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Dáil Éireann debate -
Thursday, 31 Mar 2022

Vol. 1020 No. 4

National Maternity Hospital: Statements

I thank the various Deputies for raising this important issue. I acknowledge the strong political and public interest in the development of the national maternity hospital, NMH.

First, as I have said many times, the Government is fully committed to the development of the new NMH. This is clearly laid out in the programme for Government.

The fact that concerns are being raised from some quarters in regard to the ownership and governance of the new national maternity hospital is also recognised by the Government. However, before addressing these concerns, it would be beneficial to remind ourselves of the overall vision for this vitally important, once-in-a-generation project.

We know that maternity services should be co-located with adult acute services to ensure mothers have access to a full range of medical and support services, in this case via corridor linkage, should the need arise. It is Government policy to co-locate all stand-alone maternity hospitals with adult acute services to ensure that we can provide the best possible healthcare to women and babies; the right care at the right time and in the right place.

The buildings at Holles Street are no longer fit for purpose. There is an urgent need to replace them. In particular, I am advised that the infrastructure does not enable the National Maternity Hospital to adhere to current healthcare standards and presents increased clinical risk for patients and staff, while also increasing the risk of infection and compromising the privacy and dignity of patients. These shortcomings have been highlighted in a number of reports, of which colleagues will be aware.

The new hospital is a vital piece of infrastructure, one that will help to underpin the development of maternity services and the implementation of the national maternity strategy into the future in two ways. First, this will be a dedicated, custom-built maternity hospital that is designed to deliver excellence in maternity care and to be one of the most sustainable hospital buildings in Europe. Second, the new hospital will achieve the long-awaited objective of co-location with an acute adult facility, which is international best practice. Co-location with St Vincent's Hospital will make the wide range of general medical, surgical and diagnostic facilities on the St. Vincent's Healthcare Group, SVHG, campus available to any woman who needs to be transferred from the adjacent maternity hospital. This will result in care provision that is far superior to the existing situation. Co-locating the new hospital with St. Vincent’s also builds on the long-standing working relationship between the National Maternity Hospital and St. Vincent’s University Hospital. A significant proportion of consultant staff at the National Maternity Hospital are employed by and work between the two hospitals. This creates the ideal platform to achieve the clinical ideals of co-location. The vision for this project is the delivery of the best possible healthcare for women and babies.

We have already made significant progress on this major capital project. Planning permission for the new hospital was secured in 2017. This paved the way for the contract for enabling works. These relate to a replacement pharmacy building and to a car park extension, to be awarded in 2018. I am very happy to report that these works are now completed. In terms of the construction of the new hospital, as required under the public spending code, the Department of Health is currently reviewing the draft final business case for the hospital and, in due course, this will then undergo the required consideration by Department of Public Expenditure and Reform.

Separate to the business case and the public spending code requirements, the other important element that must be addressed is the ownership and governance arrangements for the new hospital. This, I believe, is where people's concerns arise. In essence, if I may try to encapsulate these concerns, the primary one is a fear that religious influence would prevent certain services, such as termination of pregnancy or sterilisations, being provided to women in the new hospital. I believe we all agree there are no circumstances in which this could be allowed to happen. There is no circumstance in which any service should be denied. The new national maternity hospital must be a hospital that provides all lawfully permissible services to women who require them. This is a red line issue for me as Minister for Health. It is a red line issue for the Government and I will not bring to Government any proposal unless it provides absolute assurance that all legally permissible services will be provided in the new hospital.

In addition, I must ensure that the ownership and governance arrangements protect the State's significant investment in the new hospital. Work has been ongoing over some considerable time now to finalise a legal framework that sets out clearly the ownership and governance arrangements. Why do we need a legal framework? As colleagues will be aware, our public hospitals are a mix of State-owned and voluntary hospitals. Voluntary hospitals, including St Vincent's University Hospital and the National Maternity Hospital, as well as several others, are core providers within our public health system. Many are tertiary referral centres for the most complex care.

In general, the State does not own voluntary hospital buildings, but it is not unusual for the State to invest in voluntary hospital campuses as part of ensuring facilities are fit for purpose. Needless to say, any investment by the State on a voluntary hospital campus must be done with all necessary assurances around safeguarding the State's investment and the delivery of public services. In this case, we are relocating one voluntary hospital to the campus of another voluntary hospital and into a hospital building owned by the State. A legal framework will provide the necessary clarity and assurance for the State. This legal framework aims to address the State's core objectives regarding this project, which are worth emphasising again: first, that all clinically appropriate services that are legally permissible are provided for women who need them in the new national maternity hospital; second, to prevent any undue influence, religious or otherwise, in the operation of the new hospital; and, third, to protect the State's investment in regard to capital, revenue and service provision at the new hospital, for the public good.

The legal framework is based on the Mulvey agreement. As the House will be aware from previous statements and debates on this issue, this sets out the proposed corporate and clinical governance arrangements for the new national maternity hospital. The Mulvey agreement was finalised in 2016 following extensive mediation between the National Maternity Hospital and the St. Vincent's Healthcare Group, and has been published now for some considerable time. The Mulvey agreement provides for the establishment of a new company, National Maternity Hospital at Elm Park DAC. The independence of the National Maternity Hospital at Elm Park DAC, which will run the new hospital, is core to the future governance arrangements. The legal arrangements will ensure that no services in the new national maternity hospital will be prohibited or denied based on religious beliefs or the ethical code of the hospitals concerned and that all lawfully permissible services will be provided, as they are currently in the existing National Maternity Hospital. It is important to repeat that because it goes to the core of some of the concerns that have been expressed: The legal arrangements will ensure that no services in the new national maternity hospital will be prohibited or denied based on religious beliefs or the ethical code of the hospitals concerned and that all lawfully permissible services will be provided as, it is important to remind ourselves, they are currently in the existing National Maternity Hospital.

The Religious Sisters of Charity will not play any role in the governance of our new national maternity hospital. They will not play any role in the operation of the national maternity hospital and they have resigned from the St. Vincent's Hospital Group board. In addition, it is important to recognise that clinicians at the National Maternity Hospital have repeatedly and publicly expressed their support for the relocation to the St Vincent's University Hospital campus, including in letters to The Irish Times last June and earlier this year. More recently, 52 clinicians working at the National Maternity Hospital wrote to me and to the Taoiseach and expressed real concern about what they called "the misinformation and misunderstanding" that they said was disturbing their staff and patients and, potentially, putting this essential project - certainly the timing of it - in jeopardy. These are the people on the front line delivering babies and supporting women. They are the people who are providing all of the services now and who understand how important and necessary this new facility is.

To pre-empt some of the debate, it was falsely suggested in a previous debate that I am somehow accusing people of things. I am not.

I suggest the Minister checks his Facebook page.

The Minister without interruption, please.

The letter I have before me is from the midwives and doctors in the National Maternity Hospital. What they are saying is that they are extremely concerned about a combination of misinformation and misunderstanding. They state: "Concerns being raised that the new [national] maternity hospital will be curtailed by any religious ethos are misleading and ill-informed." They go on to say that concerns being raised about the ownership of the hospital, with the suggestion that only under full State ownership can the avoidance of religious influence be assured, are manifestly false.

I want to put that on the record because false accusations were made earlier and, no doubt, will be repeated in this debate. I have just read from a letter from the midwives and doctors to me and the Taoiseach.

This Government’s commitment to the national maternity hospital is in keeping with our broader commitment to delivering better health outcomes for the women of Ireland. As discussed in the earlier debate on the women’s health action plan, the Government is investing significant funding in women’s health services to ensure that improvements are made and outcomes for people using the services are enhanced. This commitment is reflected in budget 2022, for example in the allocation of €31 million for new development funding to specifically support women's health. Those measures have a full-year cost of nearly €50 million. This includes significant investment to further progress the implementation of the national maternity strategy and gynaecology service developments, as well as a further €5 million for a dedicated women’s health fund for this year.

I hope that the next time we are making statements on the national maternity hospital in this House, we will be able to speak about the finalisation of the legal framework, in what undoubtedly will be a significant milestone for achieving the goal of a new national maternity hospital, as envisioned in the national maternity strategy. As the House will be well aware, the national maternity strategy sets out a vision for future maternity services, where women are treated with dignity and respect in an appropriate physical environment. It is essential, therefore, that we move forward and build the new national maternity hospital and provide the necessary infrastructure to facilitate the delivery of a safe, high quality maternity service for women and infants. I am certain we will do that with all of the necessary safeguards and assurances.

I had written a speech but I wish to respond to the Minister's speech instead. There was nothing new in the Minister's speech. We were expecting a bit more. I must say that everything in his speech has been said before. I did not hear anything in the speech that adds to what we have already heard.

