What is it about hospitals in Ireland?

Sam Russell · 28-04-2017 9:10am #1

Why do hospitals become so political?

Tallaght took a generation to be built.

The National Children's Hospital has taken a generation to be approved, and is destined to be the most expensive children's hospital in the world by a country mile, and still has opposers wanting it to be built on a different site, but a different site from the other site that was planned for previously. There were sites offered for free but were turned down.

Now the National Maternity Hospital is running into trouble with former Masters resigning over the disputed ownership (not over the actual plan).

What has to happen to sort this nonsense out?

[By nonsense, I am referring to the constant bun fights about the politics of the matter.
Obviously, in the case of the NMH, ownership is key, at least to the former Masters and many others. If it does not matter (according to SVUH ans NMH), then why not donate the site and ownership remains with HSE?
Otherwise, it does matter - in which case, ownership of the site should be transferred by whatever method (CPO, gift, lease) to the HSE.]

marno21 · 29-04-2017 5:17pm

National Childrens Hosptial

If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

Anita Blow · 01-05-2017 8:01pm

marno21 wrote: »

National Childrens Hosptial

If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

I've posted on this before but:

A national children's hospital has to be built somewhere. It makes logical sense it's build where the majority of the population is and where it has the greatest transport links (road, rail, bus etc).

On the point of locating it along the M50, the independent 2008 report examined location & access thoroughly and they weighed it against other competing factors. What they concluded was that quality of care superseded access for routine outpatients. IE- The hospital has to be co-located with an adult tertiary hospital, particularly for emergency situations where time is critical. The time it takes for an ambulance to make it to Connolly VS James' is minutes, but with Connolly there will be the additional time it may take for an adult surgeon to get from James' to Connolly which multiply that time by a number of factors.

realitykeeper · 04-05-2017 12:05am

Hospital staff in Ireland love to take all the beds out of service so that they will have an easy time of it.

johnnyskeleton · 04-05-2017 11:41am

realitykeeper wrote: »

Hospital staff in Ireland love to take all the beds out of service so that they will have an easy time of it.

Mod note:

Please stay on topic and read the charter re: standards of posting. This thread is about why hospitals are political hot topics in Ireland. It is not an opportunity to take cheap shots at hospital staff.

OMD · 09-05-2017 2:53pm

Anita Blow wrote: »

The hospital has to be co-located with an adult tertiary hospital, particularly for emergency situations where time is critical. The time it takes for an ambulance to make it to Connolly VS James' is minutes, but with Connolly there will be the additional time it may take for an adult surgeon to get from James' to Connolly which multiply that time by a number of factors.

The hospital does not have to be co-located. That is the main issue. One group of "experts" recommended it should be. Far more "experts" have said it makes no difference. The reasons for co-location are poor. Many major children's hospitals worldwide are not co-located.

Co-location means being co-located with a tertiary referral centre. Connolly is not a tertiary referral centre (for almost all conditions) meaning locating the hospital on the grounds of Connolly essentially means it is not co-located.

NuMarvel · 11-05-2017 10:25am

Sam Russell wrote: »

Why do hospitals become so political?

Tallaght took a generation to be built.

The National Children's Hospital has taken a generation to be approved, and is destined to be the most expensive children's hospital in the world by a country mile, and still has opposers wanting it to be built on a different site, but a different site from the other site that was planned for previously. There were sites offered for free but were turned down.

Now the National Maternity Hospital is running into trouble with former Masters resigning over the disputed ownership (not over the actual plan).

What has to happen to sort this nonsense out?

[By nonsense, I am referring to the constant bun fights about the politics of the matter.
Obviously, in the case of the NMH, ownership is key, at least to the former Masters and many others. If it does not matter (according to SVUH ans NMH), then why not donate the site and ownership remains with HSE?
Otherwise, it does matter - in which case, ownership of the site should be transferred by whatever method (CPO, gift, lease) to the HSE.]

I think it's in large part down to the reaction of a not completely informed public, and politicians and others jumping on that.

Take the new NCH. I think people generally accept that it should be co-located with an adult hospital, but beyond that people's opinions on where are based on everyday issues like access and parking, and not the clinical expertise of the adult hospital. At a guess, I'd say that's because people think one large hospital is pretty much the same as the other. So politicians and others seize on that. We saw something similar with resistance to the closure of 24 hour emergency departments in smaller hospitals. Even though the clinical outcomes are better when patients go to larger hospitals for complex and emergency treatment, people still instinctually feel they are losing out if their local A&E become a minor injury unit instead.

