Turf war at heart of dispute between Holles Street and St Vincent’s

Opinion is divided within the health service as to whether the row between the National Maternity Hospital and St Vincent's hospital is a simple turf war between rival institutions or something bigger that relates to ethos.

Power plays in the health service have a long and dishonourable history, one that usually involves the interests of the patient coming last.

Both hospitals see the proposed move of the NMH from Holles Street 3.4km down the road to the St Vincent’s campus as a good thing. The co-location of maternity hospitals with adult hospitals is regarded internationally as best practice.

The problem is that both are voluntary institutions with long histories and their own boards and governance systems. Holles Street, along with the other two Dublin maternity hospitals, is run by an obstetrician serving as master, rather than a professional manager.

Identity issues

Another problem is that the site for the new maternity hospital is in the middle of the St Vincent’s campus, rather than alongside it. St Vincent’s is eight-10 times bigger than Holles Street, based on patient or staff numbers, so the potential for it to dwarf the maternity hospital is obvious.

A move to St Vincent's has been bruited since 2001, so one would think some thought had been applied to the governance issue. At the time former minister for health James Reilly gave the go-ahead in May 2013, Holles Street master Rhona Mahony said there were no plans to change the governance arrangements of her hospital. Since then, there has been change on the board of St Vincent's. The new chairman, James Menton, has insisted the governance of Holles Street should be subsumed into that of his own hospital. The maternity hospital would get a few seats on the board and a other concessions, but would have to play second fiddle.

Demarcation problems

Obvious issues of demarcation arise where two hospitals are co-located. Whose parking space is that? More importantly, who gets the benefit of additional funding from the government? Holles Street fears maternity services will lose out in the scramble.

So why is St Vincent’s playing hardball? Some observers see in its stance an attempt to subjugate Holles Street to a Catholic ethos; St Vincent’s is fully owned by the Religious Sisters of Charity.

Dr Peter Boylan, chairman of the Institute of Obstetricians, has said Catholic-controlled hospitals forbid the provision of modern contraceptive services, IVF, sterilisation operations and gender-reassignment surgery,

Boylan, a former master and the current clinical director of Holles Street, is clear he was referring to St Vincent’s inter alia when making this comment. St Vincent’s has rejected these claims, offered assurances of clinical independence for Holles Street staff and pointed out it does perform sterilisation procedures – when this is “clinically indicated”. It has yet to clarify what this means.

Two nuns sit on the board of St Vincent’s and their order generates an annual income stream from the rental of the campus to the hospital. Yet Holles Street has been noticeably silent on the claims raised by Boylan. A number of its gynaecologists hold clinics in St Vincent’s without encountering any obvious ethical issues.

On balance, the row appears to have more to do with rival branches of medicine, a battle for control of funding and a scramble for resources than it has to do with ethos.