Glacial pace of new maternity hospital a national scandal

This much is indisputable. It’s not for pride that €300 million and truckloads of frayed nerves, sweat and tears are being ploughed into the National Maternity Hospital’s move to the St Vincent’s hospital campus. The Holles Street building is simply not fit for purpose. It is a scandal that two years since the Mulvey report, planning deadlines loom, building costs rise and not a block has been laid.

Leave aside the spectacle of quietly terrified young women queuing in the grim, ground-floor corridors of Holles Street for their cervical screening reviews. This is the State’s largest maternity hospital and one of Europe’s busiest, all 14,000 square metres of narrow Byzantine corridors of it. Heavily pregnant women often wait cheek-by-jowl in corridors and small rooms for appointments.

Post-delivery, exhausted, possibly injured, new mothers negotiate a fractious, fragile newborn with cribs and accoutrements in a cramped, tiny space in a crammed, six-bed ward. How is this an acceptable beginning for the new lives we are supposed to cherish, along with labouring women and highly pressurised staff?

Standalone maternity hospitals are no longer the norm internationally, yet we have three of them within Dublin city and the system is under intolerable strain

The vast majority of women who deliver healthy babies block out the pain and go home blessing their good fortune as well as the excellent midwives and doctors. This may be why so little of this is aired in public and why improvements can be delayed and fudged. But there is a more serious point. Three in 10 of Holles Street patients are considered to be high risk. And as any lawyer or court reporter can tell you, obstetrics is a very high-risk profession.

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Access to life-saving services

Complications erupt very suddenly. Childbirth is a miracle but it is also brutal. Since Holles Street is a tertiary referral hospital, it is a reasonable assumption that a woman in the middle of a maternal haemorrhage will have rapid, 24/7, on-site access to life-saving services such as multidisciplinary teams, intensive treatment and high-dependency units, radiology and transfusions.

Not so. Instead, that desperately-ill woman must be taken by ambulance for a 3½ kilometre journey to St Vincent’s. The siting of a maternity hospital next to an acute adult hospital is not just an interesting theory.

Standalone maternity hospitals are no longer the norm internationally, yet we have three of them within Dublin city and the system is under intolerable strain. “The State party has a policy of having three births per 24 hours for every bed in maternity wards, which does not respect the normal birth process”, the UN Committee on the Elimination of Discrimination against Women reported in understated fashion in March last year. The slow pace of the National Maternity Strategy is another story.

Catholic ethos

As for this one, it is genuinely difficult to understand the delays. At one stage, fear about the Sisters of Charity asserting their Catholic ethos over the relocated National Maternity Hospital – an unconscionable idea – was rife.

It is now 18 months since the sisters announced they were quitting healthcare and were relinquishing any involvement in the site.

That doughty fighter, Dr Peter Boylan welcomed the announcement as “an explicit statement that ethical guidelines based on canon law will cease to apply within the group. This removes the spectre of Catholic ethos influencing clinical care in the new National Maternity Hospital, which has been a cause of widespread public concern”.

Legal experts – not least Nicholas Kearns, former Supreme Court judge and deputy chairman of the National Maternity Hospital – asserted that there was never any fear of that anyway, since under the “reserved powers” set out in the two-year-old Mulvey agreement, the board would have sole responsibility for clinical governance of the new hospital, control of finance, budget, the hospital building, appointments of personnel and retention of the mastership model.

A complex legal arrangement means that while the new National Maternity Hospital company will come within the ownership of St Vincent’s hospital group, it will take the form of a designated activity company (DAC), whose independent board will hold a fiduciary duty to those “reserved powers”, all overseen by the Minister for Health who holds a “golden share”.

Change to any of the “reserved powers” must be unanimous. While there are legal agreements to be finalised, the National Maternity Hospital ethos will be safe by all accounts.

The remaining issue appears to come down to the distinction between this model of voluntary hospital – represented by the Coombe, Rotunda and the National Maternity Hospital itself, which have their own board, mission and ethos – versus outright State ownership run by the HSE. Is one necessarily superior to the other?

There is an urgency to this. The new €300 million maternity hospital (whose cost will be substantially defrayed by the sale of the Holles Street site) will be transformative for women and babies: 35,000 square metres compared to 14,000, single rooms for almost every woman, public or private, 24 labour rooms compared to the current 10, five operating theatres, places to walk, neo-natal units with sleeping facilities for parents.

Both the National Maternity Hospital and St Vincent’s have warned that contracts worth €22 million to clear the site foundations must be signed by the Minister for Health by December 31st, if further substantial delays are to be avoided.

If there are other pressing reasons for any delay, we should be told now. Women deserve better than this.