National Maternity Hospital: Statements

I welcome the Minister of State, Deputy Mary Butler. She will speak to us for approximately eight minutes. All Senators will have five minutes thereafter. The Minister of State will be called on to reply not later than 10.38 a.m. Statements are to conclude at 10.45 a.m. I call on the Minister of State to make her statement.

I thank the Leas-Chathaoirleach and Senators for inviting me here today to speak to them on the new national maternity hospital. At the outset, the Minister for Health, Deputy Stephen Donnelly, is currently in Dáil taking statements, questions, and answers, in relation to the vaccine roll-out. I am delighted to have the opportunity to discuss this critical and nationally important project in the Seanad. As many here will be aware, the practice of having stand-alone maternity hospitals, as is the case in four of our maternity services, does not reflect best international practice. Ensuring that mothers and babies have access to the full range of medical and support services, should the need arise, is of paramount importance. It is widely accepted that the best way to achieve this is to co-locate maternity services with adult acute services. That is why it is Government policy, as supported by the national maternity strategy, to co-locate the four remaining stand-alone maternity hospitals with adult acute hospitals.

It is important to recognise that our stand-alone maternity hospitals have served the people of this country very well, in some cases for hundreds of years. However, they are not the modern facilities a 21st century society needs. In particular, it is well-known that the buildings housing the National Maternity Hospital at Holles Street are no longer fit for purpose. Therefore, the new national maternity hospital is planned to be the first of the four remaining stand-alone maternity hospitals to be co-located. The new hospital is a vital piece of infrastructure, one that will help underpin the development of maternity services and the implementation of the national maternity strategy in the future.

The programme for Government recognises the importance of this project and clearly sets out our commitment to its development. It is worth reiterating that commitment today, which falls very much in line with our commitment to develop better health outcomes across the board for women in Ireland. In that regard, we are placing greater focus on women’s health, and we are investing more than ever before to ensure that the progress achieved in women’s health is consolidated and expanded for all women and girls into the future. The Government is aware, however, of concerns voiced in relation to the new hospital. Those concerns centre on the ownership and clinical independence of the new hospital. We understand those concerns, and we understand where they are coming from. We also recognise that the State does not have an automatic right to the uniform trust of the women of this country, given the way they have been failed in the past.

However, I must point out that many of the concerns raised have been to the fore since the project was conceived and a significant amount of work was achieved through the Mulvey agreement, which was finalised following an extensive mediation process between the National Maternity Hospital and the St. Vincent’s Healthcare Group. The agreement was subsequently published and noted by the Government in 2017.

The Mulvey agreement provides for the establishment of a new company which will have clinical and operational, as well as financial and budgetary, independence in the provision of health services. Most importantly, the agreement ensures that a full range of services will be available at the new hospital without religious, ethnic or other distinction.

Following on from the Mulvey agreement, a draft legal framework has been developed to copper-fasten these arrangements and to address the State's core objectives: firstly, to ensure all clinically appropriate services that are legally permissible are provided for women who need them in the new national maternity hospital and to prevent any undue influence, religious or otherwise, in the operation of the new hospital; and secondly, to protect the State's investment for the public good.

Many Senators will also have heard the Minister, Deputy Stephen Donnelly, speaking on the issue of ownership of the hospital and ownership of the site on which the hospital is to be built. As stated previously, the preferred option for the Government would be to build the new hospital on land that is owned by the State.

As noted by the Government in 2017, the Minister for Health formally asked St. Vincent's Healthcare Group to consider an outright site transfer. However, this was not agreed and the current position is that the draft framework ensures that the hospital will be owned by the State and will be built on a site held on lease by the State for a period of 99 years, with a potential extension for a further 50 years. The HSE will, in turn, provide an operating licence to the new national maternity hospital and St. Vincent's Healthcare Group to facilitate the provision of health services in the building.

The Senators will no doubt have heard the Minister for Health state categorically that he will not be bringing any proposals to the Cabinet unless he is absolutely satisfied that the State's clear objectives are met through a cast-iron framework. In this context, the Minister for Health has stated that he wants to have further engagement with all stakeholders in the national maternity hospital project, as we move toward finalisation of the arrangements.

I would like the Seanad to know that we all share the same vision for maternity and women's healthcare services. We all want the very best for the women and babies of this country and we want to see them treated in the best possible environments. The best way to achieve this is by providing modern, safe, compassionate services that are delivered with dignity and respect. The planned move of the National Maternity Hospital to the Elm Park campus is a key part of achieving that aim and providing the state-of-the-art facilities that women not only need but deserve.

I look forward to hearing what the Senators have to say and I will conclude when everyone has spoken.

I welcome the Minister of State, Deputy Butler, and thank her for outlining the Government's position.

I come to this debate as somebody who has a keen interest in women's healthcare and reproductive health and rights. I campaigned for a long number of years to repeal the eighth amendment with many Senators here in this Chamber, and beyond with civil society groups. We have a very complex history here in this country about how we treat women, in particular, in relation to their reproductive health, well-being and care. I suppose we are looking at this in light of the referendum, the mother and baby homes report and that deep trauma that is still there in Irish society for women. I suppose people are terrified. There is a great fear. They do not trust the assurances of independence. That is the hill we have to climb here with this. It is incumbent on all of us here to work together. We should not stoke up fear and anxiety, because there is already enough of that out there, but we should work constructively to solve this issue.

