Presentation to Review Group Tri Located development of a National Children’s Hospital
_________________________________________________________________________________________ Presentation to Review Group Tri Located development of a National Children’s Hospital and Maternity Hospital on the St. James’s Hospital Campus 17.05.12 _________________________________________________________________________________________ _________________________________________________________________________________________ • Schedule - Introductions Mr. Ian Carter - Clinical benefits / synergies presented Dr. John Kennedy / Dr. Sean Walsh - Research & Education benefits / synergies Prof. Martina Hennessy / Ms. Geraldine Regan - Corporate Business Platform benefits Mr. Brian Fitzgerald - Capital Development Mr. John Cooper - Planning Mr. Ian McGrandles - Cost analysis / benefits Mr. Michael Hamill - Access Mr. Seamus Quigley - Summary Mr. Ian Carter - Q&A _________________________________________________________________________________________ _________________________________________________________________________________________ CLINICAL BENEFITS / SYNERGIES PRESENTED Dr. John Kennedy Chairperson Medical Board, St. James’s Hospital Dr. Sean Walsh Chair of Medical Board OLCHC _________________________________________________________________________________________ _________________________________________________________________________________________ • SJH / OLCHC existing synergies OLCHC provides 80% of paediatric tertiary care in Ireland - Paediatric Consultants - Neonatal Consultants - Adult Consultants SJH is the largest adult hospital in Ireland Many OLCHC consultants / specialists have joint adult appointments in SJH Extensive collegial support provided by SJH Co-location with SJH will provide the best available care for children and adolescents _________________________________________________________________________________________ _________________________________________________________________________________________ • Cross Hospital expertise: National Burns Unit - All major burns in Ireland are treated in SJH or OLCHC - One group of plastic surgeons. - The paediatric unit draws heavily on the expertise of the adult surgeons - A stand alone paediatric unit will have insufficient case load From this interaction a national hand surgery (traumatic and congenital) service has developed. _________________________________________________________________________________________ _________________________________________________________________________________________ • Cleft Services _________________________________________________________________________________________ _________________________________________________________________________________________ • Map of care in cleft lip and palate Birth 1 year 8 years 12 years 18+ years Diagnosis Airway Feeding Speech and Language Hearing Dental care Orthodontics and dental reconstruction Lip repair 3 months Palate 9 months Speech surgery Alveolar bone graft Jaw surgery Final revisions _________________________________________________________________________________________ • Vascular Birthmarks _________________________________________________________________________________________ • Cross Hospital Expertise: National vascular malformation clinic at OLCHC ________________________________________________________________________________________ − Two consultant dermatologists shared with SJH − Two consultant plastic surgeons shared with SJH − Interventional radiologist employed 100% by SJH provides treatment in OLCHC − Consultant vascular surgeon employed 100% by SJH provides consultation − ENT surgery joint appointment with SVH _________________________________________________________________________________________ _________________________________________________________________________________________ • Epidermolysis Bullosa _________________________________________________________________________________________ _________________________________________________________________________________________ • EB Multidisciplinary team Paediatrician EB Liasion Nurse Gastroenterologist Plastic Surgeon Endocrinologist Occupational therapy ENT Physician Ophthalmologist Physiotherapist Medical social worker Dental Surgeon Orthopaedic Dietician Haematologist Psychologist Dermatologist _________________________________________________________________________________________ Complex Cancer Surgery in Children supported by Specialist Cancer Services in SJH - Head and neck cancer (ENT, maxillofacial and Plastic Surgery) Sentinel lymph node biopsy (Plastic Surgery and Radiology at SJH) Complex thoracic oncology (Cardiothoracic surgery service in SJH) - SJH has the largest thoracic surgery programme in the country Cardiothoracic surgeons SJH provide expert advice and collaboration on complex thoracic oncology. _________________________________________________________________________________________ _________________________________________________________________________________________ • Adolescent Medicine / Transitional Care _________________________________________________________________________________________ _________________________________________________________________________________________ • Transition to Adult Care - Increasing numbers of children with chronic conditions are entering adulthood - 15 to 20% of adolescents will require specialist care - Transition requires planning and flexibility - Poor processes can result in fear of the unknown, of abandonment, problems with compliance and loss to follow-up - Optimal results in co-ordinated specialist Adolescent Medicine Programmes _________________________________________________________________________________________ ________________________________________________________________________________________ • Existing SJH transitional care - Benign and malignant haematology Cleft lip and palate Epidermolysis bullosa (OLCHC and SJH are national centres) Vascular anomalies Primary immune deficiencies _________________________________________________________________________________________ _______________________________________________________________________________________ • An Example of Transitional Care at SJH - Comprehensive haemophilia care in place at OLCHC for 1400 children with coagulation disorders - EPR (Clintec) disease management programme hosted