OPINION:Alternatives to Mater site cannot possibly provide the world-class national children's hospital this country is crying out for, writes DAVID VAUGHAN
WHILE ARGUMENTS around access and convenience are important and should not be disregarded in the discussion on the site of the new national children’s hospital (and should be considered whatever the location), it is imperative that the overwhelming benefits of such a development are outlined from the perspective of a professional.
The fundamental question is whether we want a world-class system of care for our children and if so, how can this be achieved? The McKinsey Report (2005), based on a review of many of the leading children’s hospitals around the world, provided the answer. There was not a single dissenting voice among the profession when the firm’s findings were published.
McKinsey found that of 17 leading children’s hospitals examined, 16 were co-located with adult services. This allows a critical mass of specialists to treat the greatest volumes possible of the most complex conditions, in the safest setting. These opportunities allied with the research and educational benefits will then attract the most talented healthcare professionals, further developing the expertise and international reputation of the hospital.
The alternative options to the Eccles Street site do not offer any of these benefits. They will be unable to meet the expectations of parents and their children.
This is the choice before us – stick the course and develop a world-class facility on Eccles Street or accept a compromise that will not give our sickest children the best possible chance of survival.
If any parents are asked where they want their child treated, I guarantee that given the choice, they will always want to be treated in the hospital that delivers the best outcomes, regardless of location. The first principle for the best outcomes is that size does matter.
In a small country such as ours, the number of children with uncommon conditions such as heart disease, cancer and other rare diseases is so low that only by amalgamating services in one hospital can we ensure that survival and quality of life of these vulnerable children matches the best in the world.
In the mid-1990s, a children’s hospital in Bristol unfortunately demonstrated that when one compromises quality and size for convenience, children die unnecessarily. The Bristol Inquiry (2001) concluded that paediatric heart surgeons were doing too few operations to ensure they had the skills required to deliver the best outcomes.
The result was survival rates at the Bristol hospital were alarmingly poor; 35 more children died than should have been expected over a 12-year period.
The findings of this inquiry led to ongoing rationalisation in paediatric surgery throughout the United Kingdom, with the result that there are fewer and fewer hospitals performing heart surgery.
It often appears that this is a Dublin argument, having nothing to do with children’s healthcare outside the Pale. Nothing can be further from the truth. This development offers a once-in-a-lifetime opportunity to redefine how we deliver care to children throughout the country. Rather than persisting with the status quo, a system can be developed in which children and families are at the centre, and in which the system responds to their needs rather than the wishes of some bureaucracy.
The second principle is that patients can be divided into two broad groups; those requiring emergency admission, the bulk of whom will be from Dublin and those requiring planned admissions, which will be from Dublin and throughout Ireland.
The issue of location is more pertinent to the first group and it is hard to argue that for this group, a central Dublin location is not the more preferable and equitable option. After all, 40,000 children currently attend the Temple Street emergency department. In addition, while all the arguments around access have concentrated on parents with cars, no one has ever spoken about those children who have no access to their own transport.
These children disproportionately require emergency care and admission to hospital. Surely it is more equitable that these children have easily available access?
The third principle is cost. Conservative estimates are that when the three hospitals are combined operating costs will go down by at least €20 million per year. Therefore every year this project is delayed is costing us at least €20 million. While the headline cost of the construction gathers all the publicity, people forget that this cost is written off over the lifetime of the building, at least 50 years.
The capital cost has to be weighed against the savings generated by combining the activity of three hospitals into one.
For example, the salary costs alone of one nurse employed for 40 years at current rates will be €2 to €3 million. Therefore, it is disingenuous to compare capital costs alone, especially when no alternative location and build have actually been costed.
The fourth principle relates to how we value our staff. We have some of the best-trained professionals in the world, and we put them to work across three locations, do not give them access to fit for purpose buildings, and provide inadequate support staff, equipment and IT. Despite the best will in the world, no one can reach their true potential in such circumstances.
Our staff deserve better. We saw concrete examples of this in recent years with repeated cancer scandals.
At the insistence of local politics, both healthcare and party political, cancer services were delivered in almost every hospital with predictable poor outcomes. Do we want our children to suffer a similar fate?
The fifth principle is that like medical care, education and research are best delivered when a certain critical mass has been attained.
Again, despite the best efforts of almost every individual in the system, it is likely that we have achieved nothing like our true potential in these areas.
Lastly, for those who have seen the plans and drawings of this hospital, it is truly a beautiful building, and looks nothing like traditional hospitals in this country. Nothing has been shoehorned into this site. This is the building and the opportunity of a lifetime.
If it falls victim to vested interests, if quality is traded for empty promises of easier access the only ones who will really suffer will be those children whose outcomes and lives would have been transformed by being treated in a hospital commensurate with the ideals, skills and dedication of the professionals working within.
Unfortunately as we know, children do not vote, and don’t have access to radio talk shows.
David Vaughan is a consultant respiratory paediatrician on secondment from Our Lady of Lourdes Hospital to the Health Service Executive’s directorate of quality and clinical care. He has written this piece in a personal capacity