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What the children’s hospital tells us about public sector decision-making

In planning the project, political expediency and complacency took precedence over the actual needs of children, writes Aaron McKenna.

Aaron McKenna

THE FACT THAT the new National Children’s Hospital is going ahead at all, after years of delays and much wrangling, is a net positive. Most children involved in the earliest phases of its development will be long past being eligible to enter the facility; but at least there is now an end with horror in sight instead of a horror without end in the planning.

The horror, of course, is the location of the new facility; to be built atop the cramped site of St James’s Hospital. Before James’s was selected, the Mater was the preferred option; meaning that planners for the NCH seemed highly determined to stick the facility into the most awkward spot possible.

Many campaigners, including a few who ought to know a thing or two about children’s healthcare needs like Jonathan Irwin of the Jack & Jill Foundation, have long called for the hospital to be located on a more expansive site. Connolly Hospital in Blanchardstown was Mr Irwin’s preferred, whilst some others liked Tallaght.

There are a litany of reasons why the NCH, and the proposed move of a maternity hospital to sit beside it on the same site, should happen out in somewhere like Connolly. St James’s Hospital is nestled deep inside Dublin, and from the day they break ground on the site to the day they try to land helicopters on it there will be problems related to that fact.

There is no major room to expand the site, so what you’ve got is what you’ve got. Many have complained that the building itself will be far larger and more dominating than anything around. Compromises are being made all over the shop for the location: Car parking space for staff in James’s will be cut back and still there will be a very tight premium on parking for families.

The report considering the site says rather hopefully that plans will be implemented to promote public transport access by staff and families. It seems absurd when you consider the nature of the hours the staff work or the kit that parents need to bring with them on trips to the hospital, but there you go.

Access in and out will be a problem at times given the nature of the traffic around James’s. The M50 might become a carpark at certain hours, but try making your way into a site located so deep within the capital at the same times.

Not alone will you struggle by road, but certain helicopters used by the coastguard will be unable to land at the helipad in the hospital, which will be located on the fourth floor of the building due to space constraints. The coastguard helicopters are too heavy and will have to land elsewhere for an ambulance to take the last mile – Hopefully in no traffic.

It seems that visitors to the hospital will end up with the same sort of rigmarole a wonderful mother of one told me about recently during her visits to Holles Street. A nightmare of navigation and parking creating additional undue stress at a time when peace and calm is the watchword of good outcomes.

Even simply building the damn thing will create havoc, as €700 odd million worth of construction materials and labour go into the site and become enmeshed with the daily running of the hospital that’s already there.

Oh, and there are grand plans to site the Coombe maternity hospital there too, but that hasn’t got any funding yet. Presumably they need to pay a consultant to go in and measure how many square inches they can devote to it.

Deeper issue at play

Over in Connolly, meanwhile, as Irwin has stridently pointed out, you have a 145 acre greenfield site sitting next to the M50, within 15 to 30 minutes of the exits of the radial roads leading from Dublin to the far corners of the country.

Rather than a tall building with a rooftop garden, you could just landscape fields around the place for patients and their families to enjoy. The only thing that might mire the view would be the 50-storey carpark you could build on the site and the fence around the helipad, solid concrete on solid ground that’s not going to collapse into the A&E department if you land a coastguard chopper on top.

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You could land there all day and all night without worrying about the dense residential areas you’d be required to fly over to get to James’s.

A bunch of good reasons have been elucidated as to why the NCH shouldn’t be put into a cramped city campus. I suppose the deeper issue at play here is why the planning process took so long and why we have had to deal with so much medical politicking around the whole affair.

It speaks to the dissociated nature of public sector planning: A group is set up by a Minister. Some specialists produce a report. Things don’t quite go right, it gets kicked back to touch. More reports by independent experts to throw around and eventually you get a decision. Meanwhile, years have passed; we’re still not quite clear on why such a wrongheaded decision has been made; and oh, the cost of building it has risen over all that time from €650 million to €710 million.

The actual needs of children – a quick turnaround on a quality hospital – fall down the list of priorities well behind political expediency, professional turf wars and a general sense that big government projects are never expected on time and budget anyway. It’s difficult to hold politicians accountable because the whole thing runs over multiple administrations, and anyway as they’ll say, the top men and women are on the case. It’s their fault.

As long as we continue to entertain this disassociated public planning and execution of projects, we will always have hospitals and prisons and incinerators and all the rest that go nowhere for a long time at great expense. We might consider an alternative way of handling these projects, like farming them out to firms that will take real hits on their fees if the project isn’t delivered quickly enough whilst meeting our key objectives for it. Accountability is what is needed.

Aaron McKenna is a businessman and columnist for TheJournal.ie. You can follow him on Twitter here.   

Read: The new national children’s hospital is go… but not everyone is happy about it

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