Adult Hospital Co-location

The RKW Report ( Oct 2007), commissioned by the DoH/HSE to develop a Higher Level Framework Brief for the National Paediatric Hospital, uses three Co-location operational models – (i) Standalone, (ii) Campus model, & (iii) ‘Fully Integrated’ model.

The term “Co- location” as currently used  in media debate in Ireland about the NPH  confines the term to mean only what the RKW Report calls the ‘fully integrated’ model.

There has been gross exaggeration of the importance of adult hospital adjacency . See RKW Co-Location table.
(The table is from the RKW Report, Part 3, Appendix 1- Reference Sites Database Summary. It is the first table in  Appendix 1 -General Profile).

RKW ‘s terminology appears loosely  based on directives in a HSE Document of 23 January 2007 entitled  “Outline of the development of the High Level Framework Brief for the new National Paediatric Hospital which will be carried out by RKW”.  Section 5.4 of this 11page document, headed “Consultation: Workstream 3 – Operational Policies”, contains the following bullet point

  • “RKW will draw heavily on its experience of children’s tertiary and secondary hospitals internationally which are co-located on adult sites. It is important here to differentiate between co-location examples  ( where support services are shared with adults ) and campus approaches – where the Children’s Hospital is entirely a stand alone entity – e.g.Melbourne Children’s Hospital.”

The following is the  New Children’s Hospital Alliance(NCHA) comment on the contents of  RKW Appendix Table 1, sections 1.7 and 1.8.

Section 1.7 ” ‘Co-location’ with AdultMaternityMedical School  and Research .

Seventeen children’s hospitals are studied by RKW as to their co-location operational model.
Adult    Eight are listed as co-located with adult hospitals-( 4 of which  are’ integrated’, 4 are in a  ‘campus model’- as pertains in Melbourne where the Children’s is a kilometre away from the Adult hospital ), 9 are not linked with adult facilities.
Maternity -10 are with Maternity hospitals – 5 of these in a ‘campus model’, 5 in a ‘integrated ‘ model, 7 are not with a maternity facility.
Medical school -13 are with a Medical School –  (7 of these in a ‘campus model’, 5 in an ‘integrated’ model), 4 are not with a medical school.
Research–  15 of the 17 have a Research facility.

Section1.8   Shared services  – non-clinical supportclinical supportcore clinical services

Eleven  of the 17 Paediatric hospitals do not  share any services with other hospitals  ie.  they are ‘stand alone’ either of the ‘campus model’ or truly  independent institutions. The 5 ‘fully integrated’ co-located hospitals, 3 of which are in the UK and one in Norway, share services to a varying degree. The 5th is a combined Children’s/Maternity  hospital in Vancouver not linked to an adult facility.
The stand alone Children’s Hospital of Philadelphia(CHOP) shares only a proton beam therapy unit (one of only six in the world) with the adult hospital in a shared building on an extensive campus. Of the 10 hospitals  studied by RKW in North America none has shared services with an adult hospital (other than for the proton beam in CHOP ). Vancouver Children’s hospital is ‘integrated’ only with a Maternity Hospital – they are not attached to an adult facility.

This paints a very different picture from that being promoted currently on the airwaves.

It also paints a very different picture from that by Minister Harney who as Minister for Health in an address, peppered with  multiple inaccuracies, to Seanad Eireann on the National Paediatric Hospital on the 17th November 2010 said the following:-
” After the site [the Mater] was selected and the development board was put in place, RKW, a world expert on hospital planning, came to advise on the requirements of the hospital. It also looked at 17 different hospitals around the world. In fairness, many of the hospitals were similar to the ones at which McKinsey looked. Between the two, 25 different hospitals were examined. Twenty-four of the 25 hospitals are co-located with adult hospitals.” [our emphasis – her statement is simply untrue].

Please see  Evolution of Inpatient Tertiary Paediatric  Care, International Trends 1970-2010  on ‘The Future’ page of our website, adapted from The McKinsey Report (p27). You will see that, internationally,  ‘stand alone’ paediatric hospitals ‘consolidated with Obstetrics’ is the emerging preferred model.