That Dáil Éireann:
— in May 2013, the Government announced that the National Maternity Hospital (NMH) would move to Elm Park to co-locate with St. Vincent’s University Hospital (SVUH), based on the recommendation that maternity hospitals should co-locate with acute general hospitals;
— between 2013-2016, a dispute regarding co-location versus ownership arose between the NMH and St. Vincent’s Healthcare Group (SVHG), which resulted in SVHG rejecting the proposal of co-location and adapting its position to demand full ownership of the NMH under SVHG;
— in May 2016, Kieran Mulvey was appointed to mediate the dispute between the two hospitals and the Mulvey Agreement on the Future Operation of the New Maternity Hospital – ‘The National Maternity Hospital at Elm Park DAC’ recommended the full transfer of 100 per cent ownership of the NMH to SVHG, owned by the Religious Sisters of Charity;
— following sustained public and political opposition to the deal, the Religious Sisters of Charity set up a new private company, St. Vincent’s Holdings (SVHs), into which they agreed to transfer their shareholdings of SVHG, and although SVHs was incorporated in August 2020, no transfer of ownership has yet taken place;
— under the proposed lease arrangement:
— the sole owners of the NMH (SVHs) will lease the site for the new hospital to the Health Service Executive (HSE) for 99 operating years;
— the State is required to build the maternity hospital on the land owned by the Religious Sisters of Charity and to pay, in perpetuity, the costs of the new facility set to be owned and managed by SVHs; and
— the key condition of this lease is that the HSE license SVHG to run the new maternity facility in tandem with the ‘National Maternity Hospital at Elm Park’;
— a new Board of SVHs is to be appointed in August 2021 and SVHs is a private company with charitable status, and its directors are its sole shareholders, all of whom are self-appointed, and there is no provision for a public interest director/ministerial representative, a women’s interest director, HSE representative, or any representation from the NMH itself on the Board of SVHs;
— the Board of the HSE is required to approve the transfer of the Religious Sisters of Charity’s shareholding in SVHG to SVHs, as it is a section 38 organisation and this approval has not yet been sanctioned;
— nearly four years after they first announced their intention to depart SVHG, the Religious Sisters of Charity remain the sole shareholders of SVHG and no legal agreement has been reached on the transfer of ownership; and
— under current proposals, only the shell of the hospital will be publicly owned and the State is to have no involvement in the private company set to own the new facility, nor any role in its operations;
further notes that:
— the Eighth Amendment of the Constitution of Ireland was repealed in May 2018, paving the way for safe and legal termination of pregnancy in Ireland and Catholic teaching is fully opposed to the provision of termination services;
— the 2017 SVHG Annual Report stated that future directors of SVHs will be ‘obliged to uphold the values and vision’ of Mother Mary Aikenhead, the founder of the Religious Sisters of Charity;
— the core values of the original SVHG constitution, which are based on Catholic ethos, are restated in full in the constitution of SVHs;
— the Religious Sisters of Charity received conditional permission from the Holy See to transfer their shareholding to the new company SVHs, with the proviso that ‘the provisions relating to the validity and lawfulness of alienations, found in Canons 638-639 and Canons 1292-1294 of the Code of Canon Law and in Proper Law, are to be observed’, and this requirement provides that the transfer of the Religious Sisters of Charity’s shareholding in SVHG must observe Canon Law and Canon 1293 paragraph 2 requires precautions to be taken to ‘avoid harm to the Church’ and the definition of harm expressly includes ‘activity which gives rise to grave harm to ecclesiastical teaching’; and
— the 2019 Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services concluded that, legally, the State cannot compel private Catholic entities to provide services that are contrary to their ethos;
furthermore, notes that:
— the cost of the construction of the NMH is likely to exceed €500 million; and
— the Religious Sisters of Charity’s holdings in SVHG were valued at €661 million in October 2018;
— the Catholic ethos of the proposed new facility can no longer be a matter of doubt;
— women’s reproductive healthcare would be put at risk and their safety endangered if subject to Catholic ownership and ethos;
— a hospital built using State funds should be fully owned and operated by the State;
— handing over ownership of a publicly funded hospital to a private company is in direct contradiction of the aims of Sláintecare; and
— 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, as recommended in the Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services; and calls on the Government to ensure that the proposed new publicly-funded National Maternity Hospital is constructed on land owned by the State, and that, to guarantee its secular ethos and safeguard this public investment, the new hospital be fully owned and governed by the State.
The decision to co-locate the National Maternity Hospital with St. Vincent's University Hospital has had a long and tortuous history. When the plan was announced in 2013, there were three overriding concerns: ownership, governance and religious ethos. The same concerns remain today. Nothing that has happened in the interim has done anything to dispel them.
For a long time, this Government, and the last one, refused to concede any problems existed. They said that all that was needed was time and a legal framework, and the matter would be resolved. In May 2017, the then Minister, Deputy Simon Harris, promised that we would have a legal framework “in the coming month”. In 2019, the then Taoiseach, Deputy Leo Varadkar, assured this House the details of the legal transfer would be resolved over the next couple of weeks. The current Minister for Health, Deputy Stephen Donnelly, gave similar assurances last year. This charade came to an end last week, when the Tánaiste, Deputy Varadkar, finally admitted the blindingly obvious, that the deal is fundamentally, potentially fatally, flawed.
