The Adelaide & Meath Hospital, Dublin Incorporating The National Children’s Hospital.
Children's Health
Excellence of Care
Tallaght is the only choice for Ireland's Children
A submission on behalf of The Adelaide & Meath Hospital Dublin, Incorporating the National Children's Hospital for A new children's hospital to be co-located at Tallaght
March 2006
Contents
1. In short, the case for Tallaght 2
2. The approach of this document 5
3. Demography and Social Issues 6
4. What Children Want 8
5. Quality First 9
6. The McKinsey report 12
7 The New Children's Hospital 16
8. Planning and Development Considerations 18
9 Co-location Values 23
10 Access 31
11 Governance 37
12 Beyond Mc Kinsey 39
13 Background to the Hospital 40
14 Architectural Outline of Proposed new Children’s Hospital and Women’s Hospital 46
15 Report from South Dublin County Council in Respect of Proposed New Hospital for Tertiary Paediatric Services Appendix 1
1 1. In short, the case for Tallaght
This submission is based solely upon the evidence of what is best for the children of Ireland.
It reflects the key strengths of the Hospital o Quality; o Co-location; o Access; o Governance for children.
Only the Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital at Tallaght (hereafter referred to as “the Hospital”) meets every one of the nine criteria defined by the government commissioned international experts Mc Kinsey & Co. These are -
1.1 The nine McKinsey criteria
1.1.1 Space. There is ample space on and beside the campus of the existing hospital. All existing services can be expanded to meet the needs of the new hospital.
1.1.2 Services. The National Children's Hospital at Tallaght, with a tradition of caring for children, is already there. This, combined with the experience of the adult hospital, will provide the basis for a hospital of international excellence. When the talents and resources of all the paediatric specialist hospitals in the state are focused on the Tallaght campus it will be a world class hospital. It will keep the needs of children at the forefront, and will maintain and sustain the integrity of child healthcare.
1.1.3 Co-location. The new children's hospital should be on the campus of or beside an adult hospital. The Hospital at Tallaght is unique in Ireland in that it is the only hospital that is currently so co-located.
1.1.4 Access. Tallaght is accessible from all parts of the country and the inner city of Dublin. It is therefore the logical place to offer a national children's service. It can easily be reached by ambulance, car, public transport and air. Also, the Hospital is situated in one of the fastest growing populations in Europe with a large proportion of young people.
1.1.5 Efficiency. Sharing with an adult hospital means greatly increasing efficiency in view of shared facilities. Co-location will ensure efficiency and continuity of care from cradle to grave.
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1.1.6 People. The existing Hospital is a well designed, modern, attractive place to work and provides interesting career opportunities. The National Children's Hospital at Tallaght has a nationally and internationally known brand.
1.1.7 Teaching and Research. The Hospital has a long tradition of teaching and research with Trinity College Dublin. It provides undergraduate and postgraduate education to doctors, nurses and other health professionals at undergraduate and graduate level.
1.1.8 Financial Stability. The existing Hospital is financially stable and this will continue.
1.1.9 Full Project Plan. The full project plan set out in the following pages develop the criteria set by McKinsey & Co and adds further compelling reasons that demonstrate the inescapable logic of choosing Tallaght as the location for a hospital to serve the children of Ireland.
1.2 Five further unique benefits beyond the McKinsey criteria
In addition to the Mc Kinsey criteria the Hospital has the following characteristics:
1.2.1 The Hospital has a proven track record in managing mergers between different hospitals with different cultures and in developing constructive partnerships.
1.2.2 It is a University Teaching Hospital with a Trinity College Academic Chair in Paediatrics and a well-defined research strategy that has already been incorporated into the research plan of the Trinity College Faculty of Health Sciences. Furthermore, the Hospital has been awarded the National Longitudinal Children's study.
1.2.3 The Hospital is totally patient focused and will protect both the privacy of the doctor patient relationship, and the wishes and needs of our children.
1.2.4 The Hospital is willing to accommodate the medical students of Trinity College Dublin, University College Dublin and the Royal College of Surgeons in Ireland.
1.2.5 The Hospital has the capacity and wish to develop a Women and Children's Hospital which will accommodate Obstetrics, Neonatology, Paediatrics and Adult care.
1.3 Governance In line with other world class tertiary paediatric hospitals independent governance and budget responsibility for the new hospital will be assured. 3
1.4 Minimising disruption. It would defy all logic to move Our Lady's Hospital for Sick Children, Crumlin and the National Children's Hospital away from the area which houses the most rapidly growing population and largest proportion of people of child bearing age and of young people. It would be particularly illogical to move these facilities to the inner city.
It would make both tertiary and secondary services much less accessible and would deprive the most needy and concentrated part of our population of primary care services.
1.5 National strategy. This proposal is entirely compatible with the vision of the National Children's Strategy: "An Ireland where young children are respected as young citizens with a valuable contribution to make and a voice of their own; where all children are cherished and supported by family in the wider society; where they enjoy a fulfilling childhood and realise their potential"
It is a matter of public record that international experts have set criteria that can only be met by the Hospital at Tallaght. The other unique characteristics of the Hospital add significantly to it being the only choice for Ireland's children's hospital.
4 2. The approach of this document
2.1 The goal. The establishment of a single common major tertiary paediatric hospital with substantial secondary services represents a development of enormous importance to the health of the children of Ireland.
The first and overwhelming consideration for the new hospital must be excellence of care.
2.2 This document o presents some brief information on demography and social issues; o considers (in line with current thinking) specific issues with regard to what children want; o and then establishes why the new hospital must provide care of a quality that will make it world class; o sets out the criteria that will ensure that the new hospital will deliver a service of world class quality. Section 5, pages 9 to 11, of this submission.
2.3 Best international advice. The government commissioned international experts Mc Kinsey & Co. to prepare a report entitled "Children's Health First". This expert group set nine criteria for a children's hospital to serve all of Ireland. As set out in Section 6, pages 12 to 15, of this submission only the hospital at Tallaght meets or exceeds every one of these criteria.
2.4 Partnership. The Hospital at Tallaght would welcome a partnership with colleagues from Dublin's children's hospitals. It has a proven ability of partnership after its highly successful merger of the Adelaide Hospital, the Meath Hospital, the National Children's Hospital and St Loman's Psychiatric Hospital.
2.5 Further services. The section "Beyond Mc Kinsey" , page 39 of this submission shows how the Tallaght campus can and should accommodate a maternity hospital to provide care for mothers, Neonatology and Paediatric care, and adult services.
2.6 Background and history. Pages 40 to 45 of this submission carry some background information regarding the Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital. This includes the merger, the hospital charter and its ethos and ethics.
5 3. Demographic and social issues
While this section considers National demographics, the new children’s hospital may have a vital role in serving the children of the whole island. This would approximate to 1,500,000 children.
3.1 National Demography
As a national centre, the new Children's Hospital will serve the children of a population of 3,917,203 (2002 census), an increase from 3,525,719 in 1991.
Of these, 827,428 are 0 to14 years. 313,188 are 15 to 19 years. 328,334 are 20 to 24 years. 1,180,259 are 25 to 44.
Close to one million children will need the services of this hospital as well as 1.8 million people of childbearing age.
3.2 Eastern Regional Demography
The new hospital will provide both tertiary and secondary services to the Dublin area. The former eastern regional health authority population is 1.4 million persons.
The South Western part of the area in particular has shown a striking population growth with the population of Kildare and Wicklow increasing by 11.7% since 1996. In particular, Kildare has shown a population growth of 21.5% in this time, making it the fastest growing population in the country. The Eastern region also has a higher proportion of persons of child bearing age than the rest of the country, and a lower proportion of people over 65 years of age. Females outnumber males throughout the eastern region.
3.3 Demography and Social Issues
Tallaght is a unique part of the greater Dublin conurbation. The demographic and socio economic profiles are very different from that in the rest in the Health Services Executive area. For the whole of the HSE area, the child population is 28% of the total. For the NCH catchment area the figure is 31% while for six of the Tallaght suburbs, the child population ranges from 39% to 49%. The area also shows the highest proportion of teenage births in the area at 6.3%. In addition the adolescent population in Tallaght is very high at 21% and increasing. Tallaght is also an area with an increasing population of asylum seekers, many with children.
The Tallaght area has one of the highest deprivation index scores in the country with 23% of adults having no educational attainment. A 6 significant proportion of households have only one resident parent and 23% of households live in local authority housing. Birth rate remains one of the highest in the country.
Regrettably, children from lower income households are much more likely to have low educational achievement, to become teenage parents, serve a prison sentence and have less success in the labour market. Thus the new hospital will be faced with unique challenges in secondary care as well as its tertiary care brief.
