The Rotunda Hospital is the busiest maternity facility in the country, delivering over 8,700 babies a year. It also has a proud history of over 260 years.
Situated on Parnell Square, it is a well-known inner city hospital serving a wide range of patients and has a notable safety record in that no woman has died in the Rotunda in the last 20 years.
News that the Government has not spent any taxpayers' money on the long-planned move of the Rotunda Hospital to the Connolly Hospital campus in Blanchardstown, raised many eyebrows at the Joint Committee on Health this week.
That, in addition to the fact that it has been Government policy, under co-location plans for the last 11 years, for the Rotunda to move to Connolly - but nothing has happened.
No timeline
The Department of Health told the Health Committee that there is no timeline for the project and that it is some distance in the future.
Clearly, the Rotunda is now in something of a bind - no prospect in the foreseeable future of having a new hospital at Connolly, and also facing rising births at an old facility with the need for a more modern and safer environment for mothers and babies.
The Rotunda had put its hopes in a new development on-site - a €100m critical care 80-bed facility. But last week, that project faced a major setback when planning permission was overturned by An Coimisiún Pleanála.
Strategic development option
Minister for Health Jennifer Carroll MacNeill expressed extreme disappointment with the news and now the Master of the Rotunda, Professor Seán Daly, is looking at all options. These options would include a Judicial Review, or getting Government support for its project to be designated a strategic infrastructure development (SID).
These projects mean that instead of applying to Dublin County Council, the application goes directly to An Coimisiún Pleanála.
A third option of going for a scaled-down project is not really seen as viable because it would mean taking some maternity services out.
The option most favoured by the Rotunda is the strategic project classification. In this scenario, an extra 20 beds would be added to the current plan bringing the total number of maternity beds up to 100.
Key meeting with minister
A key meeting will take place next Tuesday with senior Rotunda staff, the Minister for Health and officials to discuss the next steps. The Rotunda view the Minister, who has visited the hospital three times, as being very supportive.
Sinn Féin's Health Spokesperson David Cullinane said that if the priority is to develop the new critical care unit at the Rotunda, then it does not make sense to go ahead with the move to Connolly Hospital.
He criticised the Department of Health approach as being "wishy-washy", with a "pie in the sky" plan and said they needed to accept the move to Connolly was never going to happen, especially as not a penny has been spent on a Government policy project after 11 years.
Opposition parties want clarity on what the Government's position is now - if it remains co-location at Connolly, that could raise difficulties in any judicial review of the rejection of planning permission for the development at the Rotunda.
Links with the Mater
Connolly Hospital is not a 'Level 4' facility, however the nearby Mater University Hospital is. There have been shared consultants between the Mater and the Rotunda for decades (a Level 4 hospital is a major teaching hospital, that deals with complex, specialist care. It provides a 24/7 emergency department and takes referrals from around the country).
A Government decision, to clarify that its co-location policy is now that the Rotunda will co-locate with the Mater, would be seen as a very helpful move by the Rotunda.
Other projects are also planned for Connolly, and there is a concern that when they are built, there would not be enough space for a Rotunda move in any event. Many of those involved do not believe the Rotunda will ever go to Connolly.
The current health service priorities are: getting the new National Children’s Hospital completed and opened; progressing the move of the National Maternity Hospital to the St Vincent’s University Hospital site (tenders for the construction are being assessed); plus upgrading the Limerick University Maternity Hospital.
The Department of Health said this week it was restricted by the current capital funding envelope in terms of the Rotunda move to Connolly.
Given the experience of building the new National Children’s Hospital, it could be 10-20 years or more before the Rotunda might open at Connolly. That has to be a factor given the growing demand for services in Dublin maternity services, and a rising population.
Risks with uncertainty
Such uncertainty in the area of future women's health and maternity care poses risks.
The HSE Chief Clinical Officer, Dr Colm Henry, has said that Ireland’s maternity population has changed significantly over the past decade.
Families are starting later, clinical complexity has increased, and services now support a more diverse population.
He said that rising maternal age, higher Body Mass Index, underlying health conditions and the introduction of a public fertility service might further increase complexity and demand.
Demands for clarity
The Labour Party's Health Spokesperson Marie Sherlock said that the HSE and the Minister for Health, at a minimum, must clarify the current co-location policy in relation to the Rotunda.
She noted that clinical structures between the nearby Mater University Hospital and the Rotunda are intensifying and that co-location is essentially happening there.
Deputy Sherlock said there has to be clarity on the short, medium and long-term future of the Rotunda.
While the State has paid no money for the Rotunda-Connolly hospital project, the Rotunda itself did pay out over €804,000 between 2016-2018 from its own reserves as a voluntary hospital.
This included a design brief-activity model and project office pay and non-pay costs, according to the response to a parliamentary question last June put in by the leader of the Green Party, Roderic O' Gorman.
The challenge faced by the Rotunda now is how does it meet the immediate and medium-term needs of women and children at its current site. Also, how can it develop the infrastructure needed as quickly as possible.
A Judicial Review by the hospital master is a decision for him being the applicant in this case. The Government has signalled it wants to see the number of judicial reviews on planning cases reduced as they are costly and can also delay projects for a long time.
Intense discussions lie ahead next week between the Master of the Rotunda and the Minister for Health, and senior health officials, on how to resolve this urgent matter.
Clarity is needed quickly on what the real plan is for the Rotunda, so that expectant mothers and staff know where its future lies.
