On the face of it, Neonatal Intensive Care Units (NICUs) and nursing homes are very different places. Sick babies in NICUs are at the beginning of their lives; frail elderly people in nursing homes are close to the end of theirs. You don’t see ventilators or complicated monitoring equipment in nursing homes. Equally, you don’t see rollators or hoists in NICUs. For those who die in them, there are different size coffins and funeral eulogies, depending on which place you die in.
Having said that, NICUs and nursing homes – and their occupants – are similar in many ways.
Babies and elderly people are vulnerable. They succumb more easily to things that the rest of us just bounce back from. You don’t need to be a doctor or a nurse to know this.
Babies who are born with serious medical conditions and elderly people who are frail are the most vulnerable of all. They need to be intensively cared for, albeit in different ways and with different objectives.
They say you can tell a lot about a society from the way it cares for the very old and the very young.
At present, we are engaged in a lot of soul-searching about how we look after elderly people, not just in relation to Covid-19, but in general, as a society. Do we think they are less important than others? Do we say they’ll have to wait their turn because they are not a priority?
As we examine our consciences, particularly in relation to how we look after the frail elderly in nursing homes, we are, at the same time, building the most expensive hospital in the world for children. And although this hospital has lost some of its shine because of all the arguments over where it should be built, how much it’s costing, the very long delays in building it, and now the added complication of Covid-19, it will, in the end, be a world-class hospital except for one glaring omission: there’s no room beside it for newborn babies with life-threatening conditions who need to be born there.
Every year, more than 200 babies with complex congenital conditions are transferred within hours of birth from maternity hospitals to Crumlin and Temple Street hospitals for life-saving interventions. The mortality rate in these babies ranges from 5 per cent to 18 per cent, depending on the condition.
High-risk babies with life-threatening congenital disorders should be delivered in a co-located maternity hospital and then transferred across an internal link corridor to a tertiary children's hospital
Because of the risks associated with transport after birth, these high-risk babies from all around the country, if the diagnosis has been made in pregnancy, are delivered in one or other of the three Dublin maternity hospitals in order to reduce the transit time after delivery to paediatric hospitals. Despite a state-of-the-art national neonatal transport service, ambulance journeys for these babies, even across short distances in Dublin, remain hazardous. When the national children’s hospital opens, these babies will all be treated there.
Everyone agrees, in keeping with best international practice, that high-risk babies with life-threatening congenital disorders should be delivered in a co-located maternity hospital and then transferred across an internal link corridor to a tertiary children’s hospital.
Tragically, these sick babies will have to wait their turn too until such time as the Coombe hospital is rebuilt alongside the national children’s hospital on the St James’s Hospital campus. That’s the official plan. But apart from no timeframe or money, there’s no room for a third hospital on this very busy campus. You only have to look at RTÉ’s Inside Ireland’s Covid Battle, which was filmed at St James’s Hospital, to see this.
The Coombe hospital is less than 1km from St James’s Hospital. Both hospitals work closely together, are in the same hospital group, and share staff and services. The Coombe hospital, similar to the National Maternity Hospital and the Rotunda, needs to be rebuilt. Like the other Dublin maternity hospitals, a small number of its high-risk mothers need to be cared for on the site of a tertiary adult hospital.
Given the state of construction of the national children’s hospital, there remains a last-chance possibility of a structurally feasible Plan B solution to maternity co-location.
This would involve finding a small space within the existing shell of the national children’s hospital to co-build a small maternity unit to accommodate the small cohort of high-risk babies and mothers who need immediate access to the national children’s hospital and St James’s Hospital. Plan B would need the goodwill and ingenuity of all stakeholders to find both the space and – given the astronomical costs to date and projected – the cost-savings to do it.
As well as being a huge win for sick babies and mothers, a tri-located campus would be a big political win for the new Government, at a time when big wins are badly needed.
Importantly, this maternity unit would not be a standalone unit and would be fully integrated with the Coombe hospital, which would also continue to develop and rebuild over time on its present site.
The days at the beginning and the end of our lives are among the most important days we live. As such, it’s essential, as a society, that we do our best to care for the very young and the very old, particularly the most vulnerable – sick babies and the frail elderly.
By the time a taoiseach cuts the ribbon to open the national children’s hospital, I hope our consciences will be clearer than they are now. Hopefully, we won’t always have to wait for Prime Time or a government inquiry to tell us what we should have done.
Prof Chris Fitzpatrick is a consultant obstetrician and gynaecologist. He is a former master of the Coombe hospital.