An €800m jackpot: The master plan for the ownership and control of the new maternity hospital
Services banned by Rome have never been permitted by St Vincent's Healthcare Group. Obstetric and gynaecological services that contravene Church teaching – including but not limited to abortion – will be prohibited. Picture: RollingNews.ie
The latest proposals from St Vincent’s Healthcare Group represent a last-ditch attempt to push through their plans for the new maternity hospital at Elm Park. Legal and other documents expose the architecture of control over the hospital devised by the Religious Sisters of Charity and their advisers.
The State, although powerless to direct the activities of private providers, is intent on gifting the new facility to a private entity owned by the congregation. The Government is to have no involvement in this company, nor any role in its operations. Doubling the duration of the lease, as proposed, will not enable the State to take control of the hospital site, as claimed. Offering to add two public interest directors to a board that is to be owned and controlled by the nuns' companies will not alter the underlying power structure.
The new build, to be paid for with public monies, will cost €800m+ to build and fit out. Taxpayers will then be required to pay –in perpetuity – the hospital running costs (about €60m year on year). Only the shell of the building is to be publicly owned.
The present owners of the lands and hospitals at Elm Park, Dublin 4, and in Dún Laoghaire (where they own St Michael's) are the Religious Sisters of Charity. These assets were valued at a whopping €661m in 2018. If and when the nuns succeed in getting ownership of the new hospital company, they plan to divest themselves of their assets to a successor body that they own and control.
These assets are Church property. Their transfer – and future management –are subject to Church law. Rome has authorised the transfer on certain legal conditions. The congregation has been informed it must take precautions to ensure no harm will come to the Church as a result. So, what precautions have the congregation taken to guard against harm to Church authority and Church teaching?
The first is the corporate ownership structure. The National Maternity Hospital corporation is to be owned by a new holding company set up by St Vincent’s Healthcare Group, St Vincent's Holdings. If this deal with the Government goes through, the 'National Maternity Hospital at Elm Park DAC' will be at the bottom of the corporate ladder with the other three Vincent's hospitals, under the authority of St Vincent's Healthcare Group, set up by the nuns two decades ago.
These are Catholic companies. A job description for a staff nurse in 2019 specifies "the philosophy of St Vincent’s Healthcare Group is based on that of the Religious Sisters of Charity". The company further states its "core values" derive from the nuns' mission and philosophy.
A 2021 job spec drawn up by SVHG translates these values into Irish. The first, "human dignity", is translated as "comh mheas" or parity of esteem; the second, "compassion", is "comh bhá" or parity of sympathy; while the third, "justice", is translated as "comh pháirtíocht" or parity of partnership.
These translations – almost without provenance in Irish – reveal the anti-abortion dimension of SVHG core values. (The final two are "quality" of care and "advocacy", speaking for "the voiceless").
As a further precaution, these values are cited in the constitutions of both SVH and SVHG to ensure healthcare will be delivered within a Catholic framework, although their vagueness (in English) has served to obscure this fact. Board members are legally obliged to deliver patient care that is ethically compliant. The constitution of SVH envisages that compliance may be enforced through leasing arrangements and employment contracts guaranteeing adherence to the hospitals', evidently Catholic, "ethical codes of practice".
The new constitution of St Vincent's Healthcare Group should offer further comfort to Rome. Officially a draft, the document has been approved by the Charities Regulator and by Revenue. The present legal duty "to conduct and maintain the Facilities in accordance with the Healthcare Philosophy and Ethical Code of the Religious Sisters of Charity" has been replaced by "to conduct and maintain the Facilities in compliance with national and international best practice guidelines on medical ethics".
acts as a 'supervisory body' for the facilities. The powers exercised by the company extend to drawing up overall policies, including on healthcare, for their hospitals; appointing medical staff, including medical consultants; and laying down procedures, rules and regulations for discipline, staffing, patient care, and so on. There is no saver here for the National Maternity Hospital at Elm Park DAC.
The Religious Sisters of Charity and their advisers have repeatedly refused to hand over the freehold ownership of the hospital site. Owning the freehold has enabled the congregation to play hardball with the State by setting conditions to the leasing of the land. As a final precaution, St Vincent's Healthcare Group demanded, as a key condition of the lease, that an operating license be given back to themselves to run the hospital. The State has already signalled its agreement, and this license forms part of the draft legal framework now under discussion.
The State seems bent on funding an arrangement between two private companies, at an upfront cost of some €800m to the taxpayer, that does not serve the public interest. Contrary to the claims repeatedly made by St Vincent's Healthcare Group and the National Maternity Hospital at Holles Street, the clinical independence of the new hospital is an illusion. The truth is hiding in plain sight. The National Maternity Hospital at Elm Park DAC is set to be owned and controlled by the nuns' successor companies. The sweeping powers to be exercised by over the new facility – reinforced by the operating license – make the concept of an autonomous hospital board redundant.
Catholic guidelines on medical practice will determine patient care and service provision. Likely vetted by Church lawyers, legal instruments ensuring this are now awaiting Cabinet sign-off. Services banned by Rome have never been permitted by St Vincent's Healthcare Group. Obstetric and gynaecological services that contravene Church teaching – including but not limited to abortion – will be prohibited. Legally, the State cannot compel private Catholic entities to provide services that are contrary to their ethos.
If the lease-license lock carries through, the State will lose all control of the planned facility. Given what we now know about the level of operational control to be exercised over the new hospital, it is imperative that the Government reject this double lock and demand the freehold ownership of the hospital site.
Nothing less than full public ownership of the new facility makes sense. To continue on the present path is to ignore the 66% of the electorate who voted to repeal the Eighth Amendment, and to pave the way for the 'culture wars' – and the courtroom battles they give rise to – now being played out across the United States over abortion.
- Marie O'Connor is a medical journalist and author
Superior General of the Religious Sisters of Charity Sr Patricia Lenihan declined to be interviewed for a follow-up piece to this article. In a letter sent to the Irish Examiner, Sr Lenihan said:
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