I do agree with something the Minister said. He said that a red-line issue for him is that there can be no religious interference and that we need to get the issues of governance and ownership right. He said he will not bring any proposal to the Government unless it provides absolute assurance that all legally permissible services are provided in the new hospital and, in addition, he will ensure that the ownership and governance arrangements protect the State's significant investment in this new hospital. I share the Minister's objective, as I am sure everyone in this House does. We need to see it become a reality.

There are three key issues. There is the ownership, which is important. There is the governance of the hospital, which is also important. There is also the provision of services without any influence of any kind. As the Minister has accepted, that is also important.

He went on to say in his opening statement that the HSE or the State will own the building. We know that. What about the land? What will be the legal arrangement for the land? I heard nothing in his opening statement that referred to the land.

He also said something he attributed to healthcare workers, for whom I have enormous respect, who he said wrote to national newspapers, as we know they did. I took from the Minister's opening contribution that he was talking through those healthcare workers about misinformation and misunderstanding. The Minister cannot say, on the one hand, that he accepts there are genuine and legitimate concerns around governance and other issues, which we have all raised, and, on the other hand, say there has been misinformation and misunderstandings without giving a bit more context. I hope we are not seeing professionals, for whom I have respect, being played off against the Opposition. That would be the wrong road for the Minister to go down. It would be unacceptable. Those professionals can speak for themselves.

If the Minister is saying that those professionals do not share any of the difficulties and issues we have, is that because they have seen something we have not? The Minister spoke about the legal framework in his opening speech. I have not seen the legal framework. I do not know what is in it. He said he will bring a memo to the Cabinet that will address the concerns which have been raised by the Opposition and by campaigners and others as well. We need to see that legal framework. At the very least, the framework will have to come before the Joint Committee on Health. It will have to be fully interrogated. I would go so far as to say that a special Oireachtas committee would need to be set up to do that. This is fundamental. The Minister has stood where I am, in opposition, for many years, as did many of his colleagues, and railed against how the State treated women and how it failed women when it came to healthcare. We know about all of the mistakes and discussed some of them this morning when we spoke about the women's healthcare strategy and plan which has been put in place. Women are not going to take the Minister or anybody else at face value unless they see the detail and unless we have an opportunity to properly interrogate the legal framework that the Minister says he has secured. We want to confirm that it deals with all of our concerns. I ask the Minister to commit, in his later contribution, to at least give the health committee an opportunity to interrogate that legal framework when it is agreed and before he takes it to the Cabinet. The other option is to establish a special Oireachtas committee. This issue is of fundamental importance.

I have to say I am a bit disappointed. This debate was built up as an opportunity for the Minister to put people's concerns to bed for once and for all. Those concerns are simple. We are going to spend considerable amounts of money on this hospital. We should do that and there is no quarrel with the need for a new national maternity hospital. In fact, I do not have a problem with the location of the site because it ticks all the boxes. However, I have a concern that we could spend up to €1 billion to own the building but not the land. I have a concern about the convoluted system and governance model which appears to have been put in place. That is problematic. I have not been comforted by what I have heard in that respect.

I am disappointed that there was nothing new in what the Minister said. There was nothing he has not said on the previous three occasions we have discussed the matter in this House. I heard nothing new. The Minister must do better. He must properly meet our concerns. I do not believe, on the basis of his opening statement, that they have been met. I ask him to reflect on that. I ask that when he contributes again later in the debate he will confirm that the Opposition and the Oireachtas will have a full and proper opportunity to interrogate the legal framework he says deals with our concerns. We must also be consulted. I have to make up my own mind, as others must, that the framework addresses our concerns. I repeat that I have concerns.

I came into the Chamber to hear some answers and, unfortunately, I have not heard any. We might as well say that. We had hoped to get answers from the Minister. I do not think anyone in the House disputes the need for a new maternity hospital. I gave birth in Holles Street in 1995 and we needed a new hospital then. My daughter gave birth to my grandson in Holles Street in 2015 and we needed a new hospital then too. Nobody is disputing that this hospital is necessary. We know how necessary it is. We know that the men and women working in Holles Street day in and day out, and the women who are attending there, are doing so in appalling circumstances. The need for the new hospital is established and understood.

It is now five years since the House passed the Sinn Féin motion calling for the new maternity hospital to be built as quickly as possible. We all agreed on that. We also called for the hospital to come entirely within public ownership and with legally guaranteed independence from all non-medical influence in its clinical operations. That is the piece we need to get right. There are profound reasons that women in particular, and the Opposition in general, are very concerned about the governance arrangements and the influence that may be exerted. The Minister may not be able to codify against the chilling effect of any association with the church. That is causing consternation.

The go-ahead was given by the Vatican in 2020 for the transfer of the lands earmarked for the hospital to a new charity group. There are questions around that process. The move left us a step closer but also put the spotlight on issues of ownership and control. The decision to transfer the land from the church to the St. Vincent's holding group raised the question of why it was not gifted to the State. This has never been clarified and the fundamental question still remains unanswered: who will the hospital belong to?

We know who will own the building, but who will own the land and how will that impact on the care and on how women are treated in the hospital? What should be a fairly straightforward matter has been fraught with debate and difficulties. Simply, the hospital's independence in all its clinical operations should be guaranteed and that is what we seek. The questions around the legal terms of the ownership of the entire campus still remain. We have been asking these questions for years now and we still do not have any sufficient answers. I came in here this evening hoping to get some of those questions answered and I have not learned anything beyond what I knew when I came in.

I did this previously today but as March is her anniversary month, I will again mention Sheila Hodgers. As the Minister knows, I knew Sheila. She died in March 1983 and so did her baby. Sheila was denied treatment because of the ethos of the hospital. That is why she died. That is what killed her. I know what is written on her death certificate and I know what killed her. While the influence of the church in 1983 was very explicit, it is no less worrying, disconcerting and troubling that there would be even a hint or a suggestion of any influence in 2022. That is why we need answers to the questions that have been raised. There is a chilling effect today. I will not use the word for what it was in 1983 but we all know what happened to Sheila and her baby at that time. All our lived experience suggests we have to get this right. The statement the Minister made this evening suggests we have not achieved it right yet. There is unanimity in our support for building the hospital. We know that has to happen but we have to get it right.

In the past year, we have had three Private Members' motions on this matter, and now this evening's debate, and nothing seems to have moved forward. We are waiting on a legal framework when, fundamentally, the decision not to build and invest what may ultimately be close to €1 billion on a much-needed national maternity hospital on public land has led to where we are now. I agree with Deputy Cullinane that we need to see this legal framework. I would like to know what the timeline of that legal framework will be. I have grave concerns about that. At this stage, I am not sure anyone will be satisfied with the contents of that legal framework, such is the level of valid concern. The Minister himself has said people on this side of the House have valid concerns. I would rather be welcoming a national maternity hospital and maybe debating spiralling costs or something like that. We do not want to be having these debates. We do not want to bring forward three Private Members' motions.

Deputy O'Reilly spoke about Sheila Hodgers. That one case crystallises why there is such a chilling generational impact and why these concerns are valid. It is because of cases like hers.

Unfortunately, what the Minister read out this evening is nothing new. We need a timeline for when this legal framework will be published. I want a commitment that it will come before a committee and that it will be discussed in the Dáil. The spectre and legacy of Catholic influence on our education system and every other part of society, but particularly on our health system, is such that in a modern, post-repeal Ireland, with all the strides we have made, when we have hundreds of millions of euro and many options on the table, we are going to enter into an agreement with a Catholic institution. Whatever that agreement may be and whatever safeguards or legal framework is in place, there will always be concerns that that institution, through some mechanism or lay company, however it is constructed, will have an influence. As I said in a previous contribution on this matter, we have so far not even received any guarantees there will not be religious iconography on the walls, never mind religious influence on the clinical practice.

I understand the concerns of the clinicians in the current National Maternity Hospital, who desperately want a much-needed modern building in which to work. As someone who has been a birthing partner in the National Maternity Hospital, I have seen its limitations. I have seen the limitations on the great care that is given there due to the sheer fact the building is no longer fit for purpose. No one is arguing with the decision to co-locate. That is the way it should be done and that is the way we need to go. However, the Government and the previous Government have made a massive rod for their own backs here. None of this concern is contrived or false. Anyone speaking on this issue or any other issues relating to women's health would much rather be focusing on other issues such as the speed of delivery and not clinical governance. Unfortunately, we are where we are and it is quite a depressing and grim space. I hope the Minister will be able to give some clarity on when this legal framework will be published. It is to be hoped it will provide some kind of comfort but, unfortunately, I am not sure it will.