That said, the ownership issue with the new NMH is a bit different, and the uproar is very much (and understandably) around who are currently intended to be the owners, as opposed to the fact that the State won't own it. After all, I haven't seen anyone asking who will be the owners of the other maternity hospitals when they've moved. And the same goes for the new NCH, which will be merging of three voluntary hospitals (incuding one owned by a different order of nuns).

seamus · 11-05-2017 1:28pm

NuMarvel wrote: »

Take the new NCH. I think people generally accept that it should be co-located with an adult hospital, but beyond that people's opinions on where are based on everyday issues like access and parking, and not the clinical expertise of the adult hospital. At a guess, I'd say that's because people think one large hospital is pretty much the same as the other.

I guess people are idealists and make the assumption that the standard of care and patient outcomes should be close to identical (obviously there are going to be slight variations) regardless of which hospital you go to.

The idea that going to hospital is something of a crapshoot about whether you live or die, scares the sh1t out of people. And they make the assumption that it's all down to specific hospitals having awful staff or awful facilities. And not because of less obvious things like being 60 minutes away from an expert on complications and specialised equipment.

Therefore if you build a new hospital, it will be great and new, with great staff and all the bells and whistles.
So the only question really is around how easy it is to get there from the rest of the country.

Ultimately the concept that all large hospitals should have similar outcomes is not unreasonable. In fact, it's what we should be aiming for.

But as a country we've made the mistake of building hospital facilities absolutely everywhere with the result that budgets are stretched too thin, so compromises have to be made on what services are provided where. Or we can triple the health budget.

This is where the politics come in. Every politician loves to whinge about poor hospital facilities in their constituency, but will fight tooth and nail to hold onto their substandard hospital rather than have to travel an extra 10 miles to a far superior one.

This is what the Irish people want; sh1tty, underfunded hospitals all over the country, rather than a handful of really, really good ones, strategically located. So that's what we get.

FreudianSlippers · 18-05-2017 11:00am

OMD wrote: »

The hospital does not have to be co-located. That is the main issue. One group of "experts" recommended it should be. Far more "experts" have said it makes no difference. The reasons for co-location are poor. Many major children's hospitals worldwide are not co-located.

Co-location means being co-located with a tertiary referral centre. Connolly is not a tertiary referral centre (for almost all conditions) meaning locating the hospital on the grounds of Connolly essentially means it is not co-located.

You're right... they need to be tri-located and that group of so-called experts is basically every credible medical association in the Western World.

Tony EH · 19-05-2017 12:49pm

Anita Blow wrote: »

I've posted on this before but:

A national children's hospital has to be built somewhere. It makes logical sense it's build where the majority of the population is and where it has the greatest transport links (road, rail, bus etc).

That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.

Tony EH · 19-05-2017 12:59pm

seamus wrote: »

The idea that going to hospital is something of a crapshoot about whether you live or die, scares the sh1t out of people. And they make the assumption that it's all down to specific hospitals having awful staff or awful facilities. And not because of less obvious things like being 60 minutes away from an expert on complications and specialised equipment.

It's largely unwarranted though.

It's funny that there are people in this country that think a trip to a public hospital is an automatic death sentence. Both my parents went through the public system for years and always received the best of care. My wife's a culchie and her family's experience with hospitals is no less.

I've never really understood this fear that some people have. Ireland may have its issues with our healthcare system, but it irks the hell out of me when people start banging on.

Of course, there are horror stories - there are to everything. But, by and large, our system does well despite its problems. Do I think it could be better, yes I do. Is it the nightmare some people want to portray it as. Absolutely not.

Anita Blow · 19-05-2017 3:31pm

Tony EH wrote: »

That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.

What other options are there? The independent group based on worldwide best practice identified that the best paediatric hospitals in the world were located alongside specialist tertiary centres and that when weighed against issues such as access for outpatients, co-location was more important.
So realistically the only options were James', Tallaght, Mater, Vincent's or Beaumont. They're all subject to traffic problems. Maybe Tallaght less so but perhaps it was located too far from the maternity hospitals & other specialist services.

