Ceisteanna ó Cheannairí - Leaders' Questions

Last week, the Tánaiste, on his own behalf and presumably on behalf of the Government, made remarks that can only be described as woefully belated in respect of the new national maternity hospital. It is fair to say that we are now looking at a mess with the fingerprints of successive Governments all over it dating back to 2013, when James Reilly was Minister for Health and Children, which is more than eight years ago. Yet, to this day a situation persists where women in this State cannot get the care that they and we deserve in a world-class hospital facility.

Why is it that the Government is so late in expressing concerns about ownership of the land on which the hospital is to be built and about the governance model? It cannot say that it was not told about this. The level of public concern and, indeed, anger at any involvement by the Sisters of Charity in the governance of the hospital has been very well flagged for many years, as have the very well-founded concerns regarding the ownership of the land on which this hospital is to be located and what this means for the State’s substantial investment in the new hospital. This project is six years behind schedule and costs have escalated, ballooned by more than €500 million in that time. This project could easily top the €1 billion mark. Ghosts of the children’s hospital, in financial terms, echo through this whole saga.

A Sinn Féin motion was passed by the Dáil in 2017 and supported by the Taoiseach’s party, Fianna Fáil, at the time. It called for the new national maternity hospital to remain entirely within public ownership with legally guaranteed independence from all non-medical influence in its clinical operations. That remains the absolute bottom line and is not a matter of preference.

It is now beyond belief that more than €40 million has been invested in respect of a site that is not in the full ownership of the State or that anyone or any Government would countenance investing hundreds of million of euro in public moneys in infrastructure on a site that is not fully owned by the State.

The Sisters of Charity say that at no stage did any Government or Minister approach them on the subject of purchasing the site in question. We also know, and they confirm, that the Department of Health did agree in principle to a convoluted process of establishing a private trust with a board not appointed by the Minister and with the State spending hundreds of millions of euro on a hospital on land that it does not own.

This is a mess that goes way back to former Ministers, James Reilly and Deputies Varadkar and Harris, and it is now unfolding on the watch of the Minister, Deputy Donnelly. This needs to be urgently sorted. What does the Taoiseach propose to do on this matter? It is clear in yesterday evening’s statement that the Sisters of Charity are resisting handing over and transferring freehold of the site in question. They cite governance reasons for that. That will raise very deep concerns and suspicions as to the full bona fide independence of the hospital. Where do we go now to secure this hospital in full public ownership?

The Deputy has laid out the chronology of the situation on the new national maternity hospital and a new modern facility. The first prerequisite and objective of Government is to make sure that we can build a hospital that serves the women and children of the nation into the years ahead and that we build a first-class maternity facility with a neonatal facility co-located with a tertiary hospital. This has been the strategy in the development of maternity hospitals now for quite some time.

That said, there has been a dispute between the two voluntary hospitals involved. This is well-known and we had the Mulvey report and mediation that the then Government facilitated for the two hospitals. We are very clear that parallel with ensuring the best of modern care for women in this country in a modern, state-of-the-art maternity facility, there has to be proper State governance and ownership of the hospital itself. There have been ongoing negotiations. This Government is in office for 12 months. The Minister is treating, and will treat, this matter urgently and is engaging in consultations and meetings with the stakeholders involved.

There is an issue around the governance model and in the public interest being represented in respect of that governance. I do not intend to discuss detailed costs because that is not helpful until we see tenders, and so on. We cannot be specific about costs and people should not be bandying around hundreds of millions of euro because those are just guesstimates at this stage. We need more in terms of the public articulation of figures. The tendering processes, etc., will dictate to a certain extent that reality. The programme for Government committed this Government to conclude the governance arrangements and to commence the building of the new maternity hospital at St. Vincent’s University Hospital Dublin and that is what we intend to do through engagement with the stakeholders.

However, I am very conscious of the fact that when it comes to the ownership issue, the State is investing here and that it is taxpayer funding that is facilitating the construction of this hospital. Equally, in the new era that we are in now and as we go forward, as the State invests, the State should own.

