North Dublin
[)cvclopme nt or a Maximum Care and Teaching Hospital or 1,000 beds for North Dublin on the Site of the Existing Mater Misericordiae Hospital Preliminary Feasibility Study July 1, 1969
TABLE OF CONTENTS Chapter 1 Introduction Page Chapter 2 Objectives Page 3 Chapter ~ General Location of Mater Hospital Page 8 Chapter 4 Site Page 10 Chapter 5 The existing hospital Page 14 Chapter 6 Further development of the existing hospital Page 17 Chapter 7 First stage of development Page 21 Chapter 8 Conclusions Page 24
Appendix A Specialised services which would be provided in North Dublin Regional Hospital Page 26 Appendix B Tentative outline of the provision to be made in Stage I of the development and facilities which it is envisaged would be shared between the hospital blocks Page 27
LIST OF DRAWINGS No. I The Hospital in relation to the population to be served No. 11 Site of the Hospital within the traffic structure. No. III Hospital Site with reference to Town Planning No. IV Berlin Teaching Hospital (1,400 beds) on Mater Hospital site No. V Basic lay-out of future development No. VI Lines of basic circulation within the Hospital complex No. VII Functional concept of the Hospital complex
No. VIII Basic lay-out of First Stage Development No. IX Schematic Elevation from South No. X Allocation of space in First Stage Development
I I Deutsches Krankenhausinstitut (DKI), Dusseldorf PRELIMINARY FEASIBILITY STUDY Development of a Maximum Care and Teaching Hospital of 1,000 beds for North Dublin on the site of the existing Mater Misericordiae Hospital 1.0 Introduction 1.1 Recommendations of the Consultative Council on General Hospital Services The Consultative Council recommended that, if it is possible, it would be preferable to use the existing Mater Hospital as a base on which the major regional hospital group of about 1,000 beds for North Dublin might be developed. (For details as to the nature of the specialised services which would be provided in the hospital see Appendix A). They pointed out that as the Mater Hospital is in excellent condition, the development of the remainder of the site would represent the most economical and quickest solution of the problem of providing a comprehensive institution of adequate size in the area. The Council also adverted to the possibility of other property becoming available adjoining the Mater Hospital site, which could be used in long-term plans for the development of the group hospital project. 1.
1.2 Problems which are the subject of the Preliminary Feasibility Study 1.21 The question is to consider the feasibility and suitability of developing a regional teaching hospital on the Mater Hospital site. If this is not possible within the boundaries of the existing site there is the question of approaching this plan on condition that adjoiningproperty is acquired and existing buildings in these areas are demolished. 1.22 If the questions as to 1.21 are answered in the affirmative is the construction of a new hospital block of 420 beds including supporting services which would be shared with the existing Mater Hospital and the private nursing home thought possible? I 2.
2.0 OBJECTIVES 2.1 Reasons for Concentration The concentration of hospital care recommended by the Consultative Council is considered important and necessary from the medical point of view as well as from aspects of medical teaching. Hospitals which provide medical teaching and regional specialist services must have a sufficient number of beds in view of the requirements of modern medicine and medical technology. Significant reasons in favour of concentration are the increasing degree and inevitable growth of specialisation and super specialisation and in this connection the resulting requirements of staffing. In addition, a further important argument is the need for institutes which are a prerequisite for modern diagnostic methods and therapy as well as teaching, especially of anaesthesiology, radiology, laboratory medicine, physical therapy and pathology. According to modern standards these institutes, too, need as a basis some 1,000 beds. 3.
Modem hospital care and teaching services require very close co-operation of different clinical disciplines and institutes, i.e. in other words, the physical accommodation for these should be placed close together. An attempted co-ordination of effort between institutes and disciplines in separate hospitals at dispersed points would not give the same results as facilities concentrated in one area. Another important reason in favour of concentration is the economical aspect. Concentration of regional specialist services and teaching facilities means lower capital investments and operational costs than if the same services and facilities were provided at a number of locations. The alternative would either be acceptance of a lower standard of services or, in assuming similar standards of services, a high increase in costs, especially in staff and space requirements. 4.
