Neonatal Intensive Care Facilities at the Rotunda Hospital

Fri, Jan 15, 2021

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The Rotunda Hospital is located in a building complex which dates to 1757. Despite the incredible care the hospital provides to families at very important moments in life - indeed they have won awards for their innovative care practices - the Rotunda is trying to provide 21st-century medical care in an 18th-century infrastructural set-up. This has led to concerns regarding the provision of best practice care in their neonatal intensive care units, which Neasa has raised with the Government.


Deputy Neasa Hourigan

I wish to raise an issue today with the Department of Health and its Minister. While I acknowledge they are well aware of the issue, it is so important that it is worth highlighting again. My constituency of Dublin Central is home to the Rotunda Hospital, which is the busiest maternity hospital in Europe. In 2019, more than 8,000 babies were delivered in hospital. In the same year, more than 1,300 of those babies needed to be admitted to neonatal care units. The hospital is run on a break-even budget and incredible care is provided to families at very important moments in life. The hospital has, indeed, won awards for its innovative care practices. All of this is done in a building complex which dates to 1757. The Rotunda Hospital is a much-loved building in Dublin Central, but it is nonetheless an old one. In short, the hospital is trying to provide 21st-century medical care in an 18th-century infrastructural set-up. The situation is now very serious. There is a particular concern regarding the provision of best practice care in the neonatal intensive care unit.

Several reports have pointed to the suboptimal conditions in our maternity hospitals, including inadequate space and outdated facilities. Nowhere is this more critical than in the Rotunda Hospital. The standards of buildings have an impact on the quality of care received and therefore on the outcomes of that care. What we are seeing here is a false economy because the cost to families and the State when things go wrong is well known. HIQA has repeatedly stated that capital investment is needed in modern maternity facilities and buildings, and that that investment must be timely. Babies in neonatal care are the most vulnerable patients I can think of. The current position in respect of the physical infrastructure in the Rotunda Hospital is not best practice in neonatal intensive care facilities, particularly in respect of infection control, which is so meaningful for all of us at present.

I implore the HSE and the Minister for Health to address overcrowding in the Rotunda Hospital, and especially in the neonatal intensive care unit, NICU, in the short to medium term. In 2019, the director of the Rotunda Hospital warned that the overcrowding was an intolerable patient safety crisis. The Rotunda Hospital takes babies from all over Ireland into its care. The staff there are doing their best but they are now doing their best under unacceptable conditions.

The management of the Rotunda Hospital has a plan to tackle this urgent need. I am aware that in the long term, maternity services will be moved to the campus of Connolly Hospital. The 1,300 babies who need care every year, however, must be safe and cared for now and to the best of our ability. They cannot wait for 15 to 20 years. There is a significant business and medical case for the immediate development of a critical care wing on Parnell Square, which could mitigate current risks in the medium term. This would be compliant with Government policy and has already been approved by the planning department of Dublin City Council. The estimated cost of that wing is €61 million, though I accept that procurement costs are difficult to ascertain and be certain about now.

I acknowledge there is a long-term plan to move the Rotunda Hospital but investing in a medical care building now would still be an efficient use of public money. The inner city would have a high-quality medical building for use in perpetuity. We would get 15 to 20 years of safe NICU care for our most vulnerable babies, and it is really only the commissioning costs of less than €5 million that would be non-transferable. This is an excellent business case for the wing. As we have heard this week, we have not always cared in Ireland for our most vulnerable children in the way that we should. I hope the HSE, the Minister for Health and the Minister of State present will consider my points.

An Ceann Comhairle

I thank Deputy Hourigan for raising this important matter. I can be forgiven for saying that I am particularly pleased to hear her raising this issue, because I was born in that same hospital, though a little bit after 1757. I call the Minister of State, Deputy Rabbitte.

Minister of State, Anne Rabbitte

I thank Deputy Hourigan for raising what the Ceann Comhairle has noted is a valuable topic. I am taking this issue on behalf of the Minister for Health, whose script I have to hand. I thank the Deputy for giving me the opportunity to outline to the House the position in relation to neonatology services at the Rotunda Hospital. As the House is aware, the Rotunda is one of the world’s oldest maternity hospitals and one of the busiest such hospitals in Ireland. More than 8,000 babies, and one in four of all babies requiring neonatal intensive care in Ireland, are born there annually. Consequently, the Rotunda cares for the most vulnerable and fragile infants at the very extremes of prematurity, as well as sick babies with very complex needs. The challenges faced by the Rotunda to provide such critical services are well documented, and were also well detailed by Deputy Hourigan.

