I’d like to clarify some of the confusion surrounding the various reports that led to the Mater site being selected for the national paediatric hospital.
There were four significant ones, three of which the government relied on to ensure that the Mater was chosen, and one which they ignored because it pointed out some uncomfortable facts.
The original report in February 2006 was from McKinsey and Company, a global management consultancy. It was followed in May 2006 by the Report of the Joint HSE / Department of Health and Children Task Group, and then, in October 2007 by the High Level Framework Brief for the National Paediatric Hospital.
McKinsey was briefed, according to its own preamble, to draw up a report advising on the ‘strategic organisation of tertiary paediatric services for Ireland’ that would be ‘in the best interests of children’.
According to McKinsey: we were not briefed to consult with experts and practitioners in Ireland and did not have access to detailed hospital specific data on the nature and quality of care.
McKinsey was not asked to advise on details such as how the facility should be set up or where it should be located. Its only role was to provide the criteria that would enable the HSE to decide on a design and a location for the hospital.
The McKinsey report examined major paediatric hospitals all over the world, interviewed many foreign specialists, and identified several criteria for the ideal facility. Unfortunately, it was prevented from interviewing any Irish experts due to the terms of its brief.
It came up with nine criteria, several of which are contentious. Feel free to skip over the next part if you like.
1. Space. The new hospital should be able to accommodate all projected needs, including research and education facilities.
2. Breadth and depth of services. The hospital should be able to provide at least 25 sub-specialities
Medical – Anaesthetics, Cardiology, Endocrinology, General Medicine, Genetics, Haematology, Immunology, Infectious Diseases, Intensive care, Neonatology, Nephrology, Neurology, Oncology, Opthamology, Pathology,
Radiology, Respiratory +/- allergology, Rheumatology, Microbiology and clinical chemistry;
Surgical – Cardiothoracic , ENT , Gastroenterology/GI/ hepatobiliary surgery, General surgery, Neurosurgery,
Orthopaedic surgery, Transplant surgery, Urology
In addition, it should be able to provide family space including schools not only for the patients, but also their broithers and sisters. there should be separate single rooms for siblings and for parents.
3. Co-location. The new hospital would ideally share a site with a teaching hospital capable of providing the sub-specialities listed in paragraph 2. If the hospital is not co-located, there would need to be specific measures to address the separation from adult services.
4. Access. Good public transport and road links required. Parking for families and staff. Good family accommodation. Outreach programme to other hospitals.
5. Efficient use of resources
6. Attracting and retaining staff of high calibre.
7. Teaching and research
8. Financial stability
9. Full project plan and role assessments.
Points 1 to 4 have proven to be the most contentious, but we’ll come back to that in a minute.
Following publication of the McKinsey report, the Joint HSE / Department of Health and Children Task Group produced its own report. This group was instructed to advise on the optimum location of the proposed new hospital within two months.
This task group consisted of seven civil servants from the HSE, four civil servants from the Department of Health and one civil servant from the Office of Public Works. There were no paediatricians, nurses, representatives of parents, spatial planners or other professionals although the group included two doctors: one employed by the HSE and one employed by the department of health.
The group wrote to six academic adult teaching hospitals, asking them if they would wish to be involved with the new hospital. Unfortunately, none of these institutions met the standards laid down by McKinsey, point 2, of being able to provide at least 25 sub-specialities.
They also wrote to three maternity hospitals and received submissions from five independent groups offering various solutions.
All three maternity hospitals — the Rotunda, the Coombe and Holles Street — supported the idea of locating a maternity hospital including a neonatal unit on the same site as the new paediatric hospital and the general teaching hospital.
The group received proposals from five private organisations, all of which, according to the report, offered greenfield sites, proximity to transport links and motorways, and a willingness to be flexible about governance.
Governance has now become a big issue, as it appears that the new hospital, despite the constitutional ban on endowing religion, may well end up being a Catholic hospital, paid for with public funds. The consequences of this are significant. Certain research, despite being legal, may well be prohibited under Catholic laws, even though the taxpayer funds the new facility.
According to the report:
In relation to the clinical aspects of the assessment, information was sought by the Joint Task Group from a number of the leading international hospitals identified in “Children Health First”. Advice was also sought from clinicians in other countries on specific issues.
The reality is that the clinicians in other countries were not asked advice, but were phoned by civil servants and asked for opinions. Some of them have since protested at being quoted in this way.
The group defined four criteria :
The language is pompous and the report is poorly written in this section, but it seems to be saying that the site should be near a teaching hospital and already have some consultants available, ideally with a maternity hospital nearby. It would also be a good idea to have some research going on.
Planning and development considerations
Space – Ability to meet projected tertiary and secondary needs (with capacity to expand including potential to accommodate research and education facilities)
I think this waffle means “enough room for the future”.
The rest is more telling, and so I leave it in its waffle form.
• Scope of site to deliver suitable quality of environment
• Likely height and density of development
• Car parking capacity
• Car parking location
• Attractive work environment
This means, in my opinion, that the hospital must be a nice place for sick kids, a nice place to work, not too crowded, not too high, and with more than enough places to park safely without getting mugged on your way to the hospital or without having to walk for half an hour.
There’s a tricky one.
The report puts forward three options:
The new hospital to be fully independent of the host hospital
“Joint entity” to operate both hospitals
Host hospital to operate the new paediatric hospital
Now, since this hospital is coming out of public funds, and since there’s a constitutional prohibition on endowing any particular religion, one would imagine that the Mercy nuns, who own the Mater, would have no say in the running of the new hospital, but apparently this is not so.