2.2 Objectives as regards the situation of patient care in Dublin In Dublin there is no hospital of bed capacity and range of services which would meet the requirements of a modem regional specialist and teaching hospital. Cities which are comparable to Dublin generally dispose of large university hospitals, partly comprising 2,000 and more beds. We consider from our experience that teaching hospitals disposing of about 1,000 beds tend to give more acceptable results from the medical and economical point of view. Considering the requirements of modem regional specialist services and teaching facilities, of the hitherto existing development of patient care in Dublin, and of the structure of the City of Dublin and the surrounding area, it is thought important and suitable, according to the present experience, to aim at providing regional specialist services and teaching facilities both in North Dublin and South Dublin. 5
On the other hand, as regards the population and their need of patient care services, it is from the medical and economic point of view out of the question to run more than two top care teaching hospitals in Dublin. c.
2.3 Outline Programme Provision (See Appendix B) The outline programme at hand for the development of a regional teaching hospital in North Dublin on the site of the existing Mater Hospital will on the whole meet up-to-date requirements. The tentative outlines for the total area including provision for circulation and communications with a total of about 350,000 square feet will meet with the requirements of the hospital development proposed. There are no considerations against starting from this base in the further development of the programme. It is, however, considered to be extremely important for programming and designing to emphasize the need to provide for changing requirements in the future, and in this connection to secure that future expansion will be possible. This applies especially to such disciplines as radiology and laboratory medicine as well as out-patient services. In these cases, provision for even minor expansions in the short run should be allowed for. 7.
No. I The Hospital in relation to the population to be served to p Care (specialized services) N 'I' I-inl!la... (,l;j~nt... m Ballymun ( Jbr.1 Whih:hall llc.iuillih11 Drumcomlra Manno Phihsboro (OOIOcK S,,,,\rf n, I\.llIc~tl r ( 1011101rl Raheny SUi! )0 B. "Il (,m! 1{1~1\ r,d ~\. nl.. c!o)... CITY CENTER to p care (specialized services)
3.0 GENERAL LOCATION OF MATER HOSPITAL The location of the existing Mater Hospital is favourable for a regional teaching hospital in North Dublin. On the one hand, it is situated favourably as regards the city centre and on the other hand as regards the arterial roads opening up North Dublin and the adjoining : northern area (see Drawings Nos. I and 11). The favourable situation within the traffic network of North Dublin will guarantee that motor vehicles and public means of transportation will have reasonable access. The central location of the Mater Hospital as compared with a suburban location is looked upon as favourable above all as regards patients, their visitors and staff. Central hospitals enjoy a higher popularity than suburban hospitals. The possible advantages of a location with less noise, and more attractive scenic surroundings do not make up for the disadvantages. In this connection, the relatively short average duration of patient stay in a highly specialist hospital should be borne in mind. 8.
No. 11 Site of the Hospital within the traffic structure. N ~ CITY CENTER
Accessibility for out-patients also needs emphasis. As a matter of course, the centrally situated hospital will also facilitate the visitor of the patient. The advantages of central location must not,be undervalued as regards staffing. We know from experience that staffing of central hospitals is connected with less difficulties than the staffing of suburban hospitals. The central location of the hospital would offer advantages as regards the increasing number of part-time personnel and the increasing number of married staff that is likely to) be employed in the future. 9.
No. III Hospital Site with reference to Town Planning N ~ Hospital zone to be protected by town planning North Circular Road TEACHING HOSPITA L AREA
4.0 SITE (See Drawings Nos. III and IV) The available site of the Mater Hospital comprises about 534,000 square feet. Abollt 534 square feet would then be allotted to one bed. Ideally, we think that between 550 and 715 square feet per bed would be desirable if a major teaching hospital lies in the centre of a city. This would assume that provision is made on the site for staff residences, laundry, central sterile supply services and so on. If such services are provided off-site the area required ideally per bed can be reduced. When examining the best location for a building, however, the size of the site is not the predominating factor but above all the shape of the site. A further question is whether additional site space can be obtained in the long run in a location or locations favourable for an expansion of the hospital complex. 10
No. IV Berlin Teaching Hospital (l,400 beds) on Mater Hospital site /
I The shape of the Mater Hospital site and the possibilities for land acquisition for extensions offer very favourable prospects for the development of a regional teaching hospital on the site. To begin with, it is of advantage that the available site is of such shape and so orientated as to facilitate the development of the first stage.of the proposed expansion without interfering with the running of the existing hospital. Secondly, a development in the location proposed would permit of later organical developments and would not interfere with the possibility that the existing main hospital building might in the future require to be replaced. The available site could best be extended to the East and South, which is of advantage looked upon from the angle of hospital planning. Therefore, it is recommended on principle that all sites obtainable in these areas should be bought. This recommendation should be given to the Mater Hospital even if the North Dublin Regional Hospital were not to be provided at the site. 11.
