Would you welcome the arrival of the National Childrens Hospital to Dublin 15?

Hilly Bill

What makes you think that the new hospital wont have all that it needs after its built?

BostonB

one foot in the grave wrote: »

The evidence is that co-locating provides better outcomes for sick children esp in specialties such as cardio-thoracic surgery and neurosurgery. This is best practice and was recognised by McKinsey (2006) and Minister Reillys independent review by four independent international pediatricians (2011). ...

Personally I have no faith in a process that consistently (perhaps intentionally) creates flawed reports, then uses them as a stick to beat down any objection.

While McKinsey recommended co-location as a preferred option, they made the point that “international experience shows that it is important to weigh a decision to co-locate against pragmatic considerations, including space, and quality of access to potential sites….’’

Over 60% of the children and their parents attending the NPH will come from outside the greater Dublin area. Ease of access for these parents, who by virtue of the ill-health of their children have to travel to the hospital by car, should be a major consideration in selecting a suitable site.

http://thenewchildrenshospital.ie/index.php/mater-site/selection-process/

"They [McKinsey] came up with the pure and clear view that there would be one tertiary hospital in the whole of Ireland and that would need to be supported by all secondary care in the greater Dublin region. [But] they made the very significant point that they [McKinsey] were not asked to talk to any of the hospitals. If you look at the McKinsey report - they have at a number of times stated they weren't briefed to consult with the expert practitioners in Ireland and they did not have access to hospital-specific data on the nature and quantity of care. Then McKinsey says on page 59 of the report that this is subject to the obvious and significant step of translating this into a workable plan ‘which we [McKinsey] have not looked at'," says Dr O'Ferrall.

"But they were almost prohibited from looking at how services are configured in Ireland, and issues like traffic gridlock and location and all the other stuff, and they didn't produce a workable plan. The next thing the Government did was set up a taskforce with the job of simply looking at the location. But they [Government] didn't ask the taskforce to look either at a workable plan or look at how services would be delivered or governed. So the whole focus of everybody then, including the taskforce and the political system, was who would win out," says O'Ferrall.

Co-location was only one of nine criteria laid out by McKinsey that should be used when deciding on the new children's hospital. And even though the McKinsey report said that the new hospital "ideally" should be co-located, the HSE taskforce took this as a binding condition. That, says one eminent paediatrician who didn't want to be named, was done on a misguided assumption. "The logic behind that [co-location] was that you would have the back-up for the occasional rare operation if there wasn't a paediatric specialist available. That is flawed. There is no adult hospital in Ireland that marries a children's hospital ideally." The paediatrician points out that all the adult specialties ranging from cancer to transplants are based across a number of different hospitals in Dublin. "There is no ‘super hospital' that could deliver the benefits of co-location as envisaged in the McKinsey report. There were nine recommendations. It qualified co-location by saying that the advantages had to be described and outlined and if not co-located - so it presented the option of not co-locating."

http://www.businessandfinance.ie/index.jsp?p=164&n=399&a=1574

BostonB

Even aside from all that, I've had the misfortune in the past to spend a lot of time in the Mater with family members. I've yet to have a good experience in the place. Maybe its improved in recent years but my overriding memory of the kip is of squalor, dirt and the lack empathy for patients and relatives.They couldn't demolish the place quick enough for me.

Parking has always been a nightmare around there. Unless its the middle of the night.

We've also been in temple st a lot. When I think of that hospital I first think of parking meters and hunting for change. Got to the point where we had a special bag/sack in the car for coins for parking for hospital visits. If you a regular to outpatient clinic, you'll know they all start at 9 or 10 bang at peak time traffic for the area. The building maybe ancient, but the staff are great in temple st. no complaints there at all. Well other than the admin. But thats another story.

one foot in the grave

Hilly Bill wrote: »

What makes you think that the new hospital wont have all that it needs after its built?