There are two main issues here: the ownership issue and the ethos issue. There are ways that we can come around both of these. My big fear is that the current National Maternity Hospital is not fit for purpose. In terms of the facility, the women of Dublin deserve better than what we have currently. I am not talking about the clinical oversight there or the excellent care they get. They deserve state-of-the-art co-located facilities. That is international best practice.

I would be fearful that this is used as a battering ram and as something to make a point on, and who will lose out only the women of Ireland again? That is my main concern - that we do not go off down some mad tangent path and the women do not get the hospital that they need desperately and deserve.

The compulsory purchase order, CPO, issue has been mentioned. I would be fearful if we go down that path that this hospital would never get built.

There are substantial fears around the ownership and the ethos but we can come around those. On the leasehold of 149 years, many have been fed the line that we will not own the land and we will not own the hospital. We will own the building on it and leasehold is a substantial form of ownership. Many houses and apartments, certainly in Dublin, are held in leasehold. There is no issue with the ownership of that. You can get bulletproof long leases there and it is de facto ownership.

That issue leads into the ethos issue. I am mindful of the battles that we have all undertaken in the past number of years. I am a proud feminist. I am somebody who has worked very hard to ensure reproductive health rights are provided for every women and girl in this country.

The assurances of independence are not trusted but these issues can be overcome if we come together and work in a substantial fashion to make sure that the independence of the hospital is maintained, the golden share is bulletproof, and no Canon Law is attached to anything within the structure of the trust or within the hospital board itself. The Minister, Deputy Stephen Donnelly, understands these issues, is on board with many of the fears here and will not railroad the State into a massive investment where the lads from Rome will come and start imposing some sort of Canon Law on our hospital. That will not happen.

I have seen many posters stating, "Take your rosaries off my ovaries." The nuns are gone as well. The nuns do not want to have anything to do with this hospital. I understand that deep fear but we have a complex system of voluntary hospitals, State hospitals and privately owned hospitals in this country. I strongly believe we need to start unravelling that system but that unravelling will take a long time and I do not want the women of Ireland to fall victim to this and for their healthcare needs to be put on the back burner while we undertake that project.

Let us build this hospital. Let us get the guarantees we need. Let us do everything to make this as bulletproof as possible. Let us accept the bona fides here of the St. Vincent's Hospital Group and the religious orders here.

The religious orders have done an awful lot of good in this country as well. I was educated by the Mercy nuns in Waterford city. They educated generations of working-class women and give us the start in life that we would not have got elsewhere.

I just want to make sure that we get this hospital built and that everybody is brought into the process and given the assurances that they need.

I welcome the Minister of State to the Chamber and I also welcome her statement on the new national maternity hospital. This week an article entitled "National Maternity Hospital doctors fear ‘misinformation’ could delay move", was published by The Irish Times. “Misinformation” is the keyword in this debate, as far as I am concerned. The national media, the Taoiseach and some of the public seem to be of the belief that should we proceed with the relocation of the National Maternity Hospital to Elm Park on the site of St. Vincent’s Hospital, that this will in some way affect the services available to patients. The reality, of course, is that all the services now legal in this country will be provided in the new hospital.

We have the assertion in that regard of 42 senior clinicians in the National Maternity Hospital. They have issued a letter to persuade us of that point. In their words, "We, the consultants of the National Maternity Hospital, are concerned by the potential for misinformation". They go on to state that the project is a vital one "to create a world-class maternity hospital for the women and babies of Ireland”. Yes, it is a vital project, and we need a world-class maternity hospital. The proposed facility will be that in many ways. However, it is a tragedy that we must go hand-in-hand with services to deny unborn children their lives in circumstances where their lives could and should be saved. We know what the law is, though, and we know what the political and medical establishments are insisting on.

Why then the delay, despite the cast-iron guarantee in the proposed operating licence that all the services will be provided? Past instances of State decisions influenced by the Catholic Church have nothing to do with this new situation. The Catholic Church is entitled to be involved in healthcare, and it has a great record in providing excellent and ethical care, but it has clearly stepped back from involvement in the new national maternity hospital. Enough is enough, therefore, when it comes to beating down the Catholic Church in this country. Abortion, sterilisation and assisted reproductive services were unthinkable in the old Ireland. Now, these services are provided here. Regardless of whether the Religious Sisters of Charity retain ownership of the land at Elm Park, the new national maternity hospital is going to facilitate all services it is legally permitted to do in law. Furthermore, the religious order has said that it has nothing to do with the hospital. The order has not tried to undermine this and has not expressed any desire to interfere, nor will they.

Some will wish that the order had sought to retain a Catholic ethos at its hospitals, even if that meant that the new national maternity hospital was sited elsewhere. Would that have been such a problem? Do all the hospitals in this State need to remove their religious ethos? I reiterate that the Catholic Church is a pillar of compassion and understanding in this country and shame on us if we cannot show it the same respect and understanding. It would have been entitled to say "No" to the leasing of the land and to the new national maternity hospital. It could have, but did not. Therefore, anti-Catholic Church people in politics and in the medical establishment are having their cake and eating it. They have got the nuns out of the governance of the hospital, which Christian people have helped to pay to establish, and they are still engaged in the anti-Catholic Church invective and fearmongering. They are having it both ways.

