TO: Taoiseach Enda Kenny, Government Buildings, Merrion Street, Dublin 2.
30 October 2013
Re: New National Children’s Hospital
C.c. the Tanáiste, Minister for Health & Children, Cabinet colleagues of the aforementioned, Chair of the National Paediatric Hospital Development Board, Chair of the Children’s Hospital Group Board, Secretary General of the Department of Health, Director General of the Health Services Executive, Chair of St. James’s Hospital, Chief Medical Officer Department of Health, Chief Executive of the Health Information & Quality Authority, and the Director of Regulation & Chief Inspector at the Health Information & Quality Authority
Dear Taoiseach,
The construction of a new National Children’s Hospital is the flagship project of the 100 year commemoration of the 1916 proclamation. Signed by the principals behind the Rising, the proclamation resolves “to pursue the happiness and prosperity of the whole nation … cherishing all the children of the nation equally”.
While it will not be possible for the project to be complete by 2016, it is feasible for it to be in construction in 2016 – if the right steps are taken now. What are these vital steps – and are any being missed?
According to express recommendations already issued by the Department of Health, the Health Services Executive, as well as consultants KPMG, and in line with best international practice, the National Children’s Hospital should be co-located with a full maternity hospital.
However, with the tendering process to be re-commenced soon, the apparent failure to co-locate the
new National Children’s Hospital with a Maternity Hospital, or to coherently plan for it, sends alarm bells ringing.
To fail to provide for Maternity co-location would be to engage in project splitting. Project splitting would, in turn, fall foul of basic requirements set out in Irish and European planning law, bringing about a repeat of the previous delay all over again.
It is fortunately still possible for an application to successfully meet the requirements of planning law – but action must be taken quickly.
As Ireland’s leader, supported by your Tánaiste and Ministers, and principals in the medical field, you have the opportunity to steer this project on to the right course.
In November 2012 the Cabinet selected St James’s Hospital. Outlined in mid-May 2013, the new hospital trust structure sees St James’s Hospital and the Coombe Women and Infants University Hospital become part of the St James’s Hospital Group.
Just east of the Coombe lies some 15.3 acres (6.2 ha) of largely-vacant land controlled by NAMA and Dublin City Council (principally the former Player Wills / Bailey Gibson sites).
By extending the November 2012 decision to the entire campus of St James’s Hospital Group, this 15.3 acres can be bought for hospital development from NAMA and Dublin City Council.
The benefits of using these 15.3 acres are outstanding – immediate co-location with a fully operational tertiary referral Maternity Hospital, namely the Coombe Women and Infants University Hospital (which has benefitted from extensive investment over the past 4 years) – and which (a) can be further developed or (b) superseded by a new Maternity Hospital in the future without site constraints.
Not alone that, but the new National Children’s Hospital could be constructed without disruption to ongoing services and without site-constraint issues, as could a new co-located Maternity Hospital – in time.
The details here are set out below (please see “Detailed Considerations”), along with the many co- benefits that extending the November 2012 decision would bring.
To summarise, we are currently sleepwalking into a situation where we won’t have a new Children’s Hospital co-located with a Maternity Hospital.
Unless action is taken now, this reality will only be brought home to the wider public as the planning process unfolds – a time when it is too late to remedy the problem.
Yet time remains to avoid a repeat of the mistakes of the past. An Taisce’s role, as it has been since its foundation in 1948, is to signal to Government when warning signs are flashing, particularly in the areas of land use, planning and our environment.
Thankfully, a solution is in sight. To ensure happiness and prosperity, and to cherish all of the children of the nation equally, we ask you to act now.
Yours sincerely, James Nix
Director of Policy & Operations
An Taisce – the National Trust for Ireland
An Taisce would be most grateful to the Chair of the National Paediatric Hospital Development Board, and the Chair of the Children’s Hospital Group Board, for the circulation of this letter to their constituent board members – many thanks.
Detailed considerations
The 15.3 acres described above, taken together with the existing Coombe Hospital, is referred to here as St James’s South while today’s St James’s Hospital is referred to as St James’s West.
