National Maternity Hospital: Motion [Private Members]

Deputy Róisín Shortall

I move:

That Dáil Éireann:

notes that:

— in May 2013, the Government announced that the National Maternity Hospital (NMH) would move to Elm Park to co-locate with St. Vincent’s University Hospital (SVUH), based on the recommendation that maternity hospitals should co-locate with acute general hospitals;

— between 2013-2016, a dispute regarding co-location versus ownership arose between the NMH and St. Vincent’s Healthcare Group (SVHG), which resulted in SVHG rejecting the proposal of co-location and adapting its position to demand full ownership of the NMH under SVHG;

— in May 2016, Kieran Mulvey was appointed to mediate the dispute between the two hospitals and the Mulvey Agreement on the Future Operation of the New Maternity Hospital – ‘The National Maternity Hospital at Elm Park DAC’ recommended the full transfer of 100 per cent ownership of the NMH to SVHG, owned by the Religious Sisters of Charity;

— following sustained public and political opposition to the deal, the Religious Sisters of Charity set up a new private company, St. Vincent’s Holdings (SVHs), into which they agreed to transfer their shareholdings of SVHG, and although SVHs was incorporated in August 2020, no transfer of ownership has yet taken place;

— under the proposed lease arrangement:

— the sole owners of the NMH (SVHs) will lease the site for the new hospital to the Health Service Executive (HSE) for 99 operating years;

— the State is required to build the maternity hospital on the land owned by the Religious Sisters of Charity and to pay, in perpetuity, the costs of the new facility set to be owned and managed by SVHs; and

— the key condition of this lease is that the HSE license SVHG to run the new maternity facility in tandem with the ‘National Maternity Hospital at Elm Park’;

— a new Board of SVHs is to be appointed in August 2021 and SVHs is a private company with charitable status, and its directors are its sole shareholders, all of whom are self-appointed, and there is no provision for a public interest director/ministerial representative, a women’s interest director, HSE representative, or any representation from the NMH itself on the Board of SVHs;

— the Board of the HSE is required to approve the transfer of the Religious Sisters of Charity’s shareholding in SVHG to SVHs, as it is a section 38 organisation and this approval has not yet been sanctioned;

— nearly four years after they first announced their intention to depart SVHG, the Religious Sisters of Charity remain the sole shareholders of SVHG and no legal agreement has been reached on the transfer of ownership; and

— under current proposals, only the shell of the hospital will be publicly owned and the State is to have no involvement in the private company set to own the new facility, nor any role in its operations;

further notes that:

— the Eighth Amendment of the Constitution of Ireland was repealed in May 2018, paving the way for safe and legal termination of pregnancy in Ireland and Catholic teaching is fully opposed to the provision of termination services;

— the 2017 SVHG Annual Report stated that future directors of SVHs will be ‘obliged to uphold the values and vision’ of Mother Mary Aikenhead, the founder of the Religious Sisters of Charity;

— the core values of the original SVHG constitution, which are based on Catholic ethos, are restated in full in the constitution of SVHs;

— the Religious Sisters of Charity received conditional permission from the Holy See to transfer their shareholding to the new company SVHs, with the proviso that ‘the provisions relating to the validity and lawfulness of alienations, found in Canons 638-639 and Canons 1292-1294 of the Code of Canon Law and in Proper Law, are to be observed’, and this requirement provides that the transfer of the Religious Sisters of Charity’s shareholding in SVHG must observe Canon Law and Canon 1293 paragraph 2 requires precautions to be taken to ‘avoid harm to the Church’ and the definition of harm expressly includes ‘activity which gives rise to grave harm to ecclesiastical teaching’; and

— the 2019 Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services concluded that, legally, the State cannot compel private Catholic entities to provide services that are contrary to their ethos;

furthermore, notes that:

— the cost of the construction of the NMH is likely to exceed €500 million; and

— the Religious Sisters of Charity’s holdings in SVHG were valued at €661 million in October 2018;

agrees that:

— the Catholic ethos of the proposed new facility can no longer be a matter of doubt;

— women’s reproductive healthcare would be put at risk and their safety endangered if subject to Catholic ownership and ethos;

— a hospital built using State funds should be fully owned and operated by the State;

— handing over ownership of a publicly funded hospital to a private company is in direct contradiction of the aims of Sláintecare; and

— where the State decides to build any new hospital or facility, it should endeavour to ensure that it owns the land on which the hospital or facility is built, as recommended in the Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services; and calls on the Government to ensure that the proposed new publicly-funded National Maternity Hospital is constructed on land owned by the State, and that, to guarantee its secular ethos and safeguard this public investment, the new hospital be fully owned and governed by the State.