There is a history to this, which predates this Government. We have to deal with but it involves two voluntary hospitals coming together on a site that is owned by one of the hospitals. The State has made significant investment in St. Vincent’s University Hospital Dublin over the years and continues to invest in both current and capital expenditure in the hospital proper. The State will fund the construction of the maternity hospital itself in its entirety and that has to be taken on board in respect of agreements and the conclusion of discussions on both the issues around ownership and governance arrangements. That is the intent of Government as it engages with the stakeholders on this particular issue.

I am deeply conscious and acutely aware of the less than optimal conditions and facilities now obtaining in the current facility and that has been the case for quite a number of years. That is why there has been a genuine sense to bring this to a conclusion because the women of Ireland deserve better facilities than are currently available in Holles Street.

It is not only in the National Maternity Hospital that facilities are suboptimal. I could bring the Taoiseach to the Rotunda Hospital Dublin and could recite for him the endless process that this hospital has endured to secure funding to carry on safe service provision. I see that the Minister is leaving the Chamber now and he is well aware of what I am talking about.

I am trying to figure out what the Taoiseach means in his response because it is a case of the State funding this infrastructure and facility but it is in fact the people or the taxpayer who are funding this.

The Taoiseach says he is in favour of State spend, meaning State ownership, but will he be even more explicit than that? A message today has to go to the Sisters of Charity, with the greatest of respect to them. As people who represent the citizens and taxpayers of the State, we need to say loudly and clearly that the site in question must be in the ownership of the State-----

I thank the Deputy.

That is the beginning, the middle and the end of it. Equivocating on the point does not assist-----

Time is up, please, Deputy.

-----in the shared objective of providing those world-class services for the women and neonates the Taoiseach referred to. Will he be specific and send that message? The Sisters of Charity communicated with all of us by means of a press release. I think it appropriate that an answer is heard-----

I think it appropriate that the Deputy respect the ruling of the House. Time is up, please.

-----from the Head of Government as to his expectations. I thank the Ceann Comhairle.

My understanding is that St. Vincent's Healthcare Group communicated to us, not necessarily the Sisters of Charity, to be precise about it. The Minister is going to engage with both groups and others in that respect. He is back in the Chamber now, I point out in the context of the Deputy's reference. I am not sure what she is proposing, other than to raise the issue. I have been consistent from the get-go about this project in respect of ownership and the taxpayer being protected but also in terms of governance. The State is building a hospital, and the outcome of the negotiations so far do not, in my view, reflect what should be the case in respect of the governance issue and the public interest being represented on the board. Equally, there are issues, as I said, with the ownership of the facility and the protection of the taxpayer’s investment. There is also the core issue, which the current agreement deals with in my view. It relates to ring-fencing and ensuring that no religious ethos-----

I thank the Taoiseach. The time is up.

-----in any shape or form, influences the operation of the hospital-----

Excuse me, Taoiseach. The time is up.

Twenty-four hours is a long time in politics. Yesterday, when I raised this issue with the Taoiseach in respect of solutions, he told me to get real regarding CPOing this land. I am telling him now that the people of Ireland want him to get real. The Government cannot proceed as currently constructed. The statement yesterday by St. Vincent's Healthcare Group was a two-fingers to the Taoiseach, the Minister, me, everyone in the Chamber and the Irish people. The Taoiseach now needs to get real. I do not blame him for this mess; he inherited it.

I have gone through the documents. My colleague Senator Bacik requested them under freedom of information, which is probably why some of them were released. I know the history of this; I have been chasing it for years. We need a solution here. The Taoiseach needs to listen to the Minister of State at the Department of Health who said yesterday when she saw the statement going out, "The letters C, P and O come to mind". I understand the timeframes and the issues in that regard. I also understand that what the programme for Government states is weak. It talks about concluding governance arrangements but not about the hospital being publicly owned on public land.