An understandable distrust has been articulated in this House on several occasions and, indeed, outside it. Whether that is legitimate in 2022 is not for me to determine; it is for others to feel. I understand Opposition Members making the statements they have made this evening and on other occasions. However, the bottom line for me is what the Minister has said. Deputy Cullinane is right it is not new. It has been said many times and I do not think it is going to change. The reality of the situation versus what people might want to achieve are two different things. The Minister has said he will not bring any proposal to Government unless it provides absolute assurances that all legally permissible services will be provided in the new hospital and protects the State's investment in the new public hospital. If the religious institution is removed from the ownership of the site, the entire debate becomes moot.

That is a fundamental part of this. Of course I would prefer that the site was owned by the State. I do not think any of us have any difficulty saying that. However, if this legal framework the Minister will be bringing to Cabinet satisfies the requirements he has set out, then I am satisfied. The only thing I am interested in for the rest of this debate is what Deputy Duncan Smith referred to, that is, that the service be provided, that there be no iconography associated with the owner of the land, and that the services provided within the hospital are compliant with the law set out in this House and by the medical profession itself. That is all that has interested me throughout this debate, even going back to 2010 and 2011 when we were talking about whether it should be located at some other hospital or another facility. All these discussions are moot and the most important point is the services are co-located to provide the best possible medical care to all those who wish to avail of it in the future.

The development of this hospital is a critical step in bringing women's and girls' healthcare into the 21st century. It will be one of the most significant infrastructural investments in women's healthcare in the history of the State. The debate about the hospital has often been misdirected and, at worst, the narrative has been deliberately misled by Members of this House and members of the public. The Minister has made it very clear that no proposal will go before Government unless there is an absolute guarantee that all procedures that are legally permissible will be available in the new hospital. That is an important fact and that is the only reasonable action to take. The question of whether the legal framework will be provided to the line committee is a matter for the Government. It would be very unusual. Deputy Cullinane might understand or accept that point. That is ultimately a matter for the Minister and the Cabinet.

I also draw attention to the fact that the issues regarding ownership and governance will reflect the State's significant investment in the hospital and I look forward to the publication of the legal framework at some point in the future. The publication of this information will give clarity to the public and to staff, doctors and nurses who will work in the maternity hospital on governance and ownership. The necessity of the national maternity hospital simply cannot be overstated. As has been said, the facilities in the National Maternity Hospital, Holles Street, are, despite the best efforts of all staff, not fit for purpose. Maternity and neonatal care present some of the highest-risk situations for patients and as a result, hundreds of pregnant women require intervention every year, be they surgical or medical, which are not available within the hospital. This means that every year hundreds of women have to be transferred from Holles Street to other hospitals in Dublin. This situation even extends to intensive care, which is not available in the current premises. This is a practice that no one would find tolerable whereas the new maternity hospital will cater for all of those medical and surgical needs in a state-of-the-art facility providing world class care for people who need it most. A modern and fully equipped medical campus will allow the public to have the confidence and assuredness that they will be cared for within the highest of international standards. The pregnancy journey is often not an easy one and it carries with it worries and risks and when issues arise it can result in extreme stress and worry. Therefore, we owe it to every woman in the country to provide them with the best possible care. Like all of us, I look forward to the new national maternity hospital becoming operational in the time ahead. It will be a transformative measure for women’s healthcare and for the medical care of babies in Ireland.

I again want to stress that the operation of the hospital and the procedures carries out will be free from any religious influence. This is something that people have been rightly concerned about since the early days of this debate. However, it is no longer a legitimate concern, nor should any member of the Opposition suggest otherwise. It would be untrue and disingenuous to continue with that line given what has been said today and repeatedly in the past. The Religious Sisters of Charity will have no role in the governance of the new national maternity hospital and, in May 2017, it announced its intention to end its involvement with the hospital and transfer its shareholding from the St. Vincent’s Healthcare Group to a new company, St. Vincent’s Holdings CLG, which is a charitable not-for-profit body. Since 2017, it has not been involved in the functions or operations of the holding firm and has resigned from the board in the same year. It is also important to note, as the Minister has told the House, that clinicians have publicly and vocally supported the Government position on this hospital and have highlighted the misleading and ill-informed narrative that has surrounded this debate. In February, as the Minister has outlined, 52 doctors wrote to senior Ministers, urging them to press ahead with the vital project saying that misinformation over the site's ownership risked derailing the project. Senior medical figures, including the master of the National Maternity Hospital, Professor Shane Higgins, and three of his predecessors said that the deal on the table includes unbreakable legal stipulations to guarantee all procedures allowed under Irish law will be provided. They went on to say that concerns about the new hospital on the St. Vincent’s University Hospital campus at Elm Park "being curtailed by any religious ethos are misleading and ill-informed". In the letter they also said it was manifestly false to suggest that only full State ownership can assure the avoidance of religious influence. This is an important contribution in the debate and one that should be heard by Members of the Oireachtas and the public.

In my remaining time I would like to highlight the work being done by the Government in improving women’s healthcare in Ireland across the board. I would particularly like to welcome the publication of the Women’s Health Action Plan 2022-2023. This is a significant body of work that was formulated through engagement with women of all ages and backgrounds across Ireland. As a result we have a plan to improve health outcomes and the experiences of women and girls who require the services within our health system. Between now and the end of the year €9 million will be invested in the provision of free contraception to women aged between 17 and 25. More than €8 million will be invested in additional funding for the national maternity strategy, in excess of €1 million to support the initial establishment of the perinatal genetics service and an additional €5 million investment in the women’s healthcare fund, a large amount of which will go towards access to gynaecology clinics, raising the number of clinics to 20 nationally. These are real and transformative changes. These investments and the work of this Government will ensure that every woman and girl in Ireland will receive better, more efficient and more flexible healthcare services for generations to come. We should all be committed to this goal and it is one we can achieve.

It is hard to believe we are in this State in 2022 and when we talk about the State I often think “state” is a good word for us because we are in a bit of a state. Here we having statements and there is no additional information or clarity in the Minister’s statement. We are still trying to sort out our national maternity hospital to offer state-of-the-art medical services on a secular site. Women want a maternity hospital way and far beyond the reach and the neck of the old proverbial crozier. It is mad to think that we are even having these statements and this conversation in 2022 because in the 21st century every woman should be able to walk into our national maternity hospital secure in the fact that she is on secular ground. Women need to know their treatment will be strictly according to their medical needs and wishes without even a suggestion, look, sight or say from a religious order, its ethos or its agents. Yet here we are and here we go into another round of talking about something that should have been sorted and settled long ago. We want our maternity hospital on land owned by the State, controlled by the State and run by the State and not by private companies or charities. It should be the State alone. We have reasons to be concerned.

On a related note, our treatment of pregnant women generally continues to leave a lot to be desired. Throughout Covid, which is still with us, women were left to birth alone without their partners or birth partners and all the talk in here was about when we would open the pubs and put hospitality above our maternity hospitals. Instead women went through early birth labour alone, sometimes through delivery with daddy being confined in the car park or left out in the dark and the cold. There were jokes on social media that women would be better off giving birth in the pubs because then the daddies could have been allowed to be present.

On another relevant matter, Covid-19 put paid to the Coombe Women's Hospital antenatal clinic that was run in Naas General Hospital. I assure the Minister that the women of north Kildare are anxious to get that back. A reply to a recent parliamentary question told me that in time consideration would be given to a midlands location for that clinic but I want to tell the Minister and the HSE that mná Chill Dara will not be ceding the clinic at Naas to anywhere else and we will be loud and clear about that. In the meantime it is crucial that all infrastructure be attended to and kept as state-of-the-art as possible.

I will return to the National Maternity Hospital, Holles Street, which holds a special place in the hearts of many women who have given birth there and who have had their first real experience of unconditional love there when holding their babies. After 100 years of the conservative politics of Fianna Fáil and Fine Gael we are still not on our journey to make sure our national maternity hospital is secular and independent and to getting a national maternity hospital offering world-class care to mothers and their babies on a site owned and run by the State alone. That is a red line for us. We do not want a charity; we are far beyond that. The past 100 years was way too long for our women and girls. We want to stand on ground that is, in its own way, sacred to us because it caters for us and our needs and does not answer to anybody else or to any religious order. That needs to be done.

I want to clarify a comment the Minister made earlier about the letter from the 52 doctors. He said he did not claim that the public comments were misleading and ill-informed. On 25 February, he will recall that he posted on Facebook, quoting extensively from that letter and the comments of the 52 doctors. At the end of his post he said:

I share the view of the doctors that the allegations being made, including by certain Dail TDs, are misleading, ill informed and manifestly false.

