Sir, – Peter Boylan makes a very strong argument for the development of a high-risk maternity unit co-located with St James's Hospital and the National Children's Hospital to provide access for both mothers and babies with complex conditions from around the country to adult and paediatric intensive-care unit facilities ("Fresh thinking on National Maternity Hospital impasse vital", Opinion & Analysis, May 5th).
I share this view. Needless to say, such a unit should be State owned.
As it stands, the development of the National Maternity Hospital at St Vincent’s and the National Children’s Hospital at St James’s does nothing for babies with the most serious congenital anomalies who require to be born on the site of a tertiary paediatric hospital. Unless we join the dots, we will spend €2 billion or more on a children’s hospital and maternity hospital and still be sending critically ill babies in ambulances between hospitals after delivery.
It’s time for fresh thinking on both the National Maternity Hospital and the National Children’s Hospital – before it’s too late. The solution is now staring us in the face. – Yours, etc,
Prof CHRIS FITZPATRICK,
Coombe Women and Infants
Sir, - We refer to the Opinion piece by Dr Peter Boylan. Dr Boylan acknowledges the important work undertaken by the National Maternity Hospital and its dedication to maximising the service for mothers and babies that can be achieved from a small, city-centre hospital campus.
This small campus has extremely limited space and buildings that are almost 100 years old. This is the core issue – the National Maternity Hospital cannot continue to provide and deliver all of the services required for women and infant health in this current location. The unsustainability of this situation has long been acknowledged and is a key factor in the Government’s decision to relocate the National Maternity Hospital from its current site on Holles Street to the St Vincent’s campus at Elm Park.
Buildings of this vintage were never designed to be capable of providing the multiple infrastructural facilities associated with modern healthcare.
Retro-fitting of a building such as Holles Street with infrastructural issues relating to heating, plumbing, information technology and electrical systems is simply not feasible.
The overall layout and space are suboptimal for modern maternity care with the continued operation of “Nightingale” wards where up to 14 women occupy the ward with only a curtain separating beds, and minimal toilet and shower facilities. This is not in any way acceptable.
The proposed move to the St Vincent’s Campus at Elm Park was first considered in the 1990s and supported by successive Masters since then. An independent options appraisal conducted in 2003 concluded that the requirements for modern maternity care, even at that time, could not be provided on the Holles Street site. In 2008 the independently commissioned KPMG review of maternity services in the Greater Dublin Area recommended co-location of maternity with acute adult services for optimal clinical outcomes.
Since then, the standards have evolved and the requirement for additional space for new services has grown substantially.
The announcement of the co-location of the National Maternity Hospital in 2013 and the subsequent body of work undertaken on the design brief identified a need for a 44,000 sq m footprint to accommodate the hospital services. This will provide a majority of single en-suite rooms for maximum patient privacy and dignity, in addition to 24 delivery rooms and five operating theatres (the current Holles Street footprint is, by comparison, 15,000 sq m).
All new and expanded services place additional pressure on the current infrastructure of Holles Street. At is stands, there are very few departments in the building that meet modern requirements in terms of available space.
Never more so than during the Covid-19 pandemic have the infrastructural deficiencies been more obvious. The practising of social distancing within the hospital layout was, and remains, impossible with hastily erected temporary small cabins used as waiting and Covid-19 swabbing areas to mitigate risk.
Can it seriously be suggested that “sticking plaster” measures such as these might allow the hospital to keep functioning when an excellent state of the art project for women and infants awaits only the final sanction now from Government to proceed?
After so many years of dialogue, debate and ultimately agreement, surely that time has now come. – Yours, etc,
Director of Midwifery