Point in Time: The fight for our Hospital

MAKING its way through the streets of Dublin on Sunday, June 21 1998, a squad of 12 high-tech Eastern Health Board ambulances carefully transported their intensive and coronary care patients to the new purpose-built Adelaide, Meath and National Children’s Hospital in Tallaght.

Waiting for them at the doors of AMNCH – more generally known as Tallaght Hospital and later Tallaght University Hospital – were teams of medical and nursing staff ready to admit what represented the very first patients to the new £140 million facility built on a 35-acre site in the rapidly growing Dublin satellite.

The arrival of those 115 patients from The Meath, Adelaide and National Children’s Hospital, along with doctors and nurses from those three facilities, not only marked the completion of a highly-logistical and well-planned move, but also the culmination of a near 20-year campaign to see Tallaght become home to a development that embodied one of the biggest ever investments in the Irish healthcare system at the time.

For those who fought for the establishment of the hospital in Tallaght and those who took up the baton after it opened in ‘98, the road had been long and arduous.

From the struggle to generate sufficient political will to even make the project a reality, to shortfalls in funding that severely hamstrung the hospital from the get-go; from harmonising the divergent cultures and religious traditions of the three root hospitals that made up Tallaght, to surmounting the, at times, unfavourable attitude from officialdom to the newest player in Irish healthcare, Tallaght University Hospital and its supporters have treked a hard course since its establishment was first conceived some 40 years ago.

Indeed from the moment the concept of such a facility was initially mooted back at the outset of the 1980s, supporters of the initiative in the community had to constantly battle just to prevent the proposal sliding off the government agenda and being ultimately regarded as just another fanciful idea consigned to political dust.

Certainly the work of the Tallaght Hospital Regional Action Group was essential in keeping the hospital on the national political radar by way of regular meetings throughout Tallaght and the surrounding areas that generated huge media and public support.

The work of Richie O’Reilly, Tony Hubbard, Fr Murtagh, Bob Byrne and so many more like them, kept the flame well and truly lit particularly at a time when it was in danger of being extinguished, as the tap for the Tallaght Hospital Board – the body charged with overseeing the planning, building and equipping of the new facility – appeared to have been turned off in the early ‘90s.

“The Budget came out every April then and each year there was so much money put into keeping the Tallaght Hospital Board operating even though there was no hospital,” explained O’Reilly, a leading member of the Tallaght Hospital Action Group.

“In 1991 Chris Flood, a TD from Kilnamanagh, became a Junior Minister for Health and when the budget came out in April there was no money allocated for the Hospital Board.

“It suggested we were getting a Junior Minister, but we weren’t getting a hospital.

“After that, there were a few people talking and saying let’s get the hospital going together.

“So we got together and we called a meeting in The Priory. A number of people turned up and we formed a committee out of it. The committee was quite good, because it came from Killinarden, Jobstown, Springfield, Ciarnwood, New Bawn, Old Bawn and Kilnamanagh.

“We called our first meeting in Kilnamanagh School in September and we elected Tony Hubbard as chairperson and Bob Byrne as secretary, so we had them at the top table. We had Mary Harney, Junior Minister for the Environment, and we had Chris Flood.

“We had TDs and senators like in a jury over on the left hand side and we spoke about nothing but the hospital.

“We invited the media and RTÉ came out. There was their health correspondent George Devlin and he covered the event.

“The hall was so full, there were people standing outside looking in the window and we thought ‘This is fantastic. People are really with us on this’.

“The next evening on the 6 o’clock news it came on about the campaign to get Tallaght Hospital built and they showed Barry Desmond [then Minister for Health] in a JCB turning the sod back in ‘86 and leading on to our meeting.

“That got us up and running. We went from Kilnamanagh to Old Bawn to Rathcoole. We went to Clondalkin, to Springfield and we ended up back in The Square and we filled the whole centre of that.

“And everywhere we went, RTÉ came with us. The Irish Times got on board, the Evening Press, The Herald and of course The Echo. We got the leading articles in all those papers saying ‘Tallaght needs this hospital’.

“The Square and the likes of Thomas Davis and St Mark’s gave us great support. If we wanted halls or any notices read out, they were there.