The decision to co-locate the National Maternity Hospital with St. Vincent's University Hospital has had a long and tortuous history. When the plan was announced in 2013, there were three overriding concerns: ownership, governance and religious ethos. The same concerns remain today. Nothing that has happened in the interim has done anything to dispel them.

For a long time, this Government, and the last one, refused to concede any problems existed. They said that all that was needed was time and a legal framework, and the matter would be resolved. In May 2017, the then Minister, Deputy Simon Harris, promised that we would have a legal framework “in the coming month”. In 2019, the then Taoiseach, Deputy Leo Varadkar, assured this House the details of the legal transfer would be resolved over the next couple of weeks. The current Minister for Health, Deputy Stephen Donnelly, gave similar assurances last year. This charade came to an end last week, when the Tánaiste, Deputy Varadkar, finally admitted the blindingly obvious, that the deal is fundamentally, potentially fatally, flawed.

Where did it all go wrong, then? The obvious place to start is in 2016 and the mediated agreement that was hammered out between the two hospitals: St. Vincent's University Hospital and the National Maternity Hospital, NMH, Holles Street. It concluded that the new national maternity hospital would become a wholly owned subsidiary of St. Vincent's University Hospital. It was no longer co-location, but full integration, essentially a takeover. Private interests were represented in this mediation, but what about the public interest? That was conspicuous in its absence. The deal was silent on safeguarding a valuable public investment, on ensuring a secular ethos and on mandating public governance of a public hospital. Handing over a valuable public asset to a private religious entity was deemed the reasonable, even sensible, thing to do. The public felt very differently and made their feelings known with large public protests.

The Religious Sisters of Charity Ireland then announced its intention to withdraw from St. Vincent's Healthcare Group. It said it would no longer be involved in the ownership or management of the new national maternity hospital and would set up a holding company into which they would transfer their shareholding in St. Vincent's Healthcare Group. While this holding company has been incorporated as a private company with charitable status, as of today, the Religious Sisters of Charity has not transferred its shareholding to this holding company. It should also be noted that, having said it would give the gift to the site to the Irish people, it gifted it to its own holding company.

The proposed new corporate structure of this deal bears further scrutiny. It entails three tiers. At the top is the holding company, whose directors are self-appointed. They will be the sole shareholders of the entire St. Vincent's operation and they can stay in office for up to 14 years. Below this unaccountable company will be the St. Vincent's Healthcare Group, which will oversee four hospitals, including the proposed new national maternity hospital. Below that again, will be the national maternity hospital board with its own four directors, four directors nominated from St. Vincent's University Hospital, and one ministerial nominee. The deal is manifestly bad for the public. The public pays the construction costs, equipment costs, staff costs, and maintenance costs. In return, St. Vincent's Holdings graciously retains ownership of the site and control of the governance structures.

The deal not only flies in the face of reason and rationality, it is also in direct contravention of a Government report by Dr. Catherine Day on publicly-funded health services. The report is unambiguous where it states that “where the State decides to build any new hospital or facility, it should endeavour to ensure that it owns the land on which the hospital or facility is built”. The report goes on to state, “Where the State is unable to secure the purchase of land … any capital investment by the State should only be provided subject to prior agreement on the services that will be delivered”. Crucially, the report concludes that legally the State cannot compel private Catholic entities to provide services that are contrary to their ethos. Remarkably, this deal fails every limb of this test. The State does not own the land. It has no means of ensuring the full range of reproductive and sexual health services currently available in Ireland, and that they are provided by the hospital.