The suitability of the Mater Hospital site as one on which to develop a regional teaching hospital of 1.000 beds was examined by projecting the outlines of a modern 1,400 bed teaching hospital on the available site. Furthermore. the suitability was examined by individual model studies of alternative developments on the site. A prerequisite for a positive judgment of the available site for the project in question is in our opinion that for the far future the buildings on the site should only be used for patient care, teaching and research. Buildings which are not of fundamental importance for patient care, teaching and research should be accommodated outside the site in the neighbouring area. This applies especially to staff residences. Services such as laundry and sterile supplies could also with advantage be provided off site. If possible, it would be advantageous to acquire buildings and sites for staff homes at the southern side of Eccles Street. 12.
From the town planning point of view in such a case as the development of a regional te~lling hospital on the Mater Hospital site a final judgment will be facilitated when alternative designs are available for assessment. The hospital site is located in an area which has been zoned as residential in the draft development plan for Dublin City. The zoning of an area as residential imposes planning restrictions which are not appropriate to a hospital development. The Corporation _of Dublin should be asked to take steps so as to ensure that a proper hospital development is not impeded. It is considered that in view of the major public importance of the proposed hospital complex the town planning authorities should keep in mind that the area between North Circular Road, Berkeley Road, Dorset Street and Eccles Street (including the buildings on the outskirts of the area) is a sphere of special interest for the hospital and its expansion, and that this area should be protected by the town planning authorities against developments in the neighbourhood which might impair the effective operation of the expanded hospital. 13.
5.0 THE EXISTING HOSPITAL The Mater Hospital is a general hospital and has 433 beds. It is used as a teaching hospital. Included in the main hospital block are a convent accommodating 65 nuns and a chapel, operating theatre facilities (which are proposed to be extended) and the main kitchen. The remaining accommodation comprises: (a) Out-Patients, Casualty, Laboratory and Medical Staff Residency (part single storey and part four storey block). This building might possibly be utilised for treatment and research purposes. (b) Cafeteria, Lecture Hall and Lecture Rooms (three storey block built in 1968). This building would continue in its present user. (c) Radiodiagnostic Department and School of Physiotherapy (two storey block). It may be necessary to demolish this building which is not significant. (d) Child Guidance Clinic (single storey block built in 1966 and now being raised to two storeys). This building would continue in use. 14.
(e) Rehabilitation block (gymnasium and remedial baths. single storey biock. previously the laundry). It will be necessary to demolish this building which is of no significance. (t) Private Nursing Home (provides for about 100 patients and has its own kitchen). This building would continue in use for the present. It does not interfere with the planning requirements of the first stage of the development (g) Maids Home (with accommodation for 91 domestics. 16 nuns and 12 trainee nulls and with its own kitchen and dining accommodation for maids and the trainee nuns). It may::b.e ~desirable to demolish this building. (h) Nurses Home and College (construction completed in 1954 accommodation for 240 nurses, kitchen, dining accommodation, etc.). This building would continue in use. It does not interfere with the planning requirements of the first stage of the development. (i) Boilerhouse and workshop facilities. These buildings would be replaceu. 15.
The nature and scope of the services in the existing hospital are of a high standard although the physical facilities, including the equipment, seem to be scarcely adequate by modern standards. To fulfil the standards required of a regional teaching hospital, however, the facilities and scope of services would need to be considerably extended. This should not be overlooked even though the hospital generally is well maintained and leaves a very good im pression. ' As stated before, the age, condition and economic value of the existing buildings differ widely. There is, however, no doubt that the main hospital block and the buildings completed in recent years can be used for a long time to come. 16.
No. V Basic lay-out of future development N "..
