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The maternity hospital “of choice” is the ambitious moniker adopted by the Rotunda Hospital, Dublin, in its recently-approved strategic plan for the years 2017 to 2021.
Initiatives that aim to respond to demands associated with increasing maternal age, multimorbidities in pregnancy and the widening digital landscape are prominent in The Rotunda — Maternity Hospital of Choice: Strategic Plan 2017- 2021. The hospital envisages developing a service that thrives rather than survives, and responds rather that reacts, but it is likely that creaking physical and supporting infrastructure will allow it develop only so far in its delivery of maternity, gynaecology and neonatal services.
Minutes of a Rotunda board meeting in March, for example, made reference to its budget for 2017 not meeting anticipated requirements and its financial controller forecasting a deficit of €2.2 million. According to the hospital, its allocation for 2017 from the HSE is €51.740 million. It did not provide comment on the projected deficit.
It is unsurprising, therefore, in an area where private and semi-private maternity registrations have held particular importance in respect of hospital income, that the Rotunda’s strategic plan is largely focused on cultivating and maintaining relationships with patients. Some 8,538 babies were born at the hospital in 2015, according to that year’s annual corporate report.
The Rotunda’s strategic plan was developed with the assistance of management consultancy firm MCO under a contract valued at €40,000, as reported by the Medical Independent (MI) in March. The Rotunda has published the strategy document on its website but decided not to upload the associated implementation plan. A hospital board meeting in May heard that the implementation plan focuses on the key strategic projects, time-frames and persons responsible. It is “a working document which will not be uploaded to the web” but will be a recurring agenda item at board meetings, according to the minutes seen by MI.
The strategy was adopted with the assumption that the hospital will remain at Parnell Square in Dublin city centre for the time period concerned. It is more than two years since an announcement was made by Government that the Rotunda would move to the campus of Connolly Hospital, Blanchardstown, where it will be located alongside a planned paediatric satellite centre of the new National Children’s Hospital (see panel).
Writing in the strategy document, Master of the Rotunda Prof Fergal Malone underlined the importance of acknowledging that the hospital was facing “a range of issues, including human and financial resources and infrastructural constraints” but it remained “committed and determined to continue providing the highest standard of care to our patients at our current location, while actively planning the development of a new Rotunda Hospital co-located on the Connolly campus”.
Prof Fergal malone, Master, Rotunda Hospital
The reality of increasing maternal age is the focus of a number of actions listed by the Rotunda in its strategic plan, which was drawn-up following engagement with internal and external stakeholders.
The proportion of births to mothers aged 40 years and over is increasing nationally, from 5 per cent in 2010 to 6.4 per cent in 2015, according to the document. “This increasing trend can be seen across the RCSI Hospitals Group, with the rate reaching almost 7 per cent of total live births in the Rotunda Hospital in 2014.”
It notes that adverse maternal and perinatal outcomes are associated with younger and older mothers. The trend towards an older population of women giving birth has implications for maternity and neonatal services, including the capability to respond to complex pregnancies, it adds.
Developing preconception and specialist antenatal care is listed as one of the hospital’s strategic projects. Allied with this objective, the Rotunda pledges to develop care for high-risk patients with recognised medical or prior pregnancy complications. Specifically, it will provide specialised services for older women who would like to become mothers, for women with complex medical needs who would like to become mothers and develop a dedicated medicines in pregnancy service with the aim of providing preconception and prenatal information on medication use for women and healthcare professionals.
The strategy also refers to developing pathways and services for genetic screening and testing in pregnancy while, elsewhere in the document, the hospital commits to optimising the regional pathway for fertility testing and treatment.
However, any advance into provision of advanced fertility treatment envisaged by the Rotunda would likely depend on public funds becoming available. Prior to the General Election in 2016, then Minister for Health Leo Varadkar said the State would begin providing funding for fertility treatment in tandem with the introduction of legislation on assisted human reproduction (AHR).