This brings me to religious ethos. The Religious Sisters of Charity Ireland’s proposal to transfer its shareholding into St. Vincent's Holdings required Vatican approval and is subject to Canon Law. This obligation requires the nuns to ensure that they avoid harm to the church in the transfer. In this case, harm expressly includes activity which gives rise to great harm to ecclesiastical teaching. It is not disputed that the Catholic Church does not sanction the full range of reproductive and sexual health services that are legal in Ireland. The Catholic Church stands firmly against abortion, which it calls a "grave sin". It has judged in vitro fertilisation as immoral. It opposes same-sex relationships, rejects the existence of transgender people, and condemns gender reassignment surgery. We know Canon Law will be followed during the sisters' transfer of their shareholding, but what about future governance?

The constitution of St. Vincent's Holdings espouses the same core values of Mother Mary Aikenhead, the founder of the Religious Sisters of Charity Ireland. In 2017, the St. Vincent's Healthcare Group annual report stated what future directors of St. Vincent's Holdings will be obliged to do, that is, that they will be obliged to uphold the values and vision of Mother Mary Aikenhead.

The Government may deny Catholic values will persist at the new hospital, but that is what the corporate structure is designed to facilitate, namely, the continuation of the ethical code of the Religious Sisters of Charity Ireland, not only for the three existing hospitals in the group, but also for the new national maternity hospital. When the Government was negotiating this deal, it is now clear that the parties were mismatched. It was a David and Goliath situation, and the sisters were not diminutive. It is not the first time they have run rings around the Government.

When the sisters built St. Vincent's University Hospital at Elm Park, they did so with public money. Not only did they use public money for, they negotiated a deal whereby the State would have no involvement in the control and management of the hospital, despite the more than £5 million the order received between 1934 and 1969 when Elm Park opened. There was also another proviso, that if the sisters sold their old hospital at St. Stephen’s Green, the proceeds would be given to the State via the hospital trust fund. Predictably, that never happened. The sisters sold the old hospital, but the proceeds were never handed over. Commenting on that deal in the Dáil in 1972, Noël Browne said, “surely, this is an extraordinary principle to permit, that an organisation - I do not care who they are, whether they are religious orders or others … - should be allowed to sell off property, keep the money and then be given a 100% grant to build a new hospital?” I wonder what Dr. Browne would have to say about this current quagmire. I think most of us can guess. Noël Browne spent his political life trying to disentangle the church from the provision of health care services and to create a proper public health service. It is extraordinary that this House, all these years later, is still convulsed by these exact same issues.

The State's record on the provision of public services is a long litany of failure. The new national maternity hospital is a chance to finally get it right. It will be a public hospital, paid for by the people. There is no justification whatsoever for the ownership and the governance structures to be in the hands of a private company.

Deputy Jennifer Whitmore

After everything that women, past and present, have gone through in this country to defend the right to healthcare, it is an absolute fallacy to believe that it is possible for a privately-controlled hospital, built on Catholic lands and founded under a Catholic ethos, to provide healthcare that is based solely on medical science and that religious ethos will not influence it in any shape or form. The vote to repeal the eighth amendment could not have been clearer. Women and men in Ireland will not allow for their health and that of their loved ones to be dictated by any organisation that places ethos above science. For women in my constituency of Wicklow, the new national maternity hospital will be the hospital they will go to for maternity services. I get many emails, as I am sure the Minister does, on this issue. People are very concerned that the Government seems intent on making the same mistakes of the past, not learning from them, and walking straight into another scandal in the provision of women's healthcare in this country. Many ask, after the repeal of the eighth amendment and the treatment of women in mother and baby homes, can this Government seriously consider gifting a publicly-funded new national maternity hospital worth €800 million to a private company established by the Religious Sister of Charity.

In December 2018, the then Minister for Health, Deputy Harris, insisted during Dáil questions, "I am not giving any hospital to the nuns." Three years later, the nuns still hold the keys and control of this hospital, despite what they say. St. Vincent's Hospital Group has stated in recent days that "the new national maternity hospital will be clinically independent". From whom will it be clinically independent? Will it be independent from the HSE? The group has stated, "There will be no religious or Vatican influence." It will be an absolute miracle if that is the case because nowhere in the world is healthcare that goes against the ethos of the Catholic Church provided if the lands concerned are owned by the Catholic Church. The group also stated that all medical procedures will be provided in accordance with the laws of the land. In 2017, the Mater Hospital was in the media because it would not provide prescriptions for contraceptives. At the time, the HSE stated it would not get involved or intervene because it was a matter for the Mater itself, as a private institution.

