Presentation to Review Group Tri Located development of a National Children’s Hospital

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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
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• Schedule
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Introductions
Mr. Ian Carter
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Clinical benefits / synergies presented
Dr. John Kennedy /
Dr. Sean Walsh
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Research & Education benefits / synergies
Prof. Martina Hennessy /
Ms. Geraldine Regan
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Corporate Business Platform benefits
Mr. Brian Fitzgerald
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Capital Development
Mr. John Cooper
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Planning
Mr. Ian McGrandles
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Cost analysis / benefits
Mr. Michael Hamill
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Access
Mr. Seamus Quigley
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Summary
Mr. Ian Carter
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Q&A
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CLINICAL BENEFITS / SYNERGIES PRESENTED
Dr. John Kennedy
Chairperson
Medical Board, St. James’s Hospital
Dr. Sean Walsh
Chair of Medical Board
OLCHC
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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
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• Cross Hospital expertise: National Burns Unit
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All major burns in Ireland are treated in SJH or OLCHC
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One group of plastic surgeons.
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The paediatric unit draws heavily on the expertise of the adult
surgeons
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A stand alone paediatric unit will have insufficient case load
From this interaction a national hand surgery (traumatic and congenital)
service has developed.
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• Cleft Services
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• 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
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• Vascular Birthmarks
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• Cross Hospital Expertise: National vascular
malformation clinic at OLCHC
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− 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
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• Epidermolysis Bullosa
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• 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
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Complex Cancer Surgery in Children supported by
Specialist Cancer Services in SJH
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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)
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SJH has the largest thoracic surgery programme in the country
Cardiothoracic surgeons SJH provide expert advice and collaboration
on complex thoracic oncology.
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• Adolescent Medicine / Transitional Care
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• Transition to Adult Care
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Increasing numbers of children with chronic conditions are entering
adulthood
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15 to 20% of adolescents will require specialist care
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Transition requires planning and flexibility
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Poor processes can result in fear of the unknown, of abandonment,
problems with compliance and loss to follow-up
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Optimal results in co-ordinated specialist Adolescent Medicine
Programmes
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• Existing SJH transitional care
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Benign and malignant haematology
Cleft lip and palate
Epidermolysis bullosa (OLCHC and SJH are national centres)
Vascular anomalies
Primary immune deficiencies
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• An Example of Transitional Care at SJH
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Comprehensive haemophilia care in place at OLCHC for 1400
children with coagulation disorders
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EPR (Clintec) disease management programme hosted in
NCHCD at SJH supports OLCHC, Cork and the Coombe
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SJH holds the national budget for factor concentrates
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Transition starts at 13 years and is complete by 16
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MDT approach at SJH to long term adverse effects, e.g.
orthopaedics, hepatitis C, HIV and extensive psychological
support
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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
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• Summary of Existing Clinical Synergies
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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.
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• 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.
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• Other Tertiary Facilities to serve the NPH
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National Blood Center
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National Maxillofacial Surgery Unit and dentistry / orthodontics
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Cryobiology unit (compliance with EUTCD)
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National PET / CT facility
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National Center for Pharmacoeconomics
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Center for Molecular Diagnostics
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Largest hospital pharmacy and aseptic compounding unit in the
country
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Outpatient child psychiatry
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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
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• SJH: Summary of Key Strengths
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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.
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….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.
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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
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Education AND Research Benefits and Synergies
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An Educated competent workforce is essential to support good
outcomes for children and Adult Patients.
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Research is essential to insure that the life limiting diseases of today
can be cured or extend life in the future
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The best hospitals in the world tri-locate Clinical services education
and research.
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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
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There are efficiencies to be gained from Tri-locating on the SJH site
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There are investments and resources to be gained from this Model
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The future will be different…..
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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
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Institute for Molecular Medicine
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• Wellcome Trust HRB
Centre for Clinical Research / Centre for Advanced Medical Imaging
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• 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 _________________________________________________________________________________________
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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 ‐
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• The Eczema Gene
Irvine A et al Nature Genetics 2007
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• Our Objectives
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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
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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
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To attract the best human resources possible to paediatric research
through both philanthropic and peer review grant funding
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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
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To build our relationships with industry and with other Institutes of
Research across the city.
