THE MASTER OF the Rotunda Hospital has urged the Minister for Health to approve funding for an additional hospital wing to minimise “further patient safety incidents”.
Professor Fergal Malone told Simon Harris the only “viable” way to solve its space and patient safety crisis involves the construction of a new building on the west side of Parnell Square.
Malone believes that the development of the Rotunda’s West Wing will provide the most “efficient and timeliest” solution to its patient safety needs in light of a recent infection outbreak in the neonatal intensive care unit (NICU), which TheJournal.ie reported on yesterday.
He has asked Harris for “urgent assistance” in progressing the required decision-making and funding necessary to advance its Parnell Square development plans.
We have regrettably reached the point at which further delay in reaching a formal decision on our Parnell Square infrastructure is intolerable and will lead to further adverse outcomes.
“At this stage, the slow pace of progress is such that urgent leadership at the highest levels of the Department of Health and the HSE is required to minimise further patient safety incidents,” he said.
As previously reported by TheJournal.ie, the Rotunda Hospital, which is responsible for over one-quarter of Ireland’s neonatal intensive care capacity, said it is facing an “intolerable patient safety crisis” due to overcrowding and poor infrastructure.
The Rotunda’s neonatal intensive care unit was previously forced to close due to the outbreak of a multi-drug resistant organism. On 10 May, Malone said the hospital had been struggling to contain this infection, identified as “ESBL-producing Klebsiella”, for six weeks.
He added eight premature babies have been affected to date.
One baby which had been infected had died after 25 weeks’ gestation – the exact cause of death is yet to be determined by the Dublin City Coroner. Three other babies developed an invasive infection with this bacteria. The principal factor in the spread of this infection, he says, is overcrowding.
In a letter obtained under Freedom of Information by Noteworthy, the investigative journalism platform from TheJournal.ie, Malone disclosed that the Rotunda is engaging with the families of the eight babies involved in this outbreak, in line with HSE guidance on open disclosure.
He went on to warn Harris that the potential financial liabilities for the state associated with Clinical Indemnity Scheme payments for “damages or dead babies may be very significant, potentially exceeding the cost of our proposed interim development”.
In 2015, the then-Minister for Health and current Taoiseach, Leo Varadkar announced that the Rotunda would be relocated to Connolly Hospital in Blanchardstown as part of a six-year health capital programme.
At the time it was announced, the Government noted that the exact timing of the delivery of the programmes and projects in the plan “will have regard to issues such as planning, and the overall total of funding available each year”.
Almost four years later, it is the Rotunda’s belief that relocation is some 15 years away.
In the letter seen by TheJournal.ie, Malone said the Rotunda has had extensive interactions with HSE Estates, HSE Acute Hospital, RCSI Hospitals Group and the National Women and Infants Health Programme looking at the steps required to relocate the Rotunda to Connolly.
He said these interactions also analysed the requirement of an interim physical infrastructure improvement on the current Parnell Square campus. These interactions he says “reinforced the reality that the relocation of the Rotunda to Connolly is a minimum of 10-15 years away, and likely longer”.
His determination was made for the following reasons:
Connolly is a model 3, rather than a model 4, hospital and requires a minimum of €70 million in infrastructure upgrades as well as extensive new clinical programme developments to make Connolly a safe site to receive the Rotunda. As confirmed by an independently verified report by Deloitte.
The new Rotunda construction on the Connolly campus will cost an estimated €360 million. Based on 2017 pricing
No progress has been achieved with HSE Estates in progressing the appointment of the required design team personnel which once eventually appointed will still require years of work before the first steps in the construction of the new Rotunda can commence on the Connolly campus.
While the Rotunda is supportive of the move to Connolly, it previously acknowledged last year that “it is unrealistic to expect the completion of this relocation in the near future”.
In the absence of any indication to the contrary, it is likely that it will take at least ten years to realise the Connolly relocation.
The statement from the hospital came after a 2017 Hiqa report found that the infrastructure of the neonatal unit and post-natal ward inspected was outdated and did not meet desirable modern standards or “facilitate the implementation of effective infection prevention and control measures”.
Each NICU cot area should have 16m2 of space but according to Malone, the Rotunda can only provide 5m2 of space for each baby’s care.
Hiqa’s report noted that staff in the neonatal unit worked within a very challenging infrastructure. It said that space around cots in open plan areas was “very limited and was not in line with current recommendations which poses a risk of spreading infection in the unit”.
During the inspection, the hospital management team reported to inspectors and documentation showed that there had been an increase in the number of outbreaks of infection in the neonatal unit in 2017.
“On the day of inspection, an outbreak due to a respiratory viral infection had been declared in the neonatal unit.”
In August 2017, work began on a new four-bed extension to the special care area, followed in January 2018 by a renovation and modernisation of the remaining NICU which was completed by December. Despite these refurbishments, ideal incubator and cot spacing could not be achieved in the NICU due to “space restrictions”.
Malone says in the meantime, the Rotunda continues to face an “intolerable patient safety crisis” on its Parnell Square campus.
Having analysed the hospital’s current physical infrastructure, the only viable solution that has been proposed in the short to medium term to solve its space and patient safety crisis involves the construction of a new building on the west side of Parnell Square.
This will allow the Rotunda to decant the entire NICU from its older buildings, as well as providing dignified, safe care for postpartum mothers consistent with the requirements of the National Maternity Strategy.
Malone believes that the Rotunda’s West Wing development is the best solution to patient safety needs while also remaining consistent with its longer-term goal of relocation to the Connolly campus. He said this has been validated by a cost-benefit analysis performed by Ernst and Young.
With additional reporting from Ken Foxe and the team at Noteworthy.ie – find out more about their work here.