The St. Vincent's Hospital Group has also stated it needs to own this site for the delivery of integrated patient care on the campus. It beggars belief that the group thinks we will fall for that. It wants us to believe it can provide integrated care if it is offered a 150-year lease but cannot if the State owns the land. That makes no sense. The question that all of us, including the Minister, need to ask is why the church and nuns want this complex structure. Why will they not just gift the site to the State as promised? It is clear that this is about power and ethos and not about healthcare.

I listened to the Minister's radio interviews this morning and have a few things to say about them. Women do not want tea and sympathy on this issue. We do not want to hear that the Minister understands our concerns. We want action. We want to see this resolved, once and for all. We want healthcare that is based on science and that will put our needs before those of a religious organisation. We will not be fobbed off by an extra 50 years on a 100-year lease or by so-called ironclad guarantees because, as the Minister said this morning, there is no solution that will keep all the stakeholders happy. The Government is trying to square a circle and that is not going to be possible. The Minister has also said that it would not be conducive to enter these negotiations with a red line in mind but he absolutely must enter these negotiations with a red line in mind. That red line is our healthcare. He cannot go in and negotiate away our rights to healthcare. That must be a red line and if the Minister does not believe that, I ask him to send someone else to negotiate with the nuns.

We refuse to fall foul of power plays any longer. We refuse for our healthcare to be up for discussion or negotiation. It must be based on science and medical need. There is no wrong time for one to admit one has made a mistake and I believe the Government must admit it has made a mistake and do the right thing for women and their families in this country.

Deputy Holly Cairns

The story of maternal healthcare in Ireland is the story of how we have treated women in this country. It is far from a happy story; it is a lot closer to a horror story. Irish maternal healthcare was a place where misogyny reigned, where women were defined solely in terms of their reproductive functions and where they were denied control of themselves, their bodies and their lives. In the early days of the Free State, as the Dáil limited women’s opportunity in public life, we had disgracefully high maternal and infant mortality rates. Maternity services were under-resourced and the Criminal Law (Amendment) Act 1935 made the use of contraception a criminal offence, an actual criminal offence.

A twisted version of Catholic morality and Irish misogyny created the mother and baby homes, a system of Church-run, State-funded institutions in every county which intentionally incarcerated, abused and dehumanised women and girls for being pregnant. It punished rape victims, women with disabilities and women from disadvantaged groups, while the rapists, predators and men of good character washed their hands. This system, administered in many cases by nuns, abused generations of girls and women, and led to the death of thousands of infants and young children. This included the Religious Sisters of Charity who ran Magdalen laundries and residential institutions for children. We are still dealing with the legacy of these abuses as the State rallies to limit survivors' rights, their access to the truth and proper redress.

In the late 1940s, Dr. Noel Browne’s mother and child scheme aimed to reduce high rates of child mortality by modernising healthcare and providing free service for mothers and children. This chance of real progress to save lives and help empower women was strongly opposed by the Catholic Church, the Irish Medical Association and many of Dr. Browne’s colleagues. Pre-empting liberalisation and secularity in Irish society, lay Catholic organisations pushed for the eighth amendment which introduced one of the most oppressive abortion regimes in western countries. For 35 years, it not only restricted bodily autonomy but it caused immeasurable damage and suffering. It was only thanks to the activism and dogged determination of women that it was repealed. Politicians delayed and obstructed, opposing even giving the Irish people a vote until the pressure was too much for them to hold back.

Despite the historic victory for women’s rights, we know women still have to travel long distances, especially in rural areas, for medical terminations and families are still forced to go to the UK for care when they need terminations for medical reasons. These barriers are even greater for young people, people with disabilities and women from minority groups. We are still living in the remnants of this history. It is not the past, it is the present. Much of our health and educational infrastructure is still controlled by the Roman Catholic Church which has limited people’s access to procedures and even information. This motion is a reminder that this struggle for women’s healthcare continues today. It may not be as acute, but many of the fundamental points remain the same. Do we want a system based on medical science and the informed decision-making of individuals or do we want one that prioritises harmful religious teachings?

