Sticking-plaster solution the worst of all possible outcomes

 

What aspects would be lost if the ‘grandiose’ elements are shaved off the original plan?

“WE UNDERSTAND that no one site has all of the requisite adult and current paediatric services that make that site a perfect choice. Given those services that are available, and the plan to consolidate others at the Mater site, our recommendation is again reinforced. We unequivocally believe that co-locating with tertiary adult and maternity hospitals is essential to the development of an excellent paediatric service.”

This is the clear message sent last year to Minister for Health James Reilly by the expert group he asked to review the national paediatric hospital plans he inherited from the previous government. Now faced by a probable fallback decision of shoehorning a smaller development on to the Mater hospital site, and, in his own words, scaling back some of the original proposal’s “grandiose” elements, what aspects of the plan could be jettisoned?

The original high-level framework brief for the national paediatric hospital, prepared by consultants RKW, listed the following criteria for the project: to support the best clinical practice which minimises risk to patients; to achieve the objective of child- and family-centred care; to promote multidisciplinary and cross-specialty working; to make efficient use of resources – staff, equipment and facilities; and to ensure future flexibility to respond to changes in service range and volume.

Ditching the co-location of a maternity hospital will certainly hurt cross-specialty working and hinder the more efficient use of resources.

At present, both the Rotunda and Temple Street hospitals run neonatal intensive care units.

It would be safer and more efficient to have a single unit whereby very sick newborns would no longer require transfer between hospitals. Neonatal consultants’ productivity would also improve working at a single site.

Of the 17 international paediatric hospitals used as reference by the initial planning group, it is interesting to note that less than half share a site with an adult hospital. Ironically, given the Mater hospital’s raison d’etre, it would appear from international experience that co-location with an adult service is seen as less of an imperative than sharing facilities with a maternity unit.

The main benefit for patients of co-locating with an adult hospital occurs when those with a chronic illness reach age 16 or 17. Their care will be seamless on a single site; at present, some continue to attend a paediatric hospital until the end of their teens.

What about research? There is no doubt a flagship tertiary hospital must have a significant research capacity. This is how medical advances are made; it is also well known that cancer patients, for example, have better outcomes when enrolled in clinical trials as part of their treatment.

The beneficial impact of “bench to bedside” and translational medicine for children could disappear if on-site research was scaled back or abandoned.

All of which adds up to a major headache for the latest review group, facing the question: is a scaled-down Mater still the best site or must we look for alternatives that meet the original specifications? Whatever else, we must avoid a sticking plaster solution cobbled together in haste.