In particular, given the age of the buildings, the infrastructure of the hospital presents significant difficulties in terms of infection prevention control and patient safety. The Deputy is aware that in the medium term, the Rotunda will be co-located with Connolly Hospital. This is in line with Government policy, as articulated in the national maternity strategy. To ensure the provision of optimum and safe services, that policy states that all stand-alone maternity hospitals should be co-located with adult acute hospitals. The relocation of the Rotunda Hospital to the campus of Connolly Hospital is included as a commitment in the programme for Government.

The health and safety of mothers and babies in our care is always of the utmost priority. It is acknowledged that there is a need, in the short term, to address the highest infrastructural risks and capacity issues at the existing hospital on Parnell Square. However, given the plans to redevelop the Rotunda Hospital, we must ensure that any interim development and investment must be limited to the extent necessary to address priority patient safety risks. There has been significant engagement between the Department of Health, the HSE and the management of the Rotunda Hospital in an attempt to clarify the scope and extent of the developments needed at the Rotunda Hospital to resolve patient safety risks arising from infrastructural challenges at the hospital.

In 2020, €4.6 million was provided to the Rotunda Hospital to address capacity and infrastructural needs in the foetal assessment unit, neonatal intensive care unit, emergency theatre and delivery suites. Given the age and condition of the original hospital buildings, however, other issues remain. In that context, the management of the Rotunda Hospital has proposed a new development which will address identified key clinical risks. Additional funding of €100,000 was provided to the Rotunda Hospital in 2020 to prepare a strategic assessment report and preliminary business case in support of the proposed development, as required under the public spending code. I am advised that these reports have now been submitted to the HSE and are under consideration.

I also understand that the HSE intends to allocate additional capital funding of €250,000 to the Rotunda Hospital this year to further assist with the progress of proposals to address areas of critical risk with a particular focus on the neonatal intensive care unit. This investment will help ensure that the hospital is facilitated to make the necessary plans to ensure the babies born in the Rotunda Hospital continue to receive the safest, high-quality specialised care possible in advance of the hospital’s move to the campus of Connolly Hospital.

Deputy Neasa Hourigan

I share the Ceann Comhairle’s fondness for the Rotunda. All three of my children were born there, one with only seconds to spare. It is a place which is very special to many of us. I welcome the response from the Minister of State. The Department of Health has engaged with the management of the Rotunda Hospital. We welcome that engagement. To be clear, the best practice in neonatal intensive care units is that every child would have 16 sq. m. In the Rotunda Hospital now, the space available is 5 sq. m., and that impacts on children’s care, as well as how much a mother can engage with her child and how many people can be in the room. It is, therefore, an urgent and serious situation.

I have a specific request. The Minister for Health and the HSE can see that there is a viable business case here and a medical argument in respect of a medical care wing being attached to the Rotunda Hospital, even given the deadline for the move to the campus of Connolly Hospital.

Fifteen to 20 years is a long time to have a difference of that kind of space of 16 sq. m, versus 5 sq. m for those incredibly vulnerable babies. I am also aware that the Department and the HSE have a number of processes to go through for cost-benefit analysis before they would consider something like this or give it the green light, which is as it should be. For the project to proceed, one of the first steps is to complete gate 2 of the public spending code, which is the completion of a final business case and initial planning document and design. This requires financial support of, I believe, more than €250,000. I thank the Minister of State, Deputy Rabbitte, for giving her time today to answer this. Perhaps the Minister of State could communicate back to the Minister for Health our genuine request that the Department and the HSE would consider supporting even this next stage of gate 2 of the public spending code in order that we can at least move forward with the cost benefit analysis for the neonatal intensive care unit, NICU.

Minister of State, Anne Rabbitte

I will take on board exactly what Deputy Hourigan has requested here this evening. I will articulate it to the Minister, Deputy Donnelly. Perhaps I could facilitate a meeting between Deputy Hourigan, the Minister and our new Secretary General, acting in the Department of Health, who has come from the Department of Public Expenditure and Reform and who would have a really good understanding of the gate 2 process the Deputy has referred to.