The Taoiseach is said to retain concerns around governance and possible religious influence in the facility, but why? It is because political commentators have told him to be wary. Political commentators have weighed in on the matter and because they have, that is why this is happening. It is because political commentators have decided to make the new national maternity hospital their new point of issue with the Catholic Church. If this matter concerned any other religious denomination outside of Catholicism, would we be standing here today giving statements? Would political commentators have been involved? Would we waste our time like we are here? It is unfair to the Catholic Church and to the mothers and babies of this country to continue to talk like this. There is no reason for the Taoiseach to retain concerns, there is no reason for him to be wary, and there must be an end to this misinformation campaign, the cost of which will fall on taxpayers. We need a new national maternity hospital and I am as eager as the senior clinicians to ensure this happens quickly and without unnecessary delay concerning further debate on whether the religious orders retain ownership of the land. I, and many others would prefer harmful and-----

I thank the Senator.

This is why it is important that we get the new national maternity hospital built and that we just get and do this project. I thank the Minister of State.

Senator Keogan has given a stellar and robust defence of the Catholic Church. However, I remind her that plenty went on in this country that the Catholic Church should rightfully be ashamed of.

There were many good things too.

I do not believe that it has any place in healthcare in this country. With that said, I welcome the Minister of State to the House. As always, she is very welcome. This is a key commitment in the programme for Government. It is a pity that successive Governments did not deal with this issue and facilitate the building of a new national maternity hospital on a greenfield site which had no hand, act or connection with any religious bodies whatsoever. It is fair to say that the nuns and the religious bodies played a key role in providing healthcare when the State did not step up to the plate and provide it. Over the past 40 years, however, the State has incrementally improved the level of healthcare it is providing. Unfortunately, when it comes to maternity care and reproductive care, we fall far short. This project, which is probably going to cost €1 billion, if not more, should have been done years ago. It has to be done now, but it must also be done right. There is no reason St. Vincent’s Hospital Healthcare Group should not gift this site to the State so that we can clear up all the issues to do with ownership. There is no reason whatsoever that cannot happen, but it is not happening. I was most disappointed with the statement from the St. Vincent’s Healthcare Group last week which threw confusion and ambiguity into the waters, instead of the type of clarity which one would have expected.

The Catholic Church and any religious ethos can have no influence, ever, in respect of the services and the governance of the National Maternity Hospital. I have heard commentary that we must prevent undue influence. I do not know why people would even suggest that any influence of any kind is appropriate, because it is not. We must completely detach any religious ethos of any kind or any denomination from having any future role in the National Maternity Hospital. There should have been no need for a Mulvey report because we should not have been in that position in the first place. Like the Minister of State, however, I want to see this essential facility, which the women of Ireland have been deprived of for generations, built as quickly as possible. I welcome that the Minister for Health is engaging with the St. Vincent’s Healthcare Group to devise and identify a workable solution. However, that workable solution must ensure total independence regarding the governance and the services provided in the new national maternity hospital. It would be ideal if we had ownership of the site as well.

Let us get the hospital built. That is what needs to happen now. In future, however, we may need to look at a constitutional referendum in this country to take ownership of the site so that in 50 or 100 years' time no future representatives from a future St. Vincent's Healthcare Group can try to create a scenario where there is undue influence. We cannot have any of that kind of influence. We must, however, ensure that the facility is built as quickly as possible. A significant amount of taxpayers' money has been committed to this project and spent. The project, though, must go ahead.

I take seriously the statements by clinicians that it will be independent, the governance of it will be independent and the services which are legally available in maternity hospitals will continue to be available. However, there is concern and that concern has to be dealt with. The Government and the Minister have a duty to ensure that in all circumstances they can stand over the independence of the hospital before the country spends €1 billion on a site which is not ideal.

As I said at the beginning of my remarks, the ideal site would be a greenfield site which we would own, control and manage and the taxpayers and citizens of this country would have full control and influence over the maternity hospital. Unfortunately, because of the inaction of previous Governments and the failure of previous Governments to deal with this issue, we are in the situation we are in today.

Is í an chéad chainteoir eile ná an Seanadóir Ivana Bacik.

I welcome the Minister of State to the House. I thank her for coming in, on foot of a request I made last week to the leader of the Seanad, to have this important debate. I ask her to relay our concerns back to the Minister, Deputy Stephen Donnelly, as I know she will. This has been a long saga. We have seen many years of obfuscation, Byzantine legal deliberations and much lack of clarity. Nobody denies the need for a new maternity hospital and we are all agreed it should be co-located with an adult acute service. That is something we are agreed on. However, valid and serious concerns remain about the ownership and clinical independence of the proposed new maternity hospital.

