driving from all over the country, but on-site accommodation for parents who are staying at/near their children's bedside.

The proposed NCH at the Mater, due to the fact that will be a new children's hospital shoe-horned into a small space, will have neither. Ergo, the site is inappropriate, and will result in a second rate solution.

I tend towards the view that the hospital should instead be built on a greenfield site, along the proposed Metro North alignment for easy access from the City, while ideally being close to main road links for those who must drive in. And that it should be built on such a site with all the desirable facilities.

[jd]

From what I can gather, the issue with a green field site is that it would mean it wouldn't be co-located with a major teaching hospital giving access to specialised clinical staff when necessary.

[Tragedy]

Look at the clinicians who oppose the NCH at the Mater. The vast majority(if not all) of Paediatric Consultants are against the Mater site. You had the most respected childrens Doctors in Ireland coming out and uniting against the NCH (http://www.irishexaminer.com/ireland/kfcwgbgbqley/rss2/ for example).

Staff, experts and patients don't want the NCH site. The only people who do are HSE 'Experts'.

The matter is even more complex because Prof Drumm worked in Crumlin until last summer and was a leading advocate for its redevelopment as well as the overall re-organisation of children's hospital services. His €180,000-a-year press adviser, Karl Anderson, was also one of the founders of the parents' group which formed to lobby for the re-building of Crumlin.

Karl Anderson became a special advisor to Drumm when he became head of the HSE and has so far received €1million since 2005.

Take the article with a huge grain of salt, it's an 'opinion' piece from Drumm's Press Adviser.

[Tragedy]

Originally Posted by SeanW

The proposed NCH at the Mater, due to the fact that will be a new children's hospital shoe-horned into a small space, will have neither. Ergo, the site is inappropriate, and will result in a second rate solution.

I tend towards the view that the hospital should instead be built on a greenfield site, along the proposed Metro North alignment for easy access from the City, while ideally being close to main road links for those who must drive in. And that it should be built on such a site with all the desirable facilities.

SDCC have a huge amount of land available less than 10minutes walk from Tallaght Hospital and 5minutes from the Cookstown Luas stop. Would have better access to M50/N7/N4(i.e. majority of ireland's population) than somewhere along the proposed Metro North.

[mgmt]

Plenty of land available around Blanchardstown Hospital too. Beside M50, M3, rail. NAC closeby for the kids too.

[paddydriver]

Originally Posted by jd

From what I can gather, the issue with a green field site is that it would mean it wouldn't be co-located with a major teaching hospital giving access to specialised clinical staff when necessary.

This is BS political spin... Can you honestly say that if a child is critically ill in Crumlin they have to wait a few hours more whilst the "specialized clinical" staff make their way through traffic from another hospital? - doesn't happen. The whole idea of a dedicated childrens hospital is that you have specialized doctors/clinicians for children.

The Mater site is a mistake - it was a decision made back in Bertie's day and FF don't have the balls to change it, neither does Harney...

I do occasional work in that area at the Mater Private and there are times I have driven in circles for half an hour to find parking - and at that I am likely 10-15 mins walk away. It is one of the countries worst traffic/parking black spot's and digging a great big hole in the ground the park the cars is not going to get them in to the area any faster. As I heard someone point out on radio recently too - what happens on the day that someone needs to get their very sick child to the hospital quickly... and its All Ireland day in Croke Park... forget it!

I agree that the naysayers will have nothing constructive to say if it does now happen, and someone will have to take the wrap for it... well, probably not cause politicians don't do accountability.

Someone needs to take the ballsy decision and move this to a better site that is more accessible for all - and won't cost €3.00 an hour to park in!

Paddy

[jd]

Originally Posted by paddydriver

This is BS political spin... Can you honestly say that if a child is critically ill in Crumlin they have to wait a few hours more whilst the "specialized clinical" staff make their way through traffic from another hospital? - doesn't happen. The whole idea of a dedicated childrens hospital is that you have specialized doctors/clinicians for children.
Paddy

I think the argument being made was the level of expertise in different specialities that would be available if located near a large teaching hospital.

There is an interesting article here - according to this article the McKinsey Report in 2006 identified the following criteria to be used by the HSE in hospital location/design

1. Space. The new hospital should be able to accommodate all projected needs, including research and education facilities.

2. Breadth and depth of services. The hospital should be able to provide at least 25 sub-specialities

Medical – Anaesthetics, Cardiology, Endocrinology, General Medicine, Genetics, Haematology, Immunology, Infectious Diseases, Intensive care, Neonatology, Nephrology, Neurology, Oncology, Opthamology, Pathology,
Radiology, Respiratory +/- allergology, Rheumatology, Microbiology and clinical chemistry;

Surgical – Cardiothoracic , ENT , Gastroenterology/GI/ hepatobiliary surgery, General surgery, Neurosurgery,
Orthopaedic surgery, Transplant surgery, Urology

In addition, it should be able to provide family space including schools not only for the patients, but also their broithers and sisters. there should be separate single rooms for siblings and for parents.

3. Co-location. The new hospital would ideally share a site with a teaching hospital capable of providing the sub-specialities listed in paragraph 2. If the hospital is not co-located, there would need to be specific measures to address the separation from adult services.

