All of Tallinn's hospital buildings were constructed in the last century, so there is no doubt that the infrastructure needs updating. However, before moving forward with planning a new hospital, Tallinn's medical system should first be reorganized. For instance, in Tartu, separate hospitals were first brought under unified management, and only then was their infrastructure gradually modernized.

In Tallinn, questions remain unanswered, such as how many different hospitals the city needs and what their respective roles should be. Debates continue over whether there should be one or two maternity hospitals, whether the Children's Hospital should remain an independent entity or be merged with another hospital, and if so, with which one. Additionally, the roles of Tallinn's hospitals within the broader Estonian healthcare system and in the education of the next generation of medical professionals have not been clearly defined. Without answers to these questions, planning for a new hospital cannot proceed.

The project for a new Tallinn hospital, which was halted in the spring, was extensive and primarily involved the merger of West Tallinn Central Hospital (LTKH) and East Tallinn Central Hospital (ITK). This would have perpetuated a situation where the maternity hospital, the Children's Hospital and much of the tertiary care services would remain in separate administrative units and different parts of the city. As a result, despite enormous expenses, patients would still have to be transported from one end of the city to the other, or parallel structures would need to be created, even though there are not enough patients or staff to fully support even one highly specialized department.

From a construction perspective, it is possible to build as large a hospital as one's heart desires. However, staffing such a massive complex is an entirely different challenge. It's no secret that we already lack enough doctors and nurses. Increasing the number of medical graduates is not a viable solution, as fewer young people are graduating from high school, and not all of them aspire to a career in medicine. A new hospital should focus on reducing duplicative services, which would allow for staff savings rather than an increase.

The design of the new hospital should also take into account the lessons learned from the pandemic. For example, there is no longer a need for separate infectious disease wards in the 21st century. The capacity to isolate patients should be integrated into all departments, so that patients can be placed where they will receive the best treatment for their primary condition. In today's highly specialized medical field, it is unrealistic to expect infectious disease doctors and nurses to be multi-specialists capable of treating all types of patients.

Eesti 200 supports the continuation of efforts to reorganize Tallinn's medical system. However, this process should begin with a comprehensive view of the health system and medical economics, which would logically lead to decisions on modernizing the infrastructure, rather than the other way around. Therefore, before we sign yet another design contract, we should first reassess the size and structure of the hospital (or hospitals) that we need in Tallinn.

This is not just a problem for Tallinn residents; it impacts the entire Estonian healthcare system. We expect an informed discussion on Tallinn's medical system from politicians and the medical community. Rushing forward would indicate that we have learned nothing from the pandemic or the developments in medicine.

The Estonian hospital medicine development plan is expected to be presented to the government soon. We should wait for this plan first. It should clarify the role that Tallinn's hospitals will play in the Estonian healthcare system.

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