It won't be co-located with James's or the Mater so already it's not the best we can deliver.

one foot in the grave

BostonB wrote: »

Personally I have no faith in a process that consistently (perhaps intentionally) creates flawed reports, then uses them as a stick to beat down any objection.





http://thenewchildrenshospital.ie/index.php/mater-site/selection-process/



http://www.businessandfinance.ie/index.jsp?p=164&n=399&a=1574

The article you quote is full of quotes of those in Crumlin who had wished to see this hospital revamped and increased in size. A "vested interest" you could say. The majority of pediatricians had accepted the report and agreed on the Mater or James's as a location for this hospital.

To quote Dr Jane Collins, paediatric neurologist and Chief Executive of the Great Ormond Street Hospital for Children and her colleagues (the four independent international pediatricians who compiled Minister Reillys independent review) -

"We unequivocally believe that co-locating with tertiary adult and maternity hospitals is essential to the development of an excellent paediatric service. This has become best practice internationally and was recognized in the McKinsey report".

"The reality is that no perfect site is available, and consequently the review team considered those options that are viable and achievable. We understand that no one site has all of the requisite adult and current paediatric services that make that site a perfect choice".

The question is how much more/less important is the issue of ease of access for those with private transport than the level of services/care that can be provided co-locating with a hospital that already provides national/regional specialties and has the expertise/equipment/facilities/resources that go with this provision of services.

At this stage a decision needs to be made and the hospital built.

norrie rugger

Everyone seems to be forgetting that there is already a Children's hospital in Tallaght; it has a green field expansion site, next to the main Campus; is going to be the maternity replacement for the Coomb; is sitting oon the M7/M50; plenty of hotels; Luas transport and parks/cinemas etc.

It should always have been Connolly or Tallaght but Maternity hospital and the Luas connection to both city centre train stations makes Tallaght edge it for me.

chucknorris

International recommendations aside, who did the college of surgeons recommend?

Answer = Connolly.

norrie rugger

one foot in the grave wrote: »

The question is how much more/less important is the issue of ease of access for those with private transport than the level of services/care that can be provided co-locating with a hospital that already provides national/regional specialties and has the expertise/equipment/facilities/resources that go with this provision of services.

At this stage a decision needs to be made and the hospital built.

Forget ease of access, for private transport. Have you ever been in an ambulance trying to get across Dublin City traffic? I have and I can tell you that it is not quick or easy. Now imagine a sick child coming from the fringes of the Donegal or Kerry coast? It is bad enough that our system demands a cross country trek without taking another hour to get from the M50 to the Mater site

one foot in the grave

norrie rugger wrote: »

Everyone seems to be forgetting that there is already a Children's hospital in Tallaght; it has a green field expansion site, next to the main Campus; is going to be the maternity replacement for the Coomb; is sitting oon the M7/M50; plenty of hotels; Luas transport and parks/cinemas etc.

It should always have been Connolly or Tallaght but Maternity hospital and the Luas connection to both city centre train stations makes Tallaght edge it for me.

Unfortunately Tallaght does not provide the range of services/regional specialties that the Mater, James's or Beaumont provide. It hasn't a national specialty nor is it a cancer care centre (I think). Like Blanch, it has been seriously underfunded for many many years.

one foot in the grave

norrie rugger wrote: »

Forget ease of access, for private transport. Have you ever been in an ambulance trying to get across Dublin City traffic? I have and I can tell you that it is not quick or easy. Now imagine a sick child coming from the fringes of the Donegal or Kerry coast? It is bad enough that our system demands a cross country trek without taking another hour to get from the M50 to the Mater site

I don't live in Dublin county and have had to travel there with my children. All three hospitals presently are a pain in the ass. Dublin traffic is. That problem (traffic) can be solved or are we simply not capable in Ireland in 2012 of addressing that?

"We" can ignore the expert international advice about this location. A new hospital needs to be built now. It would be a pity (imo) if we didn't make sure that the very best location was chosen to ensure the best outcomes that we can provide for children.