I do want to have a big argy-bargy argument with the Taoiseach on this. I just want to point out that he is in a very weak position. St. Vincent's Healthcare Group is pushing its weight around and trying to push the Taoiseach and the Minister, Deputy Stephen Donnelly, into a corner. They need to fight back on behalf of the Irish people. This is a seismic moment. We are at a crossroads. It is a seismic moment for the people, and the State and the Government need to stand up to bullies. The Government needs leverage and support, and it will have our support.

The Taoiseach stated earlier that the State has put significant investment in St. Vincent's Hospital over the years. He is right; I could not agree more. The leverage the Government needs is that, if the group is not willing to gift the land to the State, which it can do without all the connotations of Canon Law it is trying to delineate, we should CPO the entire site. Who paid for it in the first instance? As the Taoiseach said earlier, it was the taxpayer. In a spirit of co-operation and conceding that he inherited this, I ask the Taoiseach whether, given where we are today and the statement yesterday, we should not just CPO the entire site - public, private, maternity - and create one fantastic campus owned by the State, on land owned by the State and run by the State.

I appreciate the sentiments the Deputy articulated and the support he has offered the Government in dealing with this issue. I very deliberately yesterday and today stated that the Government has put in the bulk of funding and investment in St. Vincent's Hospital, both current and capital. The statement yesterday was not, in my view, an appropriate response at all. I said yesterday that there needs to be respectful engagement with the funders - the taxpayer and the people - who are represented by the Government of the day. That is my position. I also said some years back, and I am still of the view, that the State needs to own any facilities it builds. I believe that not just in regard to healthcare, although it is specific to tertiary healthcare because it is so complex and capital intensive and absorbs so much funding. It can be no other way into the future, given the complexity of modern tertiary hospitals. I would also apply it elsewhere. In disability services across the board, the State needs to become more involved to ensure we have proper accountability and first-class provision of services across the board.

In the case of this hospital, I made reference to a CPO. The Deputy knows the implications of a CPO.

I do. I have said it for years.

It can take a long time-----

-----and it could, let us be honest about it, undermine the prospect of ever getting the hospital built. That has to be weighed up. We do not rule anything out here but that has to be weighed up. The announcement on this was made in 2013. The Mulvey mediation took place in 2016. Planning permission has been granted for this. The enabling works on the car park and the pharmacy have been completed. That is where we are right now in respect of this.

That said, there needs to be a long, ongoing, sustained relationship between St. Vincent's Healthcare Group and the Government if the optimal care is to be provided on that site, at both the tertiary hospital and the new maternity hospital. It cannot be the approach taken yesterday. The investment the State will make in this hospital will be very significant in terms of the hundreds of millions of euro that could be spent and the need for that investment and the public interest to be protected. I am satisfied that all legally available services will be provided at the hospital, but there are issues, as I said, in respect of governance and the ownership that remain to be resolved.

The people of Ireland want the Government to make the right decision. The Taoiseach spoke about this being an equation whereby it could take some period of time for the hospital to be built if we CPO it. To be honest, given the statement issued, unless the group has a complete change of heart, engages with the Minister and decides to gift the land, I do not believe the Government will have any choice because the public will not tolerate it. That is the reality. I do not say that with any glee. I do not wish we were here, but we are here. This is a crossroads for Irish society. The idea that the church is going to have a role in healthcare and maternity care is just not an option. It cannot happen. The Taoiseach's Government is going to have to be the one that will make sure this change happens because the time is now. Not only that, I am saying clearly that the Government should nationalise the entire campus if the group is not willing to see that change. We will support it 100%. I have been advocating for the nationalisation of private hospitals, as the Taoiseach knows, for some time.

In this scenario, we need leverage. The group is not going to do anything, it is not going to change. That statement was insulting and infuriating. Let the Taoiseach consider this-----

The time is up.

I will conclude. If the group does not, in a short period, say, a month or so, meet the Minister and say that it will gift the land to the State, I ask that the Taoiseach pursue a full CPO of the whole site.

