A serious shortfall in public information that needs to be remedied soon

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Denis Doherty
Denis Doherty

Denis Doherty looks at the saga of the new National Children’s Hospital.

A luxury hotel, owned by Richard Branson, opened in Mallora recently. That hotel project took twenty years to complete but the wait has been judged to have been worthwhile. Let’s hope our National Children’s Hospital (NCH) is favorably judged whenever it opens. The fact remains though that, due to the length of time the project has taken to date, many children have been deprived of services they ought to have received when they needed them.

The early experience of the NCH contained the portents of things to come. Thirteen years elapsed between the time the suggestion of a single children’s hospital was mooted by the RCPI in 1993 and a recommendation, in a McKinsey report, that the solution should be a single national children’s hospital, into which the three existing children’s hospitals in Dublin would be merged. The fact that the NCH will, by definition, be a provider of services to all the children of the State didn’t prevent Tip O’Neill’s assertion that ‘all politics is local’ being experienced, by the way the tug-o-war that took place between vested interests claiming the hospital should be built on a particular site in Dublin. Two Chairpersons of the development board resigned during that wrangle. The Mater Hospital became the preferred site, but the planning application for the site was refused in 2012. As a result, more time was lost and costs of €35 million incurred had to be written off.

Despite the reservations of many that the next proposed site, on the campus of St. James Hospital, was too small, planning permission for the proposed development there was granted in 2016. Construction commenced soon afterwards.

Almost from the start, it seemed that the relationship between contractor and client was an uneasy one. A two- phase contracting approach appeared to be a complicating factor also. Given that the NCH is the largest public sector capital project in the history of the State, a strongly professional client/contractor relationship would have been desirable, but instead their many differences became the subject of public discussion.

Hopefully the enhanced financial and project management arrangements put in place recently will enable the hospital to be completed and handed over with fewer delays than has been the experience up until now. Even if another capital project on the scale of the NCH is unlikely in the near future and especially in the healthcare sector, public opinion will demand that all aspects of the NCH experience is evaluated, the lessons learned and incorporated in all future capital project plans.

There has been such inordinate media and political coverage of issues relating to delays and client /contractor relationships that the intended benefits of the new children’s hospital have been largely overlooked. What coverage there has been could be viewed as being of the ‘if you have to say something, say nothing’ variety. Promises that it will be a world-class hospital catering for 25% of our population is to be hoped for but just what does that mean? Surely there ought to be engagement with interested stakeholders and members of the general public throughout the State for the purpose of explaining what the new paediatric acute care services will look like, the criteria that will guide where secondary care services will be delivered and the policies and arrangements that will ensure that the serious shortcomings in existing arrangements that have failed many children will be overcome.

The NCH will be an important public hospital. World-class hospitals tend to be expensive because they need to keep up to date with developments in research, technology, service delivery and, increasingly in the future, artificial intelligence. What are the estimated additional revenue costs of our new and vitally necessary new hospital?

If claims such as ‘world class’ are to be judged as more than just a slogan then external validation will be required. We know we have many world-class employees in our health services and teams that are world class too. However world-class status needs to be earned, demonstrated and not just claimed.

There is a new hospital in Denmark that is interesting in that context. Construction work on the new Arhus University Hospital commenced in 2012 and was completed in 2018. It is attracting much favorable media coverage and claims to be already one of the leading hospitals in the world. (That claim is based on being ranked number 24 out of 2,300 in Newsweek’s annual ranking of 2,300 hospitals in the world) I am not aware of the significance, if any, that can be attributed to that claim, but it is the basis on which that hospital’s claim of world class is based. It appears that six hospitals were merged to form the new hospital, which has been ranked Denmark’s best hospital annually since 2018.The volume of information available on the services being provided and their plans for the future are impressive. Their management of beds appears to be innovative and is attracting favorable attention, even in the popular press.

An Internet search in relation to our new hospital produced very little information in relation to the service provision era of the hospital. That appears to me like a serious shortfall in public information that needs to be remedied soon.