The Coombe hospital has a new name, and an ambitious relocation plan for the future, writes Ronan McGreevy
What's in a name? The Coombe, as it is known colloquially to generations of Dubliners, has just had only the third name change in its history, stretching back to 1826.
For nearly 170 years it was known by the quaint term The Coombe Lying-In Hospital. In 1993 it became the Coombe Women's Hospital. Now, as of January 1st, it is known as the Coombe Women and Infants University Hospital.
The change is not immediately apparent. The large sign outside still says Coombe Women's Hospital and is sure to be a profitable sinecure for whichever company is employed to replace it.
Mindful of recent cutbacks in the HSE, Coombe management are going to use up every scrap of paper and letterhead with the old name before ordering new stationery and, of course, for all those who use the hospital, it will be known, as it always has been known, as simply the Coombe.
The master of the hospital, Dr Chris Fitzpatrick, says the new name reflects the fact that the Coombe is much more than just a maternity hospital - although in that regard it is busier than ever.
The first arrival in the newly named hospital, baby boy Ryan Reddell, was born a relatively tardy 2.23am on New Year's Day, but from then until the end of the year, a baby will be born on average every hour in the hospital.
A total of 8,504 babies were born there last year, an increase of nearly 500 on the 2006 total of 8,084, itself a record. Bookings for January, February and March, a very reliable indicator of future trends, are up on last year.
The Coombe, he points out, also provides the largest gynaecological service in the Republic. Last year it treated 400 women for pre-cancer of the cervix and 200 women were diagnosed and treated for gynaecological cancer there.
In 2006 it was designated as the hub centre for midwifery for the three Dublin maternity hospitals. It's also the only hospital which hosts medical students from all of the three Dublin medical schools and there are six professors on staff.
The research laboratory, a leading European Centre for Molecular Biology Research, both in terms of cancer and pregnancy, has attracted €14 million in research income in the last five years. Last year the National Clinical Skills Centre (Women and Infants Health) was set up in the hospital.
"We would very much see ourselves in this hospital being on a par with the Dublin academic teaching hospitals, such as St James's Hospital, Beaumont, Mater and Tallaght, in terms of the complexity of clinical activities we see and our teacher and training portfolio," Fitzpatrick says.
"The care of babies is a core activity, but we have a very substantial gynaecological service in the hospital and we also have a very strong academic portfolio in terms of teaching, training and research. That is reflected in the name change, particularly with the use of the name university," he says.
Even bigger changes are being put forward by Coombe management than a mere name change.
They involve nothing less than the eventual closure of the existing hospital and a move to a brand new hospital on a brownfield site in the grounds of St James's Hospital, which is less than a kilometre away.
Both the Coombe management and St James's have submitted a document to KPMG management consultants, who are currently carrying out an audit of maternity services in Dublin which is due for publication this year. Both hospitals are hoping that KPMG will endorse their proposals for co-location, a plan which would then be put to the Department of Health and the HSE for approval.
The current proposal would involve the building of a hospital similar in size to the present Coombe at an estimated cost of around €160 million.
The present Coombe Hospital was opened in 1967, but the site is restricted and the building is showing its age. Burgeoning demand for maternity services means that the hospital needs €46 million of development.
More space is required for patients on ante-natal and post-natal wards, both to increase the privacy of mothers who attend the hospital and to improve infection control.
There is also a pressing need for more privacy for the small number of couples who are bereaved in the hospital.
The neo-natal intensive care unit and services for gynaecological and obstetrics care also need to be upgraded.
Given the demands on its service, the pertinent question is whether the Coombe should press ahead with these developments on site or move to a new location at St James's Hospital.
Fitzpatrick and the hospital board reached the conclusion two years ago that redeveloping the current facility would be throwing good money after bad.
"It would be far more prudent in terms of value for money to invest in a brand new 21st-century hospital rather than to invest in a seriously sub-optimal structure that we have here," Fitzpatrick says.
"In terms of the complexity of care that is required, we need to have access to the full range of medical specialities that are available on site.
"Co-location would increase the availability of some specialist services, such as haematology, cardiology and radiology services, which would be immediately available to us for patients who have complex care requirements.
"Certainly in terms of medical and economical sense, it would be of far more benefit for us to co-locate on to the site of an adult hospital in order to have an infrastructure that meets our requirements and to have immediate access to the full range of facilities that we require in terms of a 21st-century obstetrics and gynaecological hospital," he says.
St James's too is supportive of the proposal which was first formulated two years ago and is contained in a large document which has been given to KPMG.
He says the cost of a new hospital, which is not budgeted for in the National Development Plan, could be offset by selling the present Coombe site in Dolphin's Barn and also by putting some of the money earmarked for improvements into the new hospital.
There will also be long-term savings which would come automatically from having two hospitals on the same site. Such a plan, though, would be five years from drawing board to fruition, he believes, and would take further years before approval is given.
In the meantime, the hospital has pressing needs which it needs addressed. In its annual report for 2006, the Coombe warned that an increasing workload and understaffing was potentially putting the health of patients at risk.
On foot of concerns raised by the three maternity hospitals in the Dublin area, the National Hospitals Office prioritised more than €1 million for extra resources.
The Coombe needs to recruit 50 new midwives and the HSE embargo on recruitment was lifted for the hospital.
The Coombe needs more midwives and more medical staff in terms of obstetricians, paediatricians and anaesthetists. It also needs more support staff.
At a time when the HSE seems to be under constant criticism, it is a good news story that Fitzpatrick believes often goes under-reported.
"It is fashionable to knock the HSE," he says, "but the HSE has taken our concerns very seriously. We have been in constant communication with the HSE with regard to our concern and they have prioritised patient safety in terms of maternity care and have given us additional support in terms of resources.
"However, there is a gap between what we need and what they have given us. We are very willing to sit down with the HSE and identify mechanisms whereby this gap can be narrowed in terms of additional resources on their behalf and also increasing efficiencies in the hospital."