The site at Tallaght is geographically ideally situated to provide tertiary services to the entire country, and secondary services to the Eastern- Dublin region. In addition, a consideration of the demography and social issues in the immediate catchment area indicates that the local population is increasing significantly, contains a large proportion of young people of childbearing age and suffers from considerable social deprivation. In line with HSE policy on primary care it would not be appropriate to divide this population of primary care facilities.
7 4. What children want
4.1 Increasingly, national and international opinion seeks to include the opinions of children in not only their care but also in governance issues One aspect in all the data surrounding the submissions relating to the new Children's Hospital that is strikingly lacking is any consideration of what children themselves might wish.
4.2 The National Children’s Hospital at Tallaght has already addressed this issue. The existing Charter of the National Children's Hospital at Tallaght is based on the United Nations Charter for Children, the philosophy and beliefs of the National Children's office and what is understood to be the opinions of the Ombudsman for children. These are all compatible with the governments National Children's Strategy "Our children-their lives".
4.3 The Hospital at Tallaght has already entered discussions with Ms Emily Logan, Ombudsman for Children, and Dr Jean Whyte, of the University of Dublin Children's Research Centre. A preliminary review of the literature suggests to us that the new children's hospital at Tallaght would include the following promises to children.
Promises to children o We will be honest with you. o We will listen to you. o You and your parents are part of our medical team. o We want you to help us decide the best ways to take care of you. o We will talk with you about your plan of care before you are treated, while you are treated and after you are treated. o You may talk freely with the medical team. What you say may not be told to others unless it is important to your care and safety. o It is okay to tell us what you want or do not want, if you are afraid, angry, lonely, or sad it is okay to laugh and to cry. o We will explain things in ways you can understand. o We care about you no matter what your race or religion is, if you are a boy or a girl, where you were born, what you can and cannot do, what you look like or how much money your family has.
8 5. Quality first
5.1 The primary objective of the new hospital must be to deliver world class quality.
5.2 The Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital is the only Irish hospital to have received a public service excellence award.
5.3 The existing hospital has achieved world class quality in a number of areas. In paediatrics, the work in endocrinology is known world wide. The adult hospital has a world name in gastroenterology, pancreatic cancer and cardiovascular risk prediction. The Hospital has been engaged with the HSE since 2002 in a unique First Patient Project. Phase one, on Neurology services, has been successfully undertaken, with an emphasis on integrated hospital and community care. Phase two is now been rolled out to encompass other aspects of patient centred care.
5.4 The Hospital delivers international quality teaching of doctors, nurses and paramedical staff in association with Trinity College. The Trinity Academic Department of Paediatrics is located in the hospital and was awarded the 2004 tender for the national training programme on child health surveillance for public health doctors and nurses.
5.5 The Hospital’s own research, strongly supported by the McKinsey report, is that quality is related strongly to the volume of workload achieved. This is particularly true with regard to critically ill children in an intensive care unit. In this situation, multiple specialists may be required for an infant with multiple organ failure.
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As McKinsey points out, tertiary hospitals need to provide sub specialists in at least 27 core sub specialities -
Medical Surgical
Anaesthetics Cardiothoracic surgery Cardiology ENT surgery Endocrinology Gastroenterology/GI/hepatobillary surgery Gastroenterology and Hepatology General Medicine General surgery Genetics Neurosurgery Haematology Orthopaedic surgery Immunology Transplant surgery Infectious Diseases Urology Intensive Care Oral Surgery Neonatology Nephrology Neurology Oncology Ophthalmology Pathology Radiology Respiratory Rheumatology Dentistry Microbiology & Clinical Chemistry
5.6 Because of the current co-location, most of these specialities are available to the National Children's Hospital. The full spectrum would be provided by combining the National Children's Hospital with the specialities available in Our Lady's Hospital for Sick Children, Crumlin and the Children’s University Hospital, Temple Street.
5.7 Certain specialities, such as transplantation and neurosurgery, have traditionally been undertaken in different hospitals. This special situation will need detailed discussion but could all be accommodated on the new hospital campus. The tertiary hospital will also need to accommodate holistic care of the child and family. The National Children's Hospital already has a hospital school, administered and run by the Department of Education. This can readily be expanded. There is also a substantial playroom.
5.8 Present practices of the National Children's Hospital endorse the McKinsey criteria to provide accommodation for parents both in the wards and nearby.
5.9 The existing hospital would have the capability of allowing parents and indeed children broadband Internet access. 10
5.10 With regard to achieving premier quality, it would be envisaged that the National Children's Hospital and the other Dublin children's hospitals would learn from each other. In particular, the process of seeking international, evidence based opinion with regard to optimal facilities for children's care, initiated in this report, will become an ongoing and dynamic process.
5.11 Quality is assured by a high volume workload, having a full range of specialities, and an active and committed process of ongoing review and improvement. The Hospital is interested in proceeding with this bid in the context of a truly world class service. Co-location on a site that is already highly experienced in such co-location will be a critical success factor.
5.12 Quality of access is dealt with in pages 31 to 36 of this submission.
5.13 Quality of outreach. Assuming that it is agreed that there shall be one tertiary paediatric hospital for Ireland, a detailed outreach programme will be required to provide tertiary paediatric clinic by specialist consultants in areas outside the hospital's immediate catchment area. The hospital is unique in having the University Department of Public Health and Primary Care on site. The concept of the new hospital will be that of an integrated national paediatric service that will be entirely child centred.
5.14 Retrieval. International evidence indicates that critically ill children can be transferred to a tertiary paediatric intensive care unit without undue risk. The campus at Tallaght already has a helicopter pad and easy access to Baldonnel and Dublin airports.
5.15 Efficient use of resources. Major economies will be possible by co- locating on a campus that already has a track record of efficient collaboration of paediatric and adult services. See page 14 of this submission.
5.16 Recruitment and Retention of Staff. The hospital at Tallaght has proved to be a very happy location in a building that is universally well liked. The development of a paediatric world class hospital could only strengthen the ability to recruit and retain staff. The Hospital would become a magnet site for healthcare professionals. In relation to nursing the Hospital has the highest staff retention rate of the DATHS hospitals. The Hospital’s life long learning programme also contributes to retention of staff.
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6. The McKinsey report
6.1 McKinsey Recommendations
McKinsey & Co considered the "configuration of tertiary paediatric services of Ireland and secondary services for Dublin" and made the following recommendations.
o Population and projected demands of Ireland can support only one world class tertiary centre.
o The centre would have the nine attributes outlined in the McKinsey report
o This centre would be in Dublin.
o It would ideally be co-located with a leading adult academic hospital.
o It would have space for future expansion (including education and research facilities).
o It would be easily accessible through public transport and the road network.
o The centre would be at the nexus of an integrated paediatric service also comprising: - Important outreach capabilities at key non-Dublin hospitals. - adequate geographical spread of A&E facilities (including 2-3 in Dublin). Treatment at “urgent care" centres is another option. These centres are either stand alone or attached to an adult facility with no inpatient children's beds.
o This centre would also provide care for all the secondary needs of Greater Dublin.
12 6.2 McKinsey criteria
Section 6 of the Mc Kinsey report outlines decision and proposed assessment criteria for the new children's hospital. In this section we address the criteria in an introductory way. A number of these points are considered in more detail in Section 8: “Planning and Development Considerations”, of this submission. With regard to Mc Kinsey's nine criteria, it is clear that the hospital at Tallaght is the only location in the State that fulfils all criteria.
6.2.1 Space
The 35-acre site of the Hospital at Tallaght has ample space to meet the proposed tertiary and secondary needs of paediatrics. In addition, an additional green field site has been made available immediately beside the campus that can be connected directly to accommodate expansion, a maternity hospital, and to allow for re-location of some facilities, if needs be. There is already the potential to accommodate all research and education facilities on campus. Indeed, there is already a fully developed Education Centre with the Trinity College Faculty of Health Sciences building. The latter includes dedicated Paediatric teaching facilities. Furthermore, it is planned to build a second phase Trinity centre which will accommodate the International Centre of Preventive Medicine and Advanced Health Care. A large component of this centre will be a paediatric research facility devoted to growth and metabolic medicine. The Institute of Cardio Vascular Science will be accommodated in this building, and one of the stated objectives of this is the development of the centre for the study of cardio vascular risk in young people. This will be a collaborative venture with the paediatric hospital.
It should be noted that the height restriction that operated when the present hospital at Tallaght was built has been lifted. There is an adjacent 11-storey building. New developments nearby also include substantial underground development such as parking: previous depth restrictions no longer apply.
In line with local policy it is anticipated that underground parking will also be provided.
6.2.2 Breadth and Depth Of Services
The National Children's Hospital in Tallaght can already provide many of the services outlined in the McKinsey report, and would willingly accommodate the additional requirements of the tertiary centre, including the services currently provided by Our Lady's Hospital for Sick Children, Crumlin and the Children's University Hospital, Temple Street. This would result in a unique and co-ordinated integrity of child focused healthcare.
