Health

Q&A: Why has the National Maternity Hospital project become such a mess?

The planned relocation has been beset by delays and complications over governance and ownership concerns

The plans to relocate the hospital from its current Holles Street campus have been in train since 2013

Wed Jun 23 2021 - 21:50

Why is there still controversy over the planned relocation of the National Maternity Hospital? Wasn’t this all sorted years ago?

The plans to relocate the hospital from its current Holles Street campus have been in train since 2013, but the whole thing has been beset by delays and complications over concerns around governance and ownership.

Those concerns exist to this day, despite the fact the industrial relations trouble-shooter, Kieran Mulvey, was brought in to broker a way forward in 2016. He recommended a new operating company would be set up with four directors from St Vincent’s, four from the National Maternity Hospital and one nominated by the Minister for Health. The Minister would also have a golden share to protect the public interest.

Since 2017, letters have been flying between the Department of Health and the St Vincent’s Hospital Group (SVHG) aimed at finding a way to further protect the State’s investment (the hospital is now expected to cost about €800 million) and ensuring that there will be no religious influence, which could prevent procedures such as terminations from taking place.

Clearly, the Government is still not happy with the 99-year lease proposal with a 50 year extension. It still wants to own the land the hospital will be built on.

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The Government also wants more representation on the board which will run the hospital. One source speculated that there may have been a disconnect between what health officials honestly thought would work as they carried out negotiations through the years, and what politicians know will not work.

Will the nuns be involved in the new company that is being set up to run the hospital?

The Religious Sisters of Charity own the land, which they intend to transfer to a new entity, St Vincent’s Holdings, which would in turn lease it to the State. They have said they will not be involved in any way with the hospitals in the future.

So will there be a religious influence?

The Government says no, and SVHG says no, but campaigners have outstanding concerns. The constitution of the new holding group references its core values of: human dignity, which would respect the “dignity and uniqueness” of each person; compassion; justice, which would respect the “rights of all”; quality; and advocacy which involves “speaking for the voiceless”.

Last year, superior general Sr Patricia Lenihan said: “We are confident that the St Vincent’s Healthcare Group board, management and staff will continue to provide acute healthcare services that foster Mary Aikenhead’s mission and core values of dignity, compassion, justice, equality and advocacy for all into the future.”

Former master of the maternity hospital Peter Boylan says the values are nearly identical. The concern is that the religious ethos effectively lives on, but through a different vehicle. This has not been helped by a 2017 letter sent by the chairman of the SVHG, James Menton, to the former secretary general of the Department of Health in which he said that the Sisters of Charity “concluded that the best way to perpetuate the vision and values of their founder is to transfer ownership of the group to a newly formed company with charitable status, which will not be subject to undue influence by individuals or from any source.” It raises the question of what influence might be considered undue.

It also emerged last May that Catholic primate Eamon Martin had told the Vatican he supported the congregation’s request to surrender ownership of SVHG because Ireland needs a modern maternity hospital. However, he said he would publicly oppose abortions taking place there.

Then there is the question of what procedures are currently available at St Vincent’s Hospital. It said on Tuesday that “all medical procedures, in accordance with the laws of the land, are available in SVHG hospitals, including pregnancy termination, tubal ligation and gender reassignment procedures.”

The Irish Times asked for the number of procedures carried out in each of the categories the group mentioned. In a statement, St Vincent’s said that “terminations, tubal ligations and non-complex gender affirming surgeries have been carried out in our hospitals.

“Patients requiring complex gender reassignment surgeries are referred, under the treatment abroad scheme to specialist centres in the UK, Belgium and Poland and are supported pre and post surgery by SVHG consultants. All procedures currently available in the National Maternity Hospital will continue to be available when the NMH moves to Elm Park. Hospitals in SVHG are bound by the professional code and ethics of the Medical Council and by the laws of the land.”

So why isn’t SVHG just selling the State the land? Wouldn’t it clear all of this up?

It says a single system of governance is needed. The group says it “must retain ownership of the land for clinical, governance and operational reasons including the provision of a safe, integrated system of care for patients between hospitals.”

Speaking in the Dáil, People Before Profit TD Bríd Smith asked: “why is that the case? This makes no sense at all. When required, patients are routinely transferred from one hospital to another all over this country and this has been the case for decades.” The proposed maternity hospital will be located to the east of the existing clinical services building, and there are to be direct links from the maternity operating theatres to the St Vincent’s theatres. Why having two different owners would affect the movement or transfer of patients is an outstanding question that does need to be elaborated on.

What happens next?

This is the million dollar question. It is understood about €40 million has already been spent on the project so far, not to mention the hours of work in negotiations. The opposition are calling for the land to be subjected to a compulsory purchase order.

St Vincent’s could seek a judicial review which can be granted where the High Court believes there are valid reasons why the decision should be quashed. It is legally messy.

The State could look to buy the entire site to address concerns of governance mismatches. It could also agree an option to purchase, which would see the 150-year lease go ahead, with an option to purchase in certain circumstances, which could include: insolvency, breach of funding agreements, where the facility is not used for its intended purposes or in event of an infringement of the board. And there is another option: go back to the drawing board and look at other hospitals for co-location, like Tallaght.

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