It boils down to this, after many years of discussion and debate, without State ownership of the land on which the new hospital is to be built, valid and serious concerns will remain in terms of clinical independence. I pay tribute to Dr. Peter Boylan who has been making this point for some time now. His concerns are being borne out and he is being vindicated. The Government has accepted this because we have heard the Taoiseach saying when the State is investing, the State should own. We saw an all-party consensus emerging in the Dáil last week, in the motion of 23 June. The key question we must all ask is what the Government has done since last week to move ahead on the motion to ensure this hospital will be built on Stated-owned land.

There are so many concerns about the structures which have been devised. We have to step back and remember the discussion and negotiations commenced well before our laws changed in 2018, to enable the provision of legal abortion in Ireland. As somebody who campaigned for many years - indeed decades - to see repeal of the eighth amendment, I am glad our laws have moved into the 21st century and women can now access the reproductive healthcare we need in this State. Unfortunately, that moving forward of laws has not been reflected in the negotiations on the new maternity hospital and especially on the structures around what we may call this Catholic successor company, into which ownership will pass, the St. Vincent's holding company.

I have spoken about this before. We know we have a legacy issue in this State whereby 90% of our schools being State-run and State-maintained in that the State pays teachers' salaries and building maintenance, but the land on which the schools are built and sited remains owned by religious orders or church authorities, and in a large part by the Catholic Church. I have called a syndrome, which we have seen emerging in recent years, a "developer's wife syndrome" in that we have seen the orders divesting ownership into what we may call a Catholic successor company, in the same way a male developer will often divest assets to his spouse in order to free himself of asset ownership. The liability is attached to him but he owns no assets. The partner or spouse has the asset ownership but no liabilities.

We have seen this used to serious effect by religious bodies in the past, especially the Christian Brothers divesting ownership of schools to the Edmund Rice Schools Trust. It is an ostensibly lay company but is, in fact, a Catholic successor company. I have been involved in a school divestment in which we saw this happen and we have seen endless difficulties with a lease arrangement in this context. That is what I fear about the structure the State is proposing. A 99- or even 149-year lease is a short-term lease in the eyes of the Vatican and the church authorities. The church takes a long view. I am quoting from Government people who have talked to me about this.

I attended the Oireachtas briefing with the Minister, Deputy Stephen Donnelly, two weeks ago, when we were told by officials that attempts had been made by the State to transfer the land into State ownership. The question, asked just now by a Government Senator, remains: why will the St. Vincent's holding group not simply gift the land to the State? Why is it so anxious to retain ownership? We have multiple examples of other hospitals, such as St. James's Hospital, in which we see different owners of the land. There is no requirement that it be owned by the same entity. There are five separate entities on the site of St. James's.

We must ask that question and without a sufficient answer, we are lacking the necessary assurances about clinical independence and protection of this State investment of €800 million. We no longer, in a 21st century republic, have to accept that religious entities continue to own land in which the State is investing large sums of money. We have moved on. I have sought freedom of information requests from the HSE and the Department of Health to see what attempts have been made to buy the land. We certainly do not need a constitutional amendment. We have a compulsory purchase order procedure and that should be used.

What has happened with the business case of the national maternity hospital, apparently submitted to Government and rejected? Different answers have been given. I would like clarity on that. We have no clarity as to whether abortions have been carried out at St. Vincent's Hospital. There is a serious concern when we see a Catholic religious order divesting itself of healthcare holdings into a successor company, that this is not a secular successor company and will not have the clinical independence we require as women living in a 21st century republic.

It is good to hear Senator Bacik's voice holding in prevailing conditions.

I welcome the Minister of State to the House, although she is no stranger to the convention centre. This boils down to a stranglehold the Catholic Church has had on Irish society. It is important to point out those who have been heckling others today, defending the Catholic Church and saying the Catholic Church has a right to be involved in healthcare are anti-choice. That is the concern we have. I am not a religious person. I am not Catholic. I have a right to go into a State hospital and have the kind of care I want and am legally entitled to in this country.

Someone else has a right to go into a church and pray. He or she has religious freedom. The whole point of this is the Government is in a difficult position and successive Governments have probably been in a difficult position, because our schools and hospitals have been under religious control for so long it is part of the legal basis upon which they are founded. To move from that into something else, which is completely State-owned, is difficult. It has taken eight years to get to this point.

I am also concerned by what the Mulvey agreement says in that the religious order shall not have undue influence. The term "undue influence" is the concern. It should not have any influence. Senator Conway pointed that out. The agreement which is the basis for this hospital is the concern. I am not convinced it is as straightforward as some people are pointing out to move into a different situation. I know the Minister and the Government are trying all they can and there are ongoing negotiations. What we really want is to be assured every avenue is being chased up, because the land should absolutely be in State ownership.

Most of us - not all - would say the land should be in State ownership. How we get to that point is the problem. How do we get to the point of moving the 90% of our schools which are also owned by the Catholic Church in one way or another, whether through another company or not, over into State ownership?

It is not an easy task. I do not have all the answers but most of us are on the same page and know what we want to happen. I have brought forward motions about contraceptives and worked for a long time on repealing the eighth amendment. Most of us are coming at this with the best of intentions, the Minister of State included, though we might disagree on different things. I would love to hear from her what steps are being taken to ensure we can move not just this hospital but Irish society into a different place. We are quite entitled to feel we have been let down by the Catholic church for generations because we have been. All those who are contacting us are quite right to be concerned but we also need to make sure the hospital is built because these negotiations have been going on for eight years too long and there is still not any groundwork done on that site.

