What’s wrong with St. James’s

Problems with St James’s Site – Dr Fin Breatnach

Air Pollution

Air Pollution at the site (of a hospital for the sickest children in the country) will exceed EU statutory limits and even more so the stringent, non statutory but obviously more significant, guidelines of the World Health Organisation.

Material contravention of the Dublin City Council Development Plan

The hospital building is in material contravention of the Dublin City Council (DCC) Development plan i.e. the hospital will be 40 metres longer than and just as high as Croke Park. Its height will exceed 35 metres – the upper limit for the area in the DCC plan is only 28 metres.

Helicopter restrictions

The helipad, on a fourth floor roof at one end of the children’s hospital, can receive only the lighter Air Corps AW helicopters and then only on flight paths not restricted by the adjacent upper hospital floors. The heavier Coastguard and Marine Rescue Sikorsky helicopter is not licensed for roof landings and must land at The Royal Hospital Kilmainham resulting in additional unnecessary handling of seriously ill or injured patients which will inevitably compromise outcomes.

Parking limitations

Due to the recognised poor surrounding road infrastructure, Dublin City Council have placed a car parking limit of 2,000 for the entire site i.e. for the existing adult hospital, The Mercer’s Institute for Successful Ageing, the planned relocated St.Luke’s Hospital, the National Children’s Hospital, The Children’s Innovation and Research Centre, the Ronald McDonald Family accommodation building, the National Blood Transfusion service and the full service Maternity hospital along with any future expansion of any or all of these facilities. The long, narrow St. James’s site is 19.4ha (47.93acres)in size, (10 acres leased to Trinity College, 38 acres leased to St James’s Hospital) with only one entrance at each end, will continue to have just one through road with a single lane in either direction to carry all cars, ambulances, buses and cyclists. There will be no cycle lane. In relation to the proposed children’s hospital, there is no space left on site for a surface car park. They plan on digging three floors underground at an estimated cost in the region of €40M. Unfortunately, the Main Drimnagh sewer runs through the proposed location of the underground car park and this will have to be relocated along with other services before excavation for the car park can commence. The cost of that work will add an additional €18M to the cost of the car park. They are planning on putting approximately 984 parking spaces in the underground car park. However, as they plan on building the Children’s hospital on an existing surface car park, they will lose almost 600 surface spaces leaving them with a net gain of only 420 spaces. This gives you a final cost of over €138,000 for each of the 420 car parking spaces! It is accepted that the children’s hospital will have to cope with 10,000 arrivals and departures every day. An additional 3,500 staff will work at the children’s hospital. If the essential maternity hospital is ever built, St James’s have indicated that, in keeping with Dublin city council regulations, there cannot and will not be any additional parking provided for those attending or working in that facility.

Maternity co-location
The critical co-location for the children’s hospital is a maternity hospital so that seriously ill newborns can have direct access to the appropriate paediatric experts without the need for hazardous ambulance transfer. If a full service (per KPMG study recommendations) co-located or integrated maternity hospital cannot be provided on site, then it is accepted that inevitably, babies will die each year as a result. No Maternity Hospital planning application has been made. The National Paediatric Hospital Development Board in its 2015 application to An Bord Pleanála indicated, in a “Draft Site Capacity Study” of the St James’s site that if you wished to build the maternity hospital after you had completed the children’s hospital, then the first thing you would have to do is to demolish the existing, quite new, adult out patient department and to relocate it somewhere else. You would then also have to build a new adult Accident and Emergency Department, a new adult Intensive Care Unit and a new Adult Hospital Facility Management Hub! Only then could you begin to build your maternity hospital – if you got planning permission!

Demolish and rebuild

St James’s In their submission to An Bord Pleanála St. James’s indicated that they wished to demolish and rebuild 65% of the existing adult hospital. Much of the remaining 35% would be listed buildings.

More site constraints-the FAU

The site is so constrained that the developers are not able to provide sufficient space to allow for the required number of Family Accommodation Units at the Ronald McDonald House.

Site too small for Future Expansion

Space was the number 1 priority according to the McKinsey report. There is insufficient space for future expansion and almost all of the small amount of planned green space will be quickly used up. Toronto Children’s Hospital doubled in size every ten years since the 1950’s. Texas Children’s Hospital was rebuilt twice in twenty years. The Clinical Space at Our Lady’s Children’s Hospital in Crumlin has increased by 75% in just the last 15 years. Although Our Lady’s in Crumlin was the last of the three children’s hospitals to be built in Dublin, it has become by far the largest provider of paediatric tertiary care because, unlike Temple Street and Harcourt Street Hospitals which were on constrained, city centre sites, Our Lady’s had lots of space to expand and develop. The new Lady Cilento Children’s Hospital in Brisbane, serving Queensland, opened in November 2014 beside a maternity and adult hospital. A wonderful design internally, it is now experiencing the problems that parents here in Ireland keep trying to warn the Government about – the city centre location is terrible for parents travelling with sick children – they don’t have enough parking and they don’t have enough parents’ accommodation.

More site constraints – the CRIC

The planned new Children’s Research and Innovation Centre building on the Trinity College end of the  St. James’s campus is much smaller than was initially requested by National Children’s Research Centre at Our Lady’s Children’s Hospital Crumlin – another result of the constrained nature of the site.

Even more site constraints

Clinicians and Allied Health care professionals will not have their own office and will have to rely on “hot desking”. It doesn’t work – for either families or staff!

And yet more site constraints

The requested clinical adjacencies for a single “unconscious floor” i.e. Theatre, Intensive Care Unit, Radiology, Recovery could not be provided because of the constrained site and “vertical” adjacencies requiring elevator transfer was all that was offered. Vertical adjacency is considered to be “safe”, but it is not safest or optimal – why compromise with a new building?

Far too expensive at St James’s

The Children’s Hospital at the St. James’s site was initially costed at €480M. The latest estimate has increased to €750M, and that doesn’t even cover the fit out of the building – it is likely that there will be very little change out of €1 billion! Both the Children’s Hospital along with an integrated maternity hospital could be built on the publicly owned 145 acre Connolly site for less than the cost of building the Children’s hospital alone on the St. James’s site and built more quickly as there would be no need for extensive decanting or enabling works.

Appalling access

As regards access, a photograph , taken at 4pm, and indicating the proposed new entrance to the underground car park and service yard opposite the cottages on Mount Brown,presented at the oral hearing by a local resident,and showing an ambulance stuck in traffic, said  it all.  Access, at rush hour in particular, will be an absolute nightmare with 10,000 arrivals and departures every single day on top of the already crowded streets.

So, why at St James’s?
All of the problems above are the result of a myth – the government has indicated that the reason they chose the St. James’s site was because “senior medical people” had informed them that the clinical outcomes for the children would be improved if the children’s hospital was built next to the adult hospital. There is not a scintilla of scientific evidence to support this claim and the most recently built Children’s Hospitals in the UK, Australia and the USA are stand alone in a parkland setting.  Surely all three countries couldn’t have got it wrong? END.