This document discusses building an integrated national clinical network for paediatric services in Ireland. It proposes having a single national children's hospital that acts as the central hub, linked to regional paediatric units and local centres through standardized clinical pathways and telemedicine. This would provide most same-day care locally while allowing the sickest children to access specialized care and technology at the national hospital. It points to the successful model of the national paediatric oncology network as an example to build upon. Key next steps proposed are further developing the clinical programmes, supporting hospital groups' integration plans, and demonstrating the effectiveness of satellite centres to improve access and support for community/home care.

1. Supporting an integrated
national clinical network for
Paediatrics
Eilísh Hardiman
Group CEO
Children’s Hospital Group
2 April 2014

2. “There can be no keener
revelation of a society's soul
than in the way in which it
treats its children”
Nelson Mandela

3. Children in Ireland
- Irish population 4.6 million in 2013 (CSO)
- Population growth rate 1.6% for last 5 years, 1.1% annually to 2021
- Birth-rate per 16.3 per 1000 in 2013 – highest in Europe with over
72,000 births annually for last 2 years
- Population under 16 years – 1.25 million or 23% of the population
- Growing up in Ireland - Majority of under 9’s are very healthy (73%),
healthy with a few problems (25%), with 2% unwell/quite ill
- Lifestyle issues – 25% of 3 year old children are overweight or obese
- Chronic disease - 16% reported of 3 year olds longstanding illness
- Asthma, eczema, allergies, heart abnormality, MSK illness
- Annually approximately 244,000 ED attendances

4. 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
• The sickest children and young people have better clinical
outcomes if treated in a hospital that has:
- a high caseload volumes (scale) requiring a critical
mass of 32 clinical specialties and sub-specialties
- combined with advanced medical technology and ICT
- an integrated approach to education, research and
innovation in
- facilities designed using evidence-based design with
- responsive retrieval transport service

5. TRI-LOCATION
Mothers
Staff
Children’s Hospital
Adult Hospital
Staff
Maternity Hospital
Adolescents
Infants
Staff

6. What is best for children?
- In Ireland this mean:
- 1 national tri-located children’s hospital
- linked to regional hospitals with paediatric units and
- local paediatric centres to support
- Urgent care,
- OPD access
- GP diagnostic access
- Rapid access to paediatric opinion and
- home based care
- better integrated by contemporary ICT
- within an integrated national clinical network for paediatrics and
- shared care model of working.

7. Current Paediatric Services

8. Crumlin, Temple
Street and Tallaght
Letterkenny
Sligo
Castlebar
Galway
Portiuncula
Limerick
Tralee
Acute Paediatric Services
Waterford
Wexford
Kilkenny
Portlaoise
Mullingar
Cavan
Drogheda
Cork
Clonmel
19 Neonatal Units
11 Level 1
 4 Level 2
 4 Level 3

9. H
H
H
CUH, Temple Street
Established 1872
154 Beds (in-pt and day care)
8,200 in-pts, 8,400 day cases
Voluntary Hospital
Owned by the Sisters of Mercy
OLCH, Crumlin
Established 1956
227 Beds (in-pt and day care)
10,300 in-pts, 17,500 day cases
Voluntary Hospital
Owned by the Board of OLCH
NCH at Tallaght
Opened 1998-Harcourt St (1821)
66 Beds (in-pt and day care)
7,200 in-pts, 2,900 day cases
Voluntary Hospital under Charter
for AMNCH
Owner by the Minister

10. Activity for Children‟s Hospitals
Inpatients
78% Greater Dublin Area
Day care
65% Greater Dublin Area
Out-patients
72% Greater Dublin Area
Greater Dublin Area
Dublin, Meath (part), Kildare, Wicklow

11. Activity outside local Dublin area
DONEGAL
In-patients - 1.35%
Day care - 1.30%
CORK
In-patients - 2.15%
Day care - 2.18%
GALWAY
In-patients - 1.45%
Day care - 1.63%
LIMERICK
In-patients - 1.07%
Day care - 1.22%
Most children
in Ireland receive
their paediatric
care close to
home

12. Vision for children's services
- A National Children's Hospital independent trust that puts children, young people
and their families central to its functioning and decision making
- An integrated national model of care for paediatric services with the new
children's hospital at the centre of an integrated national clinical network linked
with paediatric units in regional hospitals, local paediatric services and community
/ home based services
- The configuration of paediatric services in geographically based Hospital Groups
to support appropriate local access to paediatric services, with support from the
Children’s Hospital Group
- National paediatric and neonatal ambulance retrieval services to ensure the
timely transfer of the sickest infants and children to the appropriate hospital