13 6.2.3 Co-location
The Hospital at Tallaght is unique in that it is the only hospital in which there is co-location between an existing national children's hospital and an adult hospital. Thus, the present arrangements provide care from cradle to grave. It is envisaged that all laboratory and investigative facilities would continue to be shared, as at present, with further development to accommodate the new specialities.
6.2.4 Access
This is dealt with in more detail on pages 31 to 36 of this submission. Tallaght is accessible from all parts of the country and the inner city, and therefore is a natural and logical place for tertiary children's services. There is ready access for emergency vehicles. The Hospital is served by both the Luas and by an extensive bus network. Dublin airport is a twenty-minute direct journey by car via the M50 and M1.
The Hospital already has a helipad.
6.2.5 Efficient use of Resources
The existing hospital at Tallaght has sufficient activity to support 24/7 cover in all major specialities and sub-specialities, and it is envisaged that this would of course increase with the coming of the new hospital. The Hospital has both an adult and paediatric Accident & Emergency Department. There is already a strong record of co-operation with regard to the appropriate sharing of diagnostic equipment and other operational services, and there is space to expand both the laboratory and radiography areas.
6.2.6 People - Attract and retain
The hospital at Tallaght provides an outstandingly attractive work environment in a purpose built hospital with natural light to all areas. The hospital is rightly perceived as a well designed, modern and attractive place to work. There are already interesting career opportunities, which would be heightened by the placement of the new hospital here. The National Children's hospital at Tallaght already has a nationally and internationally known brand. The new hospital will consolidate its status as a magnet hospital. The Hospital already has the highest retention rate for nurses of the Dublin Academic Teaching Hospitals.
As well as international standard teaching and training the hospital has a quality learning programme for all staff with multiple training courses.
14 6.2.7 Teaching and Research
Strong integration with undergraduate and postgraduate training programmes already exist in medicine and nursing and the paramedical specialities. The University of Dublin, Trinity College professorship of Paediatrics is held by the National Children's Hospital as part of a contractual link with Trinity College Dublin. The Hospital has a strong mandate to pursue a clearly defined research agenda. The paediatric component of the Institute of Preventive Medicine and Advanced Healthcare forms part of an integrated strategy, which has already been accepted as an official part of the Trinity College health research plan. There is already a strong track record of fundraising both for the National Children's Hospital and for the adult Hospital and equally a strong track record of success in applying for competitive research grants.
6.2.8 Financial Stability
The existing hospital is financially stable and has remained within budget for the last five years and this will continue. It is envisaged that the new Children's Hospital will have its own demarcated budget with a governance structure that is independent but highly co-ordinated with the governance of the entire campus.
6.2.9 Full Project Plan And Role Assessments
The present submission addresses this issue. The hospital at Tallaght welcomes a partnership with colleagues from all of Dublin's children's hospitals. It has a proven ability of partnership after the successful merger of the Adelaide Hospital, the Meath Hospital, the National Children's Hospital and St Loman's Psychiatric Hospital. It is clear that Tallaght is the only choice for Ireland's children. The slogan coined by the residents of Tallaght is accurate and appropriate. "All roads lead to Tallaght. All tracks lead to Tallaght."
15 7. The New Children's Hospital
Appendix B from the Health Services Executive "request for information" summarises the requirements for the new children's hospital.
The report recommends development of a 380 bedded Children's hospital, including: • 96 tertiary non-ICU beds • 54 ICU beds • 189 secondary non-ICU beds • 41 secondary day beds
For the purpose of these deliberations, it is envisaged that all inpatient beds will be accommodated in single rooms.
The new children's hospital is to provide appropriate accommodation for the full range of clinical and other functions as envisaged in the report. This may include space to be shared between co-located hospitals, particularly in such areas as pathology, radiology, pharmacy, education, catering, stores, energy centre, etc.
It is estimated, for outline planning purposes only, that total gross internal floor area of approximately 65,000m2 will be required for this purpose.
As recommended by the report an 'expansion' allowance is to be provided. This additional space requirement has been estimated, for preliminary planning purposes, at approximately 20% or 13,000m2. Given that not all areas of the future hospital will require equal expansion, an approach to the provision of such expansion capacity should be indicated. The separate future expansion needs of the adult acute hospital need also to be considered. In particular, the approach to expansion capacity should identify whether there is land available (stating area) for development of expansion at ground level, or whether the expansion would be accommodated without ground level construction.
The report discusses alternative planning models that could result in a requirement for up to 585 beds.
• 215 tertiary non-ICU • 81 ICU beds • 248 secondary non-ICU BEDS • 41 SECONDARY DAY BEDS
The availability of land (stating area), for this significant overall capacity should also be identified and its impact on site capacity shown.
Space will also be required, inter alia, for the following:
16 • Helipad • Emergency vehicular access • Car parking for a minimum of 530 cars ( 2/bed tertiary:1/bed other) • Waste marshalling yard • Amenities
It is noted from Appendix B that a total gross internal floor area of approximately 65,000 sq. metres will be required, with a capacity to extend this by 20% or 13,000 sq. metres. There will be a need also for further expansion up to a hospital of 585 beds.
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8. Planning and development
8.1 Definition of Proposed Site including confirmation of Site Area in hectares See attached diagram to extract from OS Site map showing proposed site within the Hospital curtilage, together with additional lands for development available from South Dublin County Council.
8.2 Is the site fully contained within the existing hospital curtilage The site for the proposed Children's Hospital is fully contained within the existing hospital curtilage.
8.3 Location of how the proposed site and development of children's facilities relate to the hospitals current Development and Proposed Plan and Traffic Management Strategy There are no inherent conflicts between the proposal and the hospital's current Development Control Plan. As part of development control considerations the hospital is currently examining relocation of existing single storey buildings in the proposed area.
The hospital's traffic management and car parking strategy is being implemented on a phased basis. Additional parking, for the new hospital, will be provided in accordance with design specification and local authority requirements. The strategy proposes that the Children's Hospital would share the existing main road entrance serving the existing hospital.
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8.4 Details of route of proposed physical link with existing hospital As indicates on the sketch layouts, it is proposed that the new hospital would be contiguous with the existing hospital complex. In relation to the information requested;
(i) Linear distance from closest accessible boundary / edge of proposed site to existing hospital core building (M); 0 M
(ii) State whether the route is on surface at high level or underground; Hospital is linked on all floors at a number of points to the existing building
(iii) Covered for full length? Yes
(iv) Route ownership details; Within the curtilage of the existing hospital site.
(v) Pedestrian traffic only? Yes
(vi) Patient transfer? Direct
(vii) Transfer of goods and samples? Direct
(viii) Vehicular traffic? Shared services.
8.5 Confirmation of ownership of the entire proposed site in absence of boundary conflict issues. The entire campus is owned by the Minister for Health and Children and held by the Hospital under a 99 year lease. There are no boundary conflicting issues and confirmation of legal title of ownership is immediately available. The site is free of legal and financial encumbrances.
19 8.6 Details of Planning and Development considerations relating to the proposed site, including in particular reference to such matters as:-
8.6.1 Zoning The proposed hospital site is within the existing hospital lands so zoning is not an issue.
8.6.2 Protected structures Not applicable
8.6.3 Height restriction The proposed site falls within the Tallaght Town Centre Zoning and a height restriction of 10 - 12 floors maximum is likely to apply.
8.6.4 Development density, permissible building footprint See diagram attached, which is an extract from the Tallaght Town Centre Urban Framework Plan currently being finalised by South Dublin County Council. This framework shows the objective for this area of Tallaght is to achieve a must more dense urban development pattern than that which has hither to existed. The proposed strategy for the layout of the Children's Hospital, together with the strategy for utilising adjacent lands available from the County Council for the relocation of general hospital facilities and related patient services which do not need to be so closely attached to be integrated into the core of the hospital, is based on and closely adheres to the development density and building foot print proposals already developed by South Dublin County Council.
8.6.5 Traffic Management and Transport Plan The development proposal dovetails with South Dublin County Council general strategies for transport and traffic management in relation to the following key areas:- o pedestrian access to the hospital complex from the Tallaght Town Centre Area generally, and particularly from the Square Shopping Centre Area and Luas. o public transport via the Luas as described elsewhere in this proposal. o the development proposal complies with the Local Authority objectives for dealing with access by private cars, particularly in relation to objectives for controlling the growth in numbers of such traffic and parking provision.
8.6.6 Environmental impact It is not envisaged that the development would have any negative environmental impact.
20 8.6.7 Waste Management The proposed development links into the central spine services routes of the hospital, which facilitates the present waste management policy as an extension of the existing hospital procedures.