I thank the Minister of State for listening to me. I wish I had all the answers but I do not. I just know we need a hospital built. It should be on State land and now we need to get to that point through some form of negotiation, unfortunately. My concern about using a CPO is that it could take the same length of time again. If the church was to do the decent thing and earn back the respect of the women of this country, which it has lost, then it would gift the land to the State. People within the Catholic church might like to think about what kind of pressure they can put on their own church in that regard.

Sometimes it can feel like Groundhog Day in Ireland because every time we take a leap forward and become a more open and progressive society for our people, and especially our women, we seem to get dragged back to an Ireland of the past. That is what it feels like to stand here and have to make the case for why the national maternity hospital must be publicly owned and, more important, publicly controlled. If we do not learn from our past then we will repeat its mistakes. Nobody is denying that the church in Ireland has played a significant role in providing education and healthcare to many when the State did not, but we also have to recognise that it played a significant role in stymying the provision of care and maintaining control of the type of care provided.

St. Ultan’s hospital was a child-centred hospital that catered for women and children and was run by multi-denominational, independent women who recognised the impact of poverty on health. My own father, who was reared by a single mother in the 1940s, was a patient of St. Ultan’s and benefited from its foresight. When proposals were put forward to expand the hospital and amalgamate it with the national children’s hospital, there were echoes of what we are seeing with the national maternity hospital today. Archbishop Byrne opposed such a merger solely on the grounds of religion. To quote him, "The danger of naturalistic and wrong teachings on sex instruction or adolescent problems is a powerful argument for retaining the custody of children in Catholic hands." The power of the Catholic church in the Irish Free State was such that the proposed merger of the two hospitals never took place. Instead, the Catholic church placed the faith of Catholic children over their health, and it was another 20 years before we got a new children's hospital.

Likewise, when it comes to the influence of the church on maternity care in Ireland, my own mother had first-hand experience of it when she gave birth to my brother in the 1960s. My brother died in childbirth and my mother never got to see him. The nuns took him away and immediately buried him in an unmarked grave in Glasnevin. She was simply told to go home and try again. My mother never got over the loss of my brother and the cruel manner in which the nuns treated her. An unbaptised child was not deemed worthy of mourning or a proper burial. In fact, it was not until the 1990s that the State recognised the existence of children like my brother.

People will argue that times have changed and that we have moved on but have we really? Look at the mother and baby institutions and how we are still treating the survivors today. Women deserve so much better than the assurances we are being given by the Government that they will be able to access all services, including future services that will be legal in this State, in our national maternity hospital. Women deserve cast-iron guarantees. For too long, women's health has been at the back of the queue and even today, after repealing the eighth amendment, only half of our maternity hospitals and one in ten GPs offer abortion services.

If the Sisters of Charity are sincere in their offer to gift the land for the national maternity hospital to the State, then it has to be just that - a gift, with no strings attached. There should be no subsidiary boards. It must be a full transfer of ownership. People say that the nuns are gone. Yes, the nuns might be gone but the Catholic vested interests are still there. They are still controlling think tanks in this country that get on the airwaves every day and dictate about women's healthcare. Nobody wants to delay the delivery of first-class maternity care to women in Ireland but if we have learned one thing from past experiences of church and medical care in this country, it is that at the core of the church's role in medical care is control. It always has been and it always will be. That is why the women of Ireland deserve a national maternity hospital that is publicly owned and publicly controlled.

We all know that we need a national maternity hospital. With respect to the Minister of State, with whom I have discussed this matter before, that is not the question. I am quite concerned by references to misinformation. What we are hearing again and again are simple assurances and reminders that we need a hospital but, in fact, the information related to this matter has been very concrete and real. It is written down in negotiating texts, in the Constitution and in documents that have come from the Sisters of Charity and other organisations. A pile of evidence is building up. This is not a matter of who wants to show they care about women's healthcare. This is about the very real, concrete evidence of the dangers we face if we move ahead with the model suggested.

On the timeline of this project, I spoke about this issue in my very first year here in the Seanad. As the Minister of State acknowledged to me previously on the floor of the House, the Mulvey report is outdated. It comes from a time before the referendum to repeal the eighth amendment and a very different fiscal time. The State now has access to funding that we did not have at that time. We are in a very different context and the Mulvey report is not adequate and not acceptable as regards the idea of undue influence.

The debate must now move on to how to ensure State ownership of this site. Will it be acquired via CPO or will the church and the Sisters of Charity gift that site to the State? Those are the only questions. People talk about delay. Campaigners and consultants such as Dr. Peter Boylan, who has done incredible and detailed work on this issue for years, asked that the State start the CPO process four years ago so we would be much further along if they had been listened to at that time. They should not be blamed for any delay. Let us be clear: most of the delay since 2016 has been in waiting for the Pope to write back to us. That is what we were waiting for; a letter from the Vatican. That was the delay. The delay now is due to the complex negotiations and the fact that the Government is spending years in rooms negotiating with St. Vincent's Healthcare Group. If it is negotiating for years with that group and the Sisters of Charity, that is for a reason. Those reasons have been made very clear by the Sisters of Charity and were made clear again this week. They said they will not sell the land because they want to have clinical consistency.