Women’s healthcare is still overlooked. Take the Government’s failure to ensure the consistent easing of restrictions in maternity hospitals, Deputy Catherine Connolly’s motion highlighting the need for an implementation plan for the National Maternity Strategy 2016-2026, or the fact that the Irish Nurses and Midwives Organisation, INMO, has consistently highlighted that our midwife-to-birth ratio is much higher than it should be.

Women’s healthcare is still restricted. In religiously-controlled settings, the morning-after pill, IVF, abortion, vasectomies, sterilisation and trans-healthcare are all obstructed. Perfectly standard, normal and necessary healthcare is banned because of religious teachings. These are not practices of the 1930s or the restrictions of extremist regimes, it is the reality in Ireland today. That is unbelievable.

Women’s healthcare needs to be legally guaranteed. Without absolute certainty, we allow for the hard-won rights of individuals to be chipped away or denied. We need the national maternity hospital to be fully owned and run by the State. The situation is complex but the situation has been made complex. The Sisters of Charity wanted full ownership of public hospitals. After public pressure, they have set up a separate company with self-appointed directors who will be bound by a religious ethos. Legally, this separates the nuns from control of the site but in a practical sense, their control will remain and dominate.

The just and decent thing would be for the Religious Sisters of Charity to give the land to the women of Ireland in reparations. However, if the order will not do the moral thing, then the Government must itself ensure public ownership and State governance. For a horrifyingly long time, this country was run on shame and it was a powerful force. Shame was weaponised against women and girls for the so-called crime of getting pregnant and that shame still lingers. Shame and religious control have no place in the future of maternal healthcare in this country. Our new national maternity hospital must be wholly secular: Irish women have fought too hard and too long for anything less.

Minister for Health (Deputy Stephen Donnelly)

I thank Deputies for raising this important issue in this motion. The Government will not be opposing it. I hope to address the various points raised in the motion and to outline the huge amount of work done so far to make this hospital a reality.

All four stand-alone maternity hospitals, while they have incredible staff and provide a superb service, are now outdated. The buildings do not cater for the needs of modern maternity care. Today’s debate specifically concerns the National Maternity Hospital, NMH, currently located on Holles Street. The starting point for the new national maternity hospital is that women, mums and babies urgently need such a new, modern maternity hospital. The hospital should be co-located with a major adult teaching hospital to ensure the best possible care, and continuity of care, for women. The hospital must have clinical and operational independence, providing the full range of healthcare services.

Co-locating the National Maternity Hospital with St. Vincent’s University Hospital makes sense. Granting the operating licence to the National Maternity Hospital makes sense. The detailed design is complete, including physically connecting the new hospital with St. Vincent’s University Hospital. Planning permission for the new hospital was secured in 2017, the contract for enabling works was awarded in 2018, and a full business case has been prepared to support the final investment decision. While the capital project has progressed significantly, the ownership and governance arrangements have proven complex. This is largely due to the National Maternity Hospital and St Vincent’s University Hospital being independent voluntary hospitals. I fully recognise that some people have genuine concerns regarding the ownership and clinical independence of the new national maternity hospital, and these must be addressed. Significant work has been and continues to be undertaken in this regard.

As the first phase of that work, the then Minister for Health, Deputy Simon Harris, appointed Kieran Mulvey in 2016 to mediate between the hospitals. The Mulvey agreement was finalised following an extensive mediation process between the National Maternity Hospital and the St. Vincent’s Healthcare Group, and the agreement was published in 2017. It provides for the establishment of a new company, the National Maternity Hospital at Elm Park, which will have clinical and operational, financial and budgetary independence in the provision of maternity, gynaecology and neonatal services. 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. These are, first, to ensure all clinically appropriate services that are legally permitted 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, second, to protect the State’s investment for the public good.

As noted by Government in 2017, the then Minister for Health, Deputy Harris, 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 provides that the new hospital will be owned by the State and will be built on a site which will be held on a lease by the State for 99 years. As colleagues will be aware, an extension was agreed earlier this year for an additional 50 years, so essentially it is a lease for 149 years. The HSE would in turn provide an operating licence to the new national maternity hospital to facilitate the provision of health services in that building. Nonetheless, as I have stated previously, it is my strong preference that the hospital would be built on land owned by the State. I assure Deputies and everyone interested in this matter that all options continue to be explored and that I intend to engage further with the stakeholders in that regard.

