Still not too late to stop Mater hospital madness


HEALTH CUTS “hurt the old, the sick and the handicapped”, said the infamous Fianna Fáil slogan in 1987. And now we’re facing another batch, which will result in the closure of up to 4,000 public nursing-home beds, the imposition of a €50 annual levy on medical cards and new charges for home help.

The Department of Health has been forensically examining every budget line for further cuts in an already ramshackle health service. Yet at the same time, it plans to forge ahead with the proposed children’s hospital on the Dublin Mater site at an acknowledged cost of €650 million, and probably a lot more.

While other extravagant, boom-era boondoggle schemes such as Metro North are being cancelled, the hospital is to proceed. Indeed, Minister for Health Dr James Reilly’s recent statement that enabling works would start next year and construction in 2013 blithely assumed An Bord Pleanála approval for this contentious project.

The Government’s decision to proceed is all the more surprising given that former hospital development board chairman Philip Lynch – forced to resign more than a year ago after he queried the suitability of the site – branded the location as “a political decision, a northside job. I’ve no doubt in the world about it”.

The decision was made with unseemly haste in June 2006 “behind closed doors and signed off as government policy by the cabinet without any participation from the public, child health professionals or our elected representatives”, as Dr Roisín Healy, of the New Children’s Hospital Alliance, told An Bord Pleanála’s recent oral hearing.

The alliance opposes the Mater site on the grounds of patient care, inadequate access, physical layout and lack of space for expansion. And looking at the plans for this incredible hulk, it is hard not to conclude that the Mater must be the wrong site, especially given its sensitive location in Dublin’s northside Georgian core.

“Should an infant require an intensive care bed after a complex surgical procedure in Our Lady’s Children’s Hospital in Crumlin, they would be transferred in their incubator to the new world-class paediatric intensive-care unit [ICU] across the corridor from the theatre suite,” says Dr Catherine Nix, an anaesthetics registrar at the hospital.

The same journey in the proposed hospital would involve at least two trips in one of its 25 lifts “because the emergency department will be on level zero, radiology on level one, the [operating] theatres on level three, the ICU on level four and the five ward levels are on levels 10 to 14 respectively”, she says.

This is obviously not ideal.

Yet the new hospital would not be a stand-alone facility. Even after it was fully operational, a third of all day patients, outpatients and accident-and-emergency cases would be dealt with at Tallaght hospital, in a facility yet to be built. And up to 300 of Tallaght’s patients a month would be transferred to the Mater by ambulance.

“We have potentially produced a service configuration that will have patients from outside Dublin with complex diseases requiring tertiary care having to access the city centre for services, while Dublin patients with less complex secondary-care needs will be travelling to the periphery of the city,” said retired paediatrician Dr Finn Breathnach.

This amounts to bilocation, even if the much-vaunted “co-location” with a major adult teaching hospital is achieved. But St James’s Hospital would also have fulfilled this requirement. And because its site is four times larger than the Mater, there would also be room for lateral expansion, which the children’s hospital in Eccles Street will not have.

That’s because a new maternity hospital (to replace the Rotunda) is planned right next door to it – in pursuit of the highly idealised “trilocation” of children’s, maternity and adult services. Quite what would happen then to the Rotunda, which has provided an unbroken service to mothers and babies since 1745, is unclear.

Building upwards would be the only option for the Mater children’s hospital, adding more floors to an already tall – 16 storeys at nearly 74m (240ft) – thereby increasing the reliance on lifts. The flagship Royal Manchester Children’s Hospital, which opened in June 2009, is stretched to deal with its waiting lists.

Alternatives simply haven’t been examined, such as an affordable (€110 million) plan to expand Our Lady’s in Crumlin, where clinical space has been increased by 46 per cent over the past decade, according to Dr Breathnach. And the fate of this fine children’s hospital – the third largest in these islands – is also an open question.

Excavating the four-level basement car park for the new hospital in Eccles Street would require constant movements of trucks to shift spoil off the site. Moreover, with Metro North not proceeding, most of those availing of its services will arrive by car on congested city streets.

All of these issues are additional to the principal argument against the project – its enormous scale relative to the surrounding area and the Dublin skyline. Just because €31 million has already been racked up should not mean that it cannot be cancelled – at least €150 million was spent on Metro North before it was “deferred”.

Surely the children’s hospital has not escaped scrutiny by the EU-ECB-IMF troika? If our paymasters are content with it going ahead, they are complicitly approving the swingeing health cuts now being planned.

An Bord Pleanála would be doing the old, the sick and the disabled – not to mention taxpayers – a big favour by refusing permission.

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