I 6.0 FURTHER DEVELOPMENT OF THE EXISTING HOSPITAL (See Drawing No. V) 6.1 Access In the course of the proposed development of the hospital it would be advisable to concentrate all access in the one area. From the traffic point of view it would be advisable to have all approaches from Eccles Street with the exception of the mortuary from the North Circular Road. In Eccles Street the area between the main hospital block and the private nursing home suggests itself as the most suitable location for the entrance area. From here easy access is possible to the existing buildings as well as the new buildings proposed. 17.
6.2 Determination of use of site space Suggestions are now made for the use of the available site space. The properties east and south of the present hospital site and extending to Dorset Street and Eccles Street should be acquired as they become available. The sites on the south side of Eccles Street are of interest for possible use as staff residences. The site between the lecture theatre complex, rehabilitation block and nurses home east of the main hospital block should be reserved as the site for the first stage development of the future main teaching hospital complex. The engineering services would be provided in the north east section of the existing site. From there an operational and structural expansion to both the north/west and south/east should be envisaged. The grounds of the north/west corner should be reserved as an area for future research and teaching facilities. 18.
6.3 Planned Development In planning immediate developments care must be taken to ensure that future expansion and development in building and operation is not interfered with. In this connection planning should keep in mind the possibility that it may be necessary to replace some of the existing buildings which for many years to come are fit for use. Only in this way can it be safeguarded that buildings to be provided now do not some day turn out to be of wrong functional concept. The availability of financial resources must also be considered in the stage planning of an overall development. The basic principle for programming and designing should be that development should be in stages - small, if necessary - but as part of an overall co-ordinated planned approach. The gradual development referred to can be achieved commencing on the basis of the framework of the available site and the continued existence of the hospital buildings which are suitable for retention for the present. 19.
The gradual development referred to can be achieved within the framework of the available site and the continued existence of the hospital buildings which are suitable for retention for the present. The development of the future main teaching hospital complex as envisaged in the model plans complies with accepted principles of modern teaching hospital planning. 20.
No. VI Lines of basic circulation within the Hospital complex N ~ INTERNAL '" TRAFFI( UNf-S EXTERNAL "" ~ V 11C<i1 L rculation
7.0 FIRST STAGE OF DEVELOPMENT (See Drawings Nos. VI, VII, VIII, IX and X) The tentative outline of the provision to be made in the first stage of development (see Appendix B) is regarded as an adequate base for further programming and as the nucleus for the development of a modern teaching hospital. In this connection it is urgently recommended that attention should be paid to recent experience in the planning of major hospitals which underlines that in programming and project planning the need for flexibility and adaptability to meet changing demands should be kept in mind. Programming and planning should not determine more than is absolutely necessary the utilisation of rooms and the organisation of departments. The skeleton plan for the overall development of hospital facilities on the Mater Hospital site so as to produce an up-to-date teaching hospital of adequate size envisages that the first stage of the planned development can be carried through in such a way as not to affect the operation of the present hospital. 21.
No. VII Functional concept of the Hospital complex 5.H. C. Mai n Entra nce 5.H. T.R.F. 5.5. BW. c. CTF Staff Home Teaching and Research Facilities Supply Services (Kitchen, etc.) Boiler House and Workshops Convent Central Diagnostic and Therapeutic Facilities
It is recommended that in the first stage of the development planning should be on the basis of a three or four-storey podium from which will arise the ward block. The ward block would be developed on a double-corridor (race-track) plan with wards facing east or west. A technical floor (to house mechanical equipment such as air-conditioning plant) would be provided between the podium and the ward block. The planning conception suggested is designed to meet medical, hygienic and organisational requirements. Administration and main entrance would be provided in a single storey block connecting the present Mater Hospital and the proposed new major block. The lines of basic circulation within the hospital complex are shown on drawing number six. The internal circulation proposed demonstrates that in the first stage development communication between the present Mater Hospital and the new hospital block will be achieved in such a way as to ensure the availability in a co-ordinated manner of services (diagnostic and treatment) in the entire hospital complex. 22.