Questions have been raised regarding any potential future involvement of the Religious Sisters of Charity in the National Maternity Hospital. That religious order will not play any role in the governance or operation of the National Maternity Hospital. It has been confirmed to me that the Religious Sisters of Charity order has resigned from the board of the St. Vincent’s Healthcare Group and that it has secured Vatican approval for the proposed transfer of its shareholding to a new charitable entity, St. Vincent’s Holdings CLG. Under the terms of its service level agreement, SLA, the St. Vincent’s Healthcare Group requires the consent of the HSE to the share transfer, and the HSE intends for that to take place in the context of finalising the draft legal framework. The governance structures continue to be examined closely by the Department of Health and the HSE. I state again that I will only bring a recommendation to Government on a governance structure for the new national maternity hospital if I have clear, unambiguous and watertight confirmation of the full clinical and operational independence of the National Maternity Hospital. It is certainly the case that full independence can be achieved without owning the land. Many primary care centres around Ireland are in buildings and on land owned by third parties, and nobody would reasonably suggest that those landlords could dictate what services general practitioners, GPs, and other clinicians could or could not provide in those buildings.

I understand very clearly the concerns raised today regarding the new national maternity hospital. We are all well aware, as has been appropriately stated by the previous contributors, that the women of this country have been failed in the past when it comes to health, and particularly when it comes to sexual and reproductive health. It is for that reason that delivering the new national maternity hospital relocation project is crucial. It is why we must continue our efforts to bring the project to the next phase, and with all the necessary assurances concerning the services to be provided for women.

Ireland needs a revolution in women’s healthcare and, in spite of Covid-19, much is happening. This year the national maternity strategy was fully funded for the first time. It was a five-fold increase in funding, meaning more choice for women, more midwifery-led care, more specialist care, among other improvements set out in that strategy. Some 24 additional lactation consultants are being funded and hired, a specialist endometriosis clinic is being established and legislation on surrogacy is being prioritised. For the first time a women’s health lead has been funded at the Irish College of General Practitioners, ICGP, with the intention of specifically looking at the issue of women's health within general practice. Two new regional fertility hubs are being set up, one in Nenagh and one in Galway. We are establishing or, in some cases, expanding services across nine "see and treat" gynaecology clinics this year. These will be located in Dublin, Drogheda, Waterford, Wexford, Letterkenny, Kerry, Mayo and Portlaoise and will provide same-day services for women across many clinical areas. The women’s health task force is being funded to continue and expand its excellent work, and policies are being developed, in consultation with the task force, in areas including menopause, wellness and mental health.

We also, of course, want to get going on building a state-of-the-art modern national maternity hospital. It is an essential part of our plan to build women’s healthcare service to the level they need to be at and that has been needed for so long. I refer to providing the necessary infrastructure and environment to realise our common goal of the provision of woman-centred, modern, safe, quality healthcare for women and their families, which is delivered with compassion and dignity.

Deputy Cian O'Callaghan

Having heard the Minister's comments, I am more concerned now. I am particularly concerned about what the Minister said about the nuns not having any more involvement and that he is taking some assurance from that. We have been saying for some time that one of the key issues here is the company that has been set up by the nuns, with their ethos and values, and the role that company will play. It has been a key concern raised by people. I refer not to the nuns withdrawing, but to the manner in which they are withdrawing and in the manner in which they are carrying out that handover to reflect their values and ethos. We have been raising that key concern and the Minister has not addressed it. In fact, he seems to take assurance from the very point we are raising as a key concern.

This is not, or at least it should not be, complicated. This is about ensuring that we own the national maternity hospital that we will pay for as taxpayers. That is what the outcome of this process should be. There should be full public control and ownership and there should be no questions or ambiguity in that regard. If we are to remove all doubt, we must insist on full public ownership. Then we will not have the complex arrangements to which the Minister referred, with the hope that the result will be unambiguous in how the hospital is run. Let us remove all doubt from the situation and ensure full public ownership, with no complex arrangements giving rise to concerns. In that way, we can draw a line in the sand on this.

The fundamental, core question is whether we are content to continue to outsource healthcare to private entities or whether we insist, once and for all, that hospitals built with State funds should be in full public ownership and under full public control. There could not be a more important question for us to answer in healthcare. Why are we in a situation where the State would even contemplate settling for an arrangement involving anything less than full ownership? How are we in that situation? How can the Government even think about spending in the region of €800 million of our money on the national maternity hospital without having full public ownership and control?

