Merger of St Vincent’s and Holles Street units in best interests of women’s safety

Unfortunately there has been a lot of misinformation, and some downright untruths, in the media over the past couple of weeks about the proposed relocation of the National Maternity Hospital (NMH) to the St Vincent's Healthcare Group (SVHG) campus. Emotive charges about "power grabs", and alleged threats to vital treatments for women in Ireland, have been liberally thrown about, much of it in ignorance of the facts.

At the outset, it is important to realise that the proposed relocated NMH would become an integrated block within the St Vincent’s University Hospital (SVUH) building, not a standalone building elsewhere on the campus. The purpose of this is to provide better care for patients in emergency situations, and for those patients with complex medical or surgical conditions.

The rationale for this integrated approach is clear, and is in the best interests of the safety of women in Ireland. Maternity hospitals are not equipped to deal with all major emergencies that occur, which is why care and treatment is often required within an acute hospital setting.

In cases where the health of a woman or unborn child is at risk, there should be no time wasted as separate teams debate the process of transfer, or the relative responsibilities for patient care.

This integrated building concept has been approved by all the stakeholders in this project, including the two hospitals, the Department of Health and the HSE.

If the hospitals are operated as separately governed entities, which is apparently what the NMH is advocating, then the following issues arise:

Decisions regarding patient care are made by two separate teams, each comprising consultants and nurses who have responsibility for their own hospital. Focus shifts from the patient to the separate responsibilities and liabilities of each hospital. Insurable risk becomes a major priority in the relationship between the hospitals.

As is the case today, women will move back and forth between the two hospitals to receive the care they require at different stages of their condition, as consultants will typically operate only within their own hospital. Protocols will be required to enable the transfer of responsibility for patient care from one hospital to another in a manner that avoids any grey areas. In such circumstances, one can readily appreciate that even within an efficient system, this will results in delays and potential risks to pregnant women and/or their child.

Single system

However, if a single system of governance operates, as is advocated by SVHG, then:

All emergency cases are managed by a joint team of experts, who can provide the care required at the exact time it is needed. Patient care comes first at all times, with no restrictions on care available.

There is no need for patient care to be restricted by the physical location of the patient in a specific hospital, as care comes to the patient.

No time or cost is expended in managing transfer protocols designed to protect one hospital over another, with the fear that a medical mishap may give rise to extensive and costly litigation down the road.

With constant budgetary pressure on all healthcare services in this country, it is vital that none of the available budget is wasted and that each service receives its full HSE allocation. We have seen cases, such as at Cork University Hospital, where the maternity budget was subsumed into the general hospital budget, and funds available to maternity services were restricted. That is why St Vincent’s has proposed that:

The land needed for the new facility is provided by St Vincent’s at no cost to the taxpayer, once no additional cost accrues to St Vincent’s.

Separate service agreements and budgets are maintained by the HSE for St Vincent’s and NMH, with no right to transfer funds between the hospitals.

The new maternity facilities are reserved by legal agreement for obstetrics and gynaecology services, and cannot be taken over by the acute hospital.

The new maternity facilities are physically interconnected with the acute hospital, so that patient care can be provided on an end-to-end basis on campus, without any need for delays in transferring patients for emergency care.

Shared services, such as interventional radiology, laboratory services, pharmacy, clinical waste management, hygiene management, and catering for patients and staff, can be provided on the most cost-effective basis.

The SVHG board and management supports the National Maternity Strategy, and its recommendations, which advocate very substantial change in the ways in which obstetrical and gynaecological services are provided to the women of Ireland. In particular, there is no explicit recommendations which imply or express that the Mastership model, as currently discharged in three of the Dublin maternity hospitals, is a prerequisite to the successful implementation of the strategy.

On page 102 of the strategy, it is acknowledged that the Mastership system has served the country well for some 260 years. However, it is further acknowledged that this system may need to evolve over time, given the changing structures implicit in the new strategy which indicates that the governance structure is “currently being remodelled”, and this will “involve examining existing arrangements . . . to ensure the delivery of safe services in line with the vision articulated in this strategy”.

Evolve

It is the SVHG view that after its transfer to the Elm

Park

campus the Mastership system should evolve, which would be consistent with the remodelling of Irish maternity services as recommended in the National Maternity Strategy. The gradual evolution of the Mastership system over time, perhaps a time-span of five to 10 years, is part of our proposal.

It is very difficult to understand the adherence to the status quo, and a refusal to acknowledge the need for change, however gradual, in line with best modern international practice in the care of women in Ireland. Change is always difficult and challenging, and it can appear particularly threatening to the status quo and vested interests.

It is my sincere hope that when concerned parties, especially women, look behind the unfounded allegations about our proposal they will see that the sole concern of the St Vincent’s Healthcare Group is how we can best serve our patients, especially patients at risk who require speedy and effective treatment on our campus.

Michael Keane is clinical director of SVHG and Professor of Medicine at UCD