The Irish hospital structure is fragmented and hardly amounts to a system: a system implies overarching governance with integration of the parts. Ironically it is the Obstetrical Service, recently the source of much controversy, which has made the most progress in modernising itself through consolidation. Small non-viable units have been closed and the laudable process of creating safer units of critical mass, appended to general hospitals, has been making progress.

The specialty deserves praise for overcoming institutional chauvinism to accomplish this. Furthermore the specialty publishes excellent statistics on maternal and perinatal mortality which places Ireland very high on world “league tables”. To quote the Archbishop of Dublin, Diarmuid Martin, “Ireland is one of the safest places in the world to have a baby”.

The structure of the Irish hospital landscape has been, for better or worse, bestowed upon us by history. It has developed organically and if we were starting again we would undoubtedly do it differently, but we are stuck with it. It is imperative, however, that, as we progress, further hostages are not given to fortune causing problems to develop in the future.

The ownership of Irish hospitals is enigmatic. In any discussion of this kind the epochal contribution of the Catholic Church to health, education and much else must be acknowledged and we should not yield to the prevailing political correctness which has tended to delete uncomfortable facts from the national consciousness: historians will eventually put this right. It is nevertheless the case that the altered religious demographic of the country has made the disproportionate Catholic Church control of so many publicly funded flagship hospital sites anomalous. Furthermore one might suspect that such flagship sites are still the first choice for the location of future developments. Why did the taxpayer waste €40 million euro, at the height of the financial crisis, trying to shoe-horn the Children’s Hospital into the Mater Hospital site?

It is universally agreed that the fabric and the physical and scientific isolation of the National Maternity Hospital makes it no longer fit for purpose in a developed country: it must move and integrate as the Children’s Hospital must move. But whither shall it move? One of our less attractive attributes as a nation would appear to be our ability to snatch controversy from the most unpromising of situations. Although the Children’s Hospital debacle is still smouldering, it has been shouldered aside by the new cause célèbre, the relocation of the maternity hospital to the St Vincent’s Hospital site.

With regard to the St Vincent’s site, suitability might be considered under two headings, physical and cultural.

Physically the site is good. The Sisters of Charity were prescient and wise in accumulating a significant land bank for the use of future generations. In this regard they should be thanked, not abused. The facility can be integrated into the main hospital campus with all the benefits that accrue from shared diagnostic facilities and diffusion of knowledge. It will amount to more than the sum of the parts.

The matter of cultural suitability is not so straightforward and has become the main issue. Secularists, and indeed perhaps more than a few Catholics, wonder about the wisdom of implanting such an expensive publicly funded entity on a campus the owners of which profess a clearly defined denominational ethos. Historically the Irish health service has suffered gross interference from the Catholic hierarchy. The latter has, until relatively recently, believed in the merging rather than the separation of Church and State. The destruction of minister for health Noël Browne in 1951 by the Catholic hierarchy set the template for the future of the health service and imbued in the Catholic Voluntary Hospitals, not least St Vincent’s, a culture of immunity from the invasions of the State, notwithstanding that they were fully funded by that State. This was apparent as recently as 2015 when the Director General of the HSE found the accounts of the institution impenetrable and mooted “special administration”.

The issue of control of the new entity is fundamental. Do you really control a building and what goes on in it, when you do not own the ground on which it stands? It is worth casting our minds back to the foundation of the British (including Northern Ireland) National Health Service (1948). The British knew that they could never set up a properly integrated health service without consolidating all the hospitals in a unitary system. The system must own the hospitals. Part 11, 6(1) of the National Health Service Act, 1946 therefore had those words, which the Irish medical establishment and Archbishop McQuaid found so ominous, “Transfer of hospitals to the Minister”. McQuaid, who had lost his cathedral to the Reformation, was not about to cede his bastion hospitals to any minister or allow any developments in the health service that would threaten them. The McQuaid doctrine has disappeared from the Church but not completely from certain hospitals.

In the prevailing controversy we read a plethora of reassurances that there will be no interference in the clinical functioning and freedoms in the new entity. It will have its own board as before. It will have its own Master as before. The law of the land rather than any other will prevail. It is also offered that the nuns are now few and have no interest in interfering: indeed one has sympathy for them caught up in a controversy not of their making. There are, however, radical lay elements to whom no hostages should be offered. Given the vagaries of the law, of which “possession is nine points”, these reassurances are not convincing.

At a time of possible rapprochement between North and South we should signal that Church and State have agreed an amicable divorce. We should thank the Sisters of Charity for their profound contribution to the nation. We should, however, own the land on which the new maternity hospital is built.
Liam Kirwan, formerly of UCC and CUH is Professor of Surgery at Penang Medical College, Malaysia. He is author of An Unholy Trinity: Medicine, Politics and Religion in Ireland