A New Hospital for the Children of Ireland

The new children’s hospital (NCH) received planning permission on 28th April 2016.  It was a landmark day in the medical care of children in Ireland.  The NCH is the single biggest investment by the State in the health of Irish children. Getting to this point is the culmination of the great efforts of many dedicated, idealistic individuals in many agencies including the Department of Health, HSE, the three Dublin children’s hospitals, the Children’s Hospital Group, children in hospital Ireland, and the new children’s hospital Development Board.  Minister Leo Varadkar summed up the mood of the moment when he said ‘getting the news that the NCH had been granted planning permission was the best phone call that I have received in my career as a politician’.  Eilísh Hardiman, CEO of the Children’s Hospital Group, said ‘today’s decision will positively transform how paediatric services are delivered for children and young people here in Ireland.  These buildings are a significant catalyst for how the new national model of care will be delivered’.

The NCH will provide better care and more coordinated care for the country’s sickest children.  Currently tertiary paediatric care is spread across the 3 Dublin children’s hospitals.  It has been long recognized and accepted that this arrangement causes both fragmentation and duplication of services.  Children with complex medical or surgical disorders frequently need to be treated by experts in more than one of the hospitals.  With the advent of the NCH, all the expertise required by any seriously ill child will be ‘under one roof’.  Thirty nine specialties related to paediatric care will be available within the facility.  This all makes absolute sense.  Paediatric expertise is a scare resource and it is imperative that it is concentrated where it can be most beneficial and effectively delivered.  The mantra ‘right child, right place, right treatment’ cannot be said too often.

The need for an NCH reflects the major changes in paediatric care over the last 30 years.  The triad of a comprehensive immunisation programme, effective screening, and good nutrition has virtually eradicated many common childhood diseases.

The next ‘layer of disorders’ that children may suffer from are mostly more complex and require a higher level of subspecialist expertise.  This description includes children with cancer, congenital heart disease, chronic renal failure, brain tumours, inflammatory bowel disease, neurological conditions, metabolic disorders, respiratory problems, and newborn congenital malformations.  The NCH has been conceived and designed to address the challenging needs of this group of children.  The key drivers in the achievement of best results in complicated paediatric cases are sophisticated investigation tools, specialist surgery, paediatric anaesthesia, intensive care, medical subspecialists, and nursing expertise.  In addition the growth in health and social care professionals including clinical nutritionists, physiotherapists, occupational therapists, pharmacists and social workers is a key factor in the delivery of best care for children.  When all this expertise is brought together in the NCH, a new era will unfold for Irish paediatrics.  The specialty of paediatrics will ascend to a new level in Ireland.  The benefits will both immediate, and palpably obvious to all users of the NCH service.

The NCH consists of two components, the hospital infrastructure and the ‘software’ to make it function optimally.  The infrastructure consists of the building and its facilities.  There are 380 inpatient single rooms, 42 critical care beds, and 18 neonatal intensive care cots. There are 93 day care beds.  There are 18 operating theatres including specialized theatres for cardiac surgery, neurosurgery, and orthopaedic surgery.  A 52 bed accommodation facility for families of children with long hospital stays is being built on the campus, directly adjacent to the hospital.

Commentary picThe architects are the international design team BPD with their Irish partners OCMA.  The chief architect is Benedict Zucchi from BPD.  He has previously designed the Royal Alexandria Hospital Brighton, and the Alder hey Children’s Hospital Liverpool.  Zucchi points out that between the 1970s and 1990s not much thought was put into the design of hospitals.  They became rather forbidding places.  The new enlightenment is driven by consumer needs and opinions rather than the previous paternalistic view.  There is an emphasis on light and space.  The atrium is important as a social focus point at the centre of the hospital.  A children’s hospital has to be child-friendly, welcoming, and appealing to a wide age range from young children to teenagers.  It has been pointed out by the designers of the Evelina hospital, London that a children’s hospital is not just an adult hospital with murals. There is a movement away from low-lying land-scrapers to a more stacked up structure.  This gets away from long corridors and shortens walk distances.  Corridors are forbidding and equal ‘an institution’.  They are disorientating and cause unnecessary anxiety for children and their parents.  Zucchi points out those new technologies perform better in new buildings.  Modern hospital design leads to better patient safety.

The model of care for paediatrics and neonatology is the ‘software’ that will enable the NCH to function effectively.  It will enable it to integrate seamlessly with the other hospitals in the regions with paediatric units and children’s services throughout the country.  The model is a ground-up consensus blueprint on how best to deliver medical care to children.  It represents the agreed vision of the doctors, nurses, health and social care professionals who care for children.  The model is built on inclusiveness, with all professionals across the country being part of the network.  There is an agreed national approach to the management of a sick child irrespective of what part of the country he/she lives.  The plan is to eradicate postcode disadvantage. The established National Neonatal Transport Programme and the developing Paediatric Transport Service will key roles in the transfer of critically ill children for acute tertiary care.  There is a clear understanding that when the child’s acute management has been and/or the diagnosis has been established he will be referred back locally for his ongoing care.  The vision is clear.  The NCH will not be an isolated institution.  It will be an integral part of the national delivery network of paediatric care.

The siting of the NCH at the campus at St James’s Hospital has a number of advantages.  It simplifies the transfer of complex cases to the corresponding specialist adult services when the child reaches age 16 years.  The close proximity of the adult hospital enables the services to accurately calculate the numbers that will need to be transitioned each year.  The move can happen gradually giving the child and parent’s sufficient time to achieve the necessary adaptations.

The arrival of the NCH will promote the benefits of the large medical campus effect.  New synergies will emerge.  St James’s has 4,400 staff, and the NCH will have 3,700 staff.  The interaction and cross-fertilisation of ideas will benefit areas of common interest including basic science, research, and teaching.  The large campus will attract individuals of high quality leading to higher skill levels, better training, and higher profile research.  The brand name will grow and will be more attractive to research funding bodies both nationally and internationally.  The NCH will without doubt achieve a new reputation for Irish paediatrics.

It is important that traditions of the 3 children’s hospitals are preserved.  They have a long history of serving children and their families very well.  Tradition is based on the previous outstanding individuals that have worked in these hospitals.  There have been many.  These individuals are the inspiration to those who follow on after them.  They set down how dedication, professionalism, and attention to detail can achieve such great results.  The organizational memory that they have generated must be preserved and passed on to the NCH.

The NCH is great news for the country’s 1.1 million children.  Ireland has become a much better place to be born and grow up as a child.

JFA Murphy

Editor

P402