8.6.7 Previous planning history Not applicable
8.7 Details of any existing or planned alternative land use by or of the proposed site by the hospital and or any other parties; as outlines above the proposed site is at present occupied by the following uses:- Presently, there are no planned usages of the proposed site for new developments. The present site has a number of single storey buildings which may be accommodated elsewhere on the hospital or off site on lands provided by South Dublin County Council.
8.8 Description and extent of enabling or other works required to make available the proposed site, which may generate particular costs to facilitate a New Children's Hospital development. The proposed site for the new hospital currently contains several single storey buildings, which it is proposed to relocate within the Hospital or to the adjacent site made available by South Dublin County Council. It is not envisaged that significant site services would need to be diverted, as the line of the existing main entrance road is not altered in the scheme development. Some diversion of services would be required along the south boundary, adjoining Cookstown Way.
8.9 Manner in which enabling or other works come or the general approach to the development may impact on the time frame for development. Provision of a cleared site would be dependent on the relocation of the existing buildings as outlined above. Given the scale of the development proposed compared to the relatively modest buildings needing relocation, it is envisaged that work on clearing the site could be phased to run in tandem with the briefing, design and planning phases of the children's hospital so as not to cause any material delay to the development.
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8.10 The development of a new children's hospital on the existing hospital, which will need to provide clinical services in acceptable conditions for the duration of the development period The proposed Children's Hospital is separated from the maintained existing hospital by large court yards, of a width of 25m. It is proposed to link the Children's Hospital across to the existing hospital at 3 separate locations. However the strategy adopted means that the Children's Hospital could be built with minimum disruption / destruction to the functions of the existing hospital, as building the link blocks and breaking thru to the existing hospital could be left until late in the process, and could be completed one link at a time to minimise any negative impacts. The proposed site for the new hospital would be separately accessible for construction purposes from the adjacent Cookstown Way, thus minimising traffic disruption arising.
8.11 The sub sequential development requirements to the existing hospital, and how they would be impacted by the development of a New Children's Hospital None, over and above those already anticipated in the development plans for the Hospital campus.
8.12 Utilities infrastructure capacity of the site and how impacted by new children's hospital Additional utilities will be required which can be provided by services adjacent to the Hospital, where such capacity for the proposed development are available.
8.13 Known development constraints There are no known development constraints. In contrast, the development is entirely logical and compatible with strategy and plans of the Board of Management.
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9. Co-Location values
The Hospital is already co-located and therefore has a unique tradition of added value from co-location to bring to the bid. Care of children, adolescents and adults is already integrated. Teaching of medical and nursing students in adult and childcare is integrated. Joint grand rounds are held. The following examples of co-location values will expand in response to the additional specialities and services that will come to the site of the hospital.
9.1 Clinical
Many of the specialities listed will bring added value into the new paediatric hospital. Examples are as follows -
Anaesthetics The existing Department of Anaesthesia provides both adults and paediatric services and can continue this harmonious relationship.
Surgery The expertise of the Professorial Department of Surgery in pancreatic and gastro-intestinal disease is available to adults and children. Paediatric Oral surgery is also available on campus.
Cardiology There is an existing shared cardiological appointment with Our Lady's Hospital for Sick Children, Crumlin. Adult cardiologists advise on paediatric cases in the National Children's Hospital at Tallaght. There is already an adolescent cardiology clinic functioning which operates very successfully, and is attended by both adult and paediatric cardiologists (Dr David Mulcahy and Dr Kevin Walsh). Dr Kevin Walsh advises on percutaneous cardiological interventions in older children. A particular exciting development is the Institute of Cardiovascular Sciences project, "Cardiovascular risk in the young". Rather than focusing on only sudden death in the young, this endeavour will focus on all aspects of juvenile vascular risks, including the ability to predict heart attacks in later life, and in particular genetic screening and counselling. Potential colleagues with appropriate skills have already been identified.
Endocrinology The existing National Children's Hospital at Tallaght has special expertise in childhood obesity and endocrine disorders. Their endocrine colleagues at the adult hospital, combined with the Department of Cardiology, have a special interest in the clustering or risk factors that comprise the metabolic syndrome. The syndrome carries a high risk of diabetes in young people, and a high risk of cardiovascular disease in later life and represents a very appropriate paediatric / adult collaboration.
23 Genetics A major new development is the Chair of Clinical Genetics, which has the full approval of Trinity College Dublin, together with the appointment of a senior lecturer shared with their Department of Genetics. This development will be of critical importance to the new children's hospital. It is envisaged that established links with the National Genetics Centre will mature and develop to provide a world class genetics service.
Haematology/Oncology Both the haematology and oncology services at the Hospital have recently been substantially expanded to the benefit of both paediatric and adult medicine.
Nephrology The hospital is a regional nephrology centre and as such can and will readily extend its services to transitional care.
Dentistry Paediatric Oral Health Services are available at present.
Neurology The hospital consultant neurologists are already happy to provide advice to the National Children's Hospital at Tallaght and this relationship can and will develop.
Ophthalmology Ophthalmology services are available to adults and children alike.
Pathology One of the major economies will be the ability to continue the present collaboration in paediatrics and the adult hospital with regard to these services.
Radiology Co-located dedicated paediatric and adult radiology departments are in place.
Respiratory The present co-located site provides a comprehensive adult and child respiratory service with special expertise in cystic fibrosis.
Rheumatology The newly appointed rheumatologist will assist both adults and children services.
Microbiology and Clinical Chemistry These services are already provided to children and adults and there is space to expand them.
24 Cardio Thoracic Surgery Two cardio thoracic surgeons already provide a service to the hospital. This can readily be extended to paediatrics and indeed there will be no difficulty in accommodating the present cardiac surgical programme from Our Lady's Hospital for Sick Children, Crumlin.
ENT Surgery Present services are already available to both adults and children.
Gastroenterology Both Adult and Paediatric Services receive all Ireland tertiary referrals. The Adult Professorial Department has an international reputation.
Neurosurgery This is not presently available but can be accommodated.
Urology The adult hospital already contains a National Urology Centre. Paediatric urology services are already provided and can be extended.
Dermatology Dermatology provides a joint service.
Psychiatry A comprehensive adult and child psychiatric service, including liaison psychiatry is already provided. An Inpatient unit for childhood and adolescent psychiatry is an advanced level of planning. This will be the only such unit in Dublin. Furthermore, a Chair in child Psychiatry in conjunction with TCD will be located at the hospital.
Developmental Paediatrics There is currently an existing developmental paediatric service in the hospital for children from South West Dublin, Kildare, West Wicklow and the East Coast. It is planned to make an academic appointment in community paediatrics in the future.
Paramedical Specialities Nutrition, Social Work, Occupational Therapy, Physiotherapy and Psychology.
25
Specialty Adult service (Y/N) Number of Consultant Sessions Anaesthetics Y 157 Cardiology Y 31 Endocrinology Y 25 General Medicine Y See Below* Genetics N See Below** Haematology Y 20 Immunology Y 2 Infectious Diseases Y 2 Intensive Care Y 22 Neonatology N 0 Nephrology Y 17 Neurology Y 18 Oncology Y 17 Ophthalmology Y 6 Pathology Y 43 Radiology Y 61 Respiratory Y 13 Rheumatology Y 7 Microbiology & Clinical Chemistry Y 20 Surgery Cardiothoracic Surgery Y 3 ENT Surgery Y 16~~ Gastroenterology / GI Y 31 General Surgery Y 76 Neurosurgery N 0 Orthopaedic Surgery Y 68 Transplant Surgery N 0 Urology Y 33 Other Emergency Medicine (A&E Y 23 Geriatric Medicine Y 21 Neurophysiology Y 3 Oral & Maxillofacial N See below$ Palliative Medicine Y 7 Radiation Oncology Y 3 Rehabilitation Medicine Y 3
Dermatology Y 9 Burns N 0 Plastics N See Below~ Metabolism Y See Endo. Psychiatry Y 45 Clinical Pharmacology N 0
*General Medicine: GIM component included in specialties **Genetics - Chair & Senior Lecturer agreed ~Comhairle 2005 report recommends 3 posts priority ~~Comhairle 2005 report recommends 1 additional post with Naas $Comhairle 2005 report recommends 1 post
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9.2 Work force – non clinical
The following areas exist in highly developed form within the hospital and will bring added value to the new hospital.
Accreditation The Hospital is undergoing the Irish Health Services Accreditation Board Accreditation process. The new principles will apply to the new hospital.
Audit The hospital has a high-developed clinical and financial audit system, which again will be made available to the new hospital.
