It could have been Crumlin.
The Children’s hospital was moved from the Mater to James’s not because the Mater is a bad site, it was to defer the cost of building the hospital for a decade when it would become a problem for a different government. The IMF were in town capital budgets were cut and reviewing/changing the plans suited the Fine Gael/Labour government at the time. The actual location was irrelevant to the siting of the hospital. Though it is true that if you look at the best children’s hospitals, they are all sited in city centres. The official reason for it being moved was because of An Bord Pleanála’s decision that it would be too tall and would disrupt views around the city. I don’t however thing that anyone really believed that at the time.
There was another decision made which decided that the new hospital needed to be co-located with an adult hospital so that, for teens, there would be relatively available experts in adult care, and possibly trilocated so that birthing mothers could have access to an adult hospital while neonates could access the childrens’ hospital. That was a best practice view held by experts, and from that determination a lot of things followed. Most importantly that it couldn’t be at one of the existing children’s hospitals, specifically Crumlin. Being on site with an adult teaching hospital is something that is rarely true of the best children’s hospitals, but that could have more to do with their path dependence (being around a long time and their cities growing up around them meaning that there is not room for co-location), and maybe it is true for the top 250 Children’s hospitals in the world, and that is an adequate aspiration for an island where there are 60k children being born every year.
If you’re choosing the location based on the quality of the adjacent hospital (and on the assumption its in the Greater Dublin Area) then there’s only really three options; Vincent’s, the Mater, and James’s. I don’t think that Vincent’s were that excited about the Children’s hospital (not enough private work I expect). And, that only left two good hospitals in the running, the Mater and James’s (which had been part of the Crumlin bid which was rejected previously). Given that there was a political decision made which would ensure that the new hospital would not be sited at the Mater, then James’s was where it was going to go. It could still have been put in Crumlin at that point, but having a children’s hospital be on a shared site with a good hospital seems to be of such benefit that that argument won out, despite it being the more expensive option. Or, perhaps upgrading Crumlin would have been the kind of thing that could have been done too quickly and therefore may have impinged on the DoH budgets sooner than they would have liked? There were three big costs associated with not going with the Mater, firstly there was the redesign of the hospital. Then there were the costs associated with inflation once the build began. Finally there are the financial and social costs of the Children’s Hospital being a decade late (e.g. the wild west that’s orthopedics in Temple Street which probably wouldn’t have been able to continue for as long as it has, should other experts have had eyes on what was going on).
There was a lot of extraneous discussion about cars at the time which drove talk of Connolly hospital, and while it was popularised by those that supported Connolly, it wasn’t the reason why the Mater lost the Children’s hospital. It also missed the point of a tertiary children’s hospital; It’s not for emergency care. If your kid has 40° fever that’s not for the national children’s hospital, it’s for you’re local ED. If, however, they’ve some weird mitochondrial mutation which presents every decade or so in the Irish population then it’s good to get them to somewhere where someone may have expertise in that area. And they’ll have genetics experts that can review the wider family for risk factors, have specialists on hand who may be able to complement primary treatments etc. etc.
And that’s why, essentially, the Children’s hospital needs to be Dublin; because it needs to be somewhere where there are experts, and that limits you to Dublin or Cork, and Cork is hanging in there by a thread.
This is also one of the ways in which Connolly is ruled out, it’s a general hospital (Hiqa classify it as a 3*) 3 because it is a teaching hospital and * because you shouldn’t be getting important things done there. Connolly does secondary care things – but none of the complicated stuff. The hospitals have specialised the complicated stuff because patient the outcomes are better when you specialise the complicated stuff.
If you’ve the misfortune to have a pancreatic cancer that requires you to have a whipple (where the treatment death rate varies from 1% to 15%, depending on the expertise of the team carrying it out): Do you want to get it done in Cork where they do one once a fortnight, in Vincent’s where they are a nearly everyday event, or in Tullamore where the surgeon saw it being done ten years ago during training? Similarly, if you’re having a laryngectomy, do you want to get it done in Vincent’s private (3-4/year) or James’s where there’s a Critical Care Unit (the Bennett ward) for people who are after experiencing upper GI surgery.
Connolly is a Tullamore level hospital. In the words of a consultant I know “I wouldn’t take a dog there”. Having seen the quality of care my granny got there, that seems to have been a fair assessment. RCSI is where the dumb sons of Dr’s go to so that they don’t cause too much harm.
Maybe someone could argue that we should make Connolly a good hospital. And fair comment, all hospitals ought to be as good as possible. But the HSE never does that. HSE managed hospitals are always shite. Some of the non-HSE ones are bad too but the RCSI are handing over their poorly managed hospital to the HSE. So, once that process will have been completed I think that it is fair to speculate about whether Connolly will it be more like James’s (which just this week became the only Irish Comprehensive Cancer Centre) or will it be more like a University Hospital Limerick kind of place, I suspect the latter.