We have a serious culture of "medical politics" in Ireland, lots of turf wars. When it is built, the merging of the three childrens hospitals will be challenging for many many professionals.

You know, I know a lady who brings her son up to Dublin from Donegal every two months for a check up. She does not have access to private transport. She lands at Busaras then gets walks up to Temple St. She's one of many parents who use public transport to get to Dublin. A city centre location would suit these parents.

one foot in the grave

chucknorris wrote: »

International recommendations aside, who did the college of surgeons recommend?

Answer = Connolly.

The Royal College of Surgeons, the college that is affiliated with Beaumont hospital? Well I never ....

one foot in the grave

BostonB wrote: »

Even aside from all that, I've had the misfortune in the past to spend a lot of time in the Mater with family members. I've yet to have a good experience in the place. Maybe its improved in recent years but my overriding memory of the kip is of squalor, dirt and the lack empathy for patients and relatives.They couldn't demolish the place quick enough for me.

Parking has always been a nightmare around there. Unless its the middle of the night.

We've also been in temple st a lot. When I think of that hospital I first think of parking meters and hunting for change. Got to the point where we had a special bag/sack in the car for coins for parking for hospital visits. If you a regular to outpatient clinic, you'll know they all start at 9 or 10 bang at peak time traffic for the area. The building maybe ancient, but the staff are great in temple st. no complaints there at all. Well other than the admin. But thats another story.

Overall it's fair to say that the majority of staff in our childrens hospitals are hardworking professionals that continue to do their best under difficult conditions. I would like to see more transparency though in how they are run. E.g. Annual Reports should be published every year. From what I can see Temple St last published one in 2009, Crumlin 2006 and Tallaght never.

norrie rugger

I imagine that specialities can be moved a lot easier than trying to fit a hospital into a logistical nightmare site

one foot in the grave

norrie rugger wrote: »

I imagine that specialities can be moved a lot easier than trying to fit a hospital into a logistical nightmare site

Unfortunately, it's quite the opposite. It won't happen for a variety of reasons.

norrie rugger

one foot in the grave wrote: »

I don't live in Dublin county and have had to travel there with my children. All three hospitals presently are a pain in the ass. Dublin traffic is. That problem (traffic) can be solved or are we simply not capable in Ireland in 2012 of addressing that?

"We" can ignore the expert international advice about this location. A new hospital needs to be built now. It would be a pity (imo) if we didn't make sure that the very best location was chosen to ensure the best outcomes that we can provide for children.

We have a serious culture of "medical politics" in Ireland, lots of turf wars. When it is built, the merging of the three childrens hospitals will be challenging for many many professionals.

You know, I know a lady who brings her son up to Dublin from Donegal every two months for a check up. She does not have access to private transport. She lands at Busaras then gets walks up to Temple St. She's one of many parents who use public transport to get to Dublin. A city centre location would suit these parents.

She is able to walk, with her child. A lot are not. I am talking about an ambulance transfer from these areas.

Also people could easily get off the train, get on the Luas and be dropped right at the door of either James's or Tallaght.

norrie rugger

one foot in the grave wrote: »

Unfortunately, it's quite the opposite. It won't happen for a variety of reasons.

Explain please?

Speciality care is primarily the people involved, in giving that care. how would it be harder to move them to a new site?

one foot in the grave

norrie rugger wrote: »

She is able to walk, with her child. A lot are not. I am talking about an ambulance transfer from these areas.

Also people could easily get off the train, get on the Luas and be dropped right at the door of either James's or Tallaght.

They could for James's. Tallaght, like Blanch, does not have the expertise/specialties/facilities that make it a best choice for co-location.

BostonB

one foot in the grave wrote: »

The article you quote is full of quotes of those in Crumlin who had wished to see this hospital revamped and increased in size. A "vested interest" you could say. The majority of pediatricians had accepted the report and agreed on the Mater or James's as a location for this hospital.