Education and Training Apart from the Hospital's status as a full university teaching hospital for medical, nursing and paramedical specialities the Hospital runs many training courses. These include information technology, literature searches, powerpoint and so forth. All of these will be available to the new hospital and will be expanding.
Health Promotion The hospital has a dynamic Health Promotion Department, in line with its Charter, that functions in both the adult and children's hospital. This can and will be developed further.
Human Resources The Human Resources Department has been revitalised with the appointment of a new Director of Human Resources. The Department is capable of providing full human resources services to the new hospital.
Information Technology The hospital has the most advanced information technology strategy in the country. It is moving rapidly towards wireless, inter active electronic management for all aspects of patient care and records. This technology will of course be made available to the new hospital.
Medical Administration The central Medical Administration Department already deals with the adult and children's hospital.
Clinical Photography This Department is well developed and is available.
Audiovisual Teaching This facility is well developed and allows unique real time teaching of surgical and other practical procedures.
27 Pharmacy and Medication Safety The existing Hospital has an international reputation in its management of medication safety. This will be particularly important to the developments in paediatrics.
Risk Management The Hospital has a very advanced risk Management system from which the new hospital will benefit.
Telephony A totally integrated telephony system is envisaged.
Laboratory - Haematology, Chemical Pathology and Bacteriology These already exist to both the adult and children's hospital but will need expansion.
Radiology The Hospital has an active Radiology Department but this will need extension in the new hospital, particularly with regard to investigations such as MRI scanning.
Cardiac Catheterisation Laboratory This presently undertakes adult catheterisation procedures and can readily be extended to study children as well. The newest percutaneous interventions can be undertaken.
9.3 Non-Clinical Support Services
Catering Centralised catering of the adult and children's hospital already exists and can be readily expanded.
Technical Services The hospital’s Technical Services Department provides a comprehensive 24/7 service to all areas of the hospital.
Medical Physics and Clinical Engineering The Hospital's Medical Physics and Clinical Engineering Department assists in the provision of the highest quality of healthcare for patients by supporting all staff who apply medical device technology. Department activities include Medical Equipment Management, User and Scientific Support, Radiation Protection, Education and Training, and Research & Development.
28 9.4 Facilities
The campus includes a multi storey car park, which will need to be extended. South Dublin County Council have stated that all new developments must provide underground parking. A crèche is already available on campus for Hospital staff. There is a very spacious dining room.
9.5 Co-ordinated Fundraising
The Hospital has a strong track record of effective fundraising for Paediatric and adult services, Teaching and Research. The National Children's Hospital Foundation, the Adelaide Society and the Meath Foundation hold independent voluntary funds for these purposes and actively fundraise to augment this contribution to healthcare.
9.6 Education and Research
The Hospital is affiliated with the University of Dublin, Trinity College and is an equal partner with St. James' Hospital. In addition, the University of Dublin Academic Department of Paediatrics, including the Chair, is situated in the National Children's Hospital.
Educational facilities include a purpose built Education Centre adjacent to the Trinity College Faculty of Health Sciences centre. The Trinity building accommodates research facilities including dry and wet laboratories and substantial paediatric research is already undertaken there.
The phase two of the Trinity College building accommodates the Institute of Preventive Medicine and Advanced Healthcare. The major stakeholders are Paediatrics, Cardiology, Oncology, Respiratory, Neuro science and Genetics. The research strategy for the Institute of Preventive Medicine and Advanced Healthcare is highly co-ordinated and integrated and forms part of the University of Dublin faculty of Health Sciences overall research strategy. Particular aspects of the research portfolio that are relevant include Metabolic Medicine and Endocrinology Development and prediction of risk of the major adult causes of death, Cardio vascular diseases and Cancer. Overall, the Hospital has multiple research links with colleagues at home and abroad. The Department of Cardiology research programme, for example, has in excess of forty international partners. The Hospital is internationally renowned for the development of the SCORE (Systematic Coronary Risk Evaluation) system for evaluating risk of heart disease. This has been adopted as the European standard by the 8 major European societies interested in vascular disease. A particularly exciting development would be to extend the concept of risk reduction into early childhood where this will encompass sudden death, but by no means be confined to this area and will also include genetic diseases. In this regard the new Chair of Clinical Genetics will form a pivotal role in collaboration with the National Centre for Genetics.
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The Hospital is in collaboration with The University of Dublin, Trinity College to appoint a Chair of Medical Education, which will be of critical importance to the new development. The Board of the Hospital will work on a dynamic partnership with University College Dublin and the Royal College of Surgeons in Ireland with regard to paediatric teaching at the new centre. The development of national and international research links to paediatrics will also be strongly promoted. The plans for a Chair in Nursing Practice are well advanced. A new Chair in Psychiatry with a dynamic research programme in Neurosciences has been appointed.
30 10. Access
Location, patient access and the suitability of the site placement are to be key strengths of the new children's hospital. These factors are all positively impacted by the numerous transport options available to the Hospital at Tallaght. This site is already ideally suited to meet the key transportation requirements: o emergency vehicles; o visitors (includes patients) and staff; o deliveries; o future transport options.
10.1 Emergency Vehicles
Emergency vehicles requiring fast access by either road or air are readily served by the AMNCH campus. The Hospital is well located for rapid access to the local and strategic highway network by being based just off the M50 and within easy access of the N4 and N7.
There is already a dedicated children's emergency department.
Direct access for ambulance transfer is provided to both the main hospital entrance and the Accident and Emergency Unit. Access to the Accident and Emergency Unit is via a barrier controlled segregated road.
In addition, the Hospital already has its own helipad with dedicated route into the hospital.
10.2 Visitors and Staff
A recent survey of traffic usage report on the Hospital indicated that 20% of visitors arrive by public transport leaving 80% arriving by mechanically propelled vehicles.
However, the number of visitors and staff arriving by public transport has risen significantly with the introduction of the Luas. This may reduce the number of mechanically propelled vehicles visiting the Hospital
31 10.3 National Access
The hospital is unique in being readily accessible to all parts of the country. It is equally accessible from the inner city through the various roads and transport systems.
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10.4 Public Transport
10.4.1 LUAS
The Hospital is served by the LUAS tram network which links Tallaght to Heuston Station and Connolly Station (Red Line) as well as the Busáras Central Bus Station. There are two LUAS stops serving the hospital campus, “Cookstown” and “Hospital” parallel with the Hospital’s western perimeter. The tram facilities cater for all passenger mobility types, including step free access facilities and audible information. The service runs from 05:30 until 00:30 Monday to Friday, 06.30 to 00.30 Saturday and 07.00 to 23.30 on Sundays with a tram every 5 minutes during peak periods.
Park and Ride facilities are provided at the nearby Red Cow Depot, with free car parking for disabled drivers.
10.4.2 Buses
The Hospital is connected to an extensive bus network, one of which enters the Hospital campus. There are a number of bus stops either side of Belgard Square North Road immediately adjacent to the entrance to the hospital grounds. The table below lists bus services using these stops along with an indication of peak frequencies and vehicle accessibility.
Service Origin Destination Wheelchair Accessible Number 201 City West Bohernabreena Yes 202 City West Kilnamanagh Yes Eden Quay (city 50 City West No centre) Eden Quay (city 54A Tallaght (The Square) No centre) 65 Ballymore /BlessingtonEden Quay (city centre) Yes Eden Quay (city 65B City West Yes centre) Dun Laoghaire (Railway 75 Tallaght (The Square) No Station) 76 Fettercairn Old Lucan Road No Blanchardstown Fettercairn/ 76A No Centre Balrothery 76B Old Lucan Road Tallaght (Balrothery) No Eden Quay (city 77 Jobstown No centre) 77A Tallaght (The Square) Eden Quay (city centre) No
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10.4.3 Rail
DART and bus services provide direct links to National Rail Service (Connolly and Heuston Stations) where transfer to the LUAS provides access to the hospital campus.
10.4.4 Air
Dublin Airport is a 20-minute direct journey by car via the M50 and M1. Baldonnel airport is approximately a 10 minute journey by car. The Hospital has a helipad on campus.
10.5 Road Access
The Hospital within Tallaght, a suburb of Dublin, on the south-western periphery of the M50 motorway, which bypasses Dublin city centre and connects with major strategic links to the north, south and west of Ireland. There is a single vehicle access/egress off Cookstown Way that leads to both Belgard Road (R113) and Tallaght Bypass (N81), which in turn connects with Junction 11 on the M50. The Hospital is located a mere 5 km from the M50, connecting it with all major road networks to and from Dublin including N4/M4 (being upgraded to motorway standard as far as Kilcock), N7/M7 (currently being upgraded and widened to Naas and connecting with N8 and N9) and N11/M11 (via current extension of M50 to the south). Further access from the M50 is readily available at Junction 9, via N7 (Naas Road) and R113 (Belgard Road) and Junction 10 at Kilnamanagh /Ballymount.
