Statement on the NPH Review, March-June 2012


Statement  May 2012

NCHA welcomes the  NPH Review currently in progress.

  •  The three Dublin children’s hospitals(Crumlin, Tallaght and Temple St.) will consolidate into one, to form the  National Paediatric Hospital.  The  principal aim  of this project is to build the right children’s hospital to meet the clinical needs of the children of the state. That means the right size and the appropriate configuration. No site that does not meet those criteria, irrespective of its medical synergies, research opportunities or access advantages, should be seriously considered.
  • The  most important co-location for children is for their hospital to be physically linked by corridor to a tertiary Maternity hospital. Because of the significant numbers of sick newborn children born annually such co-location is  urgent and must take precedence over co-location with an adult hospital. Mothers with high-risk pregnancies where the baby is likely to need treatment in Intensive Care(c.550 per year) or specialist diagnostics would be referred to and delivered in this hospital.
  • All nine McKinsey Report planning assessment criteria should be reviewed and weighted in importance relative to each other, with the addition of the criterion of co-location with a Maternity hospital. A validated and transparent scoring system must be used to compare sites.
  • A “workable plan”(McKinsey report, p59) for the location of inpatient beds, secondary and emergency care(Secondary needs) for the Dublin region is required. In the unseemly rush in 2006 to name a site for the NPH such a plan  was never considered. It must now be developed and made public by government before the NPH location is finalised. Ambulance transport times for emergencies from all over the Greater Dublin Area(GDA) to each potential NPH site must be available to inform the Review Group’s recommendations so that serious emergencies within the Greater Dublin Region(GDA) do not  face unacceptable retrieval and transport time risks. Urgent Care Centres are not appropriate  for Emergency Care delivery.(McKinsey p59), (RKW Part 1, p21).
  • All Submissions, many of them very detailed, informed and expert from a wide variety of stakeholders– to the Location Group, to the Transition Group, to the RKW consultants, to the NPH Development Board and to An Bord Pleanála -should be available to the Review Group. The recommendations in several of these submissions have been almost totally ignored by  various HSE/DoHC groups.
  • Governance, budget and brand of the children’s hospital must remain identifiably independent of any adult hospital – as stressed by international comment within the McKinsey Report.
  • The importance of the presence of the Universities and space for an on-site Academic Health Sciences Centre delivering basic, translational and clinical research and educational facilities must be promoted and facilitated. Research is the engine that drives clinical excellence and the magnet that draws the natural clustering of hospitals around academic centres worldwide. Here too is where multi-disciplinary, multi-professional and multi-hospital interaction occurs.
  • The location decision, made in June 2006 without a Model of Care to inform it and widely believed to have been politically corrupted, was wrong for children in 2006 and is still wrong for children in 2012. The Model of Care developed and redeveloped ad hoc, and the proposed decanting of many services to the Tallaght site was driven by the constraints of the constricted Mater site, not by the needs of children. The  165,000 sq. metres proposed by the Review Group in its letter of  4th April 2012 to prospective ‘bidders’- as being the requirement for the NPH, a Maternity hospital and  their expansion space- is not based on any agreed or informed Model of Care.
  • Adult hospital co-location:  The relentless promotion of this option by medico-political interests has damaged and held back the consideration of the broader needs of sick chiidren. NCHA accepts that Maternity hospitals should be co-located with adult hospitals to service mothers’ potential needs. NCHA further accepts that ideally the NPH should share a campus also with an adult hospital which has the potential in the future to complement the children’s hospital as national adult specialties migrate to the adult centre. This will require significant space for the adult hospital to expand as no adult hospital at present has all the requisite specialties.   NCHA does not accept the legitimacy of the sudden proliferation of claims of so-called ‘clinical synergies’ between children’s and  current Dublin adult institutions. Children are not small adults.   Consultant posts structured with only  minor parttime  committment to children delay the development of the “breadth and depth ” of speciality expertise . Such posts should be a ‘thing of the past’.  Children with rare diseases, contrary to what has been stated in Dáil Eireann, are referred, not to adult doctors but to children’s doctors who specialise in these rare conditions. Thus, children for liver transplantation go to the UK, not to the national adult liver transplant centre at St Vincent’s University hospital. Children with complex congenital tracheo -oesophageal problems go to children’s hospitals in Prague or Boston, etc.,etc. Indeed it could be argued that in the 21st century there is little or no place for ‘adult’ doctors in a National Children’s Hospital serving the island of Ireland.  It must again be emphasized that the major gain for children is in the coming together of the three children’s hospitals thus concentrating paediatric  expertise and  developing  “breadth and depth” of service within the new hospital.
  • So,could we please have a bit more balance in the current debate – we are meant to be concentrating on children’s needs not on the ambitions of various adult institutions.
  •   Access and travel times from outwith the GDA must not be unjustifiably prolonged or difficult for the many sick children in need of tertiary care. Car parking  should have 2,500 spaces solely for the children’s hospital. This is not achievable in the city centre; so why put an elective ‘new build’ there, creating unnecessary hassle and distress for people?
  •  Finally, children would like, and use, natural green space around their hospital.