Radical reform and renewal needed in our obsolete hospital system
Opinion: Practice in the widely admired Netherlands system is to abandon a hospital building when it has outlived its usefulness and move to a greenfield site
Demolition at St Vincent’s Hospital in Dublin. Might it be time to take a radical approach to some of our older hospital buildings? Photograph: Eric Luke
All countries in the western world are struggling to fund a comprehensive healthcare system. The pace of technological development has outpaced the ability of the system to make the newer technologies available at sufficient speed to satisfy the public’s insatiable demand for the latest innovations.
Advances in the last 50 years are greater than the preceding two millennia. Healthcare needs will always outstrip the available resources and extra resources, even if affordable, will rarely solve the problem.
The healthcare service in Ireland is no exception and the situation has been compounded by our economic woes since 2008, as funding for the public service has been severely curtailed. Throughout Europe there are 10,000 hospitals and 27 discreet healthcare systems, all dissimilar, and all delivering their healthcare with subtle differences.
Even the richest oil-bearing countries in the east are unable to deliver a cost-effective healthcare system and most national health plans are based of planned scarcity. After a number of years of prosperity in Ireland, which saw an increase in our health expenditure in the public system of 125 per cent between 1997 and 2002, we are now reassessing the situation as to how more can be delivered with less. Recessionary times are excellent opportunities for reappraisal of service delivery as the efficiency and cost-effectiveness of services come under considerable scrutiny.
As 50 per cent of our Government’s spend is on hospital-based services I wish to focus on hospital design alone in this article.
If we compare our hospitals to the alternative structures required for other service industries we are in for a rude awakening. Could you envisage other industries or professions such as accountants utilising century-old office blocks that were designed before the advent of modern communication systems such as wifi or basic Cat 5 or 6 computer cabling. Would the motor industry consider 200- year- old plants to house their modern array of robots, which all too often we still accept to house our medical facilities.Without a modern infrastructure safety, efficiency and cost is compromised.
Concern about standards
Currently there is concern about standards in maternity services. Our three Dublin maternity hospitals the Rotunda, Holles Street, and the Coombe date from 1757, 1894 and 1826 with a relocation and rebuild in 1967 of the latter. Thus the average age of our maternity hospitals is 140 years. When the Coombe was relocated and rebuilt in 1967 it was noted for being the cheapest hospital constructed per square metre for its time. Some 46 years later it looks every bit of it.
The health system in the Netherlands which is highly admired and praised has gradually replaced much of its infrastructure in recent times. They consider the useful life cycle of a modern hospital is approximately 40 years. Rather than engaging in an expensive and disruptive renovation programme, when the hospital has reached the end of its useful life, they relocate the hospital to a green field site. When constructed the staff are relocated in the new hospital and the old building is bulldozed.
Unless we take a similar radical approach to providing a new hospital infrastructure on green field sites we will propagate inefficiency, obsolescence, high energy costs, excess staffing and compromised safety. A modern hospital optimises the efficiency by automation whenever possible, such as the use of robots for delivering supplies and meals, pneumatic tubes for transferring small objects such as blood specimens or pharmaceuticals, scientifically designed accommodation areas to minimise infection and to optimise the staff distances travelled.
In addition the use of sophisticated IT systems permit all ordering to be achieved electronically, as well as having an electronic patients record. The latter allows all test results including X-rays and scans to the viewed both at the bedside,as well as anywhere in the world by the use of iPhones and iPads.The availability of this data to the doctors regardless of their location, greatly enhances the safety of patients.
In Ireland we tinker at the periphery of obsolete hospitals and propagate an antiquated environment to deliver our services. We are crying out for radical reform. Such reorganisation with a modern infrastructure would result in millions of euro saved annually, as well as improving the safety and efficiency of the service.
It is difficult to comprehend how successive politicians and ministers act in such a short-sighted fashion.
Healthcare planning has to be removed from political interference which currently dominates our decision making process.
We require bold decisions, backed by rapid design,construction and commissioning of new facilities replacing much of our current infrastructure which is only suitable as museums.
Our current maternity and children’s hospitals are prime examples of which, as concerned citizens we should be ashamed.
Did any members of our current Cabinet walk the St James’s site prior to suggesting relocating the National Children’s Hospital in this region? It defies belief that this site was chosen in preference to other more suitable locations, which admirably met modern demands.
If ever there was a pressing need, to address as a nation, it is the provision of a state-of-the-art co-located maternity hospital with a new children’s tertiary care hospital. Let’s make this happen. For the future, it is not about doing more with less, it is about doing it differently and innovatively.
James M Sheehan is founder and director of the Blackrock and Galway Clinics and author of Life Close to the Bone. Musings of an Orthopaedic surgeon.