Interesting that you fail to mention that the original report, wasn't given a full list of locations to consider. It was given a limited list to begin with. Some would say this was intended to weight the decision to a specific location for political reasons.

one foot in the grave wrote: »

To quote Dr Jane Collins, paediatric neurologist and Chief Executive of the Great Ormond Street Hospital for Children and her colleagues (the four independent international pediatricians who compiled Minister Reillys independent review) -

"We unequivocally believe that co-locating with tertiary adult and maternity hospitals is essential to the development of an excellent paediatric service. This has become best practice internationally and was recognized in the McKinsey report".

"The reality is that no perfect site is available, and consequently the review team considered those options that are viable and achievable. We understand that no one site has all of the requisite adult and current paediatric services that make that site a perfect choice".

The question is how much more/less important is the issue of ease of access for those with private transport than the level of services/care that can be provided co-locating with a hospital that already provides national/regional specialties and has the expertise/equipment/facilities/resources that go with this provision of services.

Even Bord Pleanála thought that one was nuts.

You don't have to take Crumlins word on the relative importance of co-location. I quoted the bit from the original report that talked about it. Seems odd that you want to cherry pick some of the report and not other parts of simply because someone against the plan (Crumlin) quotes from it.

one foot in the grave wrote: »

At this stage a decision needs to be made and the hospital built.

Yes thats what Harney came out with the first time flaws in the plan were pointed out. The logic of lets base the decision on a flawed/bias set of reports, because we're in a hurry, makes perfect sense.

They should have had some sort of weighting of the requirements, then scored all the locations. I don't see whats hard about that. Unless of course some location would have scored so badly on some aspects that it would ruled them out. Then you'd see why they wouldn't do that. Space to expand, none = 0. Cost of land - expensive = 0. Close to a train, bus, national routes, catchment of patients, staff. These are all things that could be measured weighted.

The Blanch site isn't without its own issues. But the process thus far, I've never seen something so bias.

BostonB

one foot in the grave wrote: »

...You know, I know a lady who brings her son up to Dublin from Donegal every two months for a check up. She does not have access to private transport. She lands at Busaras then gets walks up to Temple St. She's one of many parents who use public transport to get to Dublin. A city centre location would suit these parents.

Thats because the train isn't handy for the Mater.

Interestingly that bus goes through Navan, Dunshaughlin, Airport then into town, then she has to walk out. Basically its within a stones throw of Blanch (or indeed anything on the M50, but passes it to get into Dublin. Of course because all Dublin Public Transport is radial, you have to get into the center to get out again.

one foot in the grave

norrie rugger wrote: »

Explain please?

Speciality care is primarily the people involved, in giving that care. how would it be harder to move them to a new site?

Medical politics and money come to mind.

When you provide a national specialty it's not just medical staff that are important, there are a number of professionals who have training in the specialty (like many nurses, physios, social workers), support services will have grown around the specialties like the Radiology dept (with suitably trained medical experts and support staff and the equipment). Facilities will have grown around the specialty like research facilities and extensive range of laboratory services etc. I don't see that we have the money to move specialties like this out to Blanch.

We have dished out specialties across the city for decades without forward thinking. It's a great pity. There is not one ideal hospital to co locate a NCH with. We have three that meet most of the criteria. Mater, James's and Beaumont.

BostonB

I'd love to see some stats on much used other hospitals service, (co-location services) are actually used. How urgent etc. If its that important to ignore everything else I assume they've some metrics on it.

Turbulent Bill

BostonB wrote: »

But the process thus far, I've never seen something so bias.

That's my biggest disappointment about the whole NCH debacle - the bias and lack of transparency about the process. Really poor terms of reference for experts' reports, vested interests, pure spin and a lack of objective analysis on the selection criteria. It's such a waste...

Personally, I'd be happy with Connolly as potentially best of a bad lot. Co-location seems to be a no-brainer all things being equal, but clearly the access issues are important here.

BostonB

one foot in the grave wrote: »

...We have dished out specialties across the city for decades without forward thinking. It's a great pity. There is not one ideal hospital to co locate a NCH with. We have three that meet most of the criteria. Mater, James's and Beaumont.

