New Children’s Hospital presentation

Suzanne Dempsey, Group Director of NursingChildren’s Hospital Group

20th June 2015

“There can be no keener revelation of a society's soul

than in the way in which it treats its children”

Nelson Mandela

Strategy for Child Health• Government National Policy & Framework – ‘Better

Outcomes, Brighter Futures’: the National Policy Framework for Children and Young People 2014-2020

• HSE National Clinical Programmes for Paediatrics and Neonatology – a plan for how and where acute paediatric and neonatal services are organised and delivered across the acute hospital system – due for publication Q2 2015

• 2015 HSE National Service Plan - Integrated Care Pathway for Children to commence

• All-island network for congenital cardiac disease

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Strategy for Child Health

• Government decision in 2012 on the largest capital investment in health – new children’s hospital and two satellite centres - as a catalyst for an integrated clinical network for paediatrics

• Children's Hospital Group established in 2013 as one of seven hospital groups: – Remit to integrate the three children’s hospitals in Dublin to

become one entity before transitioning to the new facilities– Develop a Strategic Plan to reform paediatric services in

greater Dublin area and– Be the client to the capital build

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Governance approach to service delivery and project delivery

• Amalgamation of 3 hospitals• Corporate / Clinical Governance • Service Integration Plan • Transfer of services to new

hospital• Client for the capital project

Children's Hospital Group Board (CHGB)

‘The Hospital Group Board’

ChairmanJim Browne

• Plan• Design • Build • Equip• Commission

National Paediatric Hospital Development Board  (NPHDB)

‘The Development Board’

ChairmanTom Costello

Children's Hospital Group

• Consists of the three children's hospitals:• Our Lady’s Children's Hospital, Crumlin; • Temple Street Children’s University Hospital; • National Children’s Hospital at Tallaght Hospital

• Group Board established on an administrative basis, with Ministerial approval given to legally establish the group using primary legislation

• Academic partnerships with all academic institutions providing paediatric professional education, planning has commenced on this framework to work as an Academic Health Sciences Network

• New children's hospital is being planned as central to an integrated clinical network for paediatric services on the island of Ireland

• Smallest hospital group with the biggest change management challenge

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Children's Hospital Group Highlight metrics:

Clinical Activity: ED - 115,372In-patients- 25,700 Day care – 27,363OPD – 180,000

Workforce - 2,891 headcount Total beds - 432Budget - annual allocation €210mAll national paediatric specialities based in either OLCHC or TSCUHSignificant variability in infrastructure

What is best for children and

young people?

3 children’s hospitals Crumlin, Temple Street & Tallaght

3 larger Paeds Units CorkGalwayLimerick

Belfast – part of all-island Congenital Cardiac Disease Network

Acute Paediatric Services

WaterfordWexfordKilkennyPortlaoiseMullingarCavanDroghedaClonmelPortiunculaTraleeLetterkennySligoCastlebarCork

National Model for Paediatrics and Neonatology20 acute paediatric services

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CUH, Temple StreetEstablished 1872154 Beds (in-pt and day care)8,200 in-pts, 8,400 day casesVoluntary Hospital Owned by the Sisters of Mercy

OLCH, CrumlinEstablished 1956227 Beds (in-pt and day care)10,300 in-pts, 17,500 day casesVoluntary Hospital Owned by the Board of OLCHC

NCH at TallaghtOpened 1998-Harcourt St (1821)66 Beds (in-pt and day care)7,200 in-pts, 2,900 day casesVoluntary Hospital under Charter for AMNCH Owner by the Minister

What is best for children?• Clinical care and treatment needs to be as near the

child’s home as clinically appropriate.• The vast majority of paediatric services are delivered

on a same day basis and delivered locally with less than 22% attending children’s hospitals from outside the greater Dublin area

DONEGALIn-patients - 1.35% Day care - 1.30%

GALWAYIn-patients - 1.45% Day care - 1.63%

CORKIn-patients - 2.15%Day care - 2.18%

LIMERICKIn-patients - 1.07% Day care - 1.22%

Greater Dublin AreaDublin, Meath (part), Kildare, Wicklow

In-patient – 78%Day Care – 65%

What is best for children?