A draft of the General Scheme of legislative provisions on AHR and associated research has been prepared. Consultation in relation to the provisions in the draft General Scheme is taking place with the Attorney General’s Office and with other relevant Government Departments. The draft General Scheme will be revised, where deemed necessary, in advance of being provided to Minister for Health Simon Harris and subsequently submitted with a memo to Government for approval.
A Department of Health spokesperson told MI: “It is not possible at this time to give a definitive timeline for the completion of the draft Bill and its subsequent passage through the Houses of the Oireachtas. However, work on the General Scheme of an AHR Bill is well advanced in the Department of Health and the Minister for Health considers this to be a priority for 2017.”
A spokesperson for the Rotunda said that, in regards to fertility testing and treatment, “the objective is to optimise a pathway but no specific details have yet been finalised”.
The Rotunda operated the HARI fertility clinic (now Rotunda IVF) before its sale in 2014 and had offered a proportion of treatments pro bono. This provision was to continue for three years after the sale under agreed terms. A spokesperson for the Rotunda told MI that a new arrangement with Rotunda IVF has been agreed for continuation of a service for 2018. “As this is a commercial deal, no details will be made available,” they said.
Speaking generally on the strategic plan, the spokesperson added that “before any informed decisions can be made or finalised in regards to services or initiatives referenced in the five-year strategic plan, the Rotunda Hospital will conduct a full review to establish what is available and where the gaps exist”.
In terms of enhancing experiences for patients and staff, the hospital is proposing to develop a “knowledge platform”. The goal will be to make the Rotunda “the go-to place for mothers, parents, families and healthcare professionals for reliable and trustworthy information related to preconception, pregnancy, women’s health and healthy lifestyle choices”.
The knowledge platform will have two aspects — a curated digital platform “that provides easily-accessible and accurate information via website, social media and other channels”; and events in the community that will provide information and promote healthy lifestyle choices for women of child-bearing age, while considering innovative ways of engaging and collaborating with partners and networks (academic partners, GPs, local communities, RCSI Hospitals Group network, women’s organisations).
The Rotunda will also establish a technology/innovation centre to harness service improvement ideas and suggestions from within the hospital. This centre will be a resource that supports the development of ideas from staff and enable them to brainstorm, prototype and test new ideas in a cross-departmental way. The centre will also support ‘horizon-scanning’ for the latest improvements in care delivery, as well as research new technology and develop technology partnerships for the benefit of patients and staff.
Other focuses in the strategic plan include a commitment to continue to upgrade infrastructure at Parnell Square to “optimise the safety, efficiency and effectiveness of service delivery” and to “continue to retain and attract workers at all skill levels”, as well as invest in IT.
The Rotunda will also conduct a “future skills needs analysis” for its services, cognisant of the changing business environment, in particular the impact of technology on skill requirements of the future.
‘No definite time frame’ on Rotunda’s relocation
There is “currently no funding commitment” and “no definite time frame” for the Rotunda’s relocation to the campus of Connolly Hospital in Blanchardstown, according to the maternity hospital’s strategic plan for the years 2017 to 2021. The announcement on the relocation was made by then Minister for Health Leo Varadkar in May 2015.
According to the strategic plan, the Rotunda’s board of governors is “enthusiastic” about the relocation decision, as it “recognises the need for a new facility fit for modern maternity services”. It says a project board and several working groups have been established by the Rotunda with the support of the HSE, the Department of Health and other stakeholders.
It is recognised that Connolly Hospital “will itself also have to be upgraded” in order to optimise the relocation of the Rotunda, according to the document.
The new Rotunda Hospital at the Connolly campus will provide advanced maternal-foetal medicine services for the RCSI Hospitals Group, extending from Dublin as far north as the border, including support for prenatal diagnosis, high-risk obstetric care and foetal treatment, it outlines.
It will provide advanced gynaecology services for the RCSI Hospitals Group and advanced neonatal intensive care facilities for the most complex and premature babies born at the Rotunda, “as well as select out-born babies from RCSI Hospitals Group network hospitals, such as Our Lady of Lourdes Hospital Drogheda and Cavan General Hospital and also nationally”.