The plight of the forgotten hospitals


The debate over a new national children’s hospital continues to take centre stage, but other urgent hospital projects have slipped off the radar, writes PRISCILLA LYNCH

ONE OF THE first things new Minister for Health Dr James Reilly did when he took office was to promise to review the previous government’s plans to build a new national children’s hospital on the site of the Mater Hospital, Dublin.

The location, objections, cost and building timeframe of the new hospital have generated masses of opinion and news inches in the past couple of years, and the possibility that the new Government could change the plans and the resignation of two board chairmen in the past six months has ensured the issue continues to be in the spotlight.

However, the new children’s hospital is far from the only major facility our health services are in need of, with some urgent projects slipping off the news agenda in the past few years.

Thought to be the oldest forensic mental health facility in Europe, the Central Mental Hospital (CMH) in Dundrum was built in 1850 and the rundown, drab structure badly needs to be replaced.

Last month saw the publication of the latest inspection report of the facility by the Inspector of Mental Health Services. Although the report gave a good overall review of the clinical care and medication use at the facility, it urged again that a replacement for the existing building “be commenced as soon as possible”.

When the inspection was carried out last year, the roof was undergoing major repair and the building was covered with scaffolding.

“The Central Mental Hospital continued to be housed in unsuitable buildings with no information as to where the new hospital would be located. In the meantime, the struggle to keep the current building habitable continued, but the level of accumulated dirt in Units 2 and 3 was inexcusable . . . Plans to move the women’s service to Unit 1 may alleviate some of the difficulties in providing a comprehensive women’s service. However, the lack of hostel accommodation for women remained a problem,” says the report.

When the HSE was formed there were pledges to prioritise the construction of a new CMH and there were many political promises that the “appalling conditions” there would be soon rectified with a new state-of-the-art facility.

After examining proposals to build a new facility on the grounds of the Dundrum site, it was eventually decided to locate a new CMH adjacent to the site of the planned new “superprison” in Thornton Hall, Dublin, despite much opposition from mental health advocacy groups.

However, that controversial plan was scrapped in 2009 after the prison proposals fell through and to date there has been no new site identified – though the grounds of St Ita’s hospital in Portrane has been suggested – or time frame for when a new CMH will be constructed.

The HSE has insisted its ambition is still “to create a world-class mental health facility for service users with forensic mental health needs” and admitted the current CMH infrastructure “no longer supports the modern practice of forensic mental healthcare”.

It said a project team to progress the development of the new national forensic mental health service has now been established under the chairmanship of Jim Ryan, HSE local health manager, and Michael Gallagher has recently been appointed project manager to advance the project.

The project work will include site identification, suitability assessment and identification of preferred funding models and the HSE confirmed it will submit a detailed proposal to the Department of Health and the Department of Finance for consideration. While this certainly appears to be progress, it gives no indication for a completion date of the new CMH which is unlikely to be anytime soon.

In addition, the capital’s three maternity hospitals are in urgent need of replacement. The baby boom of the past decade saw a 30 per cent increase in births – more than 1,000 extra a year – between 1999 and 2009. Last year, there was a total of 74,418 births in our public hospitals, 8,842 of which were in the Rotunda, 8,966 in the Coombe, and 9,972 in the National Maternity Hospital, Holles Street; numbers all well beyond their original capacity, with the national birth rate expected to be in excess of 75,728 this year.

While it is clear that all three hospitals are bursting at the seams, in the current economic climate they are having difficulty in securing the necessary funds to build new facilities.

The 2008 KPMG Review of Maternity and Gynaecology Services in the Greater Dublin Area acknowledged the three hospitals had reached capacity, were understaffed and that their model of standalone care was not the norm internationally.

The report recommended the three hospitals relocate to existing hospital sites with adult facilities: the Rotunda is to relocate to the Mater Hospital, the Coombe to Tallaght Hospital and Holles Street to St Vincent’s University Hospital.

