Oct 182010
 

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 :

Co-location benefits.

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.

Governance.

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.

Access

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)

YES

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:

AMNCH, Tallaght
Beaumont Hospital
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,
Glasgow

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.

John O’Brien
Tomie Martin
Fenton Howell
Paul deFreine
Fionnuala Duffy
Ruth Langan
Denis O’Sullivan
Philip Crowley
Paul Barron

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?

_________________________

All Bock posts on the National Children’s Hospital

http://www.hse.ie/eng/services/Publications/services/Hospitals/High_Level_Framework_Brief,_National_Paediatric_Hospital,_Part_1.pdf

http://www.hse.ie/eng/services/Publications/services/Hospitals/Report_of_the_joint_HSE_Dept_of_Health_task_group_to_advise_on_the_location_of_the_new_paediatric_hospitals.pdf

http://www.thenewchildrenshospital.ie/reports/Childrens_Health_First_McKinsey_Report_2006.pdf

  16 Responses to “National Children’s Hospital — Site Selection”

Comments (15) Pingbacks (1)
  1.  

    and all nine were paid, wined and dined for each iteration.

  2.  

    Very informative post Bock.
    I wonder how much each of these reports cost? I wonder how many trips abroad Harney had to take, along with her entourage and her hubby to meet some of these experts in the US and Australia?
    The potentially only unbiased report – McKinsey’s, seemed to have been clearly stifled with not being instructed 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.”
    All though in reading the nine criteria set out in his report, they seem like common sense to me. I don’t know how seven are contentious. I suppose common sense is contentious for our pack of dopes in government.
    “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.” What’s the point in paying for these fucking reports when the people involved are on the HSE “task force”. Illusions of democracy is all we have in this country. Vested interests and fat cat politicians milking the sytem and taking care of their buddies. i.e Bertie and his nuns.

  3.  

    the only problem is if this goes “back to the drawing board” it’s going nowhere . The existing children’s hospitals will be left to muddle along as best they can while we spend the next hundred years or so about location.

  4.  

    So should we just turn the bind eye Gary?.
    Everything should be put on hold until Harney, Drumm and the rest of the HSE managemant kebal are removed. Its fairly obvious that any decision taken by them will be percieved as tainted.

  5.  

    Darby agreed the current Cabal should go and the sooner the better, but the longer we spend faffing about “my site is better than your site” we may loose children’s lives .

  6.  

    Good post. Nothing unexpected about this process.

    I suspect this project will be scrapped. Irish children are, after all, for export only.

    Traitorous bastards.

  7.  

    Great post, nice to see you getting into ‘The Story’ and ‘Turbulence Ahead’ territory, and all the better for it.
    I remember all this going on at the time and being absolutely staggered by the audacity of our then Taoiseach – never did the phrase ‘neck like a jockey’s bollix’ seem more apt. Of course this was around the same time when he was telling anyone who dared to inject a dose of economic realism into the debate to go and commit suicide.

    Seriously, the fact that this plan has been allowed to go forward basically unchallenged (even now) exposes the depths of cynicism that prevails within our ‘elite’ and the feeling of powerlessness on the part of the people. I’m writing this from a country (France) which is basically being brought to a standstill because the government is (only) trying to raise the age of retirement from 60 to 62. Whatever you say about the French, at least they don’t give up something without a fight …..

  8.  

    “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.”

    Nothing surprising there to any of us who work in the Catholic Education System paid for in its entirety by the taxpayer.

  9.  

    I’m sick of all this bullcrap debating about it. FME, you make a good point about money being wasted but if everyone keeps debating this then more money will be spent on rubbish and no hospital will be built.

    Harney and the govt have made up their minds and that’s it. So just build the damn thing.

    No one from Kerry or some other backwater is going to give a shit if they have to drive a bit further into Dublin. They have to drive for hours as it is.

  10.  

    “No one from Kerry or some other backwater is going to give a shit if they have to drive a bit further into Dublin. They have to drive for hours as it is.”

    jaysus, I don’t know about that. Have you ever timed how long it takes after you get off the M7to get to the Mater?
    Personally I haven’t but given that you have to drive through several built up and busy townships to get into the City centre, I wouldn’t fancy doing it with a sick child in the car.
    Even if you take the M50 north in the end you still have to drive through some potentially gridlocked areas…and, is the [almost] dead centre of a smoky, noisy city really somewhere you want sick children to recuperate?

    Plus, the money being wasted on the reports, wining, dining, whoring, junkets, etc, is probably pretty small change compared to what the final cost of actually building the thing will be, so I don’t think it would be too much to continue to ask questions about this, from Bock’s article, the last part stinks to high heaven of fish.

  11.  

    If the journey time was the only issue, Caligula’s point might have some validity, although not much. The hospital is for the entire country including the backwater I live in, and the backwaters two-thirds of the population inhabit, and not just for the citizens of Dublin, but there’s far more to it than that. There’s also the question of room for expansion, cross-infection, recuperation, educational facilities, parking and accommodation for families.

    I’d also be interested to hear more about these so-called soft areas within the building, which are spaces that will be sacrificed when demand for more accommodation exerts pressure. Would they be play areas and family space?

  12.  

    An interesting exercise would to figure out how many of the two panels above own or by association with spouse or relative have any involvement with any commercial property or rental units up around there?
    A lot of developments up there in the last 15 years.

  13.  

    There’s no suggestion of that, but others seem to have been investing in property in anticipation of a political promise being delivered.

  14.  

    I’ve had experience of the Mater and parking is a massive issue. I don’t mind the part about traveling to the inner city of Dublin. If I had a sick kid my biggest concern would be the quality of the hospital itself.

    Steve, your point about the inner city environment not being the best for a sick child to recuperate is a fair one but it’s a fair bit down the list of priorities. Surely the kids spend the vast majority of time in the hospital itself so the surroundings doesn’t matter that much.

    Both sides make good arguments and counter arguments. Personally I’d prefer the location not to be in the inner city but a new kids hospital built anywhere is better than everyone arguing about it and nothing being done.

  15.  

    “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. ”

    Just had a relative in hospital for 6 weeks. She went in once, and came out once. It was the rest of us who had to consider public transport. I must have spent 200 euro on taxis visiting – and I mostly went by bus.

    Good public transport to a hospital means the kids get more visitors and stay happy.

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