They were effectively saying the same things as the doctors and accusing people who were raising concerns of misleading the public. That is clearly completely untrue. We all want to see a new national maternity hospital which is good and fit for purpose to serve future generations. We want that hospital to be modern in the way that it operates, the services it provides, and its ethos. There is no guarantee that this will be independent in ethos. We also want a hospital that is publicly owned. We should not repeat the mistakes of the past, where the State abdicated responsibility for health and education, and funded buildings and land for religious orders. Recently, we have found the difficulties with that and that we could not take it back in any way. Much of that land has been sold for a huge profit.

We want a new hospital, but the requirement is that it would have a secular ethos and be publicly owned. Neither of those requirements is being met, which is a difficulty. This issue has been live since 2016, both for the current Minister and the previous Minister, Deputy Simon Harris. Neither has been able to square that circle. For the past seven years, we regularly asked what was happening with the maternity hospital, and we were told that agreement would be reached imminently, in the coming weeks or very shortly. It has not been possible to square that circle, as the Minister knows, because under the present proposals, the hospital will not be publicly owned and it will not be secular. That is not acceptable to the public. There are a number of aspects to this, including the site on which it will be built, the building itself, and, most important, the company which will build the new national maternity hospital, DAC.

The points made by Deputy Alan Farrell are completely untrue. The proposed corporate governance structure that we have been told will apply is one where the National Maternity Hospital on Holles Street will cease to exist with its present identity. It will become a wholly owned subsidiary of St. Vincent's Holdings CLG. It will lose all of its independence and current ethos. The Minister made a disingenuous statement that all necessary services for women's healthcare are provided in Holles Street. They are, because Holles Street is not a religious hospital. It does not have the involvement of any religious order. That status will change under these proposals.

This started seven or eight years ago, when we were talking about co-location, which makes sense from a health perspective. We are no longer talking about co-location, but about a takeover. This is a full takeover of our National Maternity Hospital by St. Vincent's. That is utterly unacceptable. It is unacceptable for any hospital to be handed into private hands, whether religious or otherwise. It is particularly obnoxious that the Minister would consider doing that with a maternity hospital. Has he learned nothing from this country's recent history? Irish women simply do not accept the proposition that we would have a maternity hospital that would be controlled by a religious body which is a successor to the Religious Sisters of Charity. I can understand why the Minister is not looking up. He must be embarrassed at the prospect of doing this, in light of things that he has said over the years. Why are we handing over a €1 billion asset to a private entity, with full control being given to a successor organisation, St. Vincent's Holdings CLG, which was established by the Religious Sisters of Charity?

It is a company that must uphold the values of the Religious Sisters of Charity.

We will move to the next speaker. We are tight for time.

Nowhere in the world is there a Catholic successor hospital that provides the full range of healthcare services for women. The Minister should own up to this. What he proposes to do and is claiming to do is simply untrue. It cannot happen.

I welcome the opportunity to speak on the new national maternity hospital. It is important to acknowledge that women have been failed by the State for too long, which this Government recognises. My colleague, the Minister, Deputy Stephen Donnelly, published the Women's Health Action Plan 2022–2023 just a while ago. This puts women at the heart of the policymaking process for the first time ever. This women's health action plan is a landmark publication, which will enable us to offer better, more timely care to women, with tailored services across age groups, increasing opportunities for women to become partners in their own healthcare.

Women's health is the top priority for this Government and it is strongly supported by budget 2022, with €31 million in additional funding for the development of women's health. There is €8.6 million extra for continued implementation of the national maternity strategy. Some €9 million will be provided to fund access to contraception for women between the ages of 17 and 25. Some €5.3 million will be provided to increase the number of CIN 3 gynaecological clinics to 20 nationally, specialist menopause clinics to four nationally, and special endometriosis services to two nationally. Some €5 million will be provided to bring the women's health fund to €10 million, to support innovative new approaches to women's health nationwide. That is set out in the Women's Health Action Plan 2022–2023.

The Minister of State came to the wrong debate. We had this debate earlier today.

Let each speaker have the time to speak.

If they are speaking to the subject matter of the debate.

The Minister of State should speak to the subject.

The essence of this debate is women's and children's health.

This is out of order.

We had that already.

Allow the Minister of State to speak.

As I said, the women's health action plan deals with the issue of the national maternity hospital. There is rightfully a huge amount of interest in the national maternity hospital. The creation of the new national maternity hospital is the greatest infrastructure investment by the State in women's health. We have to recognise that we are building a once-in-a-generation world class national maternity hospital. We do not just have to look at Holles Street but also at the Coombe and the need for further development and the building of a new hospital there. We have much catching up to do with maternity services in the State, not just at Holles Street. It goes beyond that. The new national maternity hospital is a key element.

This hospital will ensure world class facilities are available for women, girls and babies for generations to come. The hospitals have worked together for decades. Approximately 40% of consultant staff at the National Maternity Hospital are employed by or work between the two hospitals at present. This creates the ideal platform to achieve clinical ideals of co-location. Everybody has accepted the value of co-location in this project. It is vital to recognise the importance of co-location of maternity services. Maternity and neonatal care are among the branches of medicine with the highest risk. The co-location with adult and acute services will ensure that mothers have access to a full range of medical and support services via corridor linkage. All too often, we hear of issues with delivery in maternity hospitals, the major difficulties that have arisen, and the high risk in these locations. It is important that we move to a situation through co-location where we will have the maximum services available in any one campus.

Annually, several hundred pregnant women at Holles Street require diagnostic, medical and surgical intervention that is not available at the current hospital site. They require transfer to St. Vincent's University Hospital, either as inpatients or outpatients. Every year, six to ten women are transferred to St. Vincent's University Hospital because they are critically ill and require intensive care that is not available on the site in Holles Street. This fragmentation of care between two sites disrupts care in some of the highest risk clinical cases in the State. The new hospital will provide women with direct access to a wide range of medical, surgical and diagnostic services and facilities.

It will facilitate a modern campus approach to healthcare, where a range of medical entities operate in close proximity to each other to increase the breadth and depth of services concentrated together with close alignment of clinicians.

In general, the State does not own voluntary hospital buildings. I want to say that again. In general, we do not own voluntary hospital buildings. However, it is not unusual for the State to invest in voluntary hospital campuses as part of ensuring facilities are fit for purpose. Needless to say, any investment by the State on voluntary hospital campuses must be done with all necessary assurances around the safeguarding of the State’s investment and the delivery of public services. It is important to point out, and this gets lost in this debate, that in this particular case we are relocating one voluntary hospital to the campus of another voluntary hospital, in a hospital building that is owned by the State. That is a clear position of what is happening. The State will own the hospital building. We have one voluntary hospital moving to the campus of another voluntary hospital.

A legal framework will provide the necessary clarity and assurances for the State. The legal framework will deal with at the State’s core objectives regarding this project, which are worth noting again. These are, first, that clinically appropriate services that are legally permissible are provided for women who need them in the new national maternity hospital. This is, as the Minister said, not just a red-line issue. It is an issue for everybody in the State that that should be the case. We also want to prevent any undue influence, religious or otherwise, in the operation of the new hospital. We want to protect the State's investment in relation to capital, revenue and services provision at the new hospital for the public good.

I understand the points that have been made and I can understand the key issues that are being highlighted by a number of Deputies here. However, we can continue having this debate, or we can continue with having the services provided. We all know the timescale that it takes to build a hospital of this nature. It goes on for several years. Some preparatory work has already been done on the site. As the Minister said earlier, that has now been completed. It is important that we move carefully, but as swiftly as possible, to ensure those legal agreements are put in place to cover those three arrangements, such that the project can then move on through the normal process. That will ultimately provide much better services than are currently arranged and are available in the current situation.

The next slot is for People Before Profit-Solidarity. Deputies Bríd Smith and Paul Murphy are sharing five minutes.

No, I am taking the whole five minutes and he can get lost. He is getting none of it.

That is a great one.

Something intrigues me and this is not to insult anybody. But I am intrigued that there is not a single female Member of the three Government parties here to talk about this issue. Not a single one.

They might all have had to go home and mind the kids. I do not know, but I think it would have been appropriate for at least one or two of them to be here to defend this issue.

Men have a role as well as Deputy Smith.

It would have been appropriate because it is Government policy to impose this new structure on us.

It is disgraceful for the Deputy to suggest that men do not have a role-----

Quieten down, Deputy McAuliffe.

There are women in the Government parties. They should be here to defend this position. That is the first thing I want to observe.

It is disgraceful. It is a disgraceful thing to suggest.


The second issue I want to observe is that the statement by the Minister, Deputy Stephen Donnelly, is extraordinary. We have been pulling teeth to get this statement here today. All of us here in the Opposition have repeatedly asked for time to debate this issue. However, we get nothing new, except omissions. Where has the Minister dropped the 99-year lease that he then announced was increased to a 299-year lease on the land? That seems to be gone from the historical record. Why is that? I am really intrigued by this question, because of this convoluted, complex way of doing business from one voluntary hospital to the other, from staff that work in both, from a holding company to a subsidiary, wholly-owned ultimately by the Sisters of Charity. Yet, the nuns have resigned from the board and have nothing to do with it and we have nothing to worry about.