If we all operate under the same rules and healthcare laws in the State, why do they need to have an extra layer of control? We know we have co-location of other public and private hospitals. Why can this not be the case? Are they telling us they will not be able to work with the public hospital? This in itself raises questions.

The key is that we know what the law is. We do not suggest they will break the law but there is a lot of room for interpretation. We know that, for example, when we were debating the eighth amendment, at a time when people could only get an abortion if they were going to die, how that might have been interpreted varyingly from place to place. It is about the services people want and are entitled to. It is not just that there might be three abortions in a year for people at death's door or that there may be one or two circumstances. It is not about having a national maternity hospital that simply does what it must do because the law makes it but having a national maternity hospital that leads the way, that embraces and is driven, and that has as its only priority women's rights and women's health services and not the interests of a private holding company, whatever they may be.

The arguments do not stand up and nor does the idea that we would be negotiating again in 150 years. We have read there is a lien on the site. This might be why it cannot be compulsorily purchased. There is nothing to stop there being a greater lien on the site in 100 years. The independent board can pile up the mortgages on the site. Here is the thing. The arguments do not stand up but, most importantly, we should not need to have this argument. We should not be condemning for another 100 years women in Ireland to further arguments or to complex power plays in the board of the national maternity hospital about who is on it this decade and who is on it that decade to inquire into the details. There should be no more arguments and there should be State ownership.

I thank the Minister of State for taking the statements. The ideal would be that we already owned the site and we already owned everything about the co-located hospital and were able to build our national maternity hospital unfettered from having to negotiate with anybody else other than developers and keeping them in check. In this instance, who do we trust? Given the legacy of the religious in the care of women and children in the State, I certainly do not trust the religious orders. This has been overwhelmingly demonstrated in report after report and commission of investigation after commission of investigation. Who do I trust? I trust the Government. I trust our negotiators of recent years. I trust those negotiating in the here and now that we have a very fine realistic balance in getting to a place where we have this hospital built. There is a danger that the perfect becomes the enemy of the good and the provision of services for women is delayed for years more. I am concerned about this balance.

We do not have the ideal and we do not own the site. We are on the back foot. If we start compulsory purchase why do we not use it for all of the other hospitals? I also campaigned for repealing the eighth amendment. I also believed in the right of women to their bodily integrity and to make choices and decisions over their bodies. Here we are, a number of years on, and back in March the health committee heard that only 50% of the hospitals throughout the country are delivering all of the services they should, and only one GP in ten is doing so. We need a wider debate. Why are we not using compulsory purchase orders for the schools that are trotting out an ethos and education programme contrary to the rights of parents and the complexity of families and the eclectic families we have at present? There is a larger debate to be had on severing the connection between the church and the State once and for all. If we are paying for it we should own it and we should have control.

There are incredibly clever and well-respected people on both sides of this debate and I want us to be fair to them all. Here is what I believe we can all agree on. We all agree we need a new maternity hospital. While Holles Street is full of rich clinical experience, it is infrastructurally poor and no longer fit for purpose. We all agree a new maternity hospital should be co-located with an adult hospital. We all agree the single biggest investment in women's healthcare is well overdue, that Irish women's healthcare has been neglected and abused, and that there should be absolutely no religious influence, interference, involvement or oversight in the operation of medical clinical practice or decisions. We all agree that legally permissible services need to be provided without question and that the investment of the State needs to be protected. We all agree that we live with the legacy of control and shame that is at the root of our understandable mistrust.

This is about control but it also needs to be about the quality of healthcare that women need and deserve as soon as possible. How do we ensure both? Owning the land seems to be the cleanest solution. A total of 42 clinicians have given a cast-iron guarantee, and State legal advice states, that all legally permissible services will be provided and that there will be no interference in the running of the new hospital. The Campaign Against Church Ownership of Women's Healthcare still states clinicians will not have the same level of control at the new site and that the only way to do this is to own the land. While the Minister of State navigates through the issues of governance and ownership, and makes a decision on the memo that will be brought to Government where much work has gone into this and continues, until she gets it right I want her to remember the trauma of control and shame. I ask that the Government shows commitment to delivering the healthcare women deserve in a place and in a way they deserve.

Ten minutes remain and we have three speakers so perhaps Senator Mullen could contain his contribution to three and a half minutes, if he would not mind.

I am not responsible for the ordering of business in the House and I have frequently criticised it.

I will be grateful if I could have my usual time.

That is fine. You can take it then.

I listened to some of the debate on the way in and I have to say I found myself strangely in agreement with some of the most hostile adversaries of the Catholic Church's role in medicine, even while being astounded at the disingenuousness of some of their arguments. I say this because it is quite clear the Sisters of Charity have abandoned any desire to be in a position to influence the ethos of anything that goes on at the St. Vincent's Hospital campus in future. As I understand it, it has appointed a board, which will in the future appoint itself, and they have not retained the ability to nominate the members of St. Vincent's holdings or, indeed, the directors.

