Jun 6, 2012

The National Children’s Hospital: A Plea to the Government to Put Children’s Interests First

Dr. Fin Breatnach

Rachel Lavin

“A nation’s greatness is measured by how it treats its weakest members”

Mahatma Ghandi

The proposal in 2005 of a New Children’s Hospital (NCH) came as a relief to sick children, their families and carers all over the country. However, while the government’s decision reflected a positive step toward improving children’s healthcare, their offerings were soon tainted by a complex and bitter dispute over location, the ultimate decision of which will come to its climax next Thursday when the recently established review group present the ‘pros and cons’ of each site to Health Minister Reilly.

But this is not an easy decision. The National Children’s Hospital is hot property, site submissions are numerous and tension is growing between a number of interest groups.

To discuss the development of the NCH I met with Dr. Fin Breatnach, retired paediatric oncologist and leading advocate for the New Children’s Hospital Alliance. Having worked in Irish healthcare all his life Fin is no stranger to struggles with the government to achieve adequate care for his patients. The children’s cancer ward in Crumlin was highly underfunded and inadequate, something he fought throughout his career to resolve.

“I’ve been dealing with the problems of government all my life. All the years I was fundraising I kept writing to the Department of Health and the ministers and I’d get the standard letter, you know, saying ‘We know your letter has been received and will receive due attention in due course’. That meant that it had been put in the bin.
It was subsequently I met with senior officials in the Department of Health in a different capacity, they had retired from their posts, and I asked them how they could justify refusing to offer me any help given how awful the facilities in Crumlin were at the time and their response was ‘We knew you could raise the money’. That’s the cynical response that I got from them… It’s soul-destroying”.

While the news of a single tertiary center of care for sick children came as a relief, it wasn’t long before problems appeared in its planning. The original location, on a site shared by the Mater Hospital, would have seen the construction of a new sixteen-story hospital, and a 60 foot excavation for an underground car park.

The site insisted on co-location with the Mater Hospital but simultaneously ruled out future expansion, and dismissed the importance of accessibility, space, risks of traffic delays to dangerously ill children travelling to hospital, and the added stress of the highly inadequate number of car parking spaces would cause not just to parents coming with their ill children from the country but to staff coming to the hospital.

“Even with the delay of 20 minutes with getting a seriously ill child to the Mater, it could well result in that child not surviving,” said Dr Breatnach. “The site was already turned down by an independent investigatory group who were looking to build a small radiotherapy unit. How it now can become the best place for a children’s hospital is beyond me.”

In reaction to the controversy over the planning process for the new hospital, the New Children’s Hospital Alliance (NCHA) was formed to act as an advocacy group for health professionals, parents, past patients and interested persons. This step was seen as particularly essential after it was found that the original Location Task Group established in 2006, remarkably, did not contain any professionals with a background in children’s healthcare.

The NCHA demanded a review of the decision to locate the new children’s hospital on the Mater site. The government agreed to this review but, to the group’s disappointment, the government review concluded once again that the Mater site was appropriate for the project.

Yet the result of the review aroused suspicion and under an FOI request, the NCHA discovered a significant paragraph that had been removed from the review group’s proposal.

The paragraph stated:
“The ideal location would be located on green space, provide for unfettered access, accommodate research and educational activity, provide sufficient space to ensure aggregation of all patient care services meeting current and future care requirements and it would be tri-located with an adult tertiary care and a maternity facility.
We all agree if there was a site and funding for such an aspirational location it would be a magnificent campus. Unfortunately give the current challenge of funding the one children’s hospital the perfect location is not possible.”

Dr Breatnach explains that “(in the reclaimed paragraph) they are saying the ideal solution to this is to have an adult hospital, a children’s hospital and a maternity hospital on a green field site large enough to accommodate future expansion. However they were prevented from putting it in. They took it out because they were afraid it would set up a further debate on the issue.”

Then, last February, came An Bord Pleanála’s refusal of the Mater for the New Children’s Hospital, on the grounds that it was an ‘over-development of the site’.

The Mater returned a revised plan promising to lower the building by six stories and move education and research into the old Mater private, donated to them by the nuns. However, as Dr. Breatnach explains, this does little to resolve the over-riding problems.
“The problems remain much the same, I think. You see an Bord Pleanála weren’t just concerned with the scale and the bulk and the height of it. The planning inspector who heard the application was very concerned about parking and access and was also particularly concerned that the development represented an over-development of such a small area.”

Despite the obvious problems with it, the Mater site is still a strong contender and just three weeks ago a prominent member of the NPH Development Board and businesswoman, Norah Casey, insisted on backing the Mater site as the best location for the project.

With so many people vying for the new hospital to be located on the Mater site, one may question what the motivational factors behind the acquisition of the New Children’s Hospital are. The NCH is hot property and many stand to gain from it being attached to their already-existing hospitals.

Such a building brings with it large amounts of jobs, improves social infrastructure and attracts business to the area, particularly biotechnology companies. As such, politicians in particular gain from having such a development in their constituency.

