Why do we get major health infrastructure projects so wrong?

Posted in Uncategorized by saraburke on April 29, 2016

Irish Independent column from 29 April 2016

It is good news that the National Children’s Hospital has got the go-ahead to be built. Construction is due to start this summer, and they say it will be open by 2020. At long last.

This hospital was first proposed more than 20 years ago. After much politics and power playing between the three existing children’s hospitals, and wrangling over the best place to locate the hospital, the Government endorsed the Mater hospital as the site in 2006. The hospital was meant to be open by 2014.

But in 2012, planning permission on the Mater site was refused by An Bord Pleanála on the basis that it would constitute “overdevelopment”. It was back to the drawing board, and in 2014, the St James’s Hospital site was chosen. Yesterday, planning permission was granted at this location.

The outgoing Government’s Capital Investment Plan 2016-2021 states that the new children’s hospital represents the “largest health infrastructure project ever undertaken in Ireland”.

But hospitals are not just about buildings. They are about providing high-quality services to children through the right care pathways and integrating the staff, expertise and care of the three existing hospitals.

This, as well as the bricks and mortar, needs to be adequately resourced. Only then will Irish children get the standard of care they deserve.

In the interim, and for the next four years, children will continue to be treated in hospitals that are unfit for purpose.

But the Capital Plan also specifies that it will support the “reorganisation of national maternity services”, which includes the relocation of the National Maternity Hospital to the St Vincent’s campus in south Dublin. Towards the later years of the plan, the Rotunda, the Coombe and Limerick maternity hospitals will move to Connolly Hospital, St James’s Hospital and University Hospital Limerick, respectively. But no specific timelines are given.

It has also emerged that there is a stand-off between Holles Street and St Vincent’s hospitals, delaying progress on the new, much-needed, national maternity hospital. First proposed in the late 1990s, it is currently housed in buildings on Holles Street first erected in the 1700s. When Holles Street was criticised for not meeting hygiene standards by HIQA in February of this year, Holles Street’s Master Dr Rhona Mahony responded by admitting the hospital was “unfit for purpose” for delivering over 9,500 babies annually. The activity level also “far exceeds the capacity of the building”.

“It is for this reason that for the past 20 years the hospital has sought relocation to a modern facility that is fit for purpose,” she added.

In May 2013, then Health Minister James Reilly announced the relocation of Holles Street to St Vincent’s, where it would be co-located alongside the adult hospital. Planning progressed between Holles Street and St Vincent’s, the site was identified, the new hospital is fully designed and the planning proposal is ready to go.

But St Vincent’s won’t submit the planning application until Holles Street agrees to certain requirements which Holles Street finds unacceptable.

In effect, St Vincent’s is looking for overall control of the clinical and financial management of the new National Maternity Hospital.

Currently, all three Dublin maternity hospitals operate under a ‘mastership’ system, whereby the Master is both CEO and the lead consultant obstetrician and gynaecologist, with overall corporate and clinical responsibility. The Master reports directly to the board of each of the three Dublin maternity hospitals.

According to the new national maternity strategy published in February 2016, the mastership is “unique to the three Dublin maternity hospitals” and has “served the country well”. It added: “There are no plans to change the mastership system at present. The mastership system demonstrates a sound governance model, operating with clear lines of accountability and responsibility.”

So government policy is that the mastership system continues and that the national maternity hospital is located on the grounds of St Vincent’s hospital. But due to the stand-off on governance and control, the future of the new national maternity hospital on the site of St Vincent’s is in jeopardy.

What is it with major health infrastructure projects in Ireland? Why do we get it so wrong?

The demographics are clear, we have the second-highest fertility rate in Europe and an ageing population. We also have a health infrastructure that is largely unfit for purpose and needs sustained investment to bring about 21st-century facilities.

It is perfectly possible to do this. But in order to do so in a timely and efficient way, government needs to plan for this and then allocate money and supports to make it happen.

Other health capital commitments in the government plan include the National Forensic Mental Health Services facility in Portrane, which will replace the Central Mental Hospital; new intensive rehabilitation mental health units, cancer facilities, primary care centres and nursing homes, none of which have specific timeframes or earmarked budgets. No further detail is available, as the HSE has not published a capital plan since 2014.

The man currently responsible for these health projects, acting Health Minister Leo Varadkar, is busy negotiating a new minority government. These discussions have been dominated by the issue of charging for water. Varadkar said yesterday that the “suspension of water charges was the wrong thing to do and was not in the public interest”.

Delaying critical, major health infrastructure is also the wrong thing to do, and not in the public interest.

It’s a pity the political squabbling between the two largest political parties could not focus on right things that are really in the public interest. Why not start with getting the site of the new national maternity hospital sorted and delivering the other vital health capital projects? Projects that a make a difference between life and death.


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