It is a great tragedy they have allowed this to happen. We all understand the vocations crisis and the situation the religious have found themselves in. We also understand they do not have the energy or the resources to continue to play an active role, but they were, in one sense, a bulwark against statism. What we hear now is an almost universal call for State-controlled medicine. There is almost something of an unintended compliment to the Catholic Church in the arguments coming from Dr. Peter Boylan, Senator Bacik and others, which is to say they do not think the religious ethos should have any role in medicine but they seem to have some kind of residual fear that a day will come in the future when public opinion would support a more Christian concept of the ethos that might run the maternity hospital. That would be a very good thing. When we think about the procedures they are upset about and anxious to ensure happen, they are all elective procedures. Some of them involve the destruction of innocent life. I have heard a person who sees themselves as a spokesperson for persons with disability speak here who seems to have no realisation that it is religious-run healthcare that speaks out against the destruction of people with disabilities in abortion, something that is routine throughout the world.

When we think of the procedures that are being advanced in the area of gender reassignment, some of them are not established on an evidence base and some of them may even be harmful. More knowledge in the future may turn out to show that they are quite harmful.

We have an ideological trust that says the State must be in charge of everything and there is no generosity in that. Remember, one third of the people voted against the destruction of innocent children in the repeal referendum. Are they not entitled to a model of healthcare that would guarantee excellent maternal care for women, including all life-saving and health-saving procedures? The religious orders always guaranteed that in their hospitals but without killing unborn children. A lot of non-believers would see the religious orders as potential champions of that ethos. That field has been abandoned.

I completely get it that the majority have a different view in this country. Senator Bacik will be elected as a Deputy next week, despite being an unremitting opponent of any protection for unborn babies down through the years. That is the fashion. I hope a day will come when there will be a more generous vision of healthcare that goes for excellence but protects everybody. It is a strange thing that it is the religious ethos that is seen by many people, believers and non-believers, as one of the few bulwarks against an aggressive statism that would target little babies in the womb and just treat it as a matter of rights.

I said the other day in the Seanad that we have some doctors who are only interested in the profit motive and who are not guided by any profound ethical procedures. You should be worried when you get highly skilled body mechanics in charge of the running of a hospital who are not moored to strong, ethical procedures about protecting the dignity of every single human being. You will reap the whirlwind of a statist mentality in healthcare. I get it though.

While the majority want something different, the national maternity hospital should not be under any religious ethos. The State is entitled to and should use compulsory purchase orders to guarantee that. I would prefer that unborn children were not being killed in a hospital under any kind of nominal patronage of the great St. Vincent and many people would share my view. There is an alternative vision for how excellent maternal care could be run. It is not on offer in this country but I hope the day would come when the State would provide the services and pay for them but that it would recognise that there are people who do things excellently but differently.

If taxpayers want those services and there are taxpayers in the country who would want those services-----

Sit down Senator Mullen. You have had your time.

-----then why should they, as taxpayers, not have a State that pays for some of those services some of the time?

I count myself as a Christian and a republican and I really think Senator Mullen's comments are regrettable when you consider the past and the history of this country or when you think of what Dr. Noël Browne was forced to do. He was forced to resign because of the hierarchy of this State back 70 years ago. It is 70 years later and we are still dealing with the Catholic Church taking control and putting its words, thoughts and so-called moral teaching into our medical care. I am so sick of that kind of rhetoric and talk because Christians and Christian teaching want women to have proper medical care and babies to be taken care of.

We will agree on that Senator Keogan. However, this State is a republic. As we enter into the next 100 years of this republic, when we start investing in our State care and hospitals, we should own everything to do with our hospitals. I feel really deeply worried and concerned about how this conversation has gone in the last five minutes but I am not going to rehash the arguments that have been made because we see that a new hospital is needed and that co-location is needed. We need to move on. I trust those doctors when they say that they will be able to do all procedures. I trust the State but I do not trust an organisation that has been set up by a Catholic institution. My trust in the Catholic institutions has gone. I discussed this endlessly and we are constantly dealing with legacy in this country, whether that be the North, the mother and baby homes or institutional abuse.

I believe to my core that this State should own every single morsel of the new hospital. In 149 or 150 years, we should not be kicking the can down the road and having the Fianna Fáil Government of 150 years time dealing with the renegotiation of another lease and the questions about whether it is Catholic-run or waiting for the Pope to write another letter. It is not acceptable and we must start a new century as a new Irish Republic looking forward and owning our mistakes that have allowed 100 years of religious interference in our medical care. There is a lot of work to do and I hope we have a proper resolution to this issue. I will stand by the Government but my core belief is that we should own what we are paying for.

The development of the new national maternity hospital is an issue that we cannot ignore. While there is no doubt that the issue is complex, we must find a solution. The debate largely receives media attention in correlation to the religious association but we must recognise the commitments the religious order has made. The commitments in the national maternity hospital vision statement aim for an Ireland where all maternity services ensure that women and babies have access to safe and high-quality care in a setting that is most appropriate to their needs. Women and families are placed at the centre of all services and are treated with dignity, respect and compassion. Parents are supported before, during and after pregnancy to allow them to give their children the best possible start in life. This is the priority that must be met. We must continue to be at the forefront for the maternity services aimed for.