As with most urban areas, the road network in the vicinity of the Hospital is subject to traffic congestion during the morning and evening peak periods (typically between 0800-0930 and 1630-1800 respectively). However, congestion in this area is relatively moderate in comparison with most areas of Dublin within the M50. Traffic congestion outside the peak periods is minimal. For those travelling from outside Dublin the M50 peripheral motorway means that they do not have to negotiate city centre traffic.
Therefore, in summary the site at Tallaght is ideally suited for both visitors and staff travelling by mechanically propelled vehicles.
10.6 Parking
Dedicated set-down and reserved parking facilities will be provided off the existing ring road adjacent to the entrance of the children's hospital for patient use.
35 In relation to staff and visitors (non-patient), there is a total of 920 surface car park spaces on the site, with a further 529 spaces in an on- site multi-storey car park for staff and visitors including 9 spaces designated for disabled users. Pedestrian access to the car park lies adjacent to the Accident and Emergency Entrance and approximately 100 metres from the main hospital entrance. Further public parking is available close to the hospital.
The Hospital has a traffic management strategy which is being implemented in a phased basis in conjunction with local and national transport authorities. Additional parking will be in line with the architectural design specification and local authority requirements on respect of new developments.
10.7 Deliveries
As described in the section 9.6, the Hospital is ideally suited for receiving mechanically propelled vehicles.
There is a ring road within the campus boundaries which serves all the needs of the hospital including Emergency Vehicles Services and deliveries. All supplies to the new children's hospital will be delivered through this facility and onward to the hospital using the existing internal distribution system.
10.8 Future transport options
There is a material difference in travel times for patients travelling from a large proportion of the catchment population to the Hospital campus on the west side of the city as compared with the other Dublin hospitals. This will make a considerable difference in travel time for patients compared to any other hospital.
36 11. Governance
In the project involving the relocation of existing paediatric services onto one site, the Hospital has considered the organisational governance model associated with the development of the new paediatric hospital and the running of the new hospital.
11.1 The development of the new paediatric hospital
The successful merger and the move of the existing paediatric services onto one site is critically dependent upon each of the three existing paediatric hospitals being equitably involved together with the HSE and other agencies in the development of the new paediatric hospital. The Hospital envisages the establishment of a single planning board under HSE leadership which would encourage each of the base hospitals to be enthusiastically committed to transcending their existing situation. By all working together, Ireland will have a new paediatric tertiary hospital that will be greater than the sum of the parts.
The Hospital at Tallaght has recent very successful experience of a major merger and move to a new campus which involved up to four component hospitals integrating on one campus while allowing each to engage in this with enthusiasm and institutional respect. A similar collaborative approach will be a critical success factor in developing the new tertiary paediatric hospital.
11.2 The running of the new Hospital
The new children’s hospital must have an independent identity with a separate budget. The new hospital must have independent governance and budget responsibilities comparable to other world class tertiary paediatric hospitals. This is entirely compatible with maximising the benefits of co- location and integration with all the associated benefits of association with an adult teaching hospital. The new tertiary hospital should reflect in its newly designed governance structures the great paediatric experience and values associated with the National Children's Hospital, the Children’s University Hospital, Temple Street and Our Lady's Hospital for Sick Children, Crumlin so that they successfully mould together and bring all their collective resources to bear on the new hospital and on its wider remit in outreach both in Dublin and nationally. There is a unique opportunity to apply best international standards to child health care in the new governance structures.
37 The governance of the new hospital must be inclusive as it will be the only tertiary teaching hospital in the Republic. The Hospital at Tallaght, under its Charter, alone of Irish hospitals, has a specific remit to have a multi-denominational and pluralist character which provides for each religious denomination to be fully involved in the total welfare of its patients. The new hospital has an opportunity to involve children and children's organisations in an innovative and supportive fashion.
The Hospital, as the only adult teaching Hospital to be co-located with a children’s hospital, has unique and vital experience in respecting the governance, cultures and traditions of its four partner hospitals.
38 12. Beyond McKinsey
The McKinsey report considers co-location to mean paediatrics and adult medicine on the same site, or on adjacent and linked sites.
However, this does not address the issue of high risk obstetrics and tertiary level neonatology. The Hospital's strategic plan specifically identifies the need to develop Women's and Children's care. The Tallaght Hospital site would be particularly suitable for an obstetrics and neonatology unit, thus, providing a complete mother and child hospital. The co-location with the adult hospital would greatly facilitate this development and there is space on the site to accommodate this.
Furthermore, the provision of a maternity hospital would fulfil one of the primary stated needs of the Tallaght population, as defined in the “People Living in Tallaght and Their Health” Report 2002 prepared by the Department of Community Health and General Practice, Trinity College Dublin. This is the wish of this large young population to have their babies locally. It would also offer the chance for one of the existing maternity hospitals to re-locate to a completely new and purpose built facility. The Hospital at Tallaght would work on the opportunity to extend its proven track record in the development of partnerships in such a venture.
In this regard the document from the Coombe Women’s Hospital relating to the organisation of tertiary paediatric services is particularly valuable. It stresses the increasing complexity of maternal and neonatal care. For example, between 2003 and 2005 approximately, 280 neonates per annum were transferred to Our Lady’s Hospital for Sick Children, Crumlin for tertiary medical and surgical care, the majority coming directly from maternity hospitals.
The Hospital would warmly welcome a national mother’s and children’s hospital co-located at Tallaght.
39 13. Background to the Hospital
13.1 The Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital.
The Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital and St Loman's, is a landmark development in Ireland's acute hospital services.
It is a public, voluntary, university teaching hospital and a member of the Dublin Academic Teaching Hospital's group.
The Hospital provides children's, adult, psychiatric and age-related healthcare on one campus, thus providing care from the cradle to the grave. There are 600 beds in the Hospital and almost 3,000 people are employed in it.
The hospital accommodates 20,000 inpatients annually, 20,000 day cases and 170,000 outpatient appointments.
The hospital is a provider of local, regional, supra regional and national specialities.
The hospital has a national urology centre, a national paediatric endocrinology centre, a regional dialysis centre and a regional orthopaedic trauma centre. The hospital complex is built on a 35-acre site. With the easing of local height restrictions there is ample room for expansion. The building is universally regarded as being outstandingly user friendly, both for patients and staff.
Mission statement of the hospital In accordance with the Charter of the Hospital our mission is to be a public, voluntary and teaching hospital operated in the interests of our patients in which we: o identify and meet the health care needs of the communities we serve so that our Hospital is a Hospital for everyone o provide the highest quality health care to all patients o undertake and support research in health care o educate all staff and students to the highest international standards o seek equal opportunities for each member of staff and for each student to fulfil their potential in health care o develop voluntary involvement and support for our Hospital to the maximum extent possible
40 13.2 The Merger
Planning for the Hospital began in 1981. It involved the merger of the Adelaide Hospital, the Meath Hospital and the National Children's Hospital which collectively brought together over 600 years of medical and nursing care and education from three different traditions. Subsequently, St Loman's Psychiatric hospital joined the group.
The outstanding part of this merger was that the various bodies negotiated intensively prior to the move to arrive at a charter for the Hospital, and to accommodate different beliefs and traditions. It is thus the most outstanding example of collaboration and partnership in the history of Irish healthcare. In particular, it is an example of co-location that provides care from early childhood to old age.
The Charter of the Adelaide & Meath Hospital, Dublin Incorporating the National Children's Hospital, took legal effect on the 1st of August 1996. As a Royal Charter, amended by the Health Act, 1970, it is a legally binding document that cannot be changed except with the approval of the Hospital and an Act of the Oireachtas. The Hospital is legally entitled to acquire, let and sell land.
The Hospital is defined in the Charter as a public voluntary teaching hospital.
13.3 The Charter
The Charter enshrines patient confidentiality. The Hospital is required "to promote and secure the availability, as a matter between the patient and his/her doctor, of such medical and surgical procedures as may lawfully be provided within the state".
The Charter ensures that "freedom of conscience of the free profession and practice of religion by all within the establishments operated by the Hospital are equally affirmed and guaranteed. The Hospital will therefore have a multi denominational and pluralist character". With regards to children's medicine, the Hospital is legally obliged "to promote and develop paediatric medicine and surgery in the State by developing the work here to be carried out by the National Children's Hospital and to associate all paediatric services with the name of the National Children's Hospital". "To maintain and develop the sick children's nursing within the college of nursing and to associate such sick children's nursing with the name of the National Children's Hospital". These requirements are legally binding upon the Hospital, upon the National Children's Hospital and upon the state. The case for co-locating the new Children's Hospital at Tallaght is overwhelming in its own right. Nevertheless this submission must also be seen within the context of binding legal requirements.