Tony EH · 19-05-2017 3:36pm

Connolly?

Pinch Flat · 19-05-2017 3:47pm

We just don't do long terms planning here, so we have a children's hospital being considered for construction nearly 35 years after it was recommended. Hospitals are planned election to election, then what was agreed previously is overturned to whatever suits the incoming regime.Hospitals are built where the political agenda suits. No necessarily the best location.

My wife works as nurse. Some of the common observations include:

The health system is grossly inefficient - no accountability, lots of waste, too many managers

The health system is understaffed and underfunded.

We have very low medical staff / consultants per head of population

We are only now getting to grips with Primary Care - a lot of our hospitals are clogged with people who could either be seen as relatively minor cases in a PC center.

No where for elderly to go when in hospital and treated, as we don't have an efficient nursing home systems that is affordable.

An unhealthy population -we have high levels of obesity, heart disease, etc. An unhealthy population means hospitals are going to be busier.

My own opinion is that the health system is kept in a mess for political gain / points scoring.

Anita Blow · 19-05-2017 3:50pm

Tony EH wrote: »

Connolly?

Connolly is a general hospital. It isn't a specialist hospital. It has nothing comparable to the level of specialities, diagnostic facilities or treatment facilities of the 5 specialist hospitals. It's the reason it has never been a runner

Podge_irl · 19-05-2017 4:06pm

I doubt Ireland is actually unique in this issue. Ultimately a lot of it comes down to elements of education and trust. A good job is not always done of explaining the reasoning behind decisions and there appears to be an assumption that there is always an ulterior motive.

Seemingly no amount of explaining to someone that the clinical outcomes for them will be better if they go an hour further away in an ambulance will make them believe shutting their local A&E is a good idea. It doesn't help that they start from a position of distrust of those making the decisions.

jimmycrackcorm · 19-05-2017 4:28pm

Anita Blow wrote:

Connolly is a general hospital. It isn't a specialist hospital. It has nothing comparable to the level of specialities, diagnostic facilities or treatment facilities of the 5 specialist hospitals. It's the reason it has never been a runner

Specialisms are a result of quality of the staff available at the location. Connolly could be upgraded to provide the necessary facilities and staff moved as required.

Site limitations restrict future growth in the city hospitals. Instead we are bringing the mountain to the man.

Anita Blow · 19-05-2017 6:31pm

jimmycrackcorm wrote: »

Specialisms are a result of quality of the staff available at the location. Connolly could be upgraded to provide the necessary facilities and staff moved as required.

Site limitations restrict future growth in the city hospitals. Instead we are bringing the mountain to the man.

Moving a 1000 bed hospital to accommodate a 450 bed hospital is bringing a mountain to the man. It would cost hundreds of millions maybe even over a billion to move James to Connolly and would be entirely unnecessary. Connolly is 250 beds to the 1000 beds of James. It has neither the physical infrastructure to support the specialities James does and nor does it have the patient throughput required for any of the specialities James offers.

devnull · 20-05-2017 12:16pm

Connolly is a poor hospital and seems very low staffed compared to others in Dublin, friend of mine was in A&E there one night after a fall after feeling unwell, was told he was 6 in the queue when he was triaged to see a doctor, was seen after 6 hours because there was only two doctors on.

When he saw the doctor after 6 hours he was sent for a blood test and an x-ray and had to wait 2.5 hours for the results. That shows you how badly run the hospitals are here, wait for 6 hours then before even had a discussion with doctor he's sent by doctor for x-ray and blood test without any talking about the actual problem.

In the UK blood tests and x-rays are ordered directly by triage if it's obvious that they are needed, in Ireland you have to see the doctor first which could take many hours then wait many more hours for the result. Nurses do very little in Ireland it seems the UK ones seem to do far more which helps speed up the process in A&E.

CeilingFly · 20-05-2017 12:26pm

marno21 wrote: »

National Childrens Hosptial

If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

But if you didn't want to drive, then a location around the m50 or further would be ridiculous.

Killarney train station to heuston, then 5 minutes luas to door of the hospital.

Remember that it won't be the only hospital for kids. Most will be transferred by ambulance or arrive by appointment, so its not as if you would suddenly be driving from Killarney.

But in my opinion access for visitors is extremely important. It is proven that having many visitors aids in recovery of children in hospital, thus having a hospital close to a major city maximises visits from friends and relatives.

