Fresh thinking on National Maternity Hospital impasse vital

It is eight years since the project to co-locate the new National Maternity Hospital (NMH) at the Elm Park campus of St Vincent’s hospital was announced. Four years ago, a wave of public outrage followed the realisation, after years of dispute and mediation, that the new NMH would be owned 100 per cent by the Religious Sisters of Charity, then and still today the sole shareholders of St Vincent’s Healthcare Group (SVHG).

In May 2017, the Sisters announced their intention to depart their hospitals and “gift to people [sic] of Ireland lands at SVHG to the value of €200 million”. In fact, the shareholding is to be transferred for €1 into a new company called St Vincent’s Holdings which has charitable status.

It emerged in 2018, despite repeated denials, that Vatican permission was in fact needed for the Sisters' shareholding transfer

Assurances were given that this process would be straightforward and ensure that Catholic ethos would not impact on women’s reproductive healthcare at the new hospital. The congregation’s leader stated that the “core values” of the constitution of SVHG that mandate its Catholic ethos would be “amended and replaced”.

What happened next was far from straightforward. It emerged in 2018, despite repeated denials, that Vatican permission was in fact needed for the Sisters’ shareholding transfer, called “alienation” in canon law. Last May, we learned that the Vatican had granted permission conditional on the Sisters observing specified canon laws.

Martyn Turner

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An earlier warning was sounded in the 2018 SVHG Annual Report which stated unambiguously that the directors of St Vincent’s Holdings must uphold into the future “the values and vision” of Mother Mary Aikenhead, the order’s founder.

When the constitution of St Vincent’s Holdings was published last August, with the “core values” of the Sisters included in full, the retention of Catholic ethos was undeniable and brought into question once again the future independence of the NMH.

As Róisín Shortall TD pointed out at the Oireachtas select committee on health last week, reproductive health services such as sterilisations or contraception were not provided to women at St Vincent’s hospital and it was hard to see how that situation would change under the new structure.

Minister for Health Stephen Donnelly responded that no religious ethos could be imposed at the planned new maternity hospital that would impact on services under any circumstances.

It was “an absolute red line”, he said. If so, then we seem to have reached it.

Cause for concern

There are other issues raised by the new structure that are a cause for concern. St Vincent’s Holdings is a company limited by guarantee. This means it does not have shareholders and is owned by its members who are also its directors. They will effectively own the three SVHG hospitals and putatively the new NMH.

The company must have at least three directors and no more than 10. The power to appoint new directors lies with the existing directors. There are currently three directors, who are also directors of SVHG and no directors representing the NMH, the State or the Health Service Executive, and no guarantee of representation in the constitution.

The directors have the power to sell, mortgage or dispose of any or all part of the company. This is particularly concerning given that in 2010 the Sisters mortgaged St Vincent’s University Hospital as collateral for a loan to build the private hospital. In consequence, Bank of Ireland has “a fixed charge over the entire St Vincent’s hospital site” and “a floating charge over all the undertakings, property and assets of SVHG both present and future”.

As with Donnelly’s “red line” on services, the new structure is in conflict with then taoiseach Leo Varadkar’s commitment to the Dáil in November 2019 that the new NMH would be “State-owned on State land”. To date, however, St Vincent’s is offering the State no more than a 99-year lease on the land and is insisting on owning the new NMH DAC, the yet-to-be-incorporated company that will run the new hospital.

This in turn falls foul of the 2019 Report on the Role of Voluntary Organisations which recommended that “where the State decides to build any new hospital or facility, it should endeavour to ensure that it owns the land on which the hospital or facility is built”.

So what can be done at this late stage?

Economic appraisal

As with all major capital projects costing more than €100 million, the Department for Public Expenditure and Reform must make a full financial and economic appraisal of the project, and assess matters of governance and project risks before issuing to Government for a decision.

Could the State attempt a compulsory purchase order on the land at Elm Park?

Since two of the SVHG hospitals are section 38 organisations – funded by the State and classified as public services – the HSE must approve (or not) the transfer, establishing with certainty that there is no risk of future problems with the provision of services.

The Government must consider the implications for Sláintecare and the likely public reaction to the gifting of the State’s newest publicly funded hospital to a private company with stated Catholic ethos.

An all-party Oireachtas group has recently been established to lobby for full State ownership and independence of the new hospital. Public interest remains high. We have reached a watershed.

Could the State attempt a compulsory purchase order on the land at Elm Park? Constitutional protection conferred on religious orders makes this likely to fail.

SVHG is largely publicly funded so could the Sisters transfer it to the State instead, not for €1 but with appropriate valuation of their assets? Canon law would raise serious, perhaps intractable, obstacles.

What if the impasse cannot be resolved? The original rationale of the project was to provide access to acute and intensive care services for women with complicated pregnancies. Could this critical objective be met in the interim by locating a high-risk maternity unit at St James’s Hospital, giving pregnant women from all over the country access to the full range of clinical specialities, and their infants immediate access to the new National Children’s Hospital? This would achieve the gold standard of tri-location of maternity, adult and neonatal and paediatric services.

Concerns that the 1930s Holles Street building was “not fit for purpose” have been significantly mitigated by ongoing investment. New operating theatres, labour rooms and a neonatal intensive care unit have been built in recent years. The postnatal wards have been refurbished and new office and teaching space has been acquired in an adjacent building. It is the only maternity hospital in the State with a dedicated MRI facility thanks to private charitable donations.

The current impasse does not serve the women of Ireland. Fresh thinking is now required.