We are all a bit hysterical anyway, are we not? We are all a bit over the top, hysterical and worried.

I wonder why? I wonder if it has anything - anything - at all to do with around 200 years of oppression and control by the church of our bodies, our lives and the hopes that we had held for the future for women and girls in this country after repeal was won.

Has it anything to do with that? Is it not bizarre that the Minister on the other side of the House finds us niggling and annoying because we keep asking this and because we looked for this debate? Then he comes into the House and does not even explain to us how this whole process is working. We will come out of here believing at the end of it, as will the people in the Gallery, that the Minister intends to hand over €1 billion worth of taxpayers’ money to a new state-of-the-art maternity hospital, with the best facilities and all the rest of it into the control of a religious order. This a religious order that has a legacy in this State of running Magdalen laundries and having illegal adoptions through the St. Patrick’s Guild. Has it anything to do with history? Has it anything to do with the position of women for decades in this country?

Shame on you. If the Minister was still sitting up beside me when we had to share the same row when he was in opposition, he would be saying exactly the same thing now. However, he has completely done a U-turn on his position on it. I want to make a reference to one line in the Minister’s statement. He says, "Second, to prevent any undue influence, religious or otherwise...". Why does the Minister not just say, "To prevent any religious influence in its totality"? Why is he sticking in the word "undue"? My "undue" might not be the Minister's "undue". I really am suspicious of what is going on here.

I also really resent the idea that the Minister spends all of his time listening to those on the front line, respect to the 52 professionals who wrote to him, but he must listen to them because they are the professionals. He has had nothing to say in response to today’s call by the Irish Nurses and Midwives Organisation, INMO, for the re-introduction of mask wearing in order to prevent the Covid-19 situation in hospitals getting out of control. I have not heard a single statement from him. If he is the one who listens to the nurses and the doctors all the time, why is he not responding to that? I am not just looking to pick holes in his statement, but there are a huge number of holes and I do not have time to go through them all. We are bitterly disappointed that we have not gained an inch of ground in this whole debacle.

Finally, I want to make this point. Whatever about the nuns, and there is a really serious case to be answered about the religious influence undue or otherwise, the Minister is handing the future of a maternity hospital that is publicly funded - the wages, the maintenance and the running of the hospital will be paid for by Joe Bloggs taxpayer and Josephine Bloggs taxpayer - over to a private company. Does that not fly in the face of Sláintecare? Does it not fly in the face of the future of all of the health services in this country? We have made huge mistakes by having combinations of voluntary, religious-run and all sorts of machinations. Now, we fundamentally need to make a break. Now is the opportunity to make a break, to separate church and State and to have the State own, run and control the new national maternity hospital.

The next speaker is yours truly. The Ceann Comhairle has arrived.

It would be terrible if I denied the Deputy the opportunity of contributing.

The Ceann Comhairle would be denying us all.

Musical chairs.

I am glad to have an opportunity to speak about this hugely important legislation. Like everybody else here, I am strongly of the opinion that we need to ensure the independence of the new national maternity hospital. We have spoken about this many times with those on the health committee. We spoke about it many times before and I am sure that we will speak about it again.

Our intention is quite clear. It is to deliver, as was promised many times, although albeit belatedly, a modern facility to support the women who need that particular support and service. It should be unlimited and unabridged, both now and in the future. I think it is coming very late. It is coming after all the debate and all the talk about the need to look after women's health and to provide for women's health, etc. Hopefully it is coming now. I am a bit worried about the crossfire in relation to it, on the basis that it might delay the provision of the hospital that is necessary.

On one hand, I absolutely and emphatically support the independence of the maternity hospital, and it must be independent. I have no reason to disbelieve that what the Minister is suggesting is anything other than that. I accept the concerns expressed by people but all the information I have to go on, and I am also still member of the Joint Committee on Health, is that the Minister proposes to deliver. There are conditions relating to that. In the political reality, it is a serious issue if a Minister does not deliver. The Minister knows that and we all know that. I, therefore, believe that he has no intention of misleading the House, or in any way misleading the women of Ireland, at this particular time on this very important subject.

We have talked about the long-standing need for this for long enough. We have identified that we must have a modern hospital. It must be the best that can be provided at the time and must serve the women and families of Ireland, now and in the future, without restriction, influence or interference of any description whatsoever from any source. An independent national maternity hospital is what the women of Ireland want and deserve and that is what we are bound to deliver to them. That is what the Government is bound to deliver to them.

At this stage, I see no evidence whatsoever other than a concern, which there would naturally be in any event; whether it is well-founded will remain to be seen. I believe it is not well-founded. I believe it is general caution. It is up to the Government and the Minister, whoever the Minister and Government may be at the time, to deliver. I expect that will happen. It is the least we might offer to the women of Ireland at this particular stage. Let us face it; we are good at talking and great at speculating in this country. We are great at promising long years in advance and then we talk about the details afterwards.

Let us not be in any doubt about it at all - we should not allow the talk on the details to deter us from our continuation of the need to provide a vital service for the women of Ireland. If we do that and drag the debate back into speculation and more doubt then we are going in the wrong direction. We need to trust each other to make sure we deliver and that we are kept to that delivery by the Opposition, as necessary. My good friend, Deputy Connolly, is looking at me. I have to say this. We have to trust somebody sometime. I can tell the Deputy that I am as well-versed as anybody in the House on this subject. I have been here longer than most of the people in the House. I want to say this: I have no reason to believe it is the intention of the Government or the Minister to mislead the public or the women in the House and of the country. There is no reason to believe that at all. The Minister knows that and I think the Opposition knows that as well.

For those who want to second guess all of us and presume that we mere males should not have an opinion on this issue, I want to say this: I would apply the same principles with regard to all care for all people of all ages in all conditions. The basis on which we have a right to speak is one of equality. We have a right and a concern despite the fact that some people have suggested in recent times that perhaps the male population is opposed to the women of Ireland. That is not true and I want to state that emphatically. That is the wrong way to go about it. It is the wrong debate to have in this country at this particular time. It is divisive, misleading and destructive.

I am sorry for digressing, a Cheann Comhairle, but the fact of the matter is that the women of Ireland need the service. They need an up-to-date, modern, reliable service that is not subject to interference from anybody or from any quarter. They must have ready access to it and be given an assurance that nobody will impede their right to avail of whatever service is available in that hospital, and that independent service will be governed by the legislation from this House.

I will make a final comment. I note the point that was made about the wholly owned subsidiary of a parent company. That is company law, about which we all know a small bit and have had to learn about in our own particular way. There are exceptions where the wholly owned subsidiary can deviate very dramatically but we want to make sure that it does not impede the delivery of the independent service that is required. I agree with Deputy Connolly entirely but there is a need to allow the process to continue in order that the service may be provided, and that we do not have to wait another ten or 15 years and that we do not, above all things, get into a debate about an alternative site, which we have had with regard to almost every hospital I can think of. The one place we should not go in the House is into deciding which would be the most important site. We are behind ten years; we will be back 20 years if that starts.

I thank the Ceann Comhairle for allowing me the opportunity to speak on this subject. I admit I am a mere male and only represent half the population. My intentions are as sincere and genuine as anybody on the other side of the House regardless of gender. Those of us who have spent a bit of time in the House are not always wrong. I listened carefully to and accept Deputy Connolly's views and I will do so again.

I thank Deputy Durkan. I am glad I was back in time to allow him to make that contribution. We move now to our next contributor, Deputy Shanahan.

I will read an excerpt from The Irish Times from Wednesday, 16 February 2022, in which the Taoiseach said, "The process of relocating the National Maternity Hospital (NMH) has gone on for 'far too long'." He went on to say, "major health projects need to be delivered 'much more quickly' than they are at present." He added, "It’s not acceptable...". Further to that, he told the Dáil there would be no involvement or influence 'in any way' from religious organisations when the hospital moves ... from Holles Street, Dublin to a site at Elm Park. The article went on to state that, "The Elm Park site would come under ... [the] control for 299 years after its transfer to the NMH from SVHG [under a licencing agreement]". The article further stated that, "Mr Martin said there would be no involvement or influence from any religious organisation, 'be it Catholic or whatever', in the new facility."

I think it is fair to say that religious ethos will not be a dominant feature in the medical politics at this new maternity hospital.