Whilst family will always make special trips to their children, aunts, uncles, nieces, nephews may not be so inclined if there was no other activity for a longish trip.

On the health side, access to high level consultants within the same grounds is hugely beneficial and James' excells in that area.

CeilingFly · 20-05-2017 12:31pm

The real blame for the politics of Irish hospitals lies with three men...

Richard Duggan
Joe McGrath
Spencer Freeman.

pilly · 20-05-2017 12:43pm

Consultants and board members of hospitals are very political by their nature and have their own best interests at heart.

They want to work where the best facilities and staff are with little regard for the patient.

That being said the people crying out for a children's hospital on the M50 assume everyone drives. That's simply not the case, especially in Dublin.

Tony EH · 20-05-2017 12:57pm

devnull wrote: »

Connolly is a poor hospital and seems very low staffed compared to others in Dublin, friend of mine was in A&E there one night after a fall after feeling unwell, was told he was 6 in the queue when he was triaged to see a doctor, was seen after 6 hours because there was only two doctors on.

When he saw the doctor after 6 hours he was sent for a blood test and an x-ray and had to wait 2.5 hours for the results. That shows you how badly run the hospitals are here, wait for 6 hours then before even had a discussion with doctor he's sent by doctor for x-ray and blood test without any talking about the actual problem.

In the UK blood tests and x-rays are ordered directly by triage if it's obvious that they are needed, in Ireland you have to see the doctor first which could take many hours then wait many more hours for the result. Nurses do very little in Ireland it seems the UK ones seem to do far more which helps speed up the process in A&E.

8.5 hours isn't much these days.

Try over 12 in James' and being worried that you were seeing that the same staff that were on when you walked into A+E were still on when you were walking out of it.

A lot of the issues for an overcrowded A+E comes from GP referals, when there shouldn't be any <- that came from the doctor that saw me at James' Hospital.

And nurses do excellent work in Ireland.

antoinolachtnai · 20-05-2017 1:02pm

Hospitals are political because so much is at stake. It costs about a million a day to run an acute hospital. The 5 main hospitals in Dublin alone account for over 2 percent of the total government budget.

They are complex organisations and there is an awful lot to get right.

devnull · 20-05-2017 1:52pm

Tony EH wrote: »

A lot of the issues for an overcrowded A+E comes from GP referals, when there shouldn't be any <- that came from the doctor that saw me at James' Hospital.

Lot of it is caused by terrible working practices and inefficient diagnosing methods that waste peoples time and that seem to be more about box ticking than actually caring about a patient

In the UK if someone obviously needs a blood test and/or an x-ray it will be ordered by the triage nurse so when the doctor is ready to see you he will have all the information which means you don't have to wait ages for the results to come back.

In Ireland if you need it you have triage, have to wait for a doctor to see you for 30 seconds and sends you for tests that could have been done whilst you were waiting to see him, adding hours on to the time that you are in the department.

In the UK now many departments have a GP there so if it's a GP type issue you go into that queue and only sent on to other queues if the GP thinks it's warranted, end result is people with GP like conditions don't clog up the A&E system.

And nurses do excellent work in Ireland.

I don't doubt they do, but the problem is that if they did some of the above it would vastly improve the efficiency of the system, if triage nurses could order basic tests like they can in most other European countries, you'd end up wasting far less time.

professore · 20-05-2017 1:52pm

CeilingFly wrote: »

But if you didn't want to drive, then a location around the m50 or further would be ridiculous.

Killarney train station to heuston, then 5 minutes luas to door of the hospital.

Remember that it won't be the only hospital for kids. Most will be transferred by ambulance or arrive by appointment, so its not as if you would suddenly be driving from Killarney.

But in my opinion access for visitors is extremely important. It is proven that having many visitors aids in recovery of children in hospital, thus having a hospital close to a major city maximises visits from friends and relatives.

Whilst family will always make special trips to their children, aunts, uncles, nieces, nephews may not be so inclined if there was no other activity for a longish trip.

On the health side, access to high level consultants within the same grounds is hugely beneficial and James' excells in that area.

Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.

CeilingFly · 20-05-2017 3:40pm

professore wrote: »

Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.

There are 53 family rooms in the new hospital so you can stay with the child.

