Sunday 23 October 2016

Thousands of hearts break over location of new children's hospital

Only in Ireland would news of planning approval for a new children's hospital be met with sorrow, writes Rachel Lavin

Rachel Lavin

Published 01/05/2016 | 02:30

Overdue: An artist’s impression of the atrium in the new National Children’s Hospital, to be built beside St James’s
Overdue: An artist’s impression of the atrium in the new National Children’s Hospital, to be built beside St James’s

Of the 112 submissions to An Bord Pleanala last November, 87 were objections, with the oral hearings inundated with parents, past-patients and paediatricians lining up for their chance to plead for a rejection. Following that, tens of thousands signed a petition asking the government to change the hospital site to the 150-acre greenfield M50 site at Connolly as part of the grassroots Connolly for Kids Hospital campaign. Outrage is widespread in the children's hospital communities.

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So as Leo Varadkar and officials posed for photos, celebrating what they called a "great day for children", around the country the grief of families with sick children was palpable. As word spread on social media, comments circulated saying "I'm so angry", "This is so wrong" and "Is there a way to stop this?".

Why has the building of a new children's hospital, one so desperately overdue, become so vociferously opposed?

Opponents claim that vested interests of adult hospitals and education institutions have overtaken the best interests of sick children resulting in the hospital being placed on a congested, inadequate site.

Then there are those who believe that the granting of the planning affirms that the controversial issues raised around the site have been resolved. However close reading of the inspector's report shows anything but. Here are five of the claims surrounding the building at James's and how the planning board dealt with them.

1."Better clinical outcomes with adult co-location"

There is no scientific evidence to back up this oft-repeated claim and no report ever specifically recommended James's. The McKinsey Report recommended a criteria in which adult co-location was preferred but not essential and the Task Group report of 2006 listed specialities that would be beneficial to co-locate. Few of those are in St. James's.

The two most significant priorities, neonatology and neurosurgery, are more likely to develop at the Connolly Hospital site, with the Rotunda Maternity hospital planning to move there and nearby Beaumont's neurosurgery indicating it would also co-locate to Connolly. These are the priorities that directly save the most lives. Following that, the Dolphin Report simply gave a list of pros and cons for each available site. In the conclusions, it clearly narrows the two clearest options to James's and Connolly pointing out that while James's was preferable from a clinical and academic perspective, it is the smallest site for construction. On the other hand, it says Connolly had limitless scope for future expansion and with investment of human and capital resources could become an adult tertiary hospital with critical mass supported by leading edge research facilities. This was before it was announced the Rotunda maternity hospital was being moved to the same site, making the 'tri-location' ideal possible without sacrificing on space and access, as in James's.

Despite this, it was not the function of An Bord Pleanala to assess the medical reasoning backing the James's site. They could only deal with the planning regulations of the brief they were given. However, there was one medical and planning issue that was bypassed.

2. "Maternity co-location will happen at James's"

Paediatricians state that babies die every year because of the ambulance transfer between maternity and children's hospitals. (An inquest last year found that the dislodgement of a tracheostomy tube causing a lack of oxygen during a five-minute ambulance transfer journey contributed to the death of a premature infant.)

That's at least 100 lives over the 100-year lifetime of the hospital directly at stake if there is no maternity co-location. However, no planning application for the proposed maternity hospital at James's was made. "There may be an application for a maternity hospital on the campus, and there may not," says the Bord's report.

"If one is made, that will be subsequently assessed. The NCH can proceed without a maternity hospital, these are not inter-dependent projects."

However, a reading of the Dolphin report on which this decision was based would tell you this should be an inter-dependent project. When the government chose James's it was on the basis that a future Coombe maternity hospital would be moved there, satisfying tri-location needs and directly saving the most lives. How could the most crucial aspect of the whole co-location model be ignored? Without planning assurances now, it is hard to believe there will ever be space provided for a maternity hospital on site.