in NCHCD at SJH supports OLCHC, Cork and the Coombe - SJH holds the national budget for factor concentrates - Transition starts at 13 years and is complete by 16 - MDT approach at SJH to long term adverse effects, e.g. orthopaedics, hepatitis C, HIV and extensive psychological support _________________________________________________________________________________________ ________________________________________________________________________________________ Irish • 400 children with homozygous SCD since 2000 • Vast majority live in Dublin inner city • Comprehensive care in place @ OLCHC • This cohort beginning to transition to SJH. • SJH fully equipped to provide services ________________________________________________________________________________________ ________________________________________________________________________________________ • Summary of Existing Clinical Synergies - Malignant diseases, both solid and haematologic National Adult Bone Marrow Transplant Unit Benign Haematology, e.g SCD National Center for Hereditary Coagulation Disorders Cardiothoracic surgery. Clinical Dermatology, including epidermolysis bullosa and other congenital disorders National Adult Burns Unit Clinical Immunology Laser service. _________________________________________________________________________________________ ________________________________________________________________________________________ • An example of future synergies: Radiation Oncology - Currently OLCHC anaesthetist and child travel to St. Luke’s for radiation therapy under general anaesthesia - Inconvenient for sick child (twice daily) - Poor use of anaesthesia time being off site - This would not change with other sites - SJH offers on-site linear accelerators and an ideal solution for these children. _________________________________________________________________________________________ _________________________________________________________________________________________ • Other Tertiary Facilities to serve the NPH - National Blood Center - National Maxillofacial Surgery Unit and dentistry / orthodontics - Cryobiology unit (compliance with EUTCD) - National PET / CT facility - National Center for Pharmacoeconomics - Center for Molecular Diagnostics - Largest hospital pharmacy and aseptic compounding unit in the country - Outpatient child psychiatry _________________________________________________________________________________________ _________________________________________________________________________________________ TERTIARY HOSPITALS TEND TO PROVIDE SUB SPECIALISTS IN AT LEAST 27 “CORE” SUB SPECIALTIES Medical Surgical Anaesthetics Cardiothoracic surgery Cardiology Endocrinology General Medicine Genetics Haematology ENT surgery Gastroenterology / GI / hepatobiliary surgery General surgery Neurosurgery Immunology Orthopaedic surgery Infectious Diseases Transplant surgery Intensive Care Urology Neonatology Nephrology Neurology Oncology Ophthalmology Pathology ‘Children’s Health First. International Best Practice in Tertiary Paediatric Services: Implications for the Strategic Organisation of Tertiary Paediatric Services in Ireland’ McKinsey and Company Inc. February 2006 Radiology Respiratory Rheumatology Microbiology & Clinical Chemistry _________________________________________________________________________________________ _________________________________________________________________________________________ • SJH: Summary of Key Strengths - An unparalleled array of secondary, tertiary and quaternary services for children and adults Core National specialties and facilities Existing experience with transition to adult services for adolescents with chronic conditions Extensive on-site core research facilities and programmes. _________________________________________________________________________________________ _________________________________________________________________________________________ ….As one of our experts put it, “children don’t fit neatly into one subspecialty. If you’re going to treat one [complex child] you need to have all the sub specialists and the whole multidisciplinary team there to provide care. Breadth with volume allows development of depth which is almost universally associated with improved outcomes.” ‘Children’s Health First. International Best Practice in Tertiary Paediatric Services: Implications for the Strategic Organisation of Tertiary Paediatric Services in Ireland’ McKinsey and Company Inc. February 2006. _________________________________________________________________________________________ ________________________________________________________________________________________ RESEARCH and EDUCATION BENEFITS / SYNERGIES PRESENTED Geraldine Regan Deputy CE / Director of Nursing, Our Lady’s Children’s Hospital, Crumlin. Associate Professor, UCD School of Nursing, Midwifery and Health Systems Martina Hennessy Director of Undergraduate Teaching Associate Professor School of Medicine Trinity College Dublin Alan Irvine Consultant Dermatologist Our Lady’s Children’s Hospital, Crumlin, St James’s Hospital Associate Professor School of Medicine Trinity College Dublin _________________________________________________________________________________________ • Education AND Research Benefits and Synergies • An Educated competent workforce is essential to support good outcomes for children and Adult Patients. • Research is essential to insure that the life limiting diseases of today can be cured or extend life in the future • The best hospitals in the world tri-locate Clinical services education and research. • Education and Research can be enhanced by tri-locating the new NPH with St James’s and a Maternity Hospital. To become a leading centre for Education and Research Nationally • There are efficiencies to be gained from Tri-locating on the SJH site • There are investments and resources to be gained from this Model _________________________________________________________________________________________ _________________________________________________________________________________________ • The future will be different….. _________________________________________________________________________________________ • Supporting Research Infrastructure Nutrition /Dietetics Cardiovascular Science Clinical and Molecular Oncology (AUCMO) St James’s Hospital DCCR School of Medicine John Durkan ICRIN Eurolife IMM TILDA Centre for