Where did it all go wrong, then? The obvious place to start is in 2016 and the mediated agreement that was hammered out between the two hospitals: St. Vincent's University Hospital and the National Maternity Hospital, NMH, Holles Street. It concluded that the new national maternity hospital would become a wholly owned subsidiary of St. Vincent's University Hospital. It was no longer co-location, but full integration, essentially a takeover. Private interests were represented in this mediation, but what about the public interest? That was conspicuous in its absence. The deal was silent on safeguarding a valuable public investment, on ensuring a secular ethos and on mandating public governance of a public hospital. Handing over a valuable public asset to a private religious entity was deemed the reasonable, even sensible, thing to do. The public felt very differently and made their feelings known with large public protests.
The Religious Sisters of Charity Ireland then announced its intention to withdraw from St. Vincent's Healthcare Group. It said it would no longer be involved in the ownership or management of the new national maternity hospital and would set up a holding company into which they would transfer their shareholding in St. Vincent's Healthcare Group. While this holding company has been incorporated as a private company with charitable status, as of today, the Religious Sisters of Charity has not transferred its shareholding to this holding company. It should also be noted that, having said it would give the gift to the site to the Irish people, it gifted it to its own holding company.
The proposed new corporate structure of this deal bears further scrutiny. It entails three tiers. At the top is the holding company, whose directors are self-appointed. They will be the sole shareholders of the entire St. Vincent's operation and they can stay in office for up to 14 years. Below this unaccountable company will be the St. Vincent's Healthcare Group, which will oversee four hospitals, including the proposed new national maternity hospital. Below that again, will be the national maternity hospital board with its own four directors, four directors nominated from St. Vincent's University Hospital, and one ministerial nominee. The deal is manifestly bad for the public. The public pays the construction costs, equipment costs, staff costs, and maintenance costs. In return, St. Vincent's Holdings graciously retains ownership of the site and control of the governance structures.
The deal not only flies in the face of reason and rationality, it is also in direct contravention of a Government report by Dr. Catherine Day on publicly-funded health services. That the report is unambiguous where it states 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”. The report goes on to state, “Where the State is unable to secure the purchase of land … any capital investment by the State should only be provided subject to prior agreement on the services that will be delivered”. Crucially, the report concludes that legally the State cannot compel private Catholic entities to provide services that are contrary to their ethos. Remarkably, this deal fails every limb of this test. The State does not own the land. It has no means of ensuring the full range of reproductive and sexual health services currently available in Ireland, and that they are provided by the hospital.
This brings me to religious ethos. The Religious Sisters of Charity Ireland’s proposal to transfer its shareholding into St. Vincent's Holdings required Vatican approval and is subject to Canon Law. This obligation requires the nuns to ensure that they avoid harm to the church in the transfer. In this case, harm expressly includes activity which gives rise to great harm to ecclesiastical teaching. It is not disputed that the Catholic Church does not sanction the full range of reproductive and sexual health services that are legal in Ireland. The Catholic Church stands firmly against abortion, which it calls a "grave sin". It has judged in vitro fertilisation as immoral. It opposes same-sex relationships, rejects the existence of transgender people, and condemns gender reassignment surgery. We know Canon Law will be followed during the sisters' transfer of their shareholding, but what about future governance?
The constitution of St. Vincent's Holdings espouses the same core values of Mother Mary Aikenhead, the founder of the Religious Sisters of Charity Ireland. In 2017, the St. Vincent's Healthcare Group annual report stated what future directors of St. Vincent's Holdings will be obliged to do, that is, that they will be obliged to uphold the values and vision of Mother Mary Aikenhead.
The Government may deny Catholic values will persist at the new hospital, but that is what the corporate structure is designed to facilitate, namely, the continuation of the ethical code of the Religious Sisters of Charity Ireland, not only for the three existing hospitals in the group, but also for the new national maternity hospital. When the Government was negotiating this deal, it is now clear that the parties were mismatched. It was a David and Goliath situation, and the sisters were not diminutive. It is not the first time they have run rings around the Government.
When the sisters built St. Vincent's University Hospital at Elm Park, they did so with public money. Not only did they use public money for, they negotiated a deal whereby the State would have no involvement in the control and management of the hospital, despite the more than £5 million the order received between 1934 and 1969 when Elm Park opened. There was also another proviso, that if the sisters sold their old hospital at St. Stephen’s Green, the proceeds would be given to the State via the hospital trust fund. Predictably, that never happened. The sisters sold the old hospital, but the proceeds were never handed over. Commenting on that deal in the Dáil in 1972, Noël Browne said, “surely, this is an extraordinary principle to permit, that an organisation - I do not care who they are, whether they are religious orders or others … - should be allowed to sell off property, keep the money and then be given a 100% grant to build a new hospital?” I wonder what Dr. Browne would have to say about this current quagmire. I think most of us can guess. Noël Browne spent his political life trying to disentangle the church from the provision of health care services and to create a proper public health service. It is extraordinary that this House, all these years later, is still convulsed by these exact same issues.
The State's record on the provision of public services is a long litany of failure. The new national maternity hospital is a chance to finally get it right. It will be a public hospital, paid for by the people. There is no justification whatsoever for the ownership and the governance structures to be in the hands of a private company.