“At the meeting in The Square, Des Rogan, who has since passed away, he was manager of the Adelaide and he was also on the Tallaght Hospital Board, he loaned us a model of the hospital.

“We put it on a table between Debenhams and the escalator where the committee went down to get a petition signed. In two-and-a-half days we got 16,000 signatures,” he remembered.

Huge wave of support for a hospital in Tallaght 

The collapse of the Fianna Fáil-Progressive Democrats coalition government in November 1992 led to a general election and the return to power of the former, this time in partnership with Labour, in January of the following year.

The huge wave of support for the building of a hospital in Tallaght was certainly not lost on the powers that be and although the proposed starting date of April was pushed back by several months by then Minister of Health, Brendan Howlin, work began on the new facility in autumn of that year.

“Brendan Howlin said he couldn’t start the hospital in April because there were three months lost with negotiations,” remembered O’Reilly.

“So we did our own turning of the sod on that day it was supposed to be done and we got on to the media to let them know this was the day it was supposed to have happened, but it was cancelled.

“It was gas that day, down there, standing in a hole with a shovel with some of the committee, but we had to keep it in the limelight, because if we let it drop at all, we’d have been waiting forever,” he insisted.

With shovels in the ground by October of 1993, the wait for Tallaght’s new hospital would last just another five years, when the new development, housing 12 theatres and 450 beds, opened its doors and admitted its first 115 patients from The Meath, Adelaide and National Children’s Hospital.

The opening of Tallaght University Hospital, which has a long affiliation with Trinity College, brought together under one roof, hundreds of years of medical and nursing practice from three of Ireland’s most celebrated medical institutions.

Indeed, The Meath, established in 1753, was the oldest university teaching hospital in the country while The Adelaide School of Nursing was founded by Ms Bramwell who worked in the Crimean War with Florence Nightingale.

And the National Children’s Hospital, originally founded in the Liberties before moving to Harcourt Street, was the first dedicated children’s hospital in the British Isles.

For Professor Rónán Collins, a geriatrician, who was part of that move to Tallaght in 1998, the undertaking, while logistically smooth, brought with it, a number of challenges.

“It was a unique experience to be involved in terms of moving hospitals. It’s not something that happens every day,” Collins told The Echo.

“The move involving the actual patients, doctors and nurses themselves went very smoothly and quite quickly.

“We had to move out in stages, ward by ward, and that’s a tricky thing to do because you had to keep the services going on both sides for a while and we had limited numbers of staff. So we had to keep skeleton services going until the move was completed.

“But it was a very exciting time moving to a new hospital.

“We were then creating new wards where people who hadn’t worked together before, were now working together.

“It sounds like that would be straight forward, but they were two very different nursing traditions coming together, so it took a while to bed that down, with team building. A lot of work went on behind the scenes for that as well.

“I was a junior doctor at the time and many of us ran between both hospitals back at the base camp anyway, so it was less of a thing for us.

“But certainly among the portering, the nursing staff and catering staff, coming from very different systems and management and even ways of doing things, it did take a long time to bed that down.

“I wouldn’t say it was all plain sailing. It’s a difficult thing to achieve very quickly, but I do think the hospital achieved it very well,” he stressed.

HR Director at TUH, Sharon Larkin has similar recollections, recalling “When we first moved out, it would have seemed like an enormous building, although we need more space now.

“There was all new equipment which was great because it was the largest investment in a health care facility at that time.

“You would have had staff, probably initially being very wary of each other, not knowing each other and, all of a sudden, working in the same department together.

“I would have done a lot of work with the Meath, Adelaide and National Children’s Hospital staff in preparing for the move up to Tallaght.

“That was a huge culture change. You were going from three sites in the city centre out to Tallaght, and they were three different hospitals.

“The Children’s Hospital is obviously a children’s hospital and we’d have had no experience of working in a children’s hospital.

“The Meath would have had an emergency department so was a small acute hospital.

“The Adelaide was more elective surgery, more planned, so all the patients coming in were scheduled and all of a sudden we’re on this new site in Tallaght with everything coming in at the same time.

“I think the first 10 years or so we were all just finding our feet with each other. It was all just so new, with people settling into their roles and how things were done,” she said.