But, even assuming that such a level of excellence can develop; that there is in fact a world where Connolly becomes a fully HSE managed hospital and standards improve; it is still not enough. There are around 350 beds in Connolly. The Mater and James’s are three times larger than Connolly, & Vincent’s is nearly so (depending on your views about counting in the Private hospital beds). So, building Connolly up to that scale of hospital would also involve literally building a new hospital, as well as a dedicated children’s hospital. And you’d have to staff them with new people (if you can find them) or alternatively close down the existing services in already beyond capacity hospitals to shift staff out to the new adult hospital.
The track record of the HSE isn’t great when it comes to closing down hospitals and moving them, Tallaght Hospital for example, doesn’t have service corridors. So, when they’re moving corpses to the mortuary this happens in sight of patients. When cleaning staff are moving bins around they have to go through patient areas, past trolleys, and mopping up any drippage as they go. I’m pretty sure that they don’t even have a staff canteen, so staff have to queue up with patients in Starbucks or sneak out to The Square to pick up a sandwich (when none of the have time for a lunchbreak). That place is a mess because decisions about how to build the hospital are often being made by people who do not have a clue. I know someone who was working on proposed move of the Rotunda to the Connolly site and Health Department officials were blocking things like infant MRIs being adjacent to the delivery rooms (because there were adult ones planned for another floor for outpatients). They refused space for teaching (despite it being a teaching hospital for both nurses and doctors). Doctors on call weren’t going to be allowed to have space for a fridge in the on-call room so that they could have food at night when the hospital was otherwise closed. No space was being allowed for nurses to do handovers with the incoming team after a shift. Hopefully it’ll never happen, and if you know anyone who may be getting pregnant make sure they look at going to the Rotunda instead of any of the other maternity hospitals, at least until it moves out to Connolly at some point in the 2040s.
A lot has been said about how the costs of the Children’s Hospital have overrun. The delay needs to be given priority. All the design work that had been done previously was wasted. All the legal bullshit around planning that had been solved before was reopened. That decision to delay also led to the decision to have a dual responsibility management structure where the needs assessments were being carried and decided upon by one group of people and while a different group of people were having to design those needs into plans which kept changing and then negotiate the changes with the developer. Then there’s also the fact that delaying the build meant that instead of building it during an economic downturn when there was spare capacity in the building sector it was being built at a time when we had to be importing builders to work her despite the lack of available housing. Covid inflation and Russian Gas inflation also hit the build in ways that couldn’t have been predicted, but ought to be part of the risk matrices in future, specifically that infrastructure prices become less and less certain (though with a strong upward bias) the longer you defer investment.
Furthermore, none of the organisational incentives aligned with delivering a hospital on time and on budget. My favorite one about the Children’s hospital is that they didn’t budget for IT, because the national digital health records transformation was going to be covering the costs, but the costs for that look like an overrun because they weren’t included in the original proposals (for a hospital that is going to be electronic only). But it was easy for the people pushing it to pretend that these weren’t real costs, and it was easy for the DoH to allow it to be delayed because they could delay investment in IT everywhere until after the pilot hospital is built. And then the HSE gets hacked because people are still fustering around with Windows 7 in 2022. And in the meantime everyone in the health system is wasting time on decrepit IT systems (herself was printing out handouts for her peers’ tutorial this morning because none of the seven printers were working and IT closed the ticket because the one time they phoned her back she wasn’t able to take the call, and so the department will be without printers until someone else gets frustrated enough to waste time on trying to get IT to sort them out and they’ll try and make do in the meantime). But none of those costs matter to the people who were making decisions because all they have to do is manage their budget line for the next two years before they can move to some other part of the system. Meanwhile, politically, the Children’s hospital is the Spiderman pointing meme for the government parties. If Fianna Fáil were in opposition they could say that if the govt had gone with the Mater we’d already have a hospital and at half the price, but they can’t. And Fine Gael never thought that 14 years after taking over they’d still be in power and having to catch all they problems they’d artfully deferred into the future where they were supposed to be fiscal landmines for Fianna Fáil and Sinn Féin to stumble upon.
And that’s all emphasises the worrying part about Chamber’s comments, that no one is responsible and therefore there is nothing to learn. It is like Patrick O’Donovan whining about the procurement for the Art’s Council IT service, when he was the Junior Minister for Procurement in Finance when the contract was being tendered. The contract that was taken advantage of was signed under the incoming government (which he was a also member of) but the mess is somehow left on the desk of the former Minister for the Arts who would have (correctly) had no powers to dispute a tender that was otherwise fairly awarded. No one is to blame, therefore no one is responsible, and anyway Chambers will probably have left politics by the time any of the decisions he makes on projects start experiencing over-runs.
