The development of a national children's hospital at the Mater site in Dublin will demand serious compromises on best practice, writes Geraldine Regan.
The decision by the board of Our Lady's Children's Hospital, Crumlin, in Dublin, to withdraw from the proposed development of a new national children's hospital at the Mater site was not taken quickly, or lightly.
The Department of Health and Children and the Health Service Executive have been made aware of our concerns over many months. These concerns are based on 50 years of experience serving children and their families and on an expert report we commissioned.
Everyone in paediatrics wants children to have excellent outcomes from their interaction with the health service and as good a quality of life as possible. So what is wrong with the proposed Mater site?
Child patients' needs are very different from those of adults. They need not just a bed and medical treatment but a home from home. This is necessary even for children who experience short encounters with a hospital. It is even more important for those with chronic illnesses such as cancer, cystic fibrosis, and heart disease, who can spend between 30 and 70 per cent of their childhood in hospital.
We are privileged to share these children's lives. We often wonder at their resilience and ability to cope with what are often life-threatening illnesses.
They need many supports to come through this difficult phase in their lives, such as schooling, play time, and the facility to develop social and family relationships in a hospital setting. They require outdoor play facilities that are large enough for their needs but are also safe and properly supervised. They need sunshine and natural light indoors, as well, to the greatest extent possible.
Research has shown that sick children respond better to treatment where they have access to natural light and a pleasant outdoor environment. They heal quicker and need less medication.
Access to natural light is particularly important to children who are not ambulant and spend long periods in hospital, such as those suffering from burns.
We are now beginning to debate constitutional rights for children. Children who are sick have rights and one of them is access to the best medical care possible in the best environment. We all share a responsibility to ensure these rights are upheld. They include the best location, planning and design for the new hospital.
Things began well with the appointment of McKinseys by the Health Service Executive in December 2005 to review paediatric services in line with international best practice. Its core recommendations that tertiary level acute paediatric care should be centralised in a single hospital was welcomed by child health professionals.
But it was never going to be easy to amalgamate three existing children's hospitals. Change management best practice recommends involvement of the key stakeholders in the decision making process from the beginning. This would have identified potential flaws and resolved them in a way that gave ownership of the project to all the participants. This never happened.
I have already outlined the special needs of sick children, but we also need to look at their parents' needs. As director of nursing in Our Lady's Children's Hospital, I regularly meet parents who come from places as far away as Donegal, Mayo, Cork and Kerry.
Some of them spend weeks living in the hospital campus to be near their child. Often other children are with them.
One parent may stay for a prolonged period during which time both the child and parent are isolated from family, friends, community, and not least important in this day and age, keeping in touch with an employer or with their own business. It is not an easy experience but the existence of custom-made accommodation both in the hospital and the hospital grounds, with full support facilities, makes the experience easier.
Some children suffer from serious medical conditions from birth that necessitate emergency transfer to a children's hospital in Dublin. Mothers may be transferred with their critically ill child immediately after giving birth, when both are particularly vulnerable. They often sit with their baby in ICU where we try to make them as comfortable as possible.
It is essential that we have a national children's hospital co-located with a maternity hospital designed to deal with difficult births that provides adequate post natal care for these mothers. While Our Lady's welcomes the decision to centralise acute tertiary services for children in a single new children's hospital, we have serious concerns about the proposed location. These are:
- The site is too small - a quarter of the size of Our Lady's hospital;
- Putting three hospitals on such a site demands serious compromises on best practice;
- There will be inadequate space for the co-location of a maternity hospital;
- There will be no room for playgrounds;
- There will be no natural light on the first five floors of the building because of surrounding structures;
- Services will be fragmented because of space constraints, creating operational and administrative problems;
- Rooms will be too small for parents to remain with their child, or even allow all medical equipment required by the child to be in the room;
- Parents' accommodation will be off-site;
- Research, development and education facilities will be off-site;
- There will be no room for expansion - except upwards - exacerbating the problems already outlined;
- The site proposed is on a flying freehold basis. The legal and planning implications of this, like so much else about the proposal, are unclear;
- Access will be difficult for many parents and their sick children, who often arrive as emergencies from many parts of Ireland.
I recently attended a talk by the Children's Ombudsman, Emily Logan.
She spoke of the need to listen to children and help them articulate their needs. Health professionals in Our Lady's have worked with children and their families for 50 years.
We are well aware of the deficiencies in the existing services but we want a world class hospital and we should not settle for anything less.
Geraldine Regan is director of nursing at Our Lady's Children's Hospital, Crumlin and a member of the board.