No sign of open diagnosis on children’s hospital

No sign of open diagnosis on children's hospital

FAST forward to 2012. You might be aware that this is the year London hosts the Olympics. It is also when the east of Scotland 's new children's hospital is scheduled to open its doors. A shining palace of health, it will be a place where those who come to be treated will be children first and sick second.

Perhaps it will also have a shiny, blue, two-storey helter-skelter like London 's new children's hospital, the Evalina, which was recently visited by a focus group from Edinburgh.

"We don't want a cheap box, we want something that is really outstanding, that has a wow factor, " says consultant paediatric surgeon Bill Manson.

Unfortunately, Mr Manson’s musings are interrupted. He is travelling across town on a Lothian bus and he has to break off while he is loudly berated by a fellow passenger for talking on his mobile phone.

It is perhaps an apt metaphor for the real-life progress of the Edinburgh project. Concerns are growing that a GBP60m plan for the Edinburgh ‘s Royal Hospital for Sick Children, which involves a new building at Edinburgh Royal Infirmary on the south side of the city, are increasingly becoming mired in political skirmishing.

“There appears to be a lot of faffing about. There are some difficult decisions that have to be made if this project is going to get off the ground and there is too much kicking the ball about at the touchline, ” said Ross Finnie, Liberal Democrat health spokesman and a former Scottish minister.

“Politicians have to take some of the blame for that. We are not managing to have an honest debate about it.”

Consultation has begun and some groups representing patients have already expressed concern about proposed locations. Finnie said involving patient groups in consultations about the building’s “flow” and what it should have in it appeared premature and misleading. “People in Edinburgh and the Lothians think they are getting a new children’s hospital. People are discussing what they want it to look like.

“But I don’t think you should engage people on that level when you don’t know the exact location on the Little France site where it is going to go, you don’t know where the money is coming from and you don’t even know what services the hospital is going to provide.”

One political hot potato is deciding which children’s services should be centralised. The Child Health Support Group has been working on a report on the subject for more than two years, which is now due to be delivered in early 2008.

It is expected to say that, for some specialisms, there is a link between the number of patients seen in a centre and the survival rates. With Scotland ‘s relatively small population, that means services like children’s neuroscience and children’s cancer may benefit from being handled mainly in Edinburgh or Glasgow.

But if too many specialisms go to Glasgow , there may be issues around the provision of services like high-dependency children’s intensive care in Edinburgh.

“Edinburgh and Glasgow need to work together to sort this out, ” said Finnie. “The priority has to be the best interests of the child. If centralising something like child neurosurgery in one city is going to lead to a better survival rate then it will have to be done. But that is going to require political leadership.

“The decisions need to be made swiftly. Glasgow needs to know the answers as well – it is building a new children’s hospital, too.” Unison’s David Forbes says his members are concerned. ” Edinburgh needs to retain enough specialisms to make it viable in the long term. We don’t want to hear in five or 10 years time, ‘well, Edinburgh doesn’t really have the infrastructure to provide an acute children’s hospital’. The people of the Lothians will never stand for that.”

He also argues that transport and accessibility are big issues that are not taken seriously enough by planners. “The new hospital is a lot less accessible to the majority of the poor of the city than it was before.

” Edinburgh is getting a new innovative transport system, the tram, and it is getting a new innovative hospital complex, but the tram isn’t going anywhere near the hospital. It is going from the airport to the shopping centre. What does that tell you about priorities?

“We think transport is central and it will get even more so if some specialisms are in one city only. We don’t want families saying, can we afford to visit our youngest today? Who is going to look after the other two if I go through because it is going to take the whole day?”

He also urged the Scottish Government stump up the cash for a public build similar to Glasgow ‘s. At the moment, a Private Finance Initiative (PFI) is still being considered.

Another issue that remains unresolved, and is likely to remain so for the forseeable future, is the actual location of the hospital. One proposal has been to put it on what is currently Car Park B at the Edinburgh Royal Infirmary, which is at the centre of the site and a stone’s throw from A&E.

However, that site is hemmed in by buildings and lacks green space for playgrounds or natural amenities of the kind families can access at the current site on the edge of the Meadows.

Director of strategic planning for NHS Lothian, Jackie Sanderson, said: “We don’t know where we are going to put the building. We don’t know where it could go. We don’t know if there is a possibility of getting a part of the proposed biomedical park site that is close by.”

However, she insisted the project was still on track for completion by 2012.

“We are looking at how the hospital works, how it flows, what we want to have in it. We are very excited that Edinburgh is getting a brand new, state-of-the-art children’s hospital.”

An outline business plan is due to be submitted by the end of this year, but it is unlikely to clarify where the hospital willgo or what services it will provide. Next year, the NHS team plans to write a brief and say they plan to hold an architectural competition.

One critic of the process is architect Howard Liddell of Gaia Architects. He dismissed the current consultation over the brief for the building as “amateurish” on the grounds that an architect is not running the discussions that are underway with patient and family groups and staff.

“I’m appalled that they don’t have an architect on board at this stage. I think it is amateurish.

“Can you imagine writing a brief for a piece of neurosurgery without consulting a neurosurgeon? You would be very likely to get it wrong. They don’t know what they don’t know about architecture, but it will be a lot.

“Architects train for seven years, like doctors, and they have a lot of professional knowledge. If an architect is involved in the early stage, he or she can ask the right questions and learn about what the client wants.”

Liddell said organising an architecture competition was not a good solution. “An architectural competition is just a beauty contest. If you can’t talk to the clients, how can you design a building for them? It is very superficial.

“The best way is to have a competitive interview, find an architect whose previous work is good and who the team can work with. If they write their own brief and then hold a competition they could find themselves in a shotgun marriage.

“Just because a jury has decided that X is the most interesting looking building, they are stuck with that architect. It’s not how I would do it. But then, if I wanted some medical treatment, I would consult a doctor.”

A timeline for the Evalina hospital, part of Guy’s in London , shows that architects were hired more than five years before the hospital opened its doors and contractors began work three-and-a-half-years before the opening.

By comparison, Edinburgh ‘s equivalent has no site, no architects, its funding is unclear and so is its specialist status.

Nicola Sturgeon, Cabinet Secretary for Health and Wellbeing, told The Herald Society: “The Scottish Government is fully committed to support the development of a new children’s hospital in Edinburgh , and we look forward to receiving the outline business case from NHS Lothian so that they can progress to the next stage.

“We will also be consulting on a National Delivery Plan for Specialist Children’s Services early in 2008 which will help to ensure sustainable services for children and young people in the future.”

The Herald
Tuesday 13-Nov-2007