Dolphin Report: Assessment of hospital bids chapter

Tuesday 06 November 2012 08.54
Several sites in Dublin were considered
Several sites in Dublin were considered

The unpublished chapter of the Dolphin Report on its assessment of bids for the National Children's Hospital:

DOLPHIN REVIEW HOSPITAL RECOMMENDATIONS CHAPTER 13

The decision about the location of the new children's hospital is not a simple one.

Its needs are not only for Dublin but nationally and for its co-location with an adult hospital.

The original decision was made in 2006.

Since then, through a number of reviews and reports, there has been a consistency of opinion regarding where it should be located and what type of adult hospital it should co locate with has been the subject of debate for as many years.

It not only replaces the three existing children's hospitals in Dublin but because of its size and pivotal role will be the centre for determining the national standards of care with which we treat our children in the future.

We received many offers and suggestions of sites, the majority of which were greenfield.

Should the minister and the Government decide to choose a greenfield site, we believe that it will need to include an adult teaching hospital, requiring very substantial investment of human and capital resources to develop over time into an adult tertiary hospital, with critical mass supported by leading edge research facilities and may have ramifications in terms of zoning, planning, procurement and time.

We are of the view that co-location is essential and trilocation optimal.

It is also important to note that 70 per cent of the patients attending the hospital will come from the greater Dublin area.

Therefore, we considered only those site proposals which were supported by a Dublin academic teaching hospital (DATH).

Within that group of hospitals there are different levels of subspecialties and academic research.

In 2006, the joint task force shortlisted three hospitals - St James's, the Mater and Beaumont Hospital because of their higher levels of clinical complexity.

These hospitals are still at that higher level with St James's now having the widest range of specialties.

However, all 3 have restricted sites to varying degrees, which they have addressed in their proposals.

This is not a stand alone decision.

In making it, a balance must be struck between the clinical and research synergies that the adult hospital can bring, verses the restrictions that an established site will impose.

Our assessments of the comparative strengths and weaknesses of the 6 potential co-location sites for the new children's hospital has shown that while there is no single perfect solution, some locations are more advantageous than others.

Therefore the decision must be based on key parameters including optimal clinical and research synergies, site suitability and planning risk together with cost and time benefits.

Hospitals proposals

We considered the proposals from the hospitals which made submissions to the group.

In their indicative costs some proposals have presented significant cost savings and have included the maternity hospital within the overall budget.

The proposal for the Mater site has been significantly reworked, especially in terms of its height.

It also includes the offer of the 1861 building (a protected structure) for purposes such as research and education. This will add space but not significantly on site capacity. Whether the site is sufficiently large to accommodate a high quality maternity hospital as well as a children's hospitals remains a concern.

Should the Government choose not to go ahead with the revised Mater proposal, we strongly recommend that they take into account in their deliberations the internationally recognised clinical and research platforms that the existing adult hospitals offer and the design and planning restrictions of exact sites. Details of which are outlined in Chapter 10.

From a clinical and academic perspective we identified St James's Hospital as the existing DATH that best meets the criteria to be the adult partner in co-location because it has the broadest range of national specialties and excellent research and education infrastructure. However, the proposed St James's plan offers the smallest site for construction of the new children's hospital, albeit with greater site capacity overall (See table 1 on page 48), has some drawbacks in terms of site suitability and is not without planning risk.

The site adjacent to the Coombe is large enough to accommodate the new children's hospital and to allow design flexibility. Furthermore, corridor-linked co-location of the new children's hospital to the existing Coombe Maternity Hospital (or a new maternity hospital at St James's Hospital) can establish the maternity co-location conditions for a level 4 neonatal intensive care unit as recommended by the 2008 KPMG report.

We believe that there are a number of possible solutions that could build on the strengths of the St James's and Coombe proposals given their proximity to each other if they presented a joint plan.

From a design and planning perspective the sites adjoining Connolly and the Coombe hospital offer the best potential for future expansion and a landscape setting.

In our view the 36 hectare site on the national sports campus lands proposed by Connolly Hospital offers an attractive parkland setting and practically limitless scope for future expansion.

Access by car is excellent and existing bus services could be upgraded to meet demands.

However, Connolly Hospital would need very substantial investments of human and capital resources to develop over time into an adult tertiary hospital with critical mass supported by leading edge research facilities and even if such resources could be made available, it could take several decades to achieve such high standards of clinical and research excellence.

The proposed integration with Beaumont and RCSI and the universities would have to be accelerated.

The site at Beaumont is located in a low rise housing area and may face difficulty in gaining approval for a large building up to 10 storeys high and in any event construction of the children's hospital cannot start until the existing multi-story public car park and other buildings are rebuilt elsewhere on the campus.

The design and layout of the new hospital on the Tallaght Hospital site would be significantly constrained by the proximity of an existing apartment complex.

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