The Cabinet finally signed off on an agreement to build the new National Maternity Hospital (NMH) this week following years of public protest and debate, which did bring about alterations to the final version of the deal.
In the last two weeks, there was an information blitz from doctors and lawyers, as well as Government politicians, expressing their certainty that the co-location of a maternity hospital on the campus of St Vincent's Healthcare Group (SVHG) is much-needed progress.
It was always going to be difficult to get objectors onside, given that one of the first online petitions against the deal, as it was in 2017, gathered 104,574 signatures at a time when large protests were taking place around the country.
One easy-to-see change is that the lease is for 299 years, having been announced as 99 years in December 2018.
The new hospital will be co-located on the SVHG Elm Park campus. The HSE and the State will lease the building and this part of the campus from St Vincent’s at a rent of €10 a year. They have argued this effectively amounts to ownership.
This followed the final and much-delayed transfer of ownership from the Religious Sisters of Charity, previous owners of the hospital group, to a new charitable body only last month.
This is an Irish not-for-profit company with charitable status, approved by the Charities Regulator and the Companies Registration Office, so it is bound by Irish company law.
The land on which the hospital sits is owned by this new company and the HSE has a “leasehold interest” on the site and the building.
A newly inserted and controversial phrase “clinically appropriate” protects the use of the building for maternity services only.
Legal assurances given through documents, including the constitution for the new hospital, say services available will include voluntary sterilization, terminations, tubal ligation, fertility services, and gender-affirming procedures.
The HSE requested this phrase be included and this week HSE chief executive Paul Reid said it ensured other medical services could not be placed into the building.
The new hospital’s board is independent. This was not clear in 2017 when Professor Chris Fitzpatrick resigned from the project board for the new hospital due to concerns about lack of protection for corporate and clinical independence.
The nine-member new hospital board now includes three directors from the NMH, three from SVHG, and three appointed by the health minister of the day.
Under the 2016 Mulvey Agreement around the co-location, there was just one public-interest member.
Unfortunately the projected cost has also changed significantly. This is worth remembering in light of the ballooning costs for the new children’s hospital, which is not yet open.
In 2017 the new maternity hospital was projected to cost €300m; now it is expected to cost at least €800m, if not €1bn. It is expected to continue offering specialist care to women from other parts of the country as well as its Dublin catchment area, but how much are we willing to spend?
Health minister Stephen Donnelly told theit has to be built quickly and he expected the procurement process to go faster than that for the children’s hospital.
That is certainly the hope of people such as Dr Rhona Mahony, a former master of the NMH in Holles Street. She told a health committee hearing: “When we look back at the history of women's health in particular and the interplay between Church and State, it has been very difficult for women.”
She described repeal of the eighth amendment, which blocked abortions here, as a “pivotal moment” for women’s health and said this new hospital is another such moment.
However, some of those who oppose the move continue to have questions, including campaigners such as Ailbhe Smyth.
She pledged this week to “keep fighting”, saying the deal is a betrayal of women’s healthcare and a sabotage of Sláintecare, the Government’s health reform plan.
Addressing the health committee before the agreement was accepted, Dr Peter Boylan, former master of the NMH at Holles Street, raised questions about links to the Vatican remaining.
The Religious Sisters of Charity had to seek approval from the Vatican for transferring their ownership of the hospital group and documentation around this has not been made public.
Dr Boylan fears this is because the Vatican’s permission may have been conditional on the new owners observing aspects of Roman Catholic canon law.
The order has never stated it would release these documents but it is understood the agreement contains no conditions of transfer relating to religious conduct or religious ethos pertaining to the use of the land.
Superior General Sr Patrician Lenihan previously said: “We will have no role in the future of the new independent charity, the St Vincent’s Healthcare Group, St Vincent’s Holding CLG, or the new National Maternity Hospital.”
People Before Profit TD Bríd Smith is still concerned and during a hearing on this she focused on trappings of the Church remaining at SVHG, worried this would be replicated in the new hospital.
SVHG chairman James Menton told her removal of iconography in the grounds of the Elm Park campus has started. He expects this to be complete in the buildings within three to six months.
This could pose a tricky conundrum for many Irish hospitals beyond this new facility.
Cork University Hospital and Cork University Maternity Hospital, as typical examples of public hospitals, offer access to a chaplaincy run by Catholic priests and Church of Ireland pastors. There is an annual Service of Remembrance for people who experienced pregnancy or infant loss.
Many Irish women who travelled to Liverpool Women’s Hospital for terminations, some under the most tragic circumstances when their baby was diagnosed with fatal fetal anomaly, have spoken to this reporter of compassion shown to them by Catholic priests ministering there.
Access to terminations has expanded slowly in Ireland, with eight of the 19 maternity units still not offering these services. As it reaches every part of the country, can that same compassion be expected here?
In 2017, the then health minister Simon Harris called for a national conversation around the religious legacy in Irish healthcare similar to what is going on in education around school patronage.
Is there space now for a conversation around whether all hospitals should remove religious icons and chaplains, around whether all patients would even agree or want that? How many people in Ireland want to see chapels closed in all hospitals?
Is it time for a conversation around the bigger issues of religious ownership and involvement in many of our hospitals and community health services in parallel with a debate around the State’s ability to take this on if required?
These conversations have never happened. The debate around religious influence and ethos in healthcare, which started with the Repeal the 8th movement, has become bogged down in this one hospital, but maybe now there will be space to allow us start talking about all of these things.