No. VIII Basic lay-out of First Stage Development North Circular Road N ~
Drawmg number seven demonstrates the functional order whicll can be achieved as between the different components of the overall hospital complex. The diagrammatic illustration shows clearly that effective integration can be achievcd bctween the existing hospital buildings and the new hospital block. In regard to catering facilities it is assumed that the kitchen in the southern part of the main block will be abandoned and that a new kitchen will be provided at lower ground floor level in the north/eastern section of the podium. Facilities for parking can be provided for staff on the south side of the complex, adjoining the main entrance area. and for others to the east of the proposed new block. 23.
No. X Allocation 0 f space in First Stage Development N ~ {,..I1 l!'~ \\-orl.. hops HolI. rhoilsl Ward Un its + Teaching Accommodation Anil1l.lllah Medical Records Supply Court
8.0 CONCLUSIONS According to the studies made it is considered that a regional teaching hospital of 1,000 beds can be developed on the hospital site. The site is considered adequate for a modern teaching hospital complex provided that it is used only for patients and teaching and essential ancillary purposes. For the ancillary facilities such as staff homes, etc. every available site to the East and South of the existing site should be acquired. I t is also clear from the studies which have been carried out that a new hospital block of about 420 beds with supporting services can be located within the boundaries of the existing site without the need to acquire further site space. The schematic solution suggested shows that it is possible to construct the new buildings envisaged in the first stage of the development without interfering with the running of the present hospital and without affecting the existing hospital buildings which are suitable for retention. The proposed new block can be conveniently integrated with the existing hospital organisa tion. 24.
... No. IX Schematic Elevation from South
The new block can be further developed in such a way that in the future all possibilities will be open for the development of a completely new teaching hospital complex. DEUTSCHES KRANKENHAUSINSTITUT e.v. QiSTAND Dr. S. Eichhorn R. J Sahl. Dusseldorf, 1 July, 1969 25.
PPENDIX A. Specialised services which would be provided in the North Dublin Regional Hospital. Neurosurgery (including oto-neurology). Vascular Surgery. Cardiac Surgery. Urology. Nephrology, haemodialysis and renal transplantation. Gastro-enterology. Major accident service. Ophthalmology. Oto-rhino-Iaryngology. Geriatric assessment. Isolation Unit. Diagnostic radiology service. Medical research and medical education facilities. Comprehensive pathology service. 26.
APPENDIX B Tentative outline of the provision to be made in Stage I of the development and facilities which it is envisaged would be shared between the hospital blocks. Department Total Area (including provision for circulation and communications) (Square feet) Ward Units (Based on 70 beds on each of 6 floors) Special provision for dialysis Teaching accommodation near war~s (with basic laboratory facilities) Research Laboratories (for staff and post-graduates, including accommodation for experimental surgery, stores, technicians room, etc. Intensive Care Administration Medical Records Central Staff Changing Rooms Private Consultants' Block (waiting rooms, etc.), Treatment and Diagnostic Departments Out-Patients Department (including day-ward beds and suite for out-patients operations, endoscopy, E.E.C.,Ke.G., cystoscopy, etc. (Note - Operating Theatres Radio-diagnostic some of the specialities will be linked with their own accommodation e.g. cardiology) Medical Illustration and Clinical Photography Pharmacology Pathology Animal Laboratories Physical Medicine 118,000 4,000 6,000 5,000 5,000 16,000 6,000 8,000 10,000 40,000 23,000 21,000 1,000 5,000 25,000 2,000 11,000 27.
Service Departments Total Area (including provision for circulation and communications) Dining Central Boilerhouse Workshops and Garages Stores Pharmacy Mortuary and Post Mortem Total (Square feet) 13,000 2,000 10,000 10,000 2,000 4,000 347,000 Note Laundry and central sterilising will be provided off-site. ii Facilities which it is envisaged would be shared between the hospital blocks. (a) Pathology, Clinical investigation, Animal House. (b) Radio-diagnostic. (c) Out-Patients Department. (d) Operating Theatres (to a considerable extent). (e) Medical Illustration and Clinical Photography. (f) Lecture theatres, reading room and library facilities. (g) (h) U) (k) (1) Central Supply Department. Kitchen. Maintenance workshops and garages. Central Boilerhouse. Central Staff Changing Rooms (if necessary). (m) Private Consultant's Block. (n) Medical Records (eventually). (0) Accident and Emergency Department. (p) Residential accommodation for interns and students. (q) Mortuary and Post-Mortem. 28.