Red cow? And if a specialist from an adult hospital is required urgently, what do you do?

Anita Blow · 20-05-2017 6:33pm

professore wrote: »

Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.

As mentioned there is an adjacent building being constructed with 50+ rooms for families of long-stay children. Additionally the private rooms in the hospital are all ensuite and have a bed for the parents

MayoSalmon · 20-05-2017 11:33pm

Why do hospitals become so political?! Eh maybe because there run by the government. It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.

Sam Russell · 20-05-2017 11:43pm

MayoSalmon wrote: »

Why do hospitals become so political?! Eh maybe because there run by the government. It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.

If the hospitals were all privately run, we would have to pay for doctors, hospitals, medication and a privately run bureaucracy to administer it and give a profit to the private owner.

We might get the government run part to run better, but I doubt we could get the owners of a private hospital to take less profit.

Why, we even have to build a €300 million maternity hospital at our expense and hand it over to a private hospital entity (for free) and then pay them to run it at our expense, and they will make a profit.

Now explain the politics in that one.

Victor · 20-05-2017 11:44pm

I think a large part of it is emotional attachment. The people who demand tertiary services everywhere aren't bad, just unrealistic.

marno21 wrote: »

If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

Unless its an immuno-suppressed or contagious disease case, are you really going to make the child endure 8 hours in a car and a hospital appointment on the same day or are you going to get a train to a station one Luas stop from Heuston and a few stops from Connolly / Busáras?

Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

James's has a huge car park in the basement.

Tony EH wrote: »

That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.

If the child is in a bad way, call an ambulance.

Tony EH wrote: »

Connolly?

It seems it doesn't have the skills several of the others have.

MayoSalmon · 20-05-2017 11:52pm

Sam Russell wrote:

If the hospitals were all privately run, we would have to pay for doctors, hospitals, medication and a privately run bureaucracy to administer it and give a profit to the private owner.

Private run bureaucracy eh no and give profit to the owner?! And what does the owner do with that profit? Put it under his pillow I guess, no. Nobody spends somebody else's money as wisely as he spends his own.

Increase the autonomy of individuals. Get the government and vast, bureaucratic insurance companies out of the way, permitting the free market to work its effects in health care, just as it does in virtually every other sector of the economy. Not rocket science!

joeysoap · 21-05-2017 12:02am

I'm from Louth and my kids now have kids so maybe speaking from a distance. Isn't there a hospital in Tallaght? Isn't Tallaght on the M50? Isn't there a fairly large vacant site close to the hospital in Tallaght. I had to visit James ONCE as a visitor. Nightmare. As for a general hospital - I assume the children's hospital will be filled with specialists - and that a general hospital - properly staffed - Could deal with any emergencies the children's hospital couldn't handle. And If it couldn't why should it be be called a hospital?

Victor · 21-05-2017 12:39am

MayoSalmon wrote: »

Increase the autonomy of individuals. Get the government and vast, bureaucratic insurance companies out of the way, permitting the free market to work its effects in health care, just as it does in virtually every other sector of the economy. Not rocket science!

That all sounds very libertarian, but you forget that the worst time to pay for healthcare is when you are sick.

joeysoap wrote: »

I'm from Louth and my kids now have kids so maybe speaking from a distance. Isn't there a hospital in Tallaght? Isn't Tallaght on the M50?

Not quite - it's about 3km away.

Isn't there a fairly large vacant site close to the hospital in Tallaght.

It's fairly built-up. https://binged.it/2q4y14d

I had to visit James ONCE as a visitor. Nightmare.

In what way?

As for a general hospital - I assume the children's hospital will be filled with specialists - and that a general hospital - properly staffed - Could deal with any emergencies the children's hospital couldn't handle.

Note that "general hospital", e.g. Bantry, Naas, Castlebar has a specific connotation and that they tend to lack specialists as they have insufficient population bases.

And If it couldn't why should it be be called a hospital?

hospital
ˈhɒspɪt(ə)l/Submit
noun
1. an institution providing medical and surgical treatment and nursing care for sick or injured people.

So, the National Orthopaedic Hospital, Royal Victoria Eye and Ear Hospital, St Luke's Hospital, Rathgar and Rotunda Hospital are all hospitals, but they aren't much use if a child needs stiches.