13. - 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 that will provide safe, high quality tertiary /
quaternary specialist paediatric services for the island and secondary paediatric
services for the greater Dublin area, with transition of services to commence by
end of 2018
- Satellite centres at Connolly and Tallaght Hospitals by 2016, providing emergency
/ urgent care and better local access to general paediatric OPD services,
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
Vision for acute children's services

15. Building a network – first steps
- HSE National Clinical Programmes for Paediatrics and Neonatology to complete an
integrated national model of care for paediatric services in Q3 2014 to guide the
development of an integrated national clinical network across Ireland
- Children's Hospital Group Board established Sept 2013, Hospital Group progressing,
starting with agreeing core values, common vision and mission
- Each Hospital Group has to develop a 3 year Strategic Plan for services including paediatric,
neonatal and maternal services to support appropriate local access to these services and
implement the national model for paediatrics
- National Neonatal Transport service in place 24/7 since Dec 2013 to ensure the timely
transfer of the sickest infants to the appropriate hospital, with a National Paediatric Transport
service under development
- Government decision to build a national children's hospital and two satellite centres

16. Supporting an integrated clinical
network for Paediatrics
- Several models of an integrated clinical network exist in Irish and other
healthcare systems
- Span of control varies from:
- standardised clinical pathways collaboratively developed by the centre, shared across the system
and implemented locally (HSE Clinical Programmes)
- medical staff employed by the centre and work in / rotate into local based services, integrated ICT
systems across several locations (networked services in US system)
- a managed network of services with greater control of local services by the centre (Cancer Control)
- NHS Trusts with acute and non acute and social services managed by one structure
- A good example already exists in the Irish healthcare system. It is achieving world
standard healthcare outcomes for the most complex of paediatric treatments,
using an integrated clinical network for oncology and haematology paediatric
services

17. National Peadiatric Oncology
and Haematology Service
One national centre
„Hub‟
OLCH, Crumlin
• Shared Care
• Every child who develops cancer has
their diagnosis made & treatment
planned at the centre
• 60% of children, components of
treatment delivered by one of sixteen
hospitals or at home and in
accordance with protocols agreed with
the centre
16 local centres
„Spokes‟
Local Paeds Units
•Paediatric Cancer
• Haemophilia and related diseases
• Haemoglobinopathies (SCD)
• Haematopoietic Stem Cell Transplantation

18. National Peadiatric Oncology and
Haematology Service
- Policy and service imperative to reconfigure paediatric Haem / Onc services
- International evidence of shared care model in cancer management
- Reconfiguration of services and reassignment of existing resources, coupled
with new investment
- Shared Care Manager and Clinical Nurse Specialists
- Formation of representational shared care group
- Parents are primary providers of care with home care supported by phone
access to the centre
- Development of Supportive Care Guidelines – available on line
- Provision of regular regional paediatric cancer study days
- Development of Online Information Resource
- Continuous evaluation, audit and improvement of the service
- Strong integration with research and clinical trails (100% participation)

19. • Support and leverage service
reconfiguration / integration plans by
Hospital Groups
• Implement shared / networked care for
specific specialities
• Build on the HSE Clinical Programmes
for Paediatrics and Neonatology to
standardise care
• Underpin standardisation with
integrated clinical systems
• Demonstrate effectiveness of satellite
centres in the provision of the majority
of same day services and support
community / home based care
Building a clinical network

20. Key steps in providing quality care
20
To provide high quality neonatal care to all 72,000 babies born in Ireland annually:
 Effective screening, nutrition, immunisation programme for all healthy newborns
 Provide high quality neonatal intensive care and surgical care for ill newborns
 Seamless transfer from Level 1 to Level 2 through to Level 3 Neonatal Intensive Care
 ‘Right baby, right place right time’
 To put an efficient retro-transfer programme in place
Quality
 All babies should have equal, rapid access to neonatal intensive care and surgical treatment
irrespective of geographical location. Eradicate ‘post code’ disadvantage
Access
 Reduction in unnecessary costs by prompt identification & timely treatment of remedial
problems
 Eradicate fragmentation and duplication of newborn specialist and intensive care services
 Rationalisation of Neonatal Intensive Care
 Re-engage the wider paediatric community-GPs, AMOs, Public Health Nurses to reduce the
‘drift’ to hospital care with minor problems
Cost