While the 2000 or so employees at Tallaght University Hospital were finding their feet in their enormous new surrounds at the time, the hospital also had to contend with a lack of funding that was exacerbated by a degree of political and religious tension that came with the amalgamation of these three institutions.

“My own recollection of coming out to Tallaght at the time was that there was a lot of focus on this at a political level, how this move would work,” remembered Collins.

“There was a lot of positioning for control of the board of the hospital at political level and that fell along religious lines.

“We had a very good chief executive in my opinion at the time, a man by the name of David McCutcheon who was tasked with bringing these three hospitals together.

“Two of the hospitals would have traditionally come from the Church of Ireland tradition while one of the hospitals would have been nominally from a Catholic tradition.

“Even back in the 90’s they were sensitive things, so for him to get the three hospitals to come together and move out was an achievement in itself.

“Then of course there was the issue that we never really got enough money, so the hospital was in trouble straight away.

“But because of all those trials and tribulations in the bringing together of the different ethos and cultures in our hospital, I think it forged very strong bonds.

“And because it was seen that the hospital was always under-funded, we felt we were the underdog, but we were going to do our best to tough it out.

“I think it [the opening of the hospital] was hugely important for people out here. I got that sense that it was really needed. The people had been promised it for a long period of time.

“And one of the things I noticed very much as a new junior doctor, we came from inner city Dublin where there was a very old population, and when we came out here, suddenly the population that was coming to our hospital completely changed.

“It was a very different population. It was much younger back then, but a younger population with a lot of significant medical problems, because of, I suppose, the under investment in primary care in public health.

“People were finding themselves in much poorer physical shape at a much younger age.

“There would have been heavy alcohol use out here, heavy tobacco smoking, people were having strokes and heart attacks much younger than we would have been used to in the Meath Hospital.

“Having this healthcare facility brought a lot of hope and optimism to the people of Tallaght. It became such an important part of the community,” he insisted.

Echoing those sentiments is Killinarden woman Marie Barnes, who has been volunteering in Tallaght University Hospital from soon after it opened.

“I always felt we needed a hospital in our community,” she maintained.

“I used to travel out to Beaumont to see my lung specialist out there.

“Unemployment was rife at that time in the 1980s. I had three young children as well and my husband wasn’t working.

“The fares out to Beaumont were no joke in those days. I used to get two buses out and I’d be exhausted coming home.

“So Tallaght Hospital is not just a hospital to me. It’s our hospital within our community.

“My husband, Liam passed away eight years ago. He died in my arms here at home on the 23rd of September 2013. He had COPD and he had been attending Tallaght Hospital.

“They were so kind and so good at the end of his life, you couldn’t fault it, the support I got from everyone at that time.

“When he passed away, I started doing more then, I started getting more involved with the hospital.

“I can’t explain it, but it’s like I’m in my home when I’m there. Because I’m there over 20 years, it will tell you how I feel about Tallaght Hospital and the people in there.

“And, when I look at the facilities now and all the different services there, a lot of things have improved in the hospital over the years and I feel very proud to be part of this community and part of the hospital in Tallaght, for what they’ve done,” she said.

Whether it has been a lack of adequate funding, under-resourcing, a shortage of beds, the effects of storms and heavy snow, cyber attacks and, of course, the Covid crises, that very community in Tallaght University Hospital has faced and surmounted many challenges over the past 23 years.

One, that hurt particularly, was the fallout from the X-ray scandal back in 2010 when it emerged that almost 58,000 X-rays in Tallaght had been read only by doctors rather than by radiologists over a period of four years.

Arising from that major controversy was the Hayes Report, the findings of which were accepted by both the HSE and Tallaght Hospital which set about implementing its recommendations.

“Those kind of scandals do affect the reputation of the hospital and staff take them very personally,” said Larkin.

“Sometimes it’ll come down to policies and processes that need to be improved, but more often than that, it comes down to not having enough resources.

“Still, you feel responsible for it and you’re dealing with patients coming in and being very upset, but after that, there was a great resilience.

“Everyone was prepared to build back up the reputation of Tallaght and get confidence from the government, from the Department of Health in Tallaght Hospital and I think in the last six or seven years we’ve shown, through the investment that we’ve got, that there is great confidence in what Tallaght can deliver because we do deliver on projects,” she asserted.