The Religious Sisters of Charity made commitments when arranging the gifting of the land. The charity said it was standing back and would gift the entire hospital to the Irish people. While I understand that there is a debate and that there are reservations around the ownership of the site and the hospital, I was heartened to hear both the Minister for Health and the Tánaiste say recently that they were confident that it would be resolved and that there was ongoing engagement. To me, that was a good commitment.

Regardless of the individual reasons, the commitments to have women and families at the centre of all services have been at the forefront and the Religious Sisters of Charity have committed that they would stand back and gift the hospital to the Irish people. We must follow through with these commitments.

I apologise that I could only give you a minute and a half. It is just that Senators ran over time.

It is my first time being here when Senator Maria Byrne was present. I congratulate her on her election back to the Seanad and it is great to see her here. I am sorry her contribution was cut short but the debate was guillotined.

I thank the Senators for their time and for the contributions that were made by those who spoke. The quality and emotion of today's debate is indicative of the value we place on women's healthcare and of the critical importance of the new national maternity hospital. I have listened carefully to everything that has been said in today's debate and I thank Senators for their input. Regardless of all the comments that have been made, there is a common denominator that we all see. We all want to see a national maternity hospital built that is co-located on State land and we want to see all services that are required by women, girls and babies provided as soon as possible. There is no ambiguity there and everybody wants to see that.

As I mentioned in my opening statement, we all share the same goals across politics and our health services. The goal is best summed up through the vision of the national maternity strategy, which seeks that:

Women and babies have access to safe, high quality care in a setting that is most appropriate to their needs; women and families are placed at the centre of all services, and are treated with dignity, respect and compassion; parents are supported before, during and after pregnancy to allow them give their child the best possible start in life.

In our efforts to realise this vision, the Government has deliberately placed an enhanced focus on the progressive development of maternity and women’s healthcare in the country. This year, we allocated increased funding of €12 million for the implementation of the national maternity strategy and for the development of gynaecology services. We have, for the first time, provided funding of €5 million to the women’s health fund to build on the excellent work of the women’s health task force. This focus and investment reflect our commitments to promoting women’s health and to improving health outcomes for women and girls across our society. The provision of appropriate environments and facilities is central to ensuring that the services we invest in now continue to deliver for women and babies in the future. However, it is plain to see that the infrastructure of our four remaining stand-alone maternity hospitals cannot provide the proper environment for the delivery of modern maternity care.

The planned move of the National Maternity Hospital is a key project of national importance and will serve as both a flagship and a cornerstone for the development of maternity and women’s health services in the country. It aims to provide a state-of-the-art hospital delivering a full range of services to women and families for years to come, and to ensure the availability of on-site adult acute services for the safety of the women in its care. It is a complex project and many people have spoken about the next steps to be taken. It is important to acknowledge that the national maternity hospital project is unprecedented and inherently complex as we relocate one voluntary hospital on to the campus of another voluntary hospital and into a hospital building owned by the State. While a hospital building using State funds should, ideally, be fully owned and operated by the State, the integral role of public voluntary hospitals in our public healthcare system means that it has been necessary to examine alternative solutions.

I want to put on the record of the House today that the Minister for Health has been clear in saying that he will not bring anything to the Government unless assurances around all legally permissible services that are to be provided in the new national maternity hospital are provided. I fully agree with that and many Senators in this Chamber will know my position on the eighth amendment in 2018, and my position has not changed. However, I categorically state that I believe all services should be provided in the new national maternity hospital as is done in the current hospital building. The safeguarding of the State’s investment must also be affirmed beyond doubt. In that context, the Minister for Health, as he stated, intends to have further engagement with all stakeholders in the national maternity hospital project as we move towards the finalisation of the arrangements.

I would like the Senators to know that many of the concerns they raised were identified at an early stage and have been the subject of significant and protracted discussions over several years. In particular, the issues of governance and clinical independence have been at the core of those discussions, and nothing has been spared to ensure that those concerns are addressed. That is why so much time and effort has gone into developing the draft legal framework, a framework that provides the assurances we need in relation to the hospital’s ability to provide the full range of women’s health services in accordance with the laws and policies of the State.

As I mentioned earlier, issues of governance and ownership are a priority for the Minister and the Government. These matters will continue to be considered in the context of the Minister for Health’s intended engagement with the relevant stakeholders. The bottom line is that the new hospital must, and will, provide the full spectrum of services without any undue influence that could put women’s reproductive healthcare at risk or endanger any woman’s safety. That, as the Minister has strongly stated, is a red line issue for him and for the Government. We must move on as best as we can because too much time has been lost. As many stated, we have been talking about this project for many years. It is important that no further time is lost.

I thank the Members of the House for inviting me to speak on the issue of the new national maternity hospital. The Senators have articulated their concerns very well and I thank them for that. It is obvious that the critical nature of this project is very much appreciated by the Senators, as is the need to ensure the independence of the hospital in its provision of care. In that regard, I assure the Senators that we are very much on the same page and that we share the same vision. The most important thing we can all do now is to try to work together and continue our efforts to ensure we provide this much needed, state-of-the-art facility for the women and babies of this country.