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CORPORATE BUSINESS PLATFORM BENEFITS
Brian Fitzgerald
Director of Finance
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• 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
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• Issues To Consider
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Scale & density of SJH campus to support NPH - Risk of Integration e.g.
child guidance, orthodontic & dental. > 70k lab tests to paediatric hospital
services
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SJH campus operational savings of €35per annum (offset legacy design
cost)
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Optimum staff retention in OLCHC, Temple Street and Coombe
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Proposal offers unique utilisation of CWIUH & OLCHC vacated properties
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Sustainable socio demographic factors within Dublin inner city
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SJH campus offers a scale of patient and family amenities
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CAPITAL DEVELOPMENT
Mr. John Cooper
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CAPITAL DEVELOPMENT
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site A
4.86 hectares
site B
1.26 hectares
47
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6 months
for demolition
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Family centred
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Managing chronic disease into adulthood
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distraction and learning
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a sense of wonder
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PLANNING
Mr. Ian McGrandles
Director
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•
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
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Complies
objective
with
zoning
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•
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
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COST ANALYSIS / BENEFITS
Mr. Michael Hamill
Director
Healy, Kelly, Turner & Townsend
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• Cost Background
•
Benchmarked against major international Hospital projects we have
been involved in such as:
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Orbis, Holland (110,000 sqm)
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High quality, maximising economies of scale
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Take advantage of the market and standardisation where possible
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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
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Prices based on 108,000m² for the National Children’s Hospital and
25,000m² for Maternity Building with potential for 32,000m² expansion
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•
Estimated Costs as follows:
National Children’s Hospital
€000
■
Building Works etc.
■
VAT
358,190
45,390
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403,580
■
Fittings(1) including VAT
80,000
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■
Total
483,580
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€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
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•
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
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403,580
94,354
80,000
■
Fittings(1) including VAT
_______
■
Total
483,580
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■
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
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TRANSPORT & ACCESS BENEFITS
Mr. Seamus Quigley
Director
Malachy Walsh & Partners
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• Transport & Access Benefits:
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St. James's Hospital (SJH) is most sustainable transport location,
compared to the other possible locations.
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Lowest car dependency & highest non-car transport use.
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Lower work-based car dependency than Dublin City and other
possible locations.
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Most convenient to high capacity, high frequency, local, regional
and national public transport.
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On-campus Luas and Dublin Bus stops. 3 Luas stops at campus
Luas: 5:30am start, 19 hours / day.
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Luas connects to Heuston, Busarus, Connolly, Spencer Dock &
Dublin Bus city centre routes - facilitates one change per
passenger.
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SJH would most support the policies of Smarter Travel, the National
Roads Authority, the National Transport Authority & Dublin City
Council (DCC).
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Dublin City Council: “high level of accessibility” by public transport.
Dublin City Council policy is “intensification” of development, to
capitalise on accessibility.
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Dublin City Council support proposed enhanced vehicle access:
upgraded Rialto access; new access on Mount Brown;
dedicated emergency ambulance access on James’s Walk.
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Upgraded Rialto access: boundary set-back + widened
traffic lanes + increased lane lengths + increased signals
green time.
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New Mount Brown access: redistribute traffic & reduce demand at
other access points.
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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.
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Dublin City Council support proposed direct pedestrian access for
Rialto & Fatima Luas stops.
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Mobility Management plan implemented with staff parking spaces &
permits to be reduced to 1/10 ratio.
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Parking: Dublin City Council support overall campus quantum, including
750 spaces for NPH, with integrated way-finding.
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ENHANCED ACCESS SUPPORTED BY DUBLIN CITY COUNCIL
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• Conclusion
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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
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enables the managed delivery of adolescent care / transition to adult
care
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creates necessary research & education synergies / facilities for
Paediatric, Adolescent, Maternity and Adult Medicine
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offers true opportunities for the creation of necessary shared services
and business corporate platform
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represents the least disruption for staff concerned
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presents the best campus location to build the National Paediatric &
Maternity Hospitals
Questions & Answers