3. "There is enough space"

Crumlin's clinical space expanded by 75pc in the last 15 years, yet the James's site is smaller than Crumlin.

However, ABP approved the current plans provided for now, regardless of the need for space for future expansion. "It would be unreasonable and possibly ultra vires, of the Board to refuse permission for the current proposal solely on what may be applied for in the future," the report said.

4. "Access is a secondary concern"

ABP appears to state that "If the Mater site did not fail on the grounds of accessibility, it would be most difficult to justify a refusal on the St James's site on the grounds of accessibility." The inspector goes on to add: "There is no guarantee that locating the NCH on a greenfield site adjacent the M50 will avoid the congestion some fear will be encountered accessing the St James's site. The upgraded M50, as referred to by some at the hearing, is experiencing congestion too".

This is contradicted by the Dolphin report, which reported that at the M50 site at Connolly "access by car is excellent" and that public transport could be upgraded to meet demand. Speaking of comparisons to the Mater's refusal, ABP's inspector Una Crosse, in her report on the Mater in 2012, stated proposed parking at the Mater was "inadequate to facilitate the effective operation of the proposed development". Yet, the Mater plan provided for more parking than St James's.

5. "There is no ideal site"

Perhaps more confusing were the contradictions in the ABP report when it came to alternative sites. While the report admits that the 'vast majority' of objectors support the site at Connolly, later it justifies not considering other options because "there is no perfect or ideal site" and no 'common ground' in selecting alternatives. The assumption that "there is no ideal site" recalls an omission from the International Independent Review of June 2011 (commissioned after Fine Gael's election promise to review the decision) and later exposed under FOI.

It read: "the ideal location would be located on green space, provide for unfettered access, accommodate research and educational activity, provide sufficient space to ensure the aggregation of all patient care services meeting current and future care requirements, and be tri-located with an adult tertiary care and a maternity facility. We agree that if there was a site and funding for such an aspirational location it would be a magnificent campus."

This description describes the potential at the Connolly site and yet the paragraph was removed from the final report, because, as the reviewer claimed, they feared 'the issue will open up again'. This same group commented at the time that the St James's site, had the same, if not more problems than the Mater and it wasn't worth considering.

Of course the folly here is not An Bord Pleanala's, they shouldn't have been presented with this plan in the first place. Ultimately, this was a political decision, made by the cabinet on November 6, 2012 after what then Senator John Crown praised as 'aggressive campaigning' by St James's hospital. Despite all evidence to the contrary, the increasing appeal of the Connolly/Rotunda site, its mounting public support, and even Leo Varadkar and Joan Burton having previously shown support for Connolly, the government refuses to review the decision.

The line being trotted out now is to just 'shut up and build it'. This is swelled by a sense of urgency.

Relying on political fatigue and the urgent need for a new hospital, those behind the plan are hoping detractors will resign themselves to accepting the decision. Never mind that this is the biggest planning decision in the history of the state, that this building is to last 100 years, even that, as founder of the Blackrock, Galway and Hermitage Clinics, Jimmy Sheehan estimates, a change to Connolly would be both €200 million cheaper and faster to build.

However, perhaps the government underestimates the lay people they are dealing with. Parents of seriously ill children are a unique community of extraordinary individuals who have been battling against an inadequate health system in our current children' hospitals for years. They see the potential at Connolly and are vowing to fight until the first brick is laid. For people who have experienced the pain of nearly losing their children, the sacrifice is too great not to. Because if the hospital goes ahead, the only question for them will be how long will children have to suffer in inadequate conditions and how many will have to die in traffic before it gets to the point where this week's decision is finally seen for the disaster it truly is.

As one supporter said: "the Irish government will live to regret this decision but some of our children may not."

Rachel Lavin is a past-patient of Crumlin children's hospital, a current patient of St James's and supporter of the Connolly for Kids Hospital campaign.

Sunday Independent

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