As I said, the Minister is going to engage with the stakeholders involved-----

They have already said-----

It is not just about the church anymore; it is about trusts that follow in the aftermath of what was once religious ownership. That is happening on a number of fronts. It is about the capacity of such trusts to be in a position to manage and govern major tertiary hospitals of this magnitude and complexity into the future. This is an important moment because it sends a signal to any future developments. The Rotunda Hospital and the Coombe Women's Hospital will be more easily facilitated. Others have many issues with capital and getting the process rolling in moving to publicly owned lands where there are publicly owned hospitals. When the HSE was set up, at that time there was a medium-term view to have greater alignment between all hospitals in the country towards the one system. That has been perfected very well in the current pandemic.

I thank the Taoiseach. Time is up.

Things are changing and moving in a certain direction-----

I thank the Taoiseach. Time is up.

-----and the negotiations here must reflect that reality. The Minister will be engaging on this.

We need leverage.

Time is up. We move to Solidarity-People Before Profit. I call Deputy Smith.

Or, indeed, the other way round. Tá sé thar a bheith tábhachtach, aontaím leis an Taoiseach, go mbeadh an t-ospidéal máithreachais neamhspleách ar an eaglais. Is í an cheist atá os comhair na Dála anois ná cad a dhéanfaidh an Taoiseach agus an Rialtas chun an neamhspleáchas sin a chur chun cinn?

The Taoiseach mentioned that yesterday’s statement came from the board of directors of St. Vincent's Healthcare Group. This is not to cast aspersions on anyone but it is to state the facts; the people of Ireland should know who is on the board of directors of that group. They are James Menton, chair, Dr. David Brophy, Deirdre Burns, John Compton, Gerard Flood, Ann Hargaden, Myles Lee, Sharen McCabe, Dr. Rhona Mahony and Imelda Reynolds. We need to find out what they are thinking and why they think the way they do. As I said in the debate on the motion earlier, this is not about the integrated healthcare needs of women and babies; this is about the integrated needs of the investment of that board of directors, and the future, because they hold the privilege of being able to remortgage or sell that land. That land belongs to the people of Ireland and that hospital should fully belong to the people of Ireland.

I notice that many Ministers have eulogised the history of the Sisters of Charity in jumping into gaps that were there, and that these gaps just happened in the history of the State. These gaps were created. Although the Taoiseach has said that this history predates his Government, which it certainly does, it does not predate his party. Fianna Fáil were at the heart of the arrangements with the church to provide health and education in this country. The question for the Taoiseach is a defining one. Will he ensure that the State will now do what it is supposed to do and take full control of the ownership, ethos and delivery of services of that hospital? It is not just the idea of ownership and control that matters; it is also ultimately about the accountability of the State to the women and people of Ireland, including the accountability of the Minister, the Taoiseach, the Government and, indeed, future Governments as it is not just about the current one. Who controls the land matters. It means that if we get control of the land as a State and a society, we will control the ethos and the business that goes on there, who gets employed there and who runs it. It is clear, and it has been said time and time again, that the constitution of this group does not prioritise the people of Ireland. It actually prioritises an ethos that dates back to the era of Mother Mary Aikenhead.

I do not accept that the Sisters of Charity have no interest in this. The St. Vincent's Holdings group has indicated that it has full interest in this. The way we see it as a people and as a gender - women who can reproduce in this country - this is a very dangerous move if we do not get full ownership and accountability of the new national maternity hospital that workers are paying for.

Ar dtús, táim den tuairim go mbeidh an t-ospidéal seo neamhspleách ar an eaglais. Táim den tuairim sin ón méid atá léirithe sna conarthaí go dtí seo agus ón méid a pléadh idir an HSE agus na boird éagsúla. Ní bheidh aon tionchar ag an eaglais ar an ospidéal seo. I am strongly of the view that there will be no religious ethos influence on this hospital. That will not be the case, but the Deputy raised an interesting point about ownership. I will not get into the historic view which she, very simplistically, linked a single party to how the State evolved, and so on. We can argue that point on another day. I note people like Paddy Hillery, for example, who developed the first major State education at second level, and comprehensive and community level, and Seán Moylan who, years earlier, developed the vocational education committee. Indeed, there were the free education initiatives of Donogh O'Malley. People evolve and one cannot telescope the views of today back to earlier decades. I have a very open view on history but I do not ideologically affix my perspectives on history. I do not intend to do so now, but I take the point that ownership is important and there should be no remortgaging of this site in the future by the hospital group. The Government is not satisfied that this should be the case at all. It is clear and united on that issue.