• Saving children’s lives: The sickest children and young people have better clinical outcomes if treated in a hospital that has scale & critical mass:- scale means a high caseload volumes- critical mass means at least 32 clinical

specialties and sub-specialties- minimum population of 3.5 – 5 million required to

support this level of specialisation in one tertiary children’s hospital

- this means all specialties currently in 3 Dublin hospitals being in one hospital

- not all sub-specialties are in Paeds, so best co-located with a large adult hospital with a depth & breath of specialties and sub-specialties

- tri-location (children / adult / maternity) is the optimal model for sick children and mothers

Tri-location (Paeds/adult/maternity)

MothersSt

aff

Adult Hospital

Children’s Hospital

Staff

Maternity Hospital

Adolescents

Infants

Staff

Vision for children's services- A National Children's Healthcare independent trust that puts children,

young people & their families central to its functioning & decision making

- An Integrated Care Pathway for Children with the new children's hospital at the centre of an integrated national clinical network linking with paediatric units in regional hospitals, local paediatric services and community / home based services

- The configuration of paediatric services within geographically based Hospital Groups and CHOs to support appropriate local access to paediatric services, with outreach support from the Children’s Hospital Group

- National paediatric and neonatal ambulance transport and retrieval services to ensure the timely transfer of the sickest infants and children to the most appropriate hospital

- The successful integration of the three children's hospitals into a single organisation before moving to the new hospital facilities

- A new state-of-the-art children’s hospital tri-located on a campus with St James’s Hospital and a maternity hospital, opening in 2019, that will provide safe, high quality tertiary / quaternary specialist paediatric services for the island and in conjunction with its satellite centres, provide secondary paediatric services for the greater Dublin area

- Satellite centres at Connolly and Tallaght Hospitals to open mid 2017, providing emergency / urgent care and better local access to general paediatric & trauma ortho OPD services, chronic disease management, diagnostics and to support community and home based services

- An academic health sciences network to support greater integration of clinical service with education, innovation and research to deliver better health and wellbeing outcomes for children and young people on the island and globally

Vision for acute children's services

NEW CHILDREN’S HOSPITAL• 473 beds (380 In-patient & 93 day care subject to continuous review)

• 100% single rooms – with ensuite & family area in each room

• Advanced diagnostics, intervention and theatre facilities

• Play areas, external gardens and courtyards

• Therapy area with hydro pool & gym

• Hospital School

• Integration of Research, Innovation, Education & Clinical Services (Children’s Research & Innovation Centre)

• Parent / family accommodation adjacent to the hospital (Ronald McDonald House Charity)

•Adequate car parking for families

Satellite Centres: Key Departments

Emergency (each 20% activity) 25,000 attendances

Outpatients (each 7% activity) 15,000

Child Sexual Assault Unit

Education

HSE Primary Care Dental Services (Connolly)

Imaging (CT shared)

Sat C 2

Medical HomeCommunityPaediatrics

Sat C 1

Integrated Care – transition to lower cost settings

NCH&

CRICUCC

UL

UCG

2o3o4o

CARE2o

CARE1o

CARE

Model of Care for Paediatrics

Integrated Care – transition to lower cost settings

Medical Home

• GP / CCP / SS• Accessibility• Care coordination• Linked to community based organisations• EHR

Clinical CommunicationsCare plans

Structured Referrals

Optimal Models of CareDisease Specific Care Pathways

Structured Referrals

IT infrastructure for IP & OPE-prescribing

Test and Referral TrackingElectronic Health Record

Performance ReportingQuality / Outcomes

Finance

New hospital

2 Satellites(General

Paediatrics & Orthopaediatrics,

chronic disease management)

Model of Care for Paediatrics

RESEARCH

SOCIAL JUSTICE

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SOCIAL JUSTICE

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Academic Paediatric Medical Centre - Mission Joined up Service and Academia

Thank you