Facilities are ‘stuck in the last century’
Specifically, she looked at evidence-based design — an increasingly popular concept in healthcare architecture based on credible evidence to show that a well-designed physical environment can bring many benefits for patients and staff, not least promoting healing.
Ms Hardiman highlighted individual design elements that could contribute to improved patient experiences and outcomes. For instance, natural light led to reduced anxiety and depression, and, from a business case perspective, reduced length of stay. Positive distraction (images, music) also reduced pain and stress, leading to reduced medication and sedation, resulting in more cost savings. Noise reduction alleviated stress and cut down on sleep deprivation, vital in a hospital setting when you consider the restorative power of sleep.
But perhaps most importantly, the proposed new hospital would boast all single ensuite rooms, crucial in an environment where infection control can be a matter of life and death.
Although the new national children’s hospital has yet to get off the ground — the original proposal fell foul of planners and a new plan is being worked on — the vision presented by Ms Hardiman was an exciting one for parents of children who for years have been cared for in substandard accommodation in some of our existing children’s wards. While the quality of care in these facilities is rarely an issue, the environs frequently are.
For a prime example of poor design, look no further than the children’s unit at Cork University Hospital (CUH). A dreary afterthought of the main hospital, it runs contrary to all the principles of evidence-based design. Natural light is at a minimum, positive distractions are limited, and space is so tight that not one of the rooms boasts an ensuite. This includes the isolation rooms, housing children with compromised immune systems, maybe with leukaemia or cystic fibrosis (CF), and who, according to consultant paediatrician Dr David Mullane, need single ensuite rooms “as a minimum”.
In fact, if it was Dr Mullane’s call, he would flatten the existing facility.
“I’d love to demolish the whole thing, but we can’t flatten it, even though we would love to. The facilities that we are trying to provide a good standard of care in are stuck in the last century,” he says.
A tour of the wards quickly reveals why Dr Mullane is so disillusioned. Isolation rooms on the Ladybird ward — for children aged from two days up to 18 months — are so tight staff find themselves trying to climb in over luggage and buggies and IV pumps and monitors to get to the patient. The layout of these rooms is disastrous. Sinks are against the back wall and access is almost impossible if a parent is sitting cotside — a farcical situation in light of repeated public health messages about the importance of hand hygiene to prevent spread of infection. Catherine Fouhy, ward manager, says they have to move parents to get to the sink.
Ward manager Catherine Fouhy in children’s ward at the Cork University Hospital. Pic: Dan Linehan
“The rooms weren’t designed to modern standards. We’re in a very tight space getting to the patient. Realistically, we are not going to be able to create bigger rooms but we need to make them more child friendly, more stimulating for them, more comfortable. We need a modern, easily cleaned environment that meets the standards. For example the floors would not be Hiqa compliant,” says Catherine.
In fact, there are many aspects of the rooms unlikely to pass muster with inspectors from the Health Information and Quality Authority which has yet to inspect the CUH children’s unit. Dr Mullane tells the story of a young patient with CF — none of whom has access to a single ensuite room — who ended up queuing to use the public toilet, oxygen tank in tow.
“It was sad and embarrassing for her. She had to leave the door slightly ajar in case she needed assistance. It’s not good enough,” says Dr Mullane.
The poor layout of the baby isolation rooms also makes it difficult to access the nappy- changing area to the rear of the cot. Shelving around this area is chipped, again contrary to good hygiene and infection control.
Linda Good — mother to eight-month-old twins Ivy and Johanna, who were born 13 weeks premature — got a shock when she first arrived at the Ladybird ward.
Linda Good and daughter Ivy, from Aghada, in a room in the children’s unit, CUH. Pic: Denis Minihane
“We had been in the neonatal unit in the maternity hospital and that was top class. But we came from that sterile, state-of-the-art environment to the children’s ward with dark dull rooms and chipped furniture. You wonder about the bacteria and infection control.”
Linda says the staff are fantastic but that apart from a few cosmetic changes, the wards are relatively unchanged since being built in the 1970s.
“My sister-in-law was in here as a patient 20 years ago. Her mother came to visit the twins recently and she said ‘My God, nothing has changed’.”
Dr Mullane’s own brother had leukaemia as a child and he says that “infrastructurally, nothing has changed since then”.
Certainly, nothing has changed for the parents. Those who overnight with sick children sleep on chairs, some of which are barely classroom fare. Dr Mullane says, ideally, they would like pull-down beds. There is no wifi. Dr Mullane has a wish list. The gastro room on the Puffin ward, for older kids with diarrhoea and vomiting, has six beds and no ensuite. Currently, they use commodes, again disastrous for infection control.
“I know we can’t get six single rooms, the footprint is too small, but we need an ensuite in the gastro room. All the beds should have oxygen and suction as a basic requirement. Only one bed in the six-bed room has oxygen, which means we can’t use the room for certain things,” says Dr Mullane.
In Seahorse, the day-procedures ward, where children also come for medical review, there are kids with CF mixing with other kids.
“They should all be in an area where they are not mixing,” he says.