Successful Ageing Research Labs Mercer’s Institute of Research on Aging Sir Patrick Duns Translational Labs _________________________________________________________________________________________ Institute for Molecular Medicine _________________________________________________________________________________________ _________________________________________________________________________________________ • Wellcome Trust HRB Centre for Clinical Research / Centre for Advanced Medical Imaging _________________________________________________________________________________________ _________________________________________________________________________________________ • Educational Capacity Existing Supporting Infrastructure 3 lecture Theatres 3 clinical Skills labs 23 Seminar Rooms Medical Undergraduates 2 Teaching labs 700 Health and Social Care Placements 350 PG MSc /PhD 500 Nursing Undergraduate Placements 1200 Potential infrastructure Simulation Work Place learning Environments National Family Education Centre _________________________________________________________________________________________ • Local and National Synergies Maternal Care Community Care Hub for Education and Research in Child/Maternal Health Hub for Education and Research in Adult Health Children’s Health Shared National Resource Nursing and HSCP’s Education Neonatal Care Transitional Care Development of a Nationally networked Family Resource Education Centre ‐ _________________________________________________________________________________________ _________________________________________________________________________________________ • The Eczema Gene Irvine A et al Nature Genetics 2007 _________________________________________________________________________________________ • Our Objectives - To invest in and increase academic synergies between paediatric, adolescent, and adult medicine for the benefit of our sick children, teenagers and adults and families - To utilise existing technology platforms at the Institute of Molecular Medicine and at the Centre for Advanced Medical Imaging and to develop new technology platforms to position Dublin and the NPH at the cutting edge of international paediatric research - To attract the best human resources possible to paediatric research through both philanthropic and peer review grant funding - To attract the best international Medical students and graduates to Dublin, drawn by excellence in paediatric research-led practise To train our paediatric trainees to the highest possible level - To build our relationships with industry and with other Institutes of Research across the city. _________________________________________________________________________________________ ________________________________________________________________________________________ CORPORATE BUSINESS PLATFORM BENEFITS Brian Fitzgerald Director of Finance _________________________________________________________________________________________ _________________________________________________________________________________________ • SJH Campus Performance & Health System Support •Long established contemporary business & operational processes - Which is scalable across the Health system •Over a decade of successful financial and operational management •Leading on national initiatives e.g. financial & hr management, patient level costing, electronic health insurance claims, the latter two initiatives are key building blocks toward universal health insurance •Philanthropy and research grants significant successes •Integration of five hospitals onto the SJH campus •Lead on clinical directorate implementation with a focus on tertiary and quaternary services _________________________________________________________________________________________ _________________________________________________________________________________________ • Issues To Consider - Scale & density of SJH campus to support NPH - Risk of Integration e.g. child guidance, orthodontic & dental. > 70k lab tests to paediatric hospital services - SJH campus operational savings of €35per annum (offset legacy design cost) - Optimum staff retention in OLCHC, Temple Street and Coombe - Proposal offers unique utilisation of CWIUH & OLCHC vacated properties - Sustainable socio demographic factors within Dublin inner city - SJH campus offers a scale of patient and family amenities _________________________________________________________________________________________ ________________________________________________________________________________________ CAPITAL DEVELOPMENT Mr. John Cooper _________________________________________________________________________________________ ________________________________________________________________________________________ CAPITAL DEVELOPMENT _________________________________________________________________________________________ _________________________________________________________________________________________ 39 _________________________________________________________________________________________ ________________________________________________________________________________________ _________________________________________________________________________________________ 41 _________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 45 ________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ site A 4.86 hectares site B 1.26 hectares 47 ________________________________________________________________________________________ 6 months for demolition 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PLANNING Mr. Ian McGrandles Director _________________________________________________________________________________________ ________________________________________________________________________________________ • Planning - Complies with core strategy of Development Plan and the policies of the plan that recognise the importance of health facilities in maintaining a sustainable city - City Development Plan policy recognises the strategic role of the hospital complex in the city and supports intensification of use of site - Complies objective with zoning _________________________________________________________________________________________ _________________________________________________________________________________________ • Planning - Building height policy considerations - Co-located hospital planning permission - Benefits