Most of the research on co-location being best practice are from locations where there's one major hospital in a location, not scattered all over like Dublin has. I'm not against a City location. But the Mater site is extremely constricted.

chucknorris

one foot in the grave wrote: »

The Royal College of Surgeons, the college that is affiliated with Beaumont hospital? Well I never ....

You are as entrenched in your own view as the next person and just as dismissive.

one foot in the grave

Turbulent Bill wrote: »

That's my biggest disappointment about the whole NCH debacle - the bias and lack of transparency about the process. Really poor terms of reference for experts' reports, vested interests, pure spin and a lack of objective analysis on the selection criteria. It's such a waste...

Personally, I'd be happy with Connolly as potentially best of a bad lot. Co-location seems to be a no-brainer all things being equal, but clearly the access issues are important here.

What lack of transparency? I have found all the reports online over the years. In the public domain.

There is a lot of spin alright. From vested interests. Two independent international reports were commissioned. Not inside jobs.

Co-location is best practice and has shown to deliver the best outcomes for sick children. But it doesn't mean co-locating with any hospital. This is really going to be a stand alone facility as Blanch does not provide any of the services that make co-location worthwhile.

However, at this stage, the hospital needs to be built.

http://www.lenus.ie/hse/bitstream/10147/136831/2/NPHNACHRICHIEFReviewVol2.pdf
National Paediatric Hospital Independent Review Commissioned by Dr James Reilly TD Minister for Health.

http://www.hse.ie/eng/about/21c/National_Paediatric_Hospital/Childrens_Health_First_McKinsey_Report_2006.pdf
McKinsey Report 2006


http://www.google.ie/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCAQFjAA&url=http%3A%2F%2Fwww.newchildrenshospital.ie%2Findex.cfm%2Fpage%2Fassociateddocuments%3FtwfId%3D142%26download%3Dtrue&ei=KvBWUNuwH4yEhQej3IGQBw&usg=AFQjCNEFFXB9PiBni7mAdGU4zN2kUGf7tQ&sig2=eW4Xk39eVJBGS3oYSChF4A
Report of the Joint Health Service Executive / Department of Health and Children Task Group to advise on the optimum location of the new national paediatric hospital

one foot in the grave

chucknorris wrote: »

You are as entrenched in your own view as the next person and just as dismissive.

Well, my three vested interests (15 years, 13 years and 11 years) motivate me. As does my frustration over the years at aspects of our healthcare system (having spent 20 years nursing here).

I've been watching this unfold over many years. Makes me mad. Apologies if I come across as dismissive.

one foot in the grave

BostonB wrote: »

Most of the research on co-location being best practice are from locations where there's one major hospital in a location, not scattered all over like Dublin has. I'm not against a City location. But the Mater site is extremely constricted.

Yes it is. Surely the site of Temple St could be developed also? I would not object to St James's as the hospital to co-locate (but I see the Mater as having the edge).

BostonB

one foot in the grave wrote: »

Yes it is. Surely the site of Temple St could be developed also? I would not object to St James's as the hospital to co-locate (but I see the Mater as having the edge).

Temple street is like the old lady living a shoe.

Its like putting on jeans 5 sizes to small and hoping you'll grow into them.

BostonB

one foot in the grave wrote: »

What lack of transparency? I have found all the reports online over the years. In the public domain.

There is a lot of spin alright. From vested interests. Two independent international reports were commissioned. Not inside jobs....

I don't see how you can ignore how flawed those reports are.

Basing traffic stats on off peak free flow conditions. I dunno how you could look someone in the face and hand them that report.

one foot in the grave

BostonB wrote: »

I don't see how you can ignore how flawed those reports are.

Basing traffic stats on off peak free flow conditions. I dunno how you could look someone in the face and hand them that report.

I didn't find them flawed. There are challenges highlighted in them alright. I have no problem looking anyone in the face if I believe that the location of this hospital should be based on best practice.