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13.4 Ethos and ethics
The ethos and ethics of the Hospital are substantially dealt with in the Mission Statement and in the parts of the Charter quoted. It is important to stress the importance of the confidentiality of the doctor patient relationship to the future of the practice of medicine in Ireland. Suffice it to say here that the Hospital assumes that all of its staff will behave ethically as a matter of trust and does not impose ethical preconditions upon employment. This ensures full and free access to all medically relevant information by our patients. The population of Ireland should not and would not stand for anything less.
13.5 The National Children's Hospital
The National Children's Hospital provides child and adolescent services at primary, secondary and tertiary level to the community. In some areas services are provided in conjunction with adult services, whilst always being cognisant of the special needs of children.
The National Children's Hospital and the academic department of paediatrics transferred from their inner city location at Harcourt Street onto the campus at Tallaght in June 1998. The National Children's Hospital began as an inner city hospital for children in 1821. It became a teaching hospital for Trinity College clinical students and developed tertiary services along with the two other children's teaching hospitals in Dublin.
The Hospital at Tallaght is a full-service academic teaching hospital, allied to the University of Dublin Trinity College.
The move to Tallaght led to radical changes for the National Children's Hospital. The association with the Adelaide and Meath Hospitals and being on one site has been of particular value, giving opportunities for co-operation between child and adult care. The catchment area of the National Children’s Hospital - which includes Wicklow and Kildare as well as south Dublin - presents it with many health care challenges that are determined by the demographics as well as the social and economic circumstances of the population.
The National Children's Hospital has developed significantly since arriving on the Tallaght campus. This has included the opening of four High Dependency beds in 2003 and a separate children's A&E department with an acute assessment and observation ward.
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The Hospital Charter states its aims as: "to promote and develop paediatric medicine in the State..." and "to maintain and develop sick children's nursing...to promote preventive medicine, health education and health care...".
The National Children's Hospital wishes to maintain its city and national roles as well as providing, promoting and developing the service to the local community served by the Hospital.
The Hospital mission affirms this as it desires" ...to be a public, voluntary and teaching hospital operated in the best interests of our patients..."
The Charter of the Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital gives clear statutory authority as to the nature of the National Children's Hospital as a teaching hospital and makes it clear that this will continue in the future. Indeed, any reduction in the National Children's Hospital teaching commitments is statutorily impossible. This reduction could only happen if the government of the day was able to persuade both the Dail and Seanad that a change in the Hospital Charter was both necessary and advisable.
The Charter also clearly sets out the function of the Hospital to develop sick children's nursing with the College of Nursing. The National Children's Hospital provides hospital services to the children of a local population of about 250,000, and certain national services such as paediatric endocrinology to the whole country.
In 2005, the NCH treated the following numbers of children - o 29,445 children attended A/E o 28,731 attended Outpatient clinics o 5,364 were admitted to the wards o 3681 were treated as "Day cases"
67,221 patients were seen and treated in various departments of the NCH or 1,293 in every week of the year.
43 The following services are currently provided by the National Children's Hospital. o Cardiology (outpatients) o Cystic Fibrosis o Dentistry o Dermatology o Diabetes o Endocrinology o ENT o Infectious Diseases ( to be appointed ) o Medicine o Urology o Nutrition and Dietetics o Ophthalmology o Orthopaedics o Psychiatry o Respiratory Medicine (including Cystic Fibrosis ) o Accident and Emergency o Surgery o Neurology
The total bed capacity of the National Children's Hospital is as follows: o High Dependency 3 beds o Acute Assessment 6 beds o Day beds 6 beds o Inpatient wards 58 beds
Total 73 beds
Average LOS 2.7 days Average Acute Medical LOS 2 days Average Bed Occupancy 70% Elective Admissions 15% of total
Importantly the National Children's Hospital has a Department of Education approved, children's school, a playroom and offers accommodation for parents.
44 Outreach
Outreach is a particular strength of the National Children's Hospital. There are two Consultant Community Paediatricians in the NCH. Both work within the Acute and General Paediatric setting at AMNCH and in the HSE southwest and the voluntary organisations (children with neuro disability) within this area. Service is also provided to children of organisations outside of this geographical area, particularly the East Coast area, as this area does not have a dedicated Paediatric service. Particular strengths of the NCH include Paediatric Endocrine and Diabetes services, the Emergency Department, Paediatric Respiratory Medicine including Cystic Fibrosis and Allergy, and Child Psychiatric Liaison service.
Education and Research
The National Children's Hospital is a teaching hospital of Trinity College Dublin. The National Children's Hospital holds the chair of Paediatrics of Trinity College and it is the only centre in the country recognised for European specialist training in endocrinology. All undergraduate medical students of the University of Dublin receive their paediatric education there. The Department offers a unique programme of taught masters, academic masters and doctoral awards. MD and PhD courses in paediatrics are also provided. The National Children's Hospital has a proud track record of research.
In summary, the National Children's Hospital is a vibrant example of a modern, co-located paediatric hospital with an established record of outreach services and is the provider of all paediatric medical education for the University of Dublin. With a proven track record of partnership and development, it is inescapably logical to expand this into the national tertiary paediatric centre.
45 14 Architectural Outline of Proposed new Children’s Hospital and Women’s Hospital
14.1 3 dimensional outline of proposed children’s hospital.
14.2 Architectural schematic identifying proposed new children’s hospital, proposed new maternity hospital and identifying future potential development options
46 47
48 APPENDIX 1
South Dublin County Council
Report in Response to HSE invitation to comment in respect of Proposed New Hospital for Tertiary Paediatric Services
2 March 2006
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South Dublin County Council
Report in Response to HSE invitation to comment in respect of Proposed New Hospital for Tertiary Paediatric Services
2 March 2006
We welcome the opportunity to respond to in relation to the location the proposed new children’s hospital in Dublin.
It is understood that the new hospital will replace the existing Crumlin Children’s Hospital. To put the existing Crumlin Hospital site in context, it comprises approximately 6 hectares (15 acres) and was developed during the 1950’s at what was then the south-western fringe of City, with easy access to Dublin City Centre and the main western and southwestern arterial routes. The existing Crumlin Hospital site includes buildings up to five storeys in height.
Having considered recent correspondence from the HSE dated 24 February and in particular the appendices, it is suggested that there are two options that meet the requirement for a strategically located paediatric hospital in close proximity to the existing Tallaght Hospital site within the South Dublin County Council area.
These are described as ‘Option A’ and ‘Option B’ as follows:-
Option A Option A is co-location on a site immediately adjacent to the existing Tallaght Hospital. This comprises to southeastern part of the existing Tallaght Hospital campus currently used for landscaping/surface car parking (2 hectares/5 acres approx.) together with an immediately adjoining site owned by South Dublin County Council (3 hectares/7.5 acres approx.) currently used for traveller accommodation and which is in the process of being vacated for future development.
The total developable site area is approximately 5 hectares (12.5 acres). The draft Plan for Tallaght Town centre zones the lands for core mixed use development and a hospital is permissible. A plot ratio of 1:2.0 with up to a further 20% ‘bonus’ for public realm provision i.e. up to 1:2.4 is proposed in the draft Plan. For example, this would theoretically allow up to 120,000 sq.m. (1.3 million sq.ft.) of development, which, if five storeys in height, would cover just under half the site.
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It is also of relevance that there is almost 5,000sq.m. (52,000sq.ft) vacant office space available (at ground floor level) in the ‘Exchange’ building, which immediately adjoins both parts of the available 5 hectare (12.5 acre) site. This space could be used immediately to ‘kick-start’ the new hospital project.
Option B Option B is a ‘Linked location’ on a nearby site in the vicinity (1.5- 2km/1-1.5 miles from) the existing Tallaght Hospital. This comprises open lands southeast of Newlands Cross i.e. between the N7 Dublin- Naas Road and the Belgard Road, currently in agricultural use (60 hectares/ 50 acres approx.). Whilst these lands are privately owned, they are in two principal ownerships, the larger of which is subject to IRFU control (36 hectares/90 acres approx).
These lands are zoned ‘Green Belt’ in the South Dublin County Development Plan 2004-10. This zoning permits institutional use such as a hospital. There is no requirement for a Local Plan for these lands and therefore no specified plot ratio standard, but the lands are sufficiently extensive to allow a range of building types and options for ample car parking to be considered, subject to acquisition.
The only existing development in the vicinity is the Belgard Road Fire Station. This option offers the potential of a clean, vacant, ready to go site with no significant constraints.