......... · 21-05-2017 12:41am

Anita Blow wrote: »

I've posted on this before but:

A national children's hospital has to be built somewhere. It makes logical sense it's build where the majority of the population is and where it has the greatest transport links (road, rail, bus etc).

Then that would be near Athlone, as the majority of the population don't live in Dublin, they live in Ireland.

Victor · 21-05-2017 1:16am

......... wrote: »

Then that would be near Athlone, as the majority of the population don't live in Dublin, they live in Ireland.

Actually no, population density in the midlands is poor, access is middling and much more people live south of the Dublin-Galway line than north of it.

the_syco · 21-05-2017 1:30am

https://goo.gl/maps/JvwR8W3QSf32

IIRC, the HP plant in Leixlip was built in the manner that it was, so it could be used as a hospital should HP pull out.

Well, sadly, HP are pulling out; http://www.thejournal.ie/hp-leixlip-2-3229297-Feb2017/

It has access to the M4, it's surrounded by green area. Three very large buildings, and a smaller one at front that could be used for out patients. Five carparks, with space for two more.

Added bonus; nearby an airport, should someone needed to be flown in.

/edit;
I emailed my local TD about the above. Shall post the reply should I get one.

......... · 21-05-2017 1:47am

Victor wrote: »

Actually no, population density in the midlands is poor, access is middling and much more people live south of the Dublin-Galway line than north of it.

Actually, the majority of the population of Ireland don't live in Dublin.

the_syco · 21-05-2017 2:10am

......... wrote: »

Actually, the majority of the population of Ireland don't live in Dublin.

With the saying "all roads lead to Rome", what county is in the middle of Ireland, with multiple major roads leading to it?

Victor · 21-05-2017 2:41am

the_syco wrote: »

IIRC, the HP plant in Leixlip was built in the manner that it was, so it could be used as a hospital should HP pull out.

Horse manure.

Each building is up to 100 metres across - hardly suitable for hospital rooms, 90% of which wouldn't have windows.

the_syco · 21-05-2017 4:20am

Victor wrote: »

Horse manure.

Each building is up to 100 metres across - hardly suitable for hospital rooms, 90% of which wouldn't have windows.

Bah, you're probably right. Although I'm unsure if the buildings were the size they are now, when HP came to Leixlip in the mid-90's?

eeguy · 21-05-2017 4:39am

......... wrote: »

Actually, the majority of the population of Ireland don't live in Dublin.

Of the 4.6 million people in Ireland, 1.3 million live in County Dublin.
Dublin's population is growing faster than anywhere else
The top 5 largest towns are on the eastern seaboard.
More people live in Leinster than Munster, Connaught and Ulster combined.

Census 2016

CeilingFly · 21-05-2017 11:14am

joeysoap wrote: »

I'm from Louth and my kids now have kids so maybe speaking from a distance. Isn't there a hospital in Tallaght? Isn't Tallaght on the M50? Isn't there a fairly large vacant site close to the hospital in Tallaght. I had to visit James ONCE as a visitor. Nightmare. As for a general hospital - I assume the children's hospital will be filled with specialists - and that a general hospital - properly staffed - Could deal with any emergencies the children's hospital couldn't handle. And If it couldn't why should it be be called a hospital?

So many misunderstand what the NCH is.

Tallaght has a children's hospital - most issues with children can be dealt with there.

Many other hospitals have children's wards.

The NCH is a specialist centre of excellence for the more complicated issues. It won't be for the little infection or the broken arm, more for the serious injuries and illnesses that will sometimes require very specialist attention.

That's why there are options for additional bed in each room so that a relative can stay with a child. That's why there are 53 family accommodation units so that families can be nearby.

The rough and tumble of kids everyday issues will continue to be dealt with in local hospitals

pilly · 21-05-2017 11:30am

CeilingFly wrote:

Tallaght has a children's hospital - most issues with children can be dealt with there.

Tallaght does not have a children's hospital. They have a children's A and E.

Not that I agree with the poster about basing the NCH in Tallaght. It has the same problems as James with traffic and parking.

......... · 21-05-2017 11:41am

eeguy wrote: »

Of the 4.6 million people in Ireland, 1.3 million live in County Dublin.
Dublin's population is growing faster than anywhere else
The top 5 largest towns are on the eastern seaboard.
More people live in Leinster than Munster, Connaught and Ulster combined.

