OPINION:The way the proposed new hospital at the Mater in Dublin is run will be as important as the building itself, writes KARL ANDERSON
THE AFFIRMATION by an independent team of experts from outside Ireland that the correct site was chosen in 2006 for the development of the new national children’s hospital is welcome.
Independent clinical and hospital design experts from the UK, Canada and the US who reviewed the overall plan, viewed the site and met with representatives from the three children’s hospitals, parents and interested parties reached the same conclusion in 2007.
It may seem odd that some local paediatricians have been so critical of the location while independent experts, including many eminent paediatricians, from different continents on two separate occasions have unanimously endorsed it. Experience in other countries shows us that this is not unusual.
The Queensland government in Australia announced in 2006 that it was amalgamating Brisbane’s two children’s hospitals, the Mater Children’s Hospital and the much larger Royal Children’s Hospital, into a new €900 million hospital beside that city’s Mater site. The decision divided clinicians and fuelled allegations of political interference as the new location is in the state premier’s constituency. It also led to accusations of flawed decision-making which would supposedly seriously compromise clinical standards.
The new hospital will be completed in 2014.
In the UK the Royal Manchester Children’s Hospital opened in 2009. This brought together the former royal children’s hospital, Booth Hall Children’s Hospital and St Mary’s hospital for neonatal services.
When the plan to consolidate the three hospitals was announced, strenuous objections from clinicians followed. The protests became so vociferous and politically divisive that the project was shelved for 20 years. Now people in Manchester, including clinicians who originally opposed the development, accept that children and their families were the losers from the delay.
The debate concerning the location of our new children’s hospital is over. The time has arrived to move on and concentrate on two important tasks: merging the existing three hospitals and developing an effective governance structure for the new hospital.
Starting immediately, we must merge the three hospitals into one operational unit. Moreover, the process must continue during the next four years before the new hospital opens. If we don’t achieve this, the three hospitals will move to the new facility as a conglomeration of different work practices with outdated processes and duplicated services in a nice new building.
No one wants that.
Merging the three will not be easy. They do not have an encouraging history of co-operating and working as one.
Recently, a surgeon highlighted that he could not get access to a theatre to perform surgery to address a child’s spinal deformity caused by scoliosis. This is against the backdrop of recently published extracts from an independent report on theatre use which showed the three hospitals have theatre time going unused because of inadequate co-ordination of services.
Two years after this report pointed out that there would be significant benefits for patients if all theatres in the hospitals were managed as a single unit, they are still managed separately.
It is therefore essential that independent experts from outside the existing hospital structures direct the transition to the new facility. While the board and clinical leadership in the existing hospitals should inform this process, it is critical that they are not – just because of their histories – put in a position where they could slow progress in creating a unified service.
The challenge for us now is to harness our expertise in paediatric clinical care, research and education in a focused and determined way. It is time for paediatricians to step up to the plate. This will require them to insist that colleagues let go of traditions, institutional loyalties and old ways of doing things in favour of a fresh start.
The second challenge is to ensure the new facility delivers on its potential to become one of the world’s top five children’s hospitals. To achieve this it must become a magnet for the most skilled and highly motivated paediatricians and researchers who will view tenure in Ireland’s national children’s hospital as a prized entry on their CV. They will be attracted not only by the facilities, but by clinical care that is integrated across the hospital and satellite centres, cutting-edge research and access to experienced educationalists – all of which must be delivered to international standards.
To achieve this Minister for Health James Reilly must ensure the governance and leadership, from board level down, is focused on providing the best care possible for children nationwide. This should be its raison d’être. Everything else should be secondary and everyone who works in the new hospital should know this; they must commit to it.
Moreover, children and parents who rely on the hospitals for services must be involved in determining how it operates; not in an advisory capacity but at board level.
The board must be vibrant and ambitious, but renewed on a formal basis at regular intervals. It should be open to anyone to apply for membership, which should be based only on their potential to contribute.
If independent experts are not directing the transition and if the governance and leadership is not radically different, important decisions will be driven by the desire for consensus among powerful stakeholders and not the needs of children. At best we will end up with services far from world class. We would be making a mistake which would not deserve forgiveness as it would deny children access to the best clinical care, research and education expertise.
Getting the transition to our new children’s hospital and its leadership right is as important as the new building itself.
Karl Anderson was chairman of the New Crumlin Hospital Group (2002-2005) and adviser to former chief executive of the Health Service Executive, Prof Brendan Drumm