THE INDEPENDENT EXPERT who flagged “major generic faults” with the ventilation systems installed in half of the New Children’s Hospital operating theatres is no longer involved in the project and a new firm is to be contracted to sign-off on the systems, The Journal understands.
Malcolm Thomas from STS Consultancy and his colleagues were contracted to act as the validator for ventilation systems in the hospital when the project commenced, meaning they were monitoring progress in order to later sign off on the systems and deem the operating rooms fit for use.
STS repeatedly flagged design “faults” in the theatre’s ventilation which the firm believed could possibly pose a risk to patients down the line.
Ventilation systems for healthcare settings are designed to reduce the amount of airborne bacteria in the operating room in order to reduce the risk of children becoming infected with surgical site infections (SSI).
These infections can result in vulnerable and sick children and infants requiring longer hospital stays and, in some cases, further surgical interventions.
An expert with decades of experience in the field, Thomas wrote the regulation guidelines for healthcare ventilation systems which are used by the NHS in England. These guidelines, which are designed to reduce the incidence of SSIs in operating theatres, are also used as the benchmark for compliance by the HSE in Ireland.
‘Disappointing’ progress
In documents seen by The Journal, Thomas’s consultancy firm wrote to Children’s Health Ireland (CHI) in November 2022 after carrying out a second on-site inspection at the Dublin 8 site, informing them that progress on issues previously raised in relation to 11 operating theatres at the hospital had been “particularly disappointing”.
STS said that if these issues were not resolved, the ventilation systems would end up being deemed non-compliant with regulations and the theatres would be deemed not fit for purpose for children’s operations to take place.
The key problem was that many of the theatre air supply diffusers were positioned close to the theatre walls, which Thomas and his colleagues said would “compromise” air distribution.
They wrote that “to make a bad situation worse” some of the theatres had air supply terminals directly above extraction terminals, which would result in the room’s air supply “short circuiting”, something he flagged as “not acceptable”.
At the time, STS said that the longer these issues took to resolve, “the more expensive and time consuming” they would become to fix.
In a row in the Dáil last year, during which Sinn Féin leader Mary Lou McDonald read excerpts from leaked STS inspection reports, her party warned that the design faults in the theatres would cost “tens of millions” to fix, and could delay the opening of the hospital.
In its November 2022 correspondence, STS warned: “If the present approach to the installation of the ventilation systems serving the critical areas in this hospital is not corrected, the systems will fail the final validation and not be fit to be taken into use”.
After a brief stop on works on the theatres as a result of STS’s concerns, works resumed.
The Journal understands that Thomas and his colleagues returned to carry out another site inspection in autumn of last year.
It is further understood that at that time several of the issues identified by the firm remained unresolved.
Since then, the National Paediatric Hospital Development Board (NPHDB) has had no further contact with the consultancy firm, and it is understood that a different team will be assessing the ventilation systems in the operating theatres at the final validation stage.
This team will still be using the guidelines written by Thomas as the benchmark for compliance in its assessment.
The hospital’s board has told The Journal that responsibility for commissioning the operating rooms in accordance with the standards outlined in Thomas’s guidelines lies with BAM, the contractor.
The board said that it began a “due diligence” process with its design team and STS in 2017, and that in the course of this process STS flagged its concerns in relation to the operating theatres.
A spokesperson for the board clarified that while the due diligence process is ongoing, the board currently “has no contract with STS”.
The NPHDB spokesperson said that BAM and its subcontractors were instructed to engage in a review, which was to establish the cost, time, and work that would be involved in moving the ventilation grilles in 11 operating theatres.
They said that the review was completed “but not taken forward”, and that the “agreed option” is to replace the current type of ventilation grilles used in the theatres while leaving them in their current positions.
The board’s spokesperson said that this option has been “demonstrated” to be “in full compliance” with Thomas’s guidance. However, the board has not clarified who has verified this.
The spokesperson said that the NPHDB “will be contracting with an independent validator” at a later date, noting that it “in association with CHI will fully deliver compliant operating theatres”.
They added: “The building works to the operating theatres are not yet complete and it is expected final validation will not occur until close to Substantial Completion.”
The NPHDB has not answered follow-up questions on how much BAM estimates it would cost or how long it would take to move the ventilation grilles.
The hospital’s board, the Minister for Health and the Taoiseach have all stated at various points that the issues with the operating theatres would not further delay the opening of the Children’s Hospital, and the board has maintained that the cost of any required fixes would not be in the tens of millions, as claimed by Sinn Féin.
The National Paediatric Hospital Development Board was appointed in 2013 to build and equip the new hospital. Planning permission for the project to take place on the St James’s Hospital campus was later granted in 2016. On completion, the hospital will be handed over to CHI which will oversee its day-to-day operation.
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