Universities, including Trinity, UCD and RCSI also stand to gain from a favourable location of the new hospital. Certain universities tend to dominate hospitals, using them as their teaching grounds e.g. Trinity in St. James’s. Adding a new development like the NCH would be a huge asset to the college.

“Now, what everyone’s fighting is to win this prize of having a children’s hospital located next to their hospital. They all want this prize of having a children’s hospital next to them,” remarks Dr. Bretnach.

Why is this? For one thing, children’s hospitals attract philanthropic money. They also increase the development of specialties such as genetics, which bring further expertise to the institution.

Another relevant hot topic is the recognition that Ireland urgently needs a level one trauma centre in Dublin – a top level trauma centre with a trauma team and all the required specialties such as neurosurgery, cardiothoracic surgery, orthopaedics and critical care. The National Children’s Hospital will bring a helicopter landing pad and paediatric neurosurgery to its new site, placing its co-located adult hospital in pole position to become the main trauma centre for the country. This is a prize of huge significance to adult hospitals. Thus the stakes in the location of the NCH grow higher.

As the deadline draws nearer over forty sites have been offered with St. James’s Hospital, the Coombe Maternity Hospital, James Connolly, Tallaght, the Mater and Lissenhall being some of the main contenders bidding to be co-located with the NCH.

However, what is strongly disputed by the NCHA is the pre-eminence being given to co-location with an adult hospital. According to the McKinsey report, published in February 2006, which was the blueprint for pediatric services, not just for Dublin, but the whole country, co-location was not the priority.

What was prioritised was that it would be big enough to accommodate the national children’s hospital and that it had sufficient parking space and potential for future expansion. The NCHA believes that St. James’s and the Coombe and other adult hospital bids are still insufficient on these grounds and as such are merely repeating the mistakes of the Mater in a less extreme manner.

Dr. Breatnach remarks:
“None of the existing adult hospitals either have the required expert specialties or tertiary specialties, this children’s hospital needs and none of them have sufficient space. They talk about 20 acres, that’s just not enough.
If you go back to the McKinsey document. They said ideally this children’s hospital should be co-located with an adult’s hospital but you have to be pragmatic about this. If you can’t find a suitable adult hospital in terms of access, in terms of the specialties which exist within that hospital, then you have to look at the alternative which is to have this children’s hospital stand on its own with a maternity hospital next to it.”

This is integral because only 5% of patients transferred from a maternity hospital are adults, 95% are babies and thus their proximity to a children’s hospital is all the more important to saving lives.
As Dr. Breatnach says, “There are a number of children dying because they are too ill to be moved to a children’s hospital and if they were born in a maternity hospital that was stuck onto a children’s hospital they would be wheeled across into the children’s hospital and receive the appropriate care.”

However the current maternity hospitals are cramped, deteriorating and inadequate. Fortunately however, the government have proposed that three new maternity hospitals must be built in the next 10 to 15 years. It is under these conditions the New Children’s Hospital Alliance vision comes together.

What the NCHA are proposing is a 100 to 200 acre green field site along the M50.

Dr. Breatnach is not being fanciful either. NCHA’s vision meets the criteria of the original McKinsey report and, interestingly, is also the vision laid out by the earlier specialised review group in their draft report, which was rejected.

Dr. Breatnach explains: “What I would love is the cabinet to adopt a strategic approach to the planning and building of a new children’s hospital. I hope that eventually the government will build one very large adult hospital, which will be a level one trauma center and will have all of the adult tertiary facilities and services available to it and these services are not going to be duplicated in the other hospitals.

Their [In reference to the earlier review group] preferred option was a green field site with plenty of space, readily accessible, with a tertiary adult hospital, and a maternity hospital so their view is our view, our Alliance view. We agree with what the review group very much wished to put into their document but felt unable to do so because they felt it wasn’t realistic.”

The NCHA say that their vision is realistic, strategic and flawless in its reason. If the government take their advice the children’s hospital can be built on a green field site faster and more cheaply than an inner city location or a cramped site and create a fine center of excellence to last into the next century. It would rival the highly successful Dutch Medical University campuses and is in the best interests of children and adults.

But is that enough?

For the time being the real fate of the decision lies first with the review groups, chaired by Frank Dolphin who will put forward the site locations on Thursday, and ultimately with the cabinet, and Minister James Reilly.

There is hope that reason will triumph over political maneuvers and vested interests, even if it is a slim hope. The government do not have a good track record with the National Children’s Hospital or healthcare in general in this country. To those making the fateful decision, Dr. Breatnach simply states:

“I made this plea that everyone should leave all of their vested interests outside the door and for once just do what’s right for children, without any hidden agendas, just do what’s right for the children.”

Just before leaving Dr. Breatnach, I asked him why he dedicates so much of his life, even his retired life, to battles that may never be won.

“I don’t know really, I am who I am. You do what you have to do and the best you possibly can”.

The first round of decisions will be made this Thursday, June 7th. To show your support to the NCHA you can access their website http://thenewchildrenshospital.ie here or their Facebook page here:
http://www.facebook.com/thenewchildrenshospital

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