Two months ago the Government announced the formation of hospital groups which, after the passage of new legislation, are to become self-governing hospital trusts.
The reform reflects international experience where hospital networks and campuses work ever more closely to deliver better outcomes for patients. Very simply, it is a logical response to the synergies that can be created between hospitals. Under the new structure, St James’s Hospital and the Coombe Women and Infants University Hospital form part of the same group.
Last November the Government announced St James's Hospital as the preferred location for the planned national children's hospital. However, the announcement was made in the context of St James's and the Coombe being rivals rather than partners (in relation to this process) and, up until the eve of the announcement, the Government intended locating the proposed hospital on vacant land beside the Coombe, with the project led by St James's, as reported by The Irish Times in December.
We may never know what lay behind the last-minute change but what is clear is that the Government’s original intention foreshadows the move towards hospital trusts. St James’s and the Coombe can be considered a single campus, being only 600m apart.
The key point is the need now to transform rivalry into partnership. In other words, the May 2013 decision to create hospital trusts must prompt some reflection, putting a new lens on the collaboration which can and should take place within the hospital group spearheaded by St James’s.
The Dolphin report, a study for Government to aid its decision-making on the national children's hospital which was published last year, stresses the merit of a "joint plan" coming from St James's and the Coombe. Such a joint plan would almost certainly identify the vacant land beside the Coombe for the planned hospital.
Relocation costs
At a push there are just 3.6 hectares – 8.9 acres – at St James's (St James's West) which could be redeveloped, but to reach this figure would entail extensive relocation of medical facilities; subsequent demolition; and site resolution. For the most part the land is in reasonably active use, as opposed to being vacant.
In contrast, there are 6.2 hectares (15.3 acres) of land available for development beside the Coombe (St James’s South). As well as being almost twice as large, the land here is largely vacant. Very little demolition is required and there are no relocation costs.
There are just two access points for St James’s West. The Rialto gate, on which the proposed development would centre, already suffers a great deal of congestion – but would still need to remain operational during construction. In contrast, construction and hospital access would be different at St James’s South where the site is functionally independent and has seven access points overall, allowing activity to be better managed.
St James’s West would be a live site, which imposes onerous demands: given the close proximity of existing medical procedures it would be more difficult, costly and time consuming to build at St James’s West as distinct from St James’s South.
In terms of public transport, Luas access is better at St James’s West but bus access is superior at St James’s South. A small step, such as a frequent shuttle bus to St James’s South from Heuston Station, would deliver connectivity to both Luas and mainline rail.
Critically, St James’s South has room to expand. To progress with St James’s West is essentially to turn a blind eye to all further development which would best be located in close proximity to a national children’s hospital. As Dolphin noted, the construction of a new national children’s hospital “is not a stand-alone decision”.
Unless room for expansion was to be dismissed as an irrelevant ingredient – which is simply impossible – St James’s South is the better site. Moreover, as a leading tertiary and cancer hospital in the State, it’s vital that St James’s West campus retains scope to accommodate expanded clinical and research facilities devoted to cancer: the very essence of good campus planning is that those elements which benefit most from direct proximity are located closest to each other.
The strategic advantages of locating the national children’s hospital at St James’s South also come out in the cost figures. The cost of building at St James’s West is estimated at €510 million. The projection for St James’s South is €380 million, with €20 million of this for land purchase (the site is currently controlled by Nama and Dublin City Council).
At €130 million, the saving is about 25 per cent of total costs. In large part, that accrues from less demolition, no relocation of medical facilities and more straightforward construction. Indicative plans show that the structure at St James’s South could be seven to eight storeys in height, each floor being of roughly equal area, with the large floorplates making for lower costs and better design.
The result is better for patients too; the plans show each room having natural light, for example. With far less land available a structure at St James's West would have to be taller, denser or incorporate fewer elements – or some combination of the foregoing.
Progress to date
Progress on a new children's hospital since November 2012 appears to be slow, but we should not underestimate the progress that has been made to date. During the last 10 years or so, even the idea of the State securing 15 acres of prime land for hospital development would be viewed sceptically: today, that scepticism is gone. Similarly, the composition of the hospital group to drive this project is clear: it is the group in which St James's is the pre-eminent hospital.
Now it is a question of a soon-to-be-constituted hospital trust – and the medical professionals that make it up – looking to the best interests of their patients, present and future, the national interest, and to their own best interests to deliver a world-class national children’s hospital on their combined campus.
James Nix is policy director at An Taisce – the National Trust for Ireland. email: director@antaisce.org. antaisce.org