It seems that the Mercy nuns may well end up owning the new hospital paid for by the contributions of all Irish citizens.
Distance and time for travel of patients requiring tertiary care by both public and private transport means.
• Distance and time for travel of patients requiring secondary care in the catchment area by both public and private transport means
• Potential / likely impact of planned transport infrastructural developments
• Accessibility for air and land-based emergency services
When calculating travel times to the hospital, the group relied on information from Dublin Bus, Irish Rail, Luas and Bus Éireann websites. The group appeared to assume that some sick children would be transported to the hospital on a bus or even on foot. The report also assumes that the Luas lines would be extended and that the northern metro will be built, although this, to some extent, misses the point, since sick children will not be travelling on trams or buses anyway. The report also seems to assume that adequate car parking will be available, which is by no means certain.
The report assumes the best possible conditions for transporting sick children to the hospital, taking no account of the normal breakdowns in public transport, road closures due to matches in Croke Park or the usual inner-city gridlock in Dublin, made more likely by the fact that there’s no money to alleviate traffic by building trams and metros.
In the end, a flowchart is presented, but it only has yes answers.
Is site co-located with adult academic teaching hospital?
(Ignoring the absence of the 25 sub-specialities required by McKinsey)
Preliminary Planning and Development Considerations:
Capacity to accommodate
• Children’s hospital
• Maternity Hospital
• Further expansion capacity
(Ignoring the congested location of the site on Eccles Street with no room for expansion)
No. No. No.
This is nonsense.
The report shortlists these:
Connolly Hospital, Blanchardstown
Mater Misericordiae Hospital
St James’s Hospital
St Vincent’s University Hospital
According to the report, in order to inform the Joint Task Group’s thinking and to act as a sounding board for these clinical assessments, interviews were carried out with the following international experts in the United States, Canada, Australia and the United Kingdom:
1. Professor Sir Alan Craft, Professor of Paediatrics University of Newcastle and President of the Royal College of Paediatrics.
2. Dr Mike Berman, Paediatric Cardiologist and former COO of New York Presbyterian Hospital (NYP). He is the former Professor and Chairman of Paediatrics at the University of Maryland (UM).
3. Dr Tony Cull, CEO The Royal Children’s Hospital, Melbourne, Australia
4. Professor Les White, CEO Sydney Children’s Hospital, Sydney Australia
5. Dr Tony Penna, CEO Westmead Children’s Hospital, Sydney Australia
6. Dr Steven Altschuker CEO Children’s Hospital of Philidelphia
7. Prof Andrew Calder, Chair of Advisory Group, New Children’s Hospital,
In reality, as mentioned earlier, what really happened is that the committee phoned these people and asked them a few questions before finally recommending two alternatives: the Mater and St James’s, and while neither of them fulfils the requirements set out by McKinsey, the Mater is the worst of all. At least St James’s has some room to build more facilities, and someplace for the sick kids to walk around in the fresh air.
This is insane.
And still there’s one more report to plough through. A report of such childish pomposity that the spirit wearies when contemplating reading it.
This final effort, the RKW report, reads like something written by a second-year sociology undergraduate who recently completed a remedial reading course and feels desperately anxious to impress the tutors with business jargon.
It’s appalling. It’s deeply incoherent.
Unless you’re researching bad writing, I don’t advise reading it.
This report is the High Level Framework Brief, but hold on. Let’s have a look at the committee members.
Mr John O’Brien, Director of the National Hospitals Office (Temporary) – Joint Chair
Mr Tommie Martin, National Director, Office of the CEO
Dr Fenton Howell, Population Health Directorate
Mr Brian Gilroy, National Director of Estates
Ms Fionnuala Duffy, Assistant National Director, National Hospitals Office
Ms Ruth Langan, Office of the CEO
Ms. Angela Fitzgerald, Network Manager, Dublin North East Hospitals Group
Mr John Bulfin, Network Manager, Dublin Mid Leinster Hospitals Group
Mr Paul Barron, Assistant Secretary – Joint Chair
Mr Denis O’Sullivan, Principal Officer, Acute Hospitals Division
Dr Philip Crowley, Deputy Chief Medical Officer
Mr Paul deFreine, Deputy Chief Architectural Adviser
Ms Mary Hogan, Assistant Principal Officer, Acute Hospitals Division
And here are the members of the RKW group.
Ms. Laverne McGuiness, National Director of Shared Service, (Chairman from April 2006)
Mr. John O’ Brien, National Director (Temporary), National Hospitals Office (Chairman to April 2006)
Mr. Tommie Martin, National Director, Office of the CEO
Dr. Fenton Howell, Population Health Directorate
Mr. Joe Molloy, Director of Technical Services and Capital Projects, HSE West
Ms. Fionnuala Duffy, National Hospitals Office
Ms. Ruth Langan, Office of the CEO
Mr. Paul Barron, Assistant Secretary
Dr. Philip Crowley, Deputy Chief Medical Officer
Mr. Paul de Freine, Deputy Chief Architectural Advisor
Mr. Denis O’Sullivan Principal Officer
Mr. David Byers, Commissioner, OPW
Let’s compare the members of the RKW group and the task force.
To put it another way, nine of the twelve who made the final selection of the site were the same people who had offered the two final options.
That can’t be right, surely?
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