(Monday, 24th Nov, 2014)
Tallaght Hospital - planning for the future
By Niall Hunter - Editor
Tallaght Hospital is pressing the Government to set up two major children's hospitals in Dublin, instead of just the one on the Mater site, as is currently planned.
Tallaght Hospital in Dublin
Michael Lyons, Chief Executive of Tallaght Hospital, said it is difficult to reconcile a city that is heading for a population of two million having only one paediatric institution.
Tallaght Hospital,which currently houses the National Children's Hospital (formerly based at Harourt Street) was one of the unsuccessful applicants for the single Dublin children's hospital in the recent tendering process which was won by the Mater.
In an interview with irishhealth.com, Mr Lyons said it is Tallaght's view that there should be a single governance-twin campus solution to the provision of paediatric care in Dublin.
"The governance arrangements for the new hospital should cover one hospital for the north city and another for the south city to deliver the paediatric needs for the metropolitan area."
Mr Lyons said both hospitals could have tertiary (high-tech) specialties but both need not have very 'high order' tertiary care, such as lung transplants.
"We have communicated our proposal to Government and it is a decision for them to take. Even if Tallaght had been chosen as the site for the new hospital, the same issue would have emerged for services in north Dublin . You cannot run services in isolation from geography, transport systems etc."
Mr Lyons said it had to be borne in mind that the new children's hospital will not be serving Dublin now but for the next 50 years.
"The Government's decision was made in the best interests of paediatric care, which we accept, but we are seeking to amend the decision."
He said if the Government goes ahead with the Mater-only plan, acute services at Crumlin and Tallaght will close, although there may be plans to maintain some type of A&E services on other sites.
In the interview, Mr Lyons said Tallaght had tried to buy Mount Carmel Hospital to acquire extra bed space, wants a maternity unit built on its site and that the number of patients waiting on trolleys in its busy A&E has been reduced dramatically in recent months.
"Tallaght is the busiest A&E in Ireland, north or south. We recently opened a transition suite in A&E and that has had a significant impact on the A&E trolley waits."
The transition suite, Mr Lyons said is not a 'holding area' but anyone with a predicted length of stay of less than five days can go into it from A&E or as an emergency admission from outpatients.
He said the suite has resulted in significant reductions in the hospital's trolley figures. Tallaght is also taking other initiatives to reduce the pressure on its emergency department, including looking at lengths of stay and any bottlenecks in admissions or treatments that may arise.
"For example, we would look at the timing of doctors' rounds, lack of funding in specific areas, equipment problems. We have a major block at present with radiology services. Our CT scanner is in need of replacement and we have been approved for a new one. Our digital radiology system needs an upgrade as well. We have also applied for three new radiologists under the Winter Initiative. A new multidisciplinary discharge team has been put in place to speed up discharges. Trolley patients are virtually gone.
"We have a 'code blue' policy, under which if trolley numbers go over 15 the hospital stops elective admissions and implements a range of other measures. We used to report code blues around three out of every four days but since we have put in the new measures this would not even happen once in five days."
Mr Lyons says Tallaght is seeking further investment from the HSE to help the A&E situation. "We want more clinical posts in place. The two biggest disease categories that hit A&E are cardiology and radiology and we are low on both these specialties."
Hospital work changes
Mr Lyons says in order to attract more resources the hospital must implement internal changes. "There are specialties whose lengths of stay are not the best and we need to work with those specialties to bring them down. Also, our x-ray is not available at weekends for routine work; nor is outpatients used at weekends for routine work. Our waiting list needs to be improved. We need to configure around the patient a bit more and work with our staff on this. We will be watching closely to see what emerges from the consultant contract talks in terms of flexibility. But whatever emerges from these negotiations, there is a need for an increase in the number of consultants."
Mr Lyons says Tallaght has in the past been criticised for its public-private patient mix, with allegations that private patients are taking up beds of public patients waiting in A&E.
"The fact is that private patients are not 'blocking' beds of public patients. Seventy per cent of our admissions are emergencies and of these, there is a significant proportion of private patients. Fifty per cent of the population have private insurance.
"A private emergency patient gets a bed wherever the bed is, as does a public patient. Patients get a bed on the basis of their clinical need rather than on their insurance status."
He said Tallaght will be ensuring that it is in full compliance with Government policy on the ratio of public to private beds. "We would be near enough to this already, but we need to dispel the myth that our private patients are blocking public beds or that private patients are getting in ahead of public patients. If there was anyone seeking to bring in private electives over public electives it would be dealt with as a management issue. It would never be the case that a private elective patient would be put into a public elective bed."
Mr Lyons, pointing to the growth in Tallaght's catchment population, says there is a need for more acute beds, but only following an examination of the delivery of full primary care services and on how acute care is delivered. There are for example, a lot of inappropriate admissions to hospitals, he says, and this needs to be looked, as do long-term care needs.
He points out that shared care programmes in areas such as diabetes can significantly reduce hospital workloads but GPs need to be properly resourced to do this work.
Mr Lyons says people living in the Tallaght Hospital catchment area have said consistently that they want maternity services in the area.
"There will be a review of maternity services in the new year and we will be communicating that to the review."
While he said while there is no plan to move the Coombe Hospital to Tallaght, the two hospitals are in discussions about Tallaght providing some of the Coombe's antenatal services on site so as to make it easier for patients travelling for antenatal care.
Tallaght-St Jamesís link
Plans for a link between Tallaght and St James's Hospital, first mooted around three years ago, were suspended as a result of the recent review on the location for a new childrenís hospital, which both hospitals tendered for.
Mr Lyons admits that re had been 'creative tension' as a result of the two hospitals being involved in the bidding process.
However, he said St James's and Tallaght have recently agreed, at the behest of the Provost of TCD, to enter 'talks about talks' on having a 'Trinity Hospitals' network, with a single governance framework for the two hospitals, which would remain on their existing sites. Both hospitals are the main teaching hospitals for TCD medical school. Mr Lyons says the proposed link would significantly enhance patient care.
Private hospital plan
Mr Lyons said Tallaght had been one of the bidders for Mount Carmel Hospital when it went up for sale recently. In the end, Tallaght did not win out in the bidding process, which was won by a private healthcare firm, Harlequin Healthcare.
"It wasn't empire-building on our part. We had planned to use Mount Carmel, if we acquired it, to decompress the A&E by transferring private patients to the Mount Carmel site, which would have become an annexe of Tallaght."
He said that it was a creative proposal to relieve the A&E and bed availability situation at the hospital.
Now, Tallaght is pressing ahead under Health Minister Mary Harney's plan to build private units on public hospital sites. The private unit at Tallaght Hospital will have between 160 and 220 beds. A decision on the successful bidder to develop the unit will be made in the New Year.
Mr Lyons said the private unit will be a positive development for Tallaght and will take pressure off the public hospital. He feels the question of which consultants will work there and on private practice rights will not be an issue at the end of the day. "The assumption is that the clinicians on the public site will have full and open access to the private unit."
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