This is about who runs the State and for whom the State is run. Is it run to ameliorate private interests or in the interests of the public? As Deputies Shortall and Cairns said earlier, this is not an issue that has just arisen since 2013. It is an issue that has been with us over the past 100 years, since the foundation of the State. We saw it starkly in the 1950s with the mother and child scheme that Deputy Noel Browne tried to progress, a scheme that was all about improving maternity services and healthcare. It is incredible that 70 years later we are still having discussions in the Dáil about private interests and the role they play in shaping the way publicly-funded healthcare is delivered.

Now is clearly the time for this Dáil to catch up with the public in this area. People came out in their thousands during the grassroots campaigns on repealing the eighth amendment, marriage equality and on other campaigns to say clearly that they no longer think it acceptable for this State, this republic, to function in that manner. This is not just about the national maternity hospital. It is about how all of our publicly-funded healthcare services are delivered. It is also about how our publicly-funded schools, some of which are owned and controlled by private entities, are run. It is fundamentally about the kind of republic and society we want. The practice of continuing to spend public money to provide healthcare, education and other public services while maintaining private ownership and control must end now.

Deputy Catherine Murphy

This is not just about a new national maternity hospital. This is a moment in history and the Minister has to decide what side he will be on. Are we going to build a truly public healthcare system, which we are already paying for? This is a moment in history when we have the chance to redefine our republic. The Minister must decide that there is a red line here. This is not about language. He said he would "prefer" it if the land was owned by the State but it is essential that the land is so owned.

We are being asked to gift this hospital. A gun is being put to the head of this State. Why is this happening? In 2013, it was decided that we would build a new national maternity hospital, which would be co-located with another hospital. Since then, we have seen nothing but procrastination from the former Minister for Health and Children, James Reilly, who announced the new hospital and Deputies Varadkar and Harris, as Ministers for Health. The latter told us that he would get this sorted within a month back in 2017. We are now being told that we cannot take the compulsory purchase order, CPO, route because it will delay the project but the delays to date have happened because of procrastination.

We are spending €800 million on a new national maternity hospital, which will be a public asset. On what planet would it be okay to hand that over to a private entity? We have listened carefully to the language that is being used and we know how to decode it. The Minister is saying that he would prefer it if the land was owned by the State but it is not a question of preference. It is essential that it is so. The statement from the St. Vincent's Hospital Group reads: "For the delivery of integrated patient care on the Elm Park Campus, SVHG must retain ownership of the site". Does the group think we are total idiots? Is it seriously suggesting that it cannot provide healthcare unless it owns the ground? There is something more going on here. Is it an issue of ethos, control or money? We cannot allow this to happen.

The Minister does not appreciate how strongly people feel about this. This is not just about our daughters and granddaughters, but about their granddaughters. This is about our future care needs. He has to decide what side he is on. He told us that the Government is not going to oppose this motion but will it actively support it? Will the Government do what the motion calls for? Will it make sure that the new hospital is publicly owned and governed by the State, rather than by a private entity? Will that happen? Will the Minister give this House a categoric assurance that this is what he is aiming to achieve, rather than just preferring the land to be owned by the State? After everything that has happened in this State, as outlined by my colleagues, the idea that we would allow ourselves to be held hostage in this way is just not acceptable. I want an assurance from the Minister that this is a red line, the land will be publicly owned and we will not gift the new national maternity hospital to a private entity. The Minister and this Government must be on the right side of history with regard to this hospital.

Deputy David Cullinane

I commend the Social Democrats on tabling this motion and for giving us the opportunity to discuss this issue. I discussed this privately with the Minister a number of weeks ago and have raised it a number of times in the Dáil and at meetings of the Oireachtas Joint Committee on Health. In recent months the Minister has given us some assurances, as he would see it, regarding religious ethos in the context of the management and running of the new national maternity hospital but those assurances were not strong enough. Indeed, when the Minister was in opposition, he accepted that there are real difficulties and challenges in respect of the ownership of the site and the governance structures that are being proposed. The Tánaiste, in response to questions from me and Deputy Bríd Smith last week in the Dáil, agreed that there are fundamental issues of concern here.