Census 2016

I know people in Ireland are all supposed to bend the knee to having only a parochial moncity culture, and a Country with only one city, but the majority of the population of Ireland still don't live in Dublin. Maybe you could concentrate people in floor to ceiling timber bunk beds ?

Anita Blow · 21-05-2017 11:48am

joeysoap wrote: »

I'm from Louth and my kids now have kids so maybe speaking from a distance. Isn't there a hospital in Tallaght? Isn't Tallaght on the M50? Isn't there a fairly large vacant site close to the hospital in Tallaght. I had to visit James ONCE as a visitor. Nightmare. As for a general hospital - I assume the children's hospital will be filled with specialists - and that a general hospital - properly staffed - Could deal with any emergencies the children's hospital couldn't handle. And If it couldn't why should it be be called a hospital?

I think the above shows a certain level of misunderstanding on the part of the general public about how health services are run not just in Ireland, but around the world.
The reason for co-location with a tertiary hospital is because paediatric medicine essentially requires duplication of all the adult specialities, but it is nearly impossible to duplicate all adult specialities because it is A) costly and

poorly justified because there may not be enough children with a given illness to justify a paediatric consultant in that area. So in many cases around the world, we rely on consultants for adult services also increasing their scope to include the odd child that may present with a disease usually only seen in adults.

A general hospital cannot offer any benefit to a kid's hospital. The likes of Connolly has no medical specialities that the NCH won't already cover with its own paediatric consultants. James/Tallaght/Mater/Vincents/Beaumont on the other hand can, because they have highly specialised and niche consultants. They also have the physical infrastructure. For example James' has the national burns and plastics unit and an extremely advanced haematology unit, and these are 2 specialities that are particularly common in children.

Lastly, the argument that we should build another tertiary hospital at Connolly doesn't work, even ignoring the unrealistic cost of doing so. We don't have the population to support another tertiary hospital. For example, an adult cardiothoracic surgeon has to operate on 6 complicated paediatric patients a year to maintain their competence. At the moment, we only just about attain that standard because the complicated heart cases are rare and we already have a small population. If we were to duplicate that service, then our now 2 cardiothoracic surgeons would only see 3 patients each which isn't enough to maintain their skill.

Connolly is an absolute no go on the basis of patient safety and quality of care. Ease of access is far down on the list of priorities in comparison to those two.

Tony EH · 21-05-2017 2:23pm

Victor wrote: »

If the child is in a bad way, call an ambulance.

It was an ambulance I had in mind. They use roads too.

realitykeeper · 23-05-2017 11:04pm

Sam Russell wrote: »

Why do hospitals become so political?

Tallaght took a generation to be built.

The National Children's Hospital has taken a generation to be approved, and is destined to be the most expensive children's hospital in the world by a country mile, and still has opposers wanting it to be built on a different site, but a different site from the other site that was planned for previously. There were sites offered for free but were turned down.

Now the National Maternity Hospital is running into trouble with former Masters resigning over the disputed ownership (not over the actual plan).

What has to happen to sort this nonsense out?

[By nonsense, I am referring to the constant bun fights about the politics of the matter.
Obviously, in the case of the NMH, ownership is key, at least to the former Masters and many others. If it does not matter (according to SVUH ans NMH), then why not donate the site and ownership remains with HSE?
Otherwise, it does matter - in which case, ownership of the site should be transferred by whatever method (CPO, gift, lease) to the HSE.]

It is true that politics and local opposition need to get out of the way and to do that, professionals must be respected and allowed to do what they were trained to do. Professionalism however must start at the very top with several key experts to advise the government. The advise these experts give should be taken by the government and implemented.

On the local level, experts need to work on instructions handed down to them from experts at national level. I have seen discussions on TV where a nurse (on a panel of speakers) was giving out about the proposed location of the National Children's Hospital! Now with all due respect to the nurse and at the risk of pointing out the obvious, the nurse was trained in nursing. Why was such a person on the panel and why is it even necessary to have a panel or even a discussion when one competently trained professional working on a local project (with a mandate from a professional operating at national level) is all that is required for the professional outcome to be achieved.

Obviously, this co-ordination between national and local professionals is needed because while the local professional will produce a competent plan for a local project together with access roads and so on, - the professional project would almost certainly be located in an entirely inappropriate location if the mandated project is given to the local professional by anyone other than a national professional.