Padraig Coholan from Ballinspittle with his son Daire in the children’s ward at the Cork University Hospital. Pic: Dan Linehan
He is frustrated that the children’s unit had been largely bypassed for investment over the years when other areas got major upgrades, for example, the €85m cardiac renal unit, spanning 13,000m2 over six floors.
Despite, the fact that about quarter of the activity of the entire hospital takes place within the children’s unit — 7,500 admissions, 5,000 attend the children’s day ward, 10,000 are seen in the out-patient department — it gets just 3% of the budget. It will not benefit from any investment when a €10m two-storey extension is built on top of it to cater for the additional children the hospital will treat when the Mercy University Hospital’s paediatric service transfers over as part of the reconfiguration of services in the south.
The new floors will include a new day ward and a dedicated out-patients for children, so that they no longer have to mix with adults. The Seahorse ward will be converted into a haematology/ oncology unit. There will also be a dedicated paediatric unit for children with CF and a dedicated teaching/research area, funded by University College Cork.
The HSE is providing €5m towards that build, about €2.5m is coming from UCC, and the rest must come from fundraising.
“Out of that, there is no money at all coming to the ground floor,” says Dr Mullane. “The current in-patient accommodation is being left as is because it was not part of the reconfiguration plan, that’s what we were told. So our goal is to fundraise for what’s achievable such as proper toilet and isolation facilities and four to six ensuites.”
The children’s unit has been forced to fundraise because money has not been forthcoming from either the HSE or central government. Dr Mullane says they wrote to Health Minister James Reilly last year — after the Mater campus was turned down as the site for the new national children’s hospital — asking if some funding could be sent their way — there was no reply.
“It’s galling to see the massive spend on a project that went nowhere [the minister has conceded that €26m has been spent]. It’s frustrating when we only need a couple of million and you see multiples of that going down the drain,” says Dr Mullane. Instead, staff are expected to deliver a top-class service on a building that was “stuck on as an afterthought, shoe-horned into whatever space was left”. This is despite the fact that the unit is the biggest children’s hospital facility outside of Dublin, as busy as Tallaght and Temple St.
The play area in the children’s unit at the Cork University Hospital. Pic: Dan Linehan
Dr Mullane believes the reason central funding is so hard to come by is because children are seen “as an easy route to fundraise”.
“We are the only department in the hospital that has to fundraise for redevelopment. We shouldn’t have to fundraise for basic facilities. You don’t want to pull on the heartstrings all of the time, but sometimes, you have to.”
Dr Mullane says architects are currently looking at how to optimise the existing space and the estates team is looking at how much it will cost to provide additional light and new floors. Catherine Fouhy says the rooms need to be redesigned to optimise their functional capacity. She would also like to see more play areas, a bigger playroom, a therapy room, more storage space.
Dr Mullane would like a sensory room for children with cerebral palsy and autism, and a palliative care room. They need bathing and breastfeeding facilities and a serious upgrade of toilet facilities. But they are operating in a funding environment where they had to pay to convert the TVs to Saorview out of money donated to the ward.
There have been some improve- ments thanks to fundraising and donations — including two high dependency rooms and the upgrading of the resuscitation room.
“We can offer a very high standard of care in the event of an emergency and we are delighted with those projects,” she says. The improved equipment along with doctors returning from abroad with specialist skills means children who had to be transferred to Crumlin can now be treated in Cork. But Catherine still feels their unit is the “Angola” of the hospital, a long way off their goal of providing holistic family-centred care.
When Dr Mullane took on the job of consultant paediatrician at CUH, he didn’t envisage fundraising would become part of his role. “I have a busy full-time job, but no-one else is going to do it for us, I am not willing to sit back and accept things as they are,” he says.
To this end, the children’s ward is to be the focus of the new CUH Charity’s first fundraising appeal. In fact, the children’s unit has been selected as the official charity partner of Cork Rebel Week 2013, the city’s flagship Gathering event which takes place from Oct 14-20.
During this week of celebration, the People’s Republic will officially become “independent” for one day on Oct 16. To enter the real capital on Cork Independence Day, visitors are invited to purchase a Cork Visa for just €2 from shops and various outlets around the city and county or at one of the 50 “Visa Checkpoints” that will control entry to the Rebel County. All of the proceeds from the visa will go to the children’s unit.
Dr Mullane says they need at least 300 volunteers to make the day a success. They are also hopeful that coffee shops might come on board and offer discounts to holders of visas. Ideally, he would like 500 volunteers.
“We’re hoping people will buy into it. Cork people are very proud of their roots and of their county. But I’m not proud of the rooms that I work in. It’s embarrassing at times.”
While the children’s unit at CUH is a million miles away from the design brief of the new national children’s hospital — with it’s 100% single rooms, all ensuite, parent accommodation for critical care, family accommodation adjacent to the hospital and a therapy area with hydro pool and gym — staff at CUH are determined to do the best they can with what they have. For anyone interested in helping out on Oct 16, log onto cuhcharity.ie, phone 021 423 4529 or Email: info@cuhcharity.ie.
