A children's hospital has been the dream of several generations of Hong Kong pediatricians.

When I was a medical student in the 1970s, our professor of pediatrics had already started fighting for a children's hospital for Hong Kong. The dream finally came true when the government approved the construction of a children's hospital in 2013. It will enter service in 2018.

At present, health services for children are provided by the Department of Health, the Hospital Authority (HA) and the private sector which is delivered at a high standard. Why do we need a children's hospital? The children's hospital and existing public hospital pediatric departments will form a service network in Hong Kong to consolidate and further enhance the provision of child medical care facilities. Future child health services will adopt the principle of centralizing where necessary to improve outcomes, and localizing where possible to improve access.

Currently treatment of some rare and complex diseases in children is centralized to a few hospitals within the HA, such as the five children's cancer units, three pediatric surgical teams, one cardiac surgery team and one chronic kidney dialysis unit for children. Since the incidence of rare diseases in children is low (eg 180 new cases of childhood cancer per year), it is difficult to develop specialized facilities and expertise with the caseloads scattered among different hospitals.

These uncommon diseases frequently require a multi-disciplinary team approach in their management. For example, a child with a brain tumor requires a neurosurgeon for surgical removal of the tumor, followed by oncology treatment with chemotherapy and radiotherapy, neurological input for the control of seizures and long-term follow-up of neuro-development, in addition to physiotherapists, occupational therapists and speech therapists to assist in rehabilitation.

Centralization of caseloads also supports research. The two medical schools will play an important role in research at the future children's hospital. To conduct clinical research, there must be sufficient caseloads to test hypotheses. If clinical research can be successfully completed in shorter periods, doctors will employ new treatment methods earlier and help the unfortunate children suffering from serious illnesses. Another major role of the Children's Hospital is to educate and develop the next generation of pediatric and specialty children's healthcare workers.

With larger caseloads of rarer diseases concentrated in one hospital, trainees will be able to gain experience more quickly. They will also receive training from teams of specialists in these diseases. The children's hospital will partner with other regional hospitals in the hub-and-spoke model. Young patients with rare diseases will be transferred to the children's hospital from regional hospitals for the diagnosis and management of their conditions. Once patients have been stabilized, they may be transferred back to regional hospitals for step-down or shared care. Specialists in children's hospital will be able to provide out-reach services to regional hospitals. Specialists and trainees in regional hospitals will also be rotated with specialists at the children's hospital for training.

The 468-bed children's hospital is one of the largest public hospital capital projects undertaken. The hospital will be located in the Kai Tak Development Area and most in-patient beds will have views of the harbor. Its two towers have critical care zones, housing intensive care units, cardiology and cardiac surgical units, oncology and stem cell transplant units and a dialysis unit. There will be 12 general purpose operating theaters and two ambulatory units - one for a chemotherapy day centre, and the other for other pediatric conditions.

The hospital design will provide holistic care in a child-friendly environment. Parents will have unlimited access so that they can accompany sick children, either at the child's bedside or staying in dedicated overnight parents' rooms. There will be spacious play and activity areas as well as child-life specialists to help children adapt to the hospital routine and anesthetist-led pain management services. There will also be specialist non-governmental organizations providing support for the children and their families.

The Hong Kong Children's Hospital will begin operating in 2018. The first phase of services will include the treatment of cardiac, cancer and diseases of the kidneys, supported by the intensive care unit and operating theatres. The remaining tertiary services will gradually be introduced after phase one. The Children's Hospital will become an integrated health science system focusing on clinical services, research and education.

The author is a veteran pediatrician working in public hospitals for over 30 years.

(HK Edition 10/31/2014 page7)