Politicians are not professionals, neither are local councilors and neither are local residents. Even if a local resident happened to be a professionally qualified town planner or architect, he/she would not be competent to object because a) they did not go through the interview process and screening to get the job allocated to the professional to whom the job was assigned and b) because the professional to whom the job was assigned would of course be operating on the mandate given to him/her by professionals at the national level. In other words, what they come up with would fit into a national spacial strategy in a planned and coordinated way.

No opinion should matter other than that of the assigned professionals. At most, a suggestion forum should be allocated whereby the assigned professional could see the opinions of the local people but the final decision should be that of the professional working in cooperation with other professionals in an intelligent and coordinated way.

Sam Russell · 23-05-2017 11:29pm

realitykeeper wrote: »

It is true that politics and local opposition need to get out of the way and to do that, professionals must be respected and allowed to do what they were trained to do. Professionalism however must start at the very top with several key experts to advise the government. The advise these experts give should be taken by the government and implemented.

On the local level, experts need to work on instructions handed down to them from experts at national level. I have seen discussions on TV where a nurse (on a panel of speakers) was giving out about the proposed location of the National Children's Hospital! Now with all due respect to the nurse and at the risk of pointing out the obvious, the nurse was trained in nursing. Why was such a person on the panel and why is it even necessary to have a panel or even a discussion when one competently trained professional working on a local project (with a mandate from a professional operating at national level) is all that is required for the professional outcome to be achieved.

Obviously, this co-ordination between national and local professionals is needed because while the local professional will produce a competent plan for a local project together with access roads and so on, - the professional project would almost certainly be located in an entirely inappropriate location if the mandated projected is given to the local professional by anyone other than a national professional.

Politicians are not professionals, neither are local councilors and neither are local residents. Even if a local resident happened to be a professionally qualified town planner or architect, he/she would not be in a position to object because a) they did not go through the interview process and screening to get the job allocated to the professional to whom the job was assigned and b) because the professional to whom the job was assigned would of course be operating on the mandate given to him/her by professionals at the national level. In other words, what they come up with would fit into a national spacial strategy in a planned and coordinated way.

No opinion should matter other than that of the assigned professionals. At most, a suggestion forum should be allocated whereby the assigned professional could see the opinions of the local people but the final decision should be that of the professional working in cooperation with other professionals in an intelligent and coordinated way.

Are you a script writer for Sir Humphrey on 'Yes, Minister'?

The location of hospitals, their size and speciality are political decisions and should be made by politicians, but they should be fully informed by the Civil Servants and other advisers.

It then goes for public consultations and detail planning. The details are then subject to PP and eventually ABP. That is how things are done. But why does it take so long and so many changes and stop start plans?

realitykeeper · 24-05-2017 2:02am

Sam Russell wrote: »

Are you a script writer for Sir Humphrey on 'Yes, Minister'?

The location of hospitals, their size and speciality are political decisions and should be made by politicians, but they should be fully informed by the Civil Servants and other advisers.

It then goes for public consultations and detail planning. The details are then subject to PP and eventually ABP. That is how things are done. But why does it take so long and so many changes and stop start plans?

The problem with that is Irish politicians routinely end up doing what non professionals i.e. their constituents and the lobbyists think they should do. The professional decisions are only implemented when there are no objections which is never. If politicians simply turned the task of implementation over to professional people and ended all interference by non professionals, then projects would get done in a competent, coordinated and timely manner.

Victor · 24-05-2017 3:01am

I saw some data on Polio the other day. Every year for the last 15 or so, Ireland has had 0-10 new cases each year (some of these are likely to be people who have moved country and/or been infected abroad). Cases like this can't be treated properly in local hospitals, as the staff are likely to not have seen a Polio case before and they don't have the requisite skills. Such a caseload, of a few hundred patients, can only be handled at a national level. There are many such diseases. You can either be treated nationally or suffer / die locally.

Tony EH wrote: »

It was an ambulance I had in mind. They use roads too.

Well, the thing about roads in Dublin is that when everyone is going to work in the morning, the outbound lane is usually fairly quiet and vice versa in the evening. Then there are bus and tram lanes. Ambulances are well capable of passing stationary traffic

What is it about hospitals in Ireland?

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