I reiterate the point I made to Deputy Kelly that, as the church exits institutions of this kind, what replaces it should concern us more in terms of governance and who trustees or various companies will represent. That is a more fundamental point going into the future, given the scale and nature of State investment in the facility. I am very much of the view that if the State is building something, the State should own it. This has a history because of the fact that two voluntary hospitals have come together. The public interest demands that there be co-location; let us be clear about that. It demands that. I sometimes ask why it takes so long to build hospitals in this country. We had the same issue with Tallaght many years earlier, with protracted negotiations. I was involved in getting the maternity and neonatal unit built in Cork University Hospital. Thankfully, two State hospitals were merging, and the private hospital agreed to cease operations to facilitate the establishment of one major maternity hospital for that region with a state-of-the-art neonatal facility. It has taken much longer to get this facility in Dublin up and running.

I thank the Taoiseach. Time is up.

It has been agreed that there should be co-location because that offers better outcomes for mothers and babies, hence, that has created a context to this issue.

I will not engage in the historical debate with the Taoiseach. He has his view and I have mine, but historians have also outlined their view. It was not just Fianna Fáil but it was primarily Fianna Fáil. Fine Gael was also up to its eyes in giving the gaps to the church to fill in terms of health and education, and we live with that legacy. Let us remember Dr. Noel Browne and the struggle he engaged in to get free maternity care for women.

As the church exits, the Taoiseach asked what will replace it and that is a very good question. Will it be more privatisation of our healthcare system? The Taoiseach has said he is not in favour of that, yet we are building a national children’s hospital with private suites already allocated in it. We must move away from two-tier medicine. We need a national health service and I agree entirely with the great socialist, Deputy Alan Kelly, who said the Taoiseach should nationalise the entire St. Vincent’s complex. I would go further, as a radical socialist, and suggest that we nationalise the entire health service. That is what is required and, ultimately, that is where we are headed. What we need to deal with now is the question of who owns the new national maternity hospital.

I thank the Deputy. Time is up.

This is a defining moment for the Taoiseach.

The Government will own the new hospital. The issue is the site, which the Government wants to own as well. A religious ethos will have no influence whatsoever in the running of the hospital, nor should the site or the hospital be mortgaged.

Furthermore, strong public interest must be reflected on the board of the new hospital, given the nature and scale of the investment by the State in this new hospital. That is where the State stands. The Minister will engage with the stakeholders and will make the views of Government and the Oireachtas known. The St. Vincent’s Hospital Group should take note of the consensus in the Oireachtas on this issue, reflect on that and respond appropriately as the Minister engages with it and other stakeholders.

Yesterday in Questions on Promised Legislation, the Taoiseach stated the issue should have been raised in Leaders' Questions. He is getting those questions today because he still has not clarified his position on the new national maternity hospital. The decision to locate a State-built and funded, much-needed, modern national maternity hospital without clear clarification as to ownership of the site or governance and ethos of the hospital has resulted in the present mess. That mess has developed - and here I disagree with the Taoiseach - over the last century because of the role of the State and of vested interests in the way our hospital and health services are run. Regarding the new national maternity hospital, we face, because of the role of the church and through the Religious Sisters of Charity, what is called a very complex situation. It has developed into a complex situation and it is an issue we must deal with.

The situation in relation to the new national maternity hospital is a test for the Government and for the people, particularly women, of Ireland. Are we to have high quality, free to use public services as a right for all in a modern secular republic? Alternatively, will we have a shabby compromise with the State spending at least €800 million to build a hospital on land we do not own, funding 100% of the cost of staff, the board of governors nominated by a private charity and no certainty that all medical procedures legal in the State will be provided to women who need them? Rights are exerted, charity is bestowed. We must move away from this. I heard what the Taoiseach said before but this is the line we have to get it over.