Certainly that view is one shared by many, as Tallaght University Hospital and its services continue to develop and spread out into the community, making for one of the most preeminent medical hubs in the country.

With 12 theatres on site and a further four located in the nearby Reeves Day Surgery Centre, a new state-of-the-art facility that was opened late last year, TUH is working hard to tackle the issue of bed shortages and waiting lists.

Those efforts have been helped somewhat by the availability of step-down beds and facilities at St Luke’s and nearby Tymon North as well as the eventual opening of the new Children’s Hospital that will, in time, afford TUH more room to expand.

In 2019 the hospital completed the move of a number of out-patient clinics for endocrinology, diabetes, podiatry and neurology to the nearby Simms Building, accounting for more than 20,000 out-patient appointments in some 2300 clinics every year.

“One of our mantras is that we’re a hospital without walls. We’re expanding further out into the community,” said Lucy Nugent, CEO of Tallaght University Hospital since January 2019.

“We’re 23 years old and it’s still the newest public hospital in the country. A lot of hospitals evolved out of existing buildings, but this was a purpose-built hospital.

“There’s now a Tallaght health quarter. Outside the front gate of the hospital there are other healthcare facilities like the community radiology centre and the Institute for Population Health.

“We were able to open up our day-surgery unit, our ICU is under construction and we’re delighted that there’s going to be a new women’s health hub across the road from the hospital.

“So there’s really some fantastic developments and investment in the hospital.

“We’re now working with the HSE on a proposal for a six-storey extension next to the hospital canteen where we will be able to put in 72 in-patient rooms over three floors, a new oncology day ward and a clinical research facility among other things,” she explained.

Appointed CEO just a year out from one the greatest challenges ever to face, not only to the Irish health system, but healthcare organisations on a global scale, with the outbreak of Covid, Nugent cannot speak highly enough of the 3500 staff, representing no less than 58 nationalities, who today are employed in TUH.

“Really what the pandemic showed was the amazing staff we have. We’re a people business and the staff, as completely expected, rose to the challenge,” said Nugent.

“Here in TUH, staff tend to run towards the problem, so from that perspective, myself and the management team got huge support.

“We had to adapt and change overnight literally. Every single member of staff changed how they did their business and they did that in the knowledge that there was a very strong chance that they would get Covid, because 20 percent of health care workers do.

“And they were very conscious of their own loved ones at home, whether it was older family members or vulnerable members of their family. Some people moved out of the family home to protect their families.

“So people made huge sacrifices, and it’s testament to the Tallaght spirit. That was evident when I came here back in 2014. There’s a real ‘can-do’ attitude to find a solution.

“I think it may be a result of being a merger of three hospitals. It comes across very strongly that there’s a great team spirit here,” she smiled.

For Nugent, that ‘can-do’ spirit among her staff mirrors the prevailing attitude of the people of Tallaght to their hospital as demonstrated by the community’s near 20-year fight for the facility and the support they have given to it since it opened its doors back in 1998.

“We recognise that the community very much fought for the hospital and to have that support is great,” she stressed.

“We were the newcomers coming out, but we knew we were welcome.

“Richie O’Reilly is still a great friend of the hospital and I really respect the fact that our local community fought so hard for the hospital, to make sure that it was built and that the project wasn’t shelved throughout more difficult economic times. We really value that support that the community gave us and continues to give us,” she added.

O’Reilly, who was among those who championed the fight for the many of the major facilities Tallaght won at a time of all too apparent neglect by various governments back in the 1980s and ‘90s, views the struggle for the hospital as one of his most important.

“The population of Tallaght at the time was bigger than Limerick or Galway and we deserved a hospital,” he said.

“I mean there were hospitals in little towns all around the country and we really needed one here.

“It was a hard fight from the word go, but it’s been well worth it.

“It was the strength of the people who we had with us in our fight, and it was the power of the people that saw the hospital built. Everywhere we went, we got support and anytime we needed them, they were there.

“When I look at it today, I’m very pleased with the way the hospital has developed over the years.

“There’s still waiting lists that have to come down and various other things, but it’s made a huge difference to the lives of so many people here.”