However, progress on these plans has been painfully slow with no firm dates set by the HSE as to when the moves will actually happen.

All three masters of the maternity hospitals have consistently called for faster progress on the plans, saying they simply cannot cope any longer and that it is purely down to staff dedication that patients’ lives haven’t been put at risk by the capacity issues, but that serious consequences will occur if new facilities are not provided soon.

Master of the Rotunda, Dr Sam Coulter-Smith, has said: “All three Dublin maternity hospitals are desperately keen for new facilities. In an ideal world, they should be co-located on adult sites. We would be very keen to co-locate on the Mater site with the new paediatric hospital.

“I think you could gain very significant efficiencies by co-locating three large healthcare institutions on the same site and we’ve put a very detailed business plan forward to the HSE to move that ahead. We reckon that over 20 years we could make the move cost neutral.”

In addition, there are also plans languishing for new hospitals outside the Pale.

The Midwestern Regional Maternity Hospital in Limerick is outdated and overstretched, dealing with 5,000 births last year, when it is really designed for about 3,500, according to consultants there, while the HSE’s planned new regional acute hospital for the northeast has also been put on the backburner.

Given the freeze placed on the HSE’s capital budget a couple of years ago, and no end yet in sight to our current economic woes, medical commentators have said the new administration must find more creative ways of financing and progressing these essential projects.



December 2000 The East Coast Area Health Board, the Eastern Regional Health Authority, the Department Of Justice, Equality and Law Reform and the Department of Health establish a group to advise on proposals for the future of the CMH.

2002 The group’s finished report recommends modernising, refurbishing and extending the existing building, and providing a new residence on the campus.

Early 2003 Then minister for health Micheal Martin establishes a project team to progress the redevelopment of the hospital. The team recommends that a new hospital be built on a greenfield site of 20 acres with ready access to the M50 motorway to provide capacity for 300 admissions a year. Potential sites are to be examined.

Early 2005 Department of Health confirms it has proposed to build the new CMH on the site of the planned new “superprison” in north Dublin.

July 2005 Then minister for health Mary Harney visits the CMH and says she is appalled by the state of it. “The CMH is not a facility anybody could be proud of . . . It was worse than my worst nightmare; it was awful.”

May 2006 The government formally approves the development of a new national forensic mental health facility adjacent to the planned new prison at Thornton Hall in Co Dublin.

2006-2008 Patient and mental health advocacy groups criticise the Thornton Hall plan, saying it would stigmatise patients. The issue is debated at length by the Joint Oireachtas Committee on Health.

2009 Following planning and financing issues, the Thornton Hall prison and new CMH plan collapses.

Today There is no completion date or location for a new CMH, though the HSE does have a new project team to progress its development.


As Ireland experienced a baby boom during the past decade, each of the three Dublin maternity hospitals begin developing plans to locate to new buildings to accommodate their growing needs.

June 2007 HSE-commissioned Review of Maternity Gynaecology Services in the Greater Dublin Area by KPMG commences.

February 2009 Report is finally published and supports the hospitals’ already advancing relocation plans, with the Rotunda to relocate to the Mater Hospital, the Coombe to Tallaght Hospital (after initial plans to relocate to St James’s were dropped) and Holles Street to relocate to St Vincent’s University Hospital.

Today No set dates for when relocation of the maternity hospitals will occur, though the HSE insists the plans are progressing.


2006 The building of a major new hospital in the northeast is a key recommendation of the HSE-commissioned Teamwork report on acute hospital services in the northeast region.

A sub-committee is set up to choose the location of the new regional hospital.

April 2008 Navan is recommended as the location for the new hospital by the sub-committee report.

An independent consultant is engaged by Meath County Council to look at potential sites in the Navan area with the aim of having the hospital up and running by 2015.

August 2009 After a lack of progress’ the HSE admits it is unlikely the hospital will be built for many years, as the money is simply not available. The project is now on indefinite hold.