Regarding the need for a new Dublin maternity hospital, no one could argue regarding the need for an upgrade in maternity services from Holles Steet maternity hospital. The Minister outlined it and, indeed, people know that building was never designed for the number of patients and number of possible procedures required, or the development or innovation that has taken place in modern medical therapies, which oftentimes require significant theatre and operating room space to accommodate machinery. No one could argue whether the needs and safety of mothers and infants in this country should be paramount in our society. I know we are all agreed on that. I will raise other questions regarding the development of this hospital beyond its recognised need within the Dublin healthcare ecosystem.

My questions emanate from my interest in healthcare, particularly how healthcare operates in the regions as opposed to counties Dublin or Cork, for example. What are the associated proposed costs of this project? Initial estimates some years ago suggested the completed hospital would be built for €400 million. The national press has in the last number of weeks been touting a figure closer to €800 million. Given that we have not completed nor are we even close to the finishing costs for the national children's hospital, which will likely top out close to €2 billion, what should the cut-off point of spending be on this new national maternity hospital?

I remind the House that a second Dublin maternity hospital move is mooted to be required soon, that is, the Rotunda Hospital possibly moving to Connolly Hospital Blanchardstown. That is before what will surely be the next discussion in national maternity services of the potential adjoining of some maternity hospital units to the new national paediatric hospital. The issue of shortcomings in terms of dealing with babies who require immediate surgical intervention post-delivery has been well-known in Dublin and beyond for years.

How long more before the national capital call-out to spend whatever is required to conjoin maternity hospital services to the new national children’s hospital, all the while conveniently forgetting how much has been committed to this project and conveniently sidestepping the fact maternity co-location to the new national children's hospital site choice was not the primary driver in deciding its location? It was, in fact, ignored, and that deliberate oversight is a stain on the integrity of those who were involved in the decision-making process. It was a decision that resulted in an unnecessary bill that taxpayers and patients nationally will have to suffer for years. It is heartening to know that when it comes to spending money in Dublin, budgets come way down the list of significant political considerations.

I might digress to the subject of my local hospital, University Hospital Waterford, UHW, about which I have spoken many times in this House. It is the south-east regional heart attack centre and it continues, despite all the political promises over recent years, to offer access only 39 hours per week for emergency cardiac catheterisation. It continues to allow needless damage of patients as they incur delays in accessing emergency stenting in other regional centres. Despite this hospital being the most efficient in terms of bed and patient trolley management and Covid pathways in the entire South/South West Hospital Group, we can garner no Dáil debate on why it has the lowest capital budgets of the nine model 4 hospitals. Despite it having a patient population of more than 550,000, no one is asking for an emergency task force to decide whether to grant the resources we need to deal with our outpatient waiting list of 50,000. No one is asking why the hospital has the lowest number of healthcare staff per bed ratio of all the model 4 hospitals, or why we would should have to fumble with 2,196 health service personnel. By contrast, University Hospital Limerick, for example, which has 3,600 staff, is a similarly sized hospital but treats a catchment of 100,000 fewer patients. It appears no one in Dub-land or Dáil Éireann has any interest in exploring why UHW, in respect of almost every business case or capital development project it has proposed that would increase its bed allocations, develop additional treatment space or increase staffing, meets nothing but resistance, deliberate delay and obstruction over the years in its desire to develop additional services.

I have sympathy for the issues that continue to beset the building of a new maternity hospital in south Dublin, but my experience and that of south-eastern patients tells me Dublin medical lobbyists and politicians will find a way to deliver this project. They will continue to do so even while they continue to ignore the many valid claims for equity in healthcare spend for the citizens of this country who live outside the Pale.

I welcome the opportunity to contribute on this issue. There have been three Private Members' items of business on this issue and, unfortunately, Private Members' business does not allow time for Government backbenchers to speak, so I welcome this opportunity for statements, which do. I was in the Chamber twice in successive weeks when various Opposition Members called for time for these statements to be scheduled. During the course of this debate, I have wondered whether these statements have come too early in advance of the Government's final decision. In a way, that depends on whether we believe the Minister's decision will differ depending on the course of the debate, although I suppose the Dáil should be used to try to influence change within the Government.

Nevertheless, in my view, we are speaking in something of a vacuum because that final legal framework is not yet available and those details, that squaring of the circle Deputy Shortall spoke about, have not been finalised. It is difficult, therefore, to comment in advance on what the final arrangements will be. All I have to go on, and all many Fianna Fáil Deputies have to go on, is the commitments the Minister has given to the House and, more important, the commitments he has given to us at several parliamentary party meetings when numerous members of our parliamentary party have raised this matter with him. Off the top of my head, I can think of members such as Deputy Murnane O'Connor, Senators Fitzpatrick, McGreehan, Ardagh and O'Loughlin and many others who have spoken to him about it. In fact, it has dominated a number of the meetings. I say this not to the Deputies who are present but to people who might be watching the proceedings. This ongoing debate has been extensive. Our opportunity to influence the Minister is at that forum and it is there the Minister has given us the guarantees he gave to the House during tonight’s debate.

There are two main areas to address, namely, the issues of religious influence and the financial or legal arrangements that will protect the State's investments. Both issues are crucial and they will form the test by which we will judge whether this proposal will pass. They are based on a twofold legacy. I do not often disagree with Deputy Durkan but he suggested this is not about male Ireland versus female Ireland. We have to accept male Ireland let down women for decades and, therefore, it is utterly understandable to have genuine concerns and fears such as those expressed not only by Opposition Members but also, more important, by many women who have contacted many of our constituency offices. Their fear is there will be a religious influence on the services that are provided. That is justifiable, and anybody who has read any of the reports that have come before this House will know the reasons for those very justifiable concerns.

The second issue relates to the financial arrangements. Ireland has a legacy of the State allowing religious orders to provide social services and of those social services then being transferred into voluntary organisations. While some of those voluntary organisations retain a religious ethos and others do not, there is a complex mix of voluntary providers providing healthcare, education, disability services and so on. It is clear that as the State has matured and as we have grown in our economic ability, there is a desire that we should have increased State control and governance of social services that are provided. We can see that in the discussion on childcare or disabilities, and the Taoiseach, the Minister and many others have pointed to it. The difficulty is we are at the point where we are trying to construct a national maternity hospital and we know the right thing to do with that, from a medical perspective, is for it to be co-located. The current relationship between the two hospitals, St. Vincent's University Hospital and the National Maternity Hospital, suggests they are the correct combination but the former is a voluntary, not State, hospital.

Given the legacy of religious interference and of dependence on religious and voluntary bodies rather than on the State, we have a long way to go to prove to people we will realise the commitments the Minister has given to the House. The only way we will prove that is in the details when they arrive. Despite the calls from the Opposition for this debate to be held at a later date, I believe this is late enough. I nonetheless look forward to a debate on the final arrangements, which I imagine will be held when the time comes. The reason I came to the conclusion we should proceed with the current arrangements is one, perhaps, of pragmatism. Some within the larger parties, even within Sinn Féin, are saying that while we need to ensure it is done right, we need to just get on with this. In politics, there is always compromise. Decisions have to made in respect of complex and messy situations, such as that which I described with the legacy of all those decades. We have to work with that legacy to provide this new hospital. Many within my party and others have argued we need to get on with this, but we must put in place protections to ensure the interference and that dependency on those voluntary bodies will not exist. The difficulty is this will involve compromise. There have been some reassurances about the public ownership of the building and the removal of the religious orders from the governance arrangements, but we will have to wait and see.

A letter persuaded me, on balance, that we needed to proceed. During the repeal referendum campaign, Dr. Rhona Mahony was someone I listened to intently throughout the committee hearings in December of that year and into January. She has added her name to the letter, a copy of which I have to hand. People have quoted from it back and forth.

The letter is there for everyone to read about who was using the word "misleading" and who was using the word "misunderstanding", but it states we should get on with building the hospital on this site using the broad arrangements that are known to be the case. On balance, 52 clinicians have far more experience than I in the provision of maternity service. On balance, 52 clinicians, including somebody whom I respect greatly and who, I believe, has a strong understanding of women's health and of protecting women's health including reproductive rights, are saying that this arrangement will not compromise those. On balance, therefore, and awaiting the Minister's final arrangements, I believe we must proceed. We must not have religious interference. We must protect the State investment but we must build the hospital too.

Deputy Connolly is using the five minutes from the Rural Independent Group.

It is ironic that I have five minutes courtesy of Deputy Mattie McGrath and I thank him.

There is not a substance strong enough to calm me down after listening to the nature of this debate. We have tabled three Private Members' motions in less than a year. We have used our Questions on Promised Legislation. We have used every possible democratic procedure to bring pressure to bear on the Government to have a debate and when we have the debate, not a single female TD from the Government side comes in to participate. Not alone that, but we have male politicians coming in, for whom I have the greatest respect on a personal basis, using the time to obfuscate, to confuse, and to talk about a strategy that was discussed earlier today and not the issue, which is the ownership of the national maternity hospital.

