OPINION:THE AN Bord Pleanála decision on the proposed national children's hospital came as a shock to many, a shock still reverberating. Yet the priority now must be to embrace a collaborative approach where the best outcome can be achieved in the shortest possible time.
We need a holistic approach, one that assesses an agreed number of proposed locations against an agreed number of key considerations. (Why this has not happened to date – or has not happened to the degree necessary – is an issue for another day.) I have outlined four sample locations and benchmarked them on four grounds.
It is not suggested that the list is complete, or that the weighting is correct. The purpose is to provide a constructive and open platform. If the decision of the Government is to commit €650- €750 million to hospital construction, we must now adopt a clear framework for that investment.
The four locations benchmarked are the Mater, Crumlin, Tallaght and St James’s/Heuston South. The first three require no introduction. The fourth site, located north of St James's Hospital and west of Dr Steeven’s, was identified to the HSE in May 2011 in a response to the call for fresh proposals issued earlier last year by Minister for Health James Reilly. (The oral hearing into the Mater proposal in late 2011 heard that this proposal was received by the HSE but did not hear why it was not assessed.)
A new connection from St James’s Hospital, approximately 90 metres in length, would result in a link to the proposed site, delivering co-location with a major adult teaching hospital. There are at least five hectares available for construction at that location, with much of the land under HSE control, more than double the land available at the Mater site.
Locations must be benchmarked against each other. The first consideration is well known: how well does the existing hospital complex rate in terms of being an adult teaching hospital, and the breadth and depth of specialities/interventions undertaken there?
The second concerns access. How well is the site served by four- lane roads, public transport, parking provision, and links to other transport modes?
Here we must think not only of patients. Transport considerations for staff are important too. A location which is centrally located in Dublin’s metropolitan area will therefore score well, as the St James’s/Heuston South site does in the sample matrix.
Third, are environmental considerations. How does the site rate in terms of its capacity to take a building with at least 100,000sq m of floor area? This is also a case where environmental and functional concerns overlap. With the proliferation of medical devices, there is a strong case for large-sized floors so that equipment can be accessed without the need for the transport of patients and staff in lifts.
Put simply, eight large floors with 12,000sq m per floor delivers a better solution than 16 floors of 6,000sq m each.
Finally, there is the question of future proofing: how does the site rate in terms of expansion space, and its suitability to accommodate additional co-location (for adult and well as child medical care)?
In truth, significantly more than 100,000sq m is required. There was not enough space for genetics in the building proposed for the Mater site, or indeed for the sterilisation of medical instruments, or for up to 30 per cent of paediatric day-procedures.
Even if the Mater proposal had gone ahead, these space constraints at the site would still have meant expansion at Tallaght – but with a great deal of shuttling of patients and staff between Tallaght and the Mater being the inevitable and costly result.
And even with almost a third of day procedures taking place in Tallaght, the designers of the proposed Mater building have admitted that it would it face serious space constraints within 15 years of completion. There was no expansion space.
As former chief executive of the HSE Brendan Drumm has noted, we are only at the beginning of a wave of hospital consolidation. Last September Drumm told the Irish Medical Timesthat Birmingham's new hospital, the Queen Elizabeth, could cater for the entire area of Dublin "without taking a deep breath" and that "huge consolidation" is on the way.
Yes, a collaborative approach will be late in coming. But there is no percentage in going into why it was not adopted in the past; wholeheartedly embraced now, a collaborative approach can deliver.
Barrister and planner James Nix acted for An Taisce at the oral hearing into the children’s hospital proposed for the Mater site. He is writing in a personal capacity