4. Access. Good public transport and road links required. Parking for families and staff. Good family accommodation. Outreach programme to other hospitals.

5. Efficient use of resources

6. Attracting and retaining staff of high calibre.

7. Teaching and research

8. Financial stability

9. Full project plan and role assessments.

[michael999999]

my child has to attend crumlin 7-8 times a year at least,we travel from kerry.sometimes its only for check ups but a lot of the time he can be very sick.

the thoughts of him in the back of a car all the way from kerry and then having to crawl through city traffic is actually quiet worrying.

the argument that it should be at the mater because it will be linked to the metro and the luas is bull,as no parent will bring a sick child on public transport.

none of the nurses think the mater is a good idea,especially for parents travelling from the south.can we please listen to the people on the ground who will be asked to work there.

if its left to fianna fail it will be a disaster of epic porportions.this is all about looking after berties back yard.it will be interesting to see who will get the contract for building it.a lot of questions need to be asked as to why they want it to be built at the mater,and who will benefit from it.

[Tragedy]

Originally Posted by jd

I think the argument being made was the level of expertise in different specialities that would be available if located near a large teaching hospital.

There is an interesting article here - according to this article the McKinsey Report in 2006 identified the following criteria to be used by the HSE in hospital location/design

The only specialities that Crumlin alone don't have are
hepatobiliary surgery / Transplant surgery / allergology / Clinical Chemistry off the top of my head.

The rest they have specialist consultants and CNS's for already.

It's weird that Crumlins been doing a brilliant job with limited resources and without co-location for the last 54 years.

[mgmt]

Originally Posted by Tragedy

The only specialities that Crumlin alone don't have are
hepatobiliary surgery / Transplant surgery / allergology / Clinical Chemistry off the top of my head.

The rest they have specialist consultants and CNS's for already.

It's weird that Crumlins been doing a brilliant job with limited resources and without co-location for the last 54 years.

Someone in the HSE needed a job.

[Pete_Cavan]

Originally Posted by Tragedy

It's weird that Crumlins been doing a brilliant job with limited resources and without co-location for the last 54 years.

The whole point of having one National Childrens Hospital is that there will be huge savings in operational costs by having one hospital instead of three. That means we will be able to deliver a better service for less money. I hope you are not suggestion that the current situation is good enough. The location of the new hospital is debatable, the need for it is not.

[LeinsterDub]

Originally Posted by michael999999

my child has to attend crumlin 7-8 times a year at least,we travel from kerry.sometimes its only for check ups but a lot of the time he can be very sick.

the thoughts of him in the back of a car all the way from kerry and then having to crawl through city traffic is actually quiet worrying.

the argument that it should be at the mater because it will be linked to the metro and the luas is bull,as no parent will bring a sick child on public transport.

none of the nurses think the mater is a good idea,especially for parents travelling from the south.can we please listen to the people on the ground who will be asked to work there.

if its left to fianna fail it will be a disaster of epic porportions.this is all about looking after berties back yard.it will be interesting to see who will get the contract for building it.a lot of questions need to be asked as to why they want it to be built at the mater,and who will benefit from it.

The distance from M50 to crumlin and M50 to phibsborough is about the same.

[Tragedy]

Originally Posted by Pete_Cavan

The whole point of having one National Childrens Hospital is that there will be huge savings in operational costs by having one hospital instead of three. That means we will be able to deliver a better service for less money. I hope you are not suggestion that the current situation is good enough. The location of the new hospital is debatable, the need for it is not.

Good work on completely taking something out of context. I pointed out that Crumlin hasn't seem to have suffered without co-location with an Adult Teaching Hospital, I don't recall ever saying "Let's keep all three as they are".
Can you point out where I said or implied that?

Thanks!

A couple of more quotes for people:

one of the experts consulted by the Task Force told us that he was not consulted on location and added that Dublin’s three children’s hospitals together are large enough to stand alone. Prof Alan Craft, past president of the Royal College of Paediatrics, said his “extensive consultation” had been a telephone conversation with a member of the Task Force. He had not seen its report nor was he involved in making the decision about the site

Originally Posted by BARRY O’DONNELL, Retired Professor of Paediatric
Surgery RCSI,

Many people outside the paediatric field feel that there is strong
case for co-location with an adult hospital. It seems logical, but it
doesn’t work like that. As has been shown again and again the co-location has no tangible advantages for a large paediatric hospital. Those of us who trained in, worked in and visited standalone units all over the world will testify to that. There is, however, a strong case for crossover collaboration in research. But there is no plan for transferring the Children’s Research Centre at Our Lady’s Children’s Hospital, (founded 1965) which has been so highly successful and is now a minor part of the national fabric, to the Mater site. There is certainly no room for it there.

...

As for building on the six-hectare (15-acre) Crumlin site, the Boston
Children’s (arguably the worlds number one) was built on the site of the
old hospital’s car park, (I was twice visiting professor there) while the
hospital continued working. The builders of Our Lady’s, Crumlin say that
they could put up a building with all the modern requirements on that site without disturbing the work of the existing hospital. It would cost
something over €100 million . . . a saving of €600 million. However, it
looks as though the political Faustian pact will prevail.