The speech from the Minister, on a benign interpretation, is patronising in the extreme with a narrative designed to confuse and to place the blame on someone else for a failure to take action on this important subject - a new maternity hospital in the 21st century. On a malign interpretation, it is positively insulting that he would use, in a three-page script, a page and a half to give us a background and to tell me and my colleagues here how important this is when we have begged, implored and stood up here to state repeatedly let us build a national maternity hospital on a public site owned and run by the State.

The Minister used a letter from doctors in relation to misinformation. He did not clarify that he agrees with those doctors but he takes up his contribution to tell us what they say. They tell us that it would be a "tragedy", but the Minister did not use that line, if it did not go ahead. We all think it would be wrong if the hospital did not go ahead. There is a history here.

Let us quickly consider the history. In 2008, KPMG recommended the co-location. In 2013, the former Minister, Dr. James Reilly, announced the move. Since May 2013, there has been a delay, unacceptable on every level but not caused by the Opposition. How has it been caused? Let us look briefly in the time I have courtesy of Deputy Mattie McGrath. Because of the disinformation that is going out from here today, let us look at what happened. In April 2017, The Irish Times reported that the Sisters of Charity will own the new publicly-funded national maternity hospital, and the budget is €300 million. By May 2017, after public outrage, we are told, after a month of sustained public and political opposition, the Religious Sisters of Charity announced they were going to withdraw. They kindly tell us they are going to give it as a gift to the country but they do not give it as a gift. A new company is supposedly formed, and nothing to do with openness or accountability. We still have not received that gift. Maybe the gentleman here might ask why did that gift not become a gift and why the national maternity hospital has not been built on that site that was being gifted.

What have we? We have loads of questions here from all of the Opposition Members regarding the nature of this and the Minister comes in here today and gives us reassurances. I do not want reassurances. I want to make up my own mind based on documents before me in an open and accountable fashion and that has not happened.

We were looking at a nine-year lease with a 50-year option to renew. We were looking at a 909-year lease. We were looking at a 199-year lease. We are doing all this because the Religious Sisters of Charity or their agents have absolutely refused to give over the site, either as a gift or to sell it. The question has to be asked, what is behind that refusal? Perhaps the Minister might look up today and tell us what is behind that refusal.

How dare he come in and make a speech like that after us struggling for so long to bring some openness and accountability to this? How dare he do that on the backs of women and children who have suffered to get a national maternity strategy 100 years after 1916? In 2021, we found that it was not even funded. It is only being funded from 2021 on the backs of women such as the late Savita Halappanavar in Galway, Portlaoise, Portiuncula - I could go on - not to mention the hospitals, such as Our Lady of Lourdes, Drogheda, and all of the things that happened to women. How dare the Minister come in, twist the history and tell us a narrative that fits the boys' club? I will not accept it. I will not go over time either.

On a point of order, it is significant that we asked for this discussion. We begged for this discussion. We have the Government dominating the discussion today with the amount of time - I have no problem with that whatsoever - but they did not stand up with us when we asked repeatedly for time.

I concur completely with the points Deputy Connolly made.

I am nearly shaking with anger at the discussion we have had here today. I was hoping that at least we would get some information or update on where the Minister is at with talks and negotiations and all we got was the same as before.

I had a Topical Issue matter taken two weeks ago. I was told in reply, because the Minister was not here and it was responded to by a Minister of State, that the Minister would not say anything on the matter until he brought his memorandum to Cabinet. The Minister will keep rolling on and ignore the Dáil.

This morning, in a reply to Deputy Gino Kenny, he repeated the allegation that there are people spreading misinformation on the issues surrounding the National Maternity Hospital's relocation to the Elm Park site at St. Vincent's Hospital. The Minister raised it again in his speech tonight. He was at pains this morning to point out that it was the midwives and the doctors who were saying this, and it was not him. On the point that was made by Deputy Connolly, after 14 February when Professor Higgins was on "The Pat Kenny Show", the Minister came out with a comment on Facebook stating that he shared the view that the allegations being made about the provision of services, "including by certain Dáil TDs, are misleading, ill-informed and manifestly false". My understanding of spreading misinformation is deliberately distorting the truth. I am insulted by that. I am sure everybody else in the Chamber is the same. I would like the Minister to clarify exactly who is spreading this so-called "misinformation". Is it Dr. Peter Boylan, the former master of the National Maternity Hospital, Holles Street, a very well respected member of the medical profession? Is it Dr. Marie Casey, also a respected member of the medical profession? Is it Uplift, a campaign group? Is it the elected Members of the Dáil who have raised serious concerns about the ownership of the National Maternity Hospital, concerns which are not only held by them but reflect concerns of many people in society, or is the Minister referring to some group of conspiracy theorists on social media? I would like an answer because it is quite insulting, to say the least, to be dismissed as ill-informed, despite the intensive efforts I have made to inform myself of medical and expertise on the issue and which I am also sure has been done by others raising legitimate questions on the questions of ownership, operational control and the possibility of Catholic religious ethos being a factor. Everyone wants a maternity hospital built and I would not accept any turn of phrase that makes out that we in the Opposition are not in favour of a hospital being built.

I agree with the doctors and other medics at Holles Street who want to work in a professional, well-maintained and well-run hospital.

I will state what I consider to be facts. If I am wrong or misinformed, perhaps someone from the Government will put me right. The first fact is that the national maternity strategy set out an objective to have four new maternity hospitals co-located with acute hospitals. The issue of co-location for the national maternity hospital at St. Vincent's hospital has been taken off the agenda, as recommended by the Mulvey report. Am I right or wrong in stating that this is a fact?

The second fact is that the question of ownership of the hospital is not clear. The State will not own the land it is to be built on but will instead lease the land from a private company – St. Vincent's Holdings – which, to my knowledge, has not yet been established. The State will apparently own the hospital but not the land on which it is to be built. Why does the HSE need to negotiate a licence with a private company to run a hospital that is supposedly owned by the State? Perhaps someone will explain to me why this does not ring alarm bells and raise questions as to who will own the facility.

The Minister repeated assurances this morning and again during this debate that the national maternity hospital would not be subject to any religious ethos and that all medical procedures legal in the State would be available. I can accept the Minister's seriousness in pursuing this objective, but the wording of any legal agreement must be the subject of serious scrutiny. I find it difficult to believe that the Religious Sisters of Charity, the Catholic bishops and the Vatican would be agreeable to abortion and other legal services being available at a facility that they have an interest in and where they have fought tooth and nail to retain that interest.

If I am misinformed, please set us straight. The issues involved are too serious. The future of women's healthcare and healthcare in general depends on the resolution of this contentious issue.


I am sorry, but it is not in order to have clapping in the Public Gallery. That is a long-standing tradition.

I do not believe we will hear any more.

Some do not believe in free speech.

Well, let us not prejudge. I would welcome a response from the Minister.

I had a closing speech prepared, but I would prefer to try to address as many of the points raised as I can.

I start by thanking colleagues for their time and contributions. It is important to have this debate. It is one of several we have had on this essential issue, including at the Joint Committee on Health. I am struck by the disconnect between the amount of disagreement, which we will always have, given that this is one of the Chambers where we will probe the areas as required, and the overshadowing of the significant agreement on most parts of the project. Obviously, colleagues will speak for themselves, but I think we are all agreed that Holles Street is not fit for purpose. I think we are all agreed that co-location is the right approach for all of the reasons that have been laid out. Deputy Durkan and others have mentioned that several hundred women per year need access to medical services while in Holles Street that Holles Street does not have. I think there is broad agreement that it needs to be co-located. I think there is broad agreement that it must be a state-of-the-art hospital with a very significant investment in facilities, diagnostics, equipment and clinics. I think we all agree that this is urgent. Many Deputies have spoken about how long it has taken.

I think we are all agreed that it must be fully independent – operationally independent, clinically independent and financially independent. I believe we are all in agreement – maybe not everyone in both Houses, but certainly everyone who participated in this debate – that all services must be provided. I think we are in agreement that the State should own the building, and it will. I think we are all in agreement that it is our preference, and in many cases strong preference, that the State-----

Maybe the Minister will answer some of the questions.

Please allow the Minister, without interruption.

-----would own the land. I hope we are all in agreement that there is no easy option whereby the State could own the land. In pursuing the alternatives, for example, moving the site to somewhere other than Elm Park-----

Purchase the site.

-----or using a compulsory purchase order, the advice I have is that all of these options would carry a very significant risk of derailing this project by potentially not having it co-located at Elm Park and, at a minimum, adding many years to it.