I know what the preference of the Taoiseach and the Minister, Deputy Stephen Donnelly, is, but the stance the St. Vincent’s Healthcare Group outlined yesterday was that it must retain the land to have control of clinical governance for operational reasons, including the provision of a safe, integrated system of care for patients. If that is the case, the Taoiseach must prepare for CPO of the land. If he thinks that cannot take place because of cost, length of time or whatever, he must be prepared to move away from that site. He must make that clear to the Religious Sisters of Charity who he is negotiating with over the coming days. Seemingly, they have been out of the system since 2017 but now are a key part of it again.

The key motivating factors behind the decision to co-locate the National Maternity Hospital, Holles Street, with St. Vincent’s were safety, optimal healthcare and outcomes for women and babies plus the deteriorating conditions in the existing physical facility of Holles Street. Those were the key motivating factors in the decision, eventually announced in 2013 after ongoing discussions between the two voluntary hospitals, to co-locate the new national maternity hospital on the St. Vincent's site.

The expert medical view and all international research says that maternity should not be stand-alone. It is a feature of the improvements in our health service that we locate a maternity hospital adjacent to and integrated with a major national tertiary facility so that if women become ill, have certain conditions and so on, the expertise is on-site to intervene quickly to save lives. The fundamental motivating public interest in this is to save lies and have better outcomes in circumstances where risks are present. That does not happen across the vast majority of maternity care but the informed advice and recommendations to successive governments has been to co-locate maternity and neonatals in tertiary hospital settings. That will apply to Limerick, is in Galway and will have to apply to the Coombe and the Rotunda hospitals as well.

The difficulty here was that this location was on a private hospital group owned by a religious order. That issue has dragged on since 2013. First, there was a dispute between the two hospitals as they endeavoured to reach an agreement. Kieran Mulvey mediated between them and produced a report in 2016. In 2018, planning permission for a new hospital was secured. Enabling works were completed thereafter, in terms of a pharmacy and car park. That is where we are now.

A CPO is easily called for but, coming back to the original objective, if we move off-site, what tertiary hospital do we suggest it should go to? If we CPO, is everybody in the House prepared to say we will wait another number of years as conditions deteriorate? These obvious questions arise in the event of a CPO. We know how long CPOs go on.

That said, the three fundamental points I mentioned that have to be addressed relate to ownership, governance and, without question, the fact that there can be no religious involvement, good, bad or indifferent, in the running of the hospital or in what is allowed there.

We all want a safe modern national maternity hospital. No one challenges that. No one challenges the preference that it be co-located. The KPMG report in 2008 indicated that and the Government went by that report. However, eight years on from 2013 and 13 years on from that report, we are in a situation where the Religious Sisters of Charity still have control over this hospital being built.

The St. Vincent’s Healthcare Group said it must retain ownership of the lands for clinical governance and operational reasons, including the provision of a safe, integrated system of care for patients between the hospitals. The group has said “No”. What is the Government prepared to do? We back the Taoiseach on this. Everybody outside this building supports this being owned by the State and Government for the people of Ireland.

I thank the Deputy for her contribution. I do not accept the argument the hospital group has put forward that the ownership of the site is essential for the safe, integrated system of care. One can deploy many mechanisms to ensure safe integrated systems of care between two hospitals. The ownership of the site is not critical to that. Given the hospital, in terms of the negotiations that are under way, is in the ownership of the State in any event, I do not think that argument stacks up at all. The St. Vincent’s hospital board will have to reflect on the consensus here and on the public interest. It has to understand the public interest. There has been enormous investment in the existing St. Vincent’s hospital, both capital and current.

The State is building a new maternity hospital and the hospital will have to clear up that point.

I thank the Taoiseach. The time is up now.

They told the previous Minister for Health, Deputy Harris, that they were not going to sell the land.