from existing well developed public transport network - Outline Development Control Plan - Liberties Local Area Plan - Significant planning issues - Height, scale, form and mass of the proposed building(s); impact on established character of the local area; intensification of use of the overall site; traffic and parking _________________________________________________________________________________________ _________________________________________________________________________________________ COST ANALYSIS / BENEFITS Mr. Michael Hamill Director Healy, Kelly, Turner & Townsend _________________________________________________________________________________________ _________________________________________________________________________________________ • Cost Background • Benchmarked against major international Hospital projects we have been involved in such as: - Orbis, Holland (110,000 sqm) • High quality, maximising economies of scale • Take advantage of the market and standardisation where possible • Design and budget reflective of restricted public purse • Costs reflect excellent Net to Gross floor area ratios and external wall/floor ratio therefore providing Value for Money design • Prices at May 2012 price levels • Prices based on 108,000m² for the National Children’s Hospital and 25,000m² for Maternity Building with potential for 32,000m² expansion _________________________________________________________________________________________ _________________________________________________________________________________________ • Estimated Costs as follows: National Children’s Hospital €000 ■ Building Works etc. ■ VAT 358,190 45,390 ________ 403,580 ■ Fittings(1) including VAT 80,000 _______ ■ Total 483,580 _______ €000 €484,000 (1) Allowance for Equipment Note: Building Works include, site preparation, demolition works, new building, underground car park, external roads, paving, landscaping, fees and capital contributions and levies _________________________________________________________________________________________ • Estimated Costs as follows: National Children’s Hospital Maternity Building €000 ■ Building Works etc. ■ VAT ■ Fittings(1) including VAT €000 358,190 ■ Building Works etc. 83,875 45,390 ■ VAT 10,479 ________ _______ 403,580 94,354 80,000 ■ Fittings(1) including VAT _______ ■ Total 483,580 _______ ■ Total 119,354 _______ €000 _______ €484,000 (1) Allowance for Equipment Note: Building Works include, site preparation, demolition works, new building, underground car park, external roads, paving, landscaping, fees and capital contributions and levies 25,000 €000 (1) 120,000 Allowance for Equipment _________________________________________________________________________________________ _________________________________________________________________________________________ TRANSPORT & ACCESS BENEFITS Mr. Seamus Quigley Director Malachy Walsh & Partners _________________________________________________________________________________________ _________________________________________________________________________________________ • Transport & Access Benefits: - St. James's Hospital (SJH) is most sustainable transport location, compared to the other possible locations. - Lowest car dependency & highest non-car transport use. - Lower work-based car dependency than Dublin City and other possible locations. - Most convenient to high capacity, high frequency, local, regional and national public transport. - On-campus Luas and Dublin Bus stops. 3 Luas stops at campus Luas: 5:30am start, 19 hours / day. - Luas connects to Heuston, Busarus, Connolly, Spencer Dock & Dublin Bus city centre routes - facilitates one change per passenger. _________________________________________________________________________________________ _________________________________________________________________________________________ - SJH would most support the policies of Smarter Travel, the National Roads Authority, the National Transport Authority & Dublin City Council (DCC). - Dublin City Council: “high level of accessibility” by public transport. Dublin City Council policy is “intensification” of development, to capitalise on accessibility. - Dublin City Council support proposed enhanced vehicle access: upgraded Rialto access; new access on Mount Brown; dedicated emergency ambulance access on James’s Walk. - Upgraded Rialto access: boundary set-back + widened traffic lanes + increased lane lengths + increased signals green time. _________________________________________________________________________________________ _________________________________________________________________________________________ - New Mount Brown access: redistribute traffic & reduce demand at other access points. - Dublin City Council support dedicated Quality Bus Corridor for bus route through hospital, with increased capacity – connects to city centre and all Dublin Bus and intercity routes. - Dublin City Council support proposed direct pedestrian access for Rialto & Fatima Luas stops. - Mobility Management plan implemented with staff parking spaces & permits to be reduced to 1/10 ratio. - Parking: Dublin City Council support overall campus quantum, including 750 spaces for NPH, with integrated way-finding. _________________________________________________________________________________________ _________________________________________________________________________________________ ENHANCED ACCESS SUPPORTED BY DUBLIN CITY COUNCIL _________________________________________________________________________________________ _________________________________________________________________________________________ • Conclusion - - Construct proposed today is believed to be: accessible - for Dublin / Ireland buildable - site fit - timely delivery - cost effective delivers on the majority of require clinical synergies necessary to effect bi-location and tri-location - enables the managed delivery of adolescent care / transition to adult care - creates necessary research & education synergies / facilities for Paediatric, Adolescent, Maternity and Adult Medicine - offers true opportunities for the creation of necessary shared services and business corporate platform - represents the least disruption for staff concerned - presents the best campus location to build the National Paediatric & Maternity Hospitals Questions & Answers
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