I think we are in agreement on all of the other pieces above. Given this final piece on the ownership of the land and potentially the governance structures, colleagues are rightly looking for guarantees on the full independence of the hospital. That has been the focus of most of the contributions in this debate.

Deputy Cullinane rightly stated that he wanted to see the details. Many colleagues have said the same. I feel their frustration. I have listened carefully and taken notes on the frustration being expressed that we do not have a legal agreement in front of us, which we would all like to get into and debate. We will have that debate, but we are not in a position to do so now because there has not been Government agreement on the legal agreement yet.

Will that be before or after the Minister signs it? This is important.

I am sure he will clarify that.

The process is that I have to bring the proposal to the Government. The Government will then form a view and we will debate it. The Deputy and others have asked whether it can be brought to the health committee for detailed interrogation. Absolutely. Not only am I happy to attend, but I propose – the Deputy and I have spoken about this before – that we bring along the Department of Health, the HSE, St. Vincent's and Holles Street as well because they are the signatories to the agreement and how it will work.

Will that be prior to signing?

That is a vital question. Will it be prior to signing?

Unfortunately, what we have here this evening is a debate that is probably slightly too early. We would love to be able to get into the detail.

The debate should be-----

On the Deputies' questions about the process, Deputy Shortall has been in government. She is well aware of the process. I have to bring the proposal to the Government for the Government to interrogate.

I imagine we will then have more debates like this, but also at the health committee.

After the Government accepts it. Let us be clear about that.

That is the process by which all of these things happen.

It does not have to be. The debate could happen first if the Government wanted.

It is the process by which they all-----

Can we please let the Minister respond?

Deputy O'Reilly rightly pointed out that we need to get moving on this. She referred to how she had attended Holles Street, as had her daughter when giving birth to the Deputy's granddaughter, and that the new hospital had been agreed years ago. Much of the debate this evening and the ongoing debate is on this exact point.

Is there any chance of some answers?

With respect, I am going-----

You are repeating what others have said.

Please, Deputy.

-----through it Deputy by Deputy. I have taken notes on what everyone has said and I am trying to answer every Deputy.

You are ignoring-----

You are repeating what people have said. Can you answer some of the questions that were raised?

Deputy Shortall, please. We need a degree of mutual respect in this debate. Deputies have put questions and made statements and the Minister is in the course of attempting to respond to those. If there are remaining questions at the end, we may explore how we deal with them, but I am expecting-----

We do not need him to summarise what we said.

Please, can we just let the Minister proceed?

Deputy Bríd Smith asked about when we might see the legal framework. I would like to have it with colleagues shortly for them to look into it. She also stated that we needed to focus on the speed of delivery, on which I agree.

Deputy Alan Farrell made a salient point that went to many of the concerns that are being raised. I agree with his statement that, if we remove religious involvement from ownership, which we are doing, and if we remove religious involvement from governance, which we are doing, then at a simple level, the question of religious influence becomes moot.

Deputy Bríd Smith asked whether there was anything to read into the question of undue influence. There is not. One could substitute that for "any" influence. Maybe it was just a badly chosen word. It is not to suggest that there is some religious influence that is okay and some that is not. What is meant by that is any influence whatsoever.

Deputy Cronin raised various points around women needing to be able to access maternity services beyond the reach of the crozier, which I believe is the phrase she used.

I again assure the Deputy that there will be no such influence, no such reach and no such involvement directly, indirectly or in any other way. I would never bring such a proposal to the Government and it would never pass it. I can promise her there will be absolutely no involvement of that kind whatsoever. She quite rightly said there must be no religious influence. I assure her there will be absolutely no religious influence-----

The Minister cannot do that.

-----directly or indirectly.

There is no basis for that.

Let the Minister speak, please.

Deputy Cronin rightly praised Holles Street hospital. We need to reflect on the fact we do not own the building on Holles Street or the land it is built on. No one here tonight, or in any contribution I have ever heard in this debate, has suggested there is undue religious influence, for example, in Holles Street.

It is not a religious hospital. That is why.

If we just think about this for a second, what is happening? What are we looking to do? We have a hospital about 400 m from where we are talking this evening, which is staffed by incredible and dedicated clinicians who provide a full range of services. They are signatories to a new agreement whereby they will be moving to a state-of-the-art building at Elm Park. It is they who have signed up to this agreement and it is they who are saying they will have full independence. I believe that the clinicians, midwives and doctors in Holles Street would never in a million years surrender their independence.

Have they seen the contract?

Have all 52 seen the contract and are they legally experienced to ascertain the meaning of that contract?

Not only have they seen the contract, Holles Street has written the contract. It is one of the contracting parties-----

So all 52 signatories of that letter have seen the contract?

Can we see the contract then, if it exists?

Can we let the Minister conclude?

Can he answer that question?

Can we please let the Minister conclude? We will then see where we go with this.

I ask for a minute or two. Deputy Shortall raised several points and made several statements. She asked why I was not looking up while she was speaking. It is because I was trying to write down verbatim the statements that she made. This goes to the heart of some of the debate. The Deputy said there are no guarantees around the independence of ethos or a secular ethos. There are such guarantees. The Deputy said that she wants the hospital to be publicly owned.

It will be so owned. The Deputy has said that the national maternity hospital will lose all its independence.

This is simply a false statement.

It will be a subsidiary of St. Vincent's.

It has absolutely no basis in fact. The Deputy has said that it would be handed over into private hands. Again, this is not true.

The Deputy said that it will be a maternity hospital controlled by a religious entity.

The Deputy is obviously free to express her views, but these statements are simply not true and are causing an awful lot of concern among people-----

Will the Minister please stop gaslighting the nation?

-----who quite rightly want to know that there is an independent hospital.

That is the reality of what you just-----

The Deputy said that we are-----

Can we desist from heckling the Minister while he is attempting to deal with the questions Deputies have asked? They might not like the answers he is giving but will they at least let him give the answers?

The Deputy said that we are handing over a billion euro asset. We are not handing over a billion euro asset to anybody.

We own the asset. The asset is the building. We will own the building when it is built and we will own it at all times. We will own everything inside the building.

But not the company.

We are simply not handing over a billion euro asset to anybody. I take it that the Deputy is genuinely concerned about the independence. I accept that but the statements she is making are simply-----

The Minister will not address the fact that-----

-----Holles Street will become a subsidiary-----

They are simply not true.

-----of St. Vincent's. That is the reality.

Please, Deputy.

They will own and control the company.

Let us be clear. We cannot have a situation in the House, during a debate on any particular subject, that a Member decides he or she will continue to make his or her own personal assertions about what a situation might or might not be. That is not debate. Deputies Shortall and Connolly have raised a question that I ask the Minister to bring clarity to in order that we can wind this up this discussion. He has indicated that he will bring this matter to Cabinet and to the Joint Committee on Health, that all the component parties will be involved in the debate at the committee and that there might possibly be a debate in the House on the matter. The question that has been reasonably asked is whether that will happen before a contract is signed.

It will happen after I have brought it to the Government. The Government may decide to approve it or not to approve it.

I assume the Government will make a decision in principle.

The Government, which can make a decision, can decide to reverse that decision, if it wishes to, at another stage. That is the prerogative of the Government.

Indeed, it may choose not to accept the proposal that I bring. I do not know. All I can say is that I, as Minister for Health, have to bring the proposal to the Government. Deputy Shortall knows that.

That represents a very clear-----

She knows I have to do that.

That is as clear a response as we can expect this Minister or any Minister to give.

Can I raise a point of order?

The Minister has not answered the Ceann Comhairle's question.

The question is will he bring the proposal to the House before it is signed off on.

He has answered the question.

I am very respectful of the Minister. I just want 20 seconds to raise a point.

I will wrap up in a minute.

It will be a fait accompli.

The Minister said he has to bring it to the Cabinet, which he does, but he could bring it to an Oireachtas committee first before he does so. That is within the gift of the Minister.

There is not much point in bringing it to the Oireachtas committee first-----

Of course there is because-----

-----if there is not some sort of indication from the Cabinet on whether it is prepared to accept it or not.

He could bring it to the Cabinet after it has been properly interrogated by the relevant Oireachtas committee. There is no point bringing it to us when it is a fait accompli and the Cabinet has signed off on it. He has the opportunity to bring it to an Oireachtas committee first.

We will not get unanimous agreement on this.

We will not get an answer.

People's positions are quite clear. The time for the debate has elapsed at this stage. The debate is ended. I thank everyone who has participated. Statements on the national maternity hospital are completed.

Cuireadh an Dáil ar athló ar 7.47 p.m. go dtí 2 p.m., Dé Máirt, an 5 Aibreán 2022.
The Dáil adjourned at 7.47 p.m. until 2 p.m. on Tuesday, 5 April 2022.