In view of the tight timeframe given and the priorities outlined in correspondence, both options are evaluated under the following general headings:-
1) Road Access – National 2) Road Access – Local 3) Public Transport Access – Existing 4) Public Transport Access – Planned Future 5) Adequacy of Site for Scale of Development Envisaged 6) Impact on Scope for Expansion of Existing Hospital 7) Proportion of Development possible at Ground level 8) Helipad 9) Emergency Vehicle Access 10) Car Parking 11) Waste 12) Amenities
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1) Road Access – National
Option A – Adjoining existing Tallaght Hospital Tallaght Hospital is located in the southwest of Dublin approximately 3km/2 miles south of the N7 Naas Road and 3km/2 miles west of the M50 National routes, both of which are being upgraded at present. There is direct access to within 4 - 500m of the Hospital from each of these routes via the N81 Blessington Road and the Belgard Road, both of which are dual carriageway standard.
Option B – Linked Campus at Newlands/Belgard The lands are located in the southwest of Dublin approximately 0.5- 1km south of the N7 Naas Road and 1.5-2km west of the M50 National routes, both of which are being upgraded at present. There is direct access to the site from the Belgard Road, which is dual carriageway standard.
2) Road Access – Local
Option A – Adjoining existing Tallaght Hospital Tallaght Hospital is located at the core of Tallaght Town Centre. There are more than ten points of access to the Town Centre from the adjoining road network, with a further major link from the Outer Ring Road (Embankment Road extension) at advanced planning stage.
Option B – Linked Campus at Newlands/Belgard The lands are at a pivotal location in southwest Dublin, between the M50/N7 Red Cow Interchange and Newlands Cross on the N7 Naas Road. The site is midway between the Tallaght and Clondalkin areas and there is secondary orbital access, via the Belgard Road/Fonthill Road north-south route. There is secondary arterial access from the M50 via the M50/Ballymount Road Interchange and east-west Embankment Road, located just south of the site.
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3) Public Transport Access – Existing
Option A – Adjoining existing Tallaght Hospital Tallaght Hospital is served by the Luas Red Line (2 stops) which links the site to St. James Hospital, Heuston Station, O’Connell Street, Busaras and Connolly Station. There are also frequent bus services to Dublin City Centre and suburbs en-route such as Crumlin, Tempelogue and Dolphin’s Barn as well as points further southwest such as Jobstown and Blessington. All local bus routes are focused on the Town Centre.
Option B – Linked Campus at Newlands/Belgard The site is within 500m of the Belgard stop on the Luas Red Line which provides links to Tallaght Town Centre, St. James Hospital, Heuston Station, O’Connell Street, Busaras and Connolly Station. The site is also located on the Belgard-Fonthill Road Quality Bus Corridor and 0.5- 1km from the N7 Naas Road Quality Bus Corridor (QBC). At present, limited bus services linking Tallaght and Clondalkin pass the site.
4) Public Transport Access – Planned Future
Option A – Adjoining existing Tallaght Hospital Tallaght Hospital will be served by the ‘Metrowest’, orbital metro line announced by Government in ‘Transport 21’ last November, which will link Tallaght Town Centre to Clondalkin (including the new station interchange on the main Dublin-Countrywide rail line at Fonthill Road), Liffey Valley Shopping Centre, Blanchardstown and the Airport Metro line. Metrowest will also link with the Luas red line. There are also plans to increase the number of local bus services focused on Tallaght Town Centre.
Option B – Linked Campus at Newlands/Belgard The site will be served by ‘Metrowest’, orbital metro line, announced by Government in ‘Transport 21’ last November, which will link Tallaght to Clondalkin (including the new station interchange on the main Dublin- Countrywide rail line at Fonthill Road), Liffey Valley Shopping Centre, Blanchardstown and the Airport Metro line. Metrowest will also link with the Luas red line. The site will also benefit from enhanced local/orbital rather than arterial bus services focused on Tallaght, that will utilise the emerging Quality Bus Corridor network. For example, shuttle bus services could use this network to operate between the site and Tallaght Hospital and/or Luas at Red Cow/Belgard.
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5) Adequacy of Site for Scale of Development Envisaged
Option A – Adjoining existing Tallaght Hospital An approximate site area of up to 5 hectares/12.5 acres (50,000 sq.m.) would allow for up to 120,000sq.m./1.3 million sq.ft. of development at proposed Plan densities. In reality, the configuration of the 5 hectares/12.5 acres of land that comprise option A is such that approximately 3 hectares/7.5 acres are available as one developable block mainly to the east of the existing Hospital access road and a further 2 hectares/5 acres of developable land are available mainly to the south of the existing Hospital building.
It will also be necessary to accommodate car parking (530 indicative spaces, excluding any existing spaces displaced) either at basement/deck level or in multi-storey structures. It is estimated that this would add in the region of 13-15,000sq.m. to the quantum of development required. It is not necessary for the new hospital building and car park to occupy the same contiguous area of the site, however.
It is assumed that the indicative 65,000sq.m. hospital must occupy a single site, allowing for an urban site coverage of not more than 75%. This would result in the following development options:-
3 storeys would occupy 72% of the 3ha area of the site; 4 storeys would occupy 54% of the 3ha area of the site; 5 storeys would occupy 43% of the 3ha area of the site.
Adding a further 13,000 sq.m. for expansion would mean that:-
4 storeys would occupy 65% of the 3ha area of the site; 5 storeys would occupy 52% of the 3ha area of the site.
It is therefore necessary for any new Hospital building to be initially at least 3-4 storeys in height on this site, to meet the indicative requirements and to allow for future expansion.
Option B – Linked Campus at Newlands/Belgard The urban site development constraints of building height, plot ratio and site coverage would not apply to the same extent and a building could be designed to meet optimal operational efficiency in a more open, landscaped campus setting, subject to the extent of site acquisition.
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6) Impact on Scope for Expansion of Existing Hospital
Option A – Adjoining existing Tallaght Hospital Given the configuration of available land, much of the 2 hectare/5 acre area mainly to the south of the existing Hospital building would remain available for expansion, but would be required to accommodate the car parking requirement of the new Hospital together with any displaced car parking and access etc. This would be likely to utilise at least one third of the development potential of these lands. If surface car parking is maximised, however, the development potential of this area would be used in entirety.
Option B – Linked Campus at Newlands/Belgard There would be no limitation on the scope for expansion of the existing Tallaght Hospital.
7) Proportion of Development possible at Ground level
Option A – Adjoining existing Tallaght Hospital It is estimated that not more than 25-30% of the new hospital could be constructed at ground level. This would necessitate almost all future expansion to occur above ground level.
Option B – Linked Campus at Newlands/Belgard 100% of the new hospital could be built at ground level if that were considered optimal.
8) Helipad
Option A – Adjoining existing Tallaght Hospital The site of the existing hospital helipad would be required for car parking/future expansion of the existing hospital and would be further compromised by building encroachment. There is no scope for a replacement helipad in the immediate vicinity, but there may be an option for relocation to a more suitable site to the north of the existing hospital building. This need to relocate the existing helipad is already reflected as an objective in the current South Dublin County Development Plan.
Option B This requirement could be incorporated on the site as part of the design of the new hospital and may be required to replace the existing helipad in any event.
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9) Emergency Vehicle Access
Option A – Adjoining existing Tallaght Hospital There are currently 3 x emergency vehicle access points to the existing Hospital from the adjoining road network. The site would facilitate at least one separate additional emergency vehicle access from the adjoining road network.
Option B – Linked Campus at Newlands/Belgard The strategic location of the site on the Belgard Road in close proximity to the N7/M50 National Roads, means that emergency vehicles would have direct access to multi-lane roads all of which have dedicated QBC and/or hard shoulder provision. The existing Belgard Road Fire Station is located in the vicinity for this reason.
10) Car Parking
Option A – Adjoining existing Tallaght Hospital Car parking could be provided, but would more than likely need to be in basement, decked or multi-storey structures. It may not be possible to permit car parking immediately adjacent to the new hospital building.
Option B – Linked Campus at Newlands/Belgard Ample car parking could be provided as part of the overall design, at surface level if required.
11) Waste
Option A – Adjoining existing Tallaght Hospital There are no known constraints.
Option B – Linked Campus at Newlands/Belgard There are no known constraints.
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12) Amenities
Option A – Adjoining existing Tallaght Hospital This is a town centre site with good access to a range of facilities including hotels, residential accommodation, parks, shopping, library, food outlets, theatre, cinemas etc. and the Institute of Technology Tallaght, all within close walking distance. The urban nature of the site does require a particular design approach that reflects a higher density environment.
Option B – Linked Campus at Newlands/Belgard This site is located outside but adjoining the existing built up area and would allow a more extensive landscaped setting, i.e. a campus style facility in grounds. Proximity to the road network means that there is a selection of hotels and related facilities nearby. There are also excellent public transport links to Tallaght and Dublin City Centre, which will improve further as part of the Government ‘Transport 21’ programme.
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