Madam, - As a visiting paediatric radiologist I have listened with interest to the discussion about the construction of a new modern national children's hospital in Dublin, and the relocation of the existing three children's hospitals to a new site.
About eight years ago we had a very similar situation in Stockholm, Sweden, when our government health authorities decided it was time for a make-over of Stockholm's children's health facilities.
The current debate in Dublin reminds me of the events in Stockholm and perhaps our Swedish experience could be of some interest here.
We had at that time a big independent children's hospital in the northern part of the city, St George's Children's Hospital, with about 300 beds, providing paediatric medical and surgical services including intensive care. On the site of the Karolinska adult hospital there was another children's hospital, free-standing but administratively part of the Karolinska, with paediatric medicine, orthopaedics and oncology, as well as a neonatal intensive care ward. There were outlying paediatric clinics in other adult hospitals in the city.
The government decided to rebuild and enlarge the Karolinska paediatric unit, to close St George's Children's Hospital, and move everything (staff, furniture, equipment) to the Karolinska site together with the paediatric services at two adult hospitals in the city. The aim was to create a modern, world-class children's hospital as a free-standing hospital on the site of the Karolinska, and to concentrate all child health facilities on one site.
All hospital staff were invited to take part in the planning in a true democratic process. So we studied architects' plans and were told to deliver our opinions. The most striking feature of these plans was the size of the new hospital. Anyone could see at a glance that it was far too small. Operation theatres were undersized. Clinical spaces were much smaller. Waiting areas for the children were to be very small because in this modern new hospital, course, children wouldn't have to wait!
In democratic fashion we doctors, nurses, help nurses and other healthcare workers expressed our opinion in meetings, in lists, in letters to the board: It's too small!
The people we were trying to reach with this message were, of course, not health workers. They were politicians, keen on democracy but sadly ignorant of actual practical work - and ignorant of their own lack of knowledge. We were told there was simply not money to build bigger. The plans for the small new hospital were forced through and the move was made.
We have now been working in Astrid Lindgren's Children's Hospital at Karolinska Hospital, which is the name of the now not-so-new hospital, for eight years. We share rooms, some of us share lockers, and patients are spilling out of the small waiting areas in the emergency department, waiting all over the lobby, the foyer and the cafeteria.Demand for children's healthcare is increasing as the population of Stockholm grows, not least with the immigration of child-rich families.
Recently it dawned on the decision-makers that the doctors of the intensive care unit did their paperwork in the staff kitchen and changed their clothes in the corridor, and they decided to build an annexe to the intensive care area for working and office space. This has been done, and now plans are advancing to build a prefab in the hospital land to provide further space for the emergency department, which has also proven too small. We have the satisfaction of saying: "What did we tell you?" But that is in fact poor consolation.
Plans are now under way to move the whole Karolinska Hospital from its present location to new buildings. We at the Astrid Lindgren's Children's Hospital are left with the hope that this time the move will include more adequate space for the care of sick children and their families. - Yours, etc,
Dr HEDWIG WAHLGREN, Stockholm, Sweden.