St James's tops list of imperfect locations


Q The children’s hospital – is it in the right place?

After four years of reviews and no action, the national children’s hospital got back on track this week with the Government’s selection of St James’s Hospital as the location. But is St James’s, an inner city site that has much in common with the previous failed choice of the Mater, the right place for this flagship project?

The only thing that everyone involved agrees on is that none of the sites available was perfect. The five main locations considered – St James’s, the Coombe, the Mater, Connolly and Beaumont – possessed shortcomings, and so the decision came down to a balancing of positives and negatives. The selection was made on three criteria – medical, planning and political. St James’s was the main winner on medical grounds, with the Dolphin review group which assessed bids, finding it had the best range of medical specialities. The Mater counters that it has a broader range of specialities. Overall, there seems to be little between the two – an earlier international review favoured the Mater but Dolphin’s Irish expertise leaned the other way. Whatever gaps currently exist are likely to be plugged over time once the new hospital is built.

Connolly hospital in Blanchardstown is not in the same league as its inner-city cousins. It would undoubtedly attract more specialities if it were awarded the project but, as Dolphin said, this would take several decades.

As for planning, the Government’s desire was to minimise the risk. An Bord Pleanála’s rejection of the Mater’s plans for the hospital last February was embarrassing for Minister for Health James Reilly, who can’t afford a second such mishap.

This fear of a second rejection did for the Mater’s bid at an early stage. Even though more land had been added, Reilly said the site remained too cramped.

The review group found there was a high planning risk attaching to the St James’s proposal, where a nine-storey building at the Rialto gate end of its campus, near the South Circular Road, is proposed. Public transport links are excellent but the streets are narrow.

A report by the two planners on the group found the risk could be reduced to moderate if the building were spread out over a larger area. St James’s has more land available which it had earmarked for a maternity hospital. The result will be a six- to seven-storey building, not unheard of in Dublin 8.

Medical politics, powerful but largely unspoken, played a huge role. The large teaching hospitals and their university partners battled it out behind the scenes, and there were tensions between the worlds of paediatric and adult medicine. Grouping adult, children’s and maternity hospitals together was seen as the ideal, achievable only on the Mater site, but if that location was off the agenda, what was the next best solution?

Many child medicine specialists would prefer co-location with a maternity hospital, and are now lobbying for the children’s hospital to be sited beside the Coombe.

Dublin’s three maternity hospitals are all housed in substandard buildings and are due to move anyway. St James’s says it has ample room to build a maternity hospital, but that looks like being a long way off.

Cost wasn’t discussed much this week. The review group said all the costings provided by the main bids were over optimistic and Dr Reilly described St James’s estimate of under €500 million as “tight”. Some of the money will come from the sale of the National Lottery but, with the project running behind schedule, will the Government be able to hang on to this supposedly ring-fenced money?