New children's hospital plan puts pressure on creaky facilities

Temple Street children’s hospital was 140 years old last week and it looks every minute of it. A maze of narrow corridors and dark and dingy stairs, it looks like a cross from the worlds of Charles Dickens and Alice in Wonderland. Staff and parents alike daily toil up steps, past the “mind your head” signs and the cracked windows, and through a rabbit-warren of passages and rooms.

The lift doesn’t reach the top floors so children have to be carried up to the Top Flat ward for sick babies. Any youngster unable to climb the steep stairs likewise has to be carried up to the school and the playroom.

Top flat

Top Flat has just one adjacent toilet for 14 beds and no work area for staff. Patient notes are written up on a small ledge. Every available area of floor and wall space is used to store or hang equipment and parents staying with their children have to make do with armchairs or thin mattresses placed on the floor.

This is the reality of children’s medicine in Ireland today; a similar story could be told at Our Lady’s Hospital in Crumlin or Tallaght children’s hospital.

The Promised Land

While the new national children’s hospital is the Promised Land of child medicine in Ireland, for many of those working in the sector now it must seem like a mirage more than a tangible reality.

Last week’s announcement by the Government that the project will go ahead at St James’s finally got things back on track after An Bord Pleanála shot down the Mater’s application to build the hospital on its site last February. But there was bad news amid the generally positive message, with the admission by Minister for Health James Reilly that the project won’t be ready until 2018.

That’s six long years away for the sick children of today, and four years later than the original completion date for the Mater version of the project in 2014. It is clear that many of the potential clients of the planned facility will have grown up by the time it is ready.

The plans to build a new world-class hospital for children pose a number of challenges for the existing hospitals. Temple Street, Crumlin and Tallaght are all due to merge into the new hospital when it is completed.

That sets up its own organisational and political challenges, but there is also the question of what level of services can be provided in the interim.

Unsuitable and overcrowded

Six years is too long a period to allow for stasis in the existing hospitals and it could easily turn out to be longer if the project is delayed. Indeed, based on experience up to now, this is probable not possible.

As any parent who has had reason to bring a sick child to the three hospitals knows, all three are struggling to operate in highly unsuitable and overcrowded conditions. Long waits in emergency and out-patients are common, as is the use of improvised facilities to provide much needed extra space.

“The space is very limited,” says Gráinne Bauer, divisional nurse manager, on our tour around the labyrinth that is Temple Street. “We’ve tried to upgrade the wards, but we still don’t have enough space.”

Because of the access problems to the upper floors, bed allocation has to be planned to ensure that children are not placed on higher floors if their condition is likely to deteriorate.

The hospital was part of the Mater bid and there is disappointment all round that the new children’s hospital is going elsewhere. But there are also tough decisions to be made about whether to invest further in ageing facilities with a limited future lifespan.

You get an inkling of what the new hospital might be like by walking from the Top Flat ward in Temple Street to some of the newly renovated wards. The first thing you notice is the drop in noise level. Access in the new wards is by magnetic card and each of the bed areas boasts sliding electronic glass doors. There are banquettes for parents to sleep on and far less of the clutter found in the older parts of the hospital.

Private donations

Much of the renovation has been paid for by private donations and the efforts of individual fundraisers. Plaques on the wall pay tribute to donors such as Tesco, EBS and a Mayo Solicitors Bar Association.

Temple Street has decided that the children using Top Flat ward can’t wait any longer and it has launched a fundraising drive to raise €2 million for its renovation.

Over at Crumlin, which was once slated for demolition and rebuilding before it was decided to move the facility, new cardiac and cancer inpatient facilities are in planning.

“This is something the hospital decided to go ahead with as the facilities need to be improved now,” says spokeswoman Suzanne McCabe.

As in Temple Street, private fundraising will play a crucial role and a Fix Crumlin campaign has been launched.

However, the imminence of the new children’s hospital to be built at St James’s, and the crucial role envisaged for philanthropy to play in this project, will surely cast a shadow on the fundraising efforts of the existing hospitals as completion date approaches.