Extending the November 2012 decision to St James’s Hospital Group, and building at St James’s
South on land currently under NAMA / DCC, brings a considerable number of benefits:
• First, the use of the southern site at the campus of the St James’s Hospital Group provides immediate co-location with a Maternity Hospital – the Coombe Women and Infants University Hospital.
• Second, the area of the southern site is 70% larger. There are 15.3 acres (6.2 ha) at St James’s South versus 9 acres (3.7 hectares) at St James’s West, the southern site giving room for all-important expansion, including a new Maternity to supersede / replace the Coombe building and other maternity facilities over time, without disruption to on-going services.
• Third, vital space is preserved at St James’s West for its expansion as Ireland’s flagship cancer hospital, and where the development of further clinical and cancer research facilities will be timely and consistent with good planning.
• New-born infants requiring immediate access to the highly advanced care provided in the new National Children’s Hospital need to be delivered in a fully-resourced on-site Maternity Hospital. Subsequent transfer from the Maternity Hospital to the Children’s Hospital should be as low-risk as possible, and preferably by an internal link corridor to the new building; transfer by such an internal corridor is possible in both the short and longer term using St James’s South.
• Even if a Maternity Hospital could be afforded and developed at St. James’s West (€150m), it could not be provided for a significant period of time, during which critically ill new-born infants (who have the highest death rates of all children) would continue to face more hazardous ambulance transfers from off-site maternity hospitals. By building the new National Children’s Hospital at St James’s South, the risks associated with these dangerous transfers are resolved.
• There is a direct €130m saving on build costs for the Children’s Hospital itself. The St James’s South site entails a cost of €380m, including €20m for land purchase, versus €510m at the more land-constrained St James’s West campus site.
• As well as lower cost, there is a faster build time at St James’s South because the site is less constrained. There is less demolition, no relocation of medical facilities and more straightforward construction. The larger, southern, site is largely vacant, avoiding the complications and costs of working on a constricted ‘live’ hospital site. Compare, for example, constructing a very significant structure (more than 100,000sqm) using just one proximate access point from the public road network, namely, the Rialto gate (already very congested with hospital traffic), as compared to having seven access points at St James’s South.
• Because there is more room at St James’s South, the buildings need not be as high, thereby reducing planning risk.
• By saving money on build costs, and using a portion of it to buy extra land (15.3 acres), sufficient capacity remains at St James’s West to accommodate further clinical and research facilities devoted to cancer, already the leading national tertiary centre in this field. Indeed, the essence of good campus planning is that those elements which benefit most from direct proximity are located closest to each other. There is a deeper point here. It may be theoretically possible to earmark a portion of land at St James’s West (which is currently in use for other important services) and label it for the construction of a Maternity Hospital in future. However, in practice, St James’s West, as Ireland’s flagship cancer hospital, is under huge pressure. It would be unpardonable to find out in 5 or 10 years time that there remained insufficient space left for a maternity hospital; hence the need to right the course now, rather than run a clear risk.
• Securing 15.3 acres of additional land increases the aggregate amount of space for hospital development and future-proofing. To summarise the benefits, it gives: (1) existing Maternity co-location, (2) a Children’s Hospital built sooner, cheaper and at considerably lower planning and political risk, (3) no decanting / re-location of services, (4) no interference with the running of any clinical operations, (5) future-proofing for St James’s West for expansion, critical given its relevance as Ireland’s flagship cancer hospital, (6) allows the Children’s Hospital to be built to the right size without reliance on so-called satellite centres because of capacity issues in the main hospital, and (7) future-proofs the Children’s Hospital itself with expansion space.
The Views of this Your Say! article do not necessarily represent the views of the Fountain Resource Group. If you agree with this contributor, or perhaps you disagree and would like to write a response, feel free to email us at info@frg.ie to have your say!
PLEASE NOTE:This article was originally published on AnTaisce.ie, the website belonging to An Taisce, ‘The National Trust for Ireland’, a non-Governmental organisation. We are republishing this letter, as its content relates to the proposed major redevelopment of St. James’s Hospital into a National Children’s Hospital, right here in our local area. Work has begun on clearing the site to get it ready for the new hospital.