In fact, he went as far as saying that he agrees with us more than we would have thought. Some would argue that it is a little late in the day for the Tánaiste to finally come to the conclusion that there are fundamental issues with regard to governance matters and the ownership of the land. This is a mess, and it is entirely of Fine Gael's making. It dates back to when the former Deputy, Dr. James Reilly, was Minister for Health as well as to when the Tánaiste and Deputy Harris were the Ministers for Health.

The statement yesterday from St. Vincent's Healthcare Group was also very telling in that regard. It made it clear that, from the group's perspective, it understood it had an understanding from the Department, and I would argue from the Government, that the lease, governance and ownership arrangements that are being put in place were signed off by the State and the Department in principle, and what had to be worked out is a little more detail. That is a far cry from what the Tánaiste said in the Dáil last week. As usual, Fine Gael has come to this with too little and too late. Deputy Stephen Donnelly is now the Minister and it falls to him. I agree with the previous speakers that this is a test of the State's ability to ensure we do the right thing if we are going to build a new national maternity hospital. We all want to see it built as quickly as possible and without delay. It is already about six years behind schedule and subject to additional costs. Initially the cost was to be €300 million, then it was €500 million and it is now potentially €800 million, with some saying it will be €1 billion. We do not know what the full cost will be in respect of the capital cost and the fit-out cost, but it will be very substantial. It is a very important hospital and we all want to see it built. However, we also must get the foundations right in terms of both the governance foundations and the ownership foundations.

It was disappointing to read the statement from St. Vincent's Healthcare Group yesterday. While there is now a tug-of-war taking place between that organisation and the Government, the problem is that, again, women and the future of maternity services are left in the middle. The group referred to integrated hospital patient care and offered that as a reason the land cannot either be gifted or sold to the State. It wants to ensure integrated hospital patient care. I believe it is talking about integrated care within the St. Vincent's Healthcare Group, but we are talking about integrated care within all the maternity hospitals, which must be publicly owned, managed and governed. That is the integrated hospital care that concerns me and, I hope, all Deputies in the House. The fundamental question is: what happens now? I very much hope that we will not be sold a pup again and told that the lease will be extended from 99 years to, perhaps, 149 years and that we will look at tinkering around with some of the legal and contractual arrangements but, essentially, we will proceed with the convoluted process that has been put in place. It simply is not good enough. It beggars belief that the State would build a new, state-of-the-art hospital and pay for the building, the fit-out, the staff and the management and running of the hospital, yet some private charity would own the land, with a board of governors put in place where the Minister would not appoint all the people on the board. It cannot be argued that the board would be fully governed by the State on behalf of the public. None of that makes sense.

While we are discussing the ownership of the new national maternity hospital, I must point out that there are other maternity hospitals that are chronically underfunded. The Minister is aware of the situation in the Rotunda Hospital. I have raised it with him on previous occasions. A report by KPMG identified real clinical risks in the neonatal emergency department, the inpatient and outpatient departments and in other areas. The hospital cannot wait for the co-location option with Connolly Hospital before it gets a resolution to its problems. There are capacity issues in St. Luke's Hospital in Kilkenny and in University Hospital Waterford. There are problems with capacity across all our maternity hospitals. There is a need to continue to invest in the national maternity strategy. I welcome the additional funding that was made available last year. We must continue with that, but we also have to increase capital funding for those maternity hospitals to ensure we provide services to the highest standard across all maternity hospitals.

Women's healthcare has been left behind by successive Governments for far too long. We all know the track record, which includes CervicalCheck, symphysiotomy and even the mother and baby homes. We can chart the history of the relationship between women, healthcare and the State. It is not a very rosy one. We want to put that behind us and to move to a healthcare system that is truly secular, that delivers for women and in which there is absolutely no ambiguity about the type of healthcare that can be provided in hospitals. Notwithstanding any legal guarantees or assurances that the Minister can offer this House, and he spoke about this on national radio, when there is a doubt, where ambiguity exists and when there is a convoluted process that involves a board and company that are not owned and managed by the State, there is a problem.

My final point relates directly to the St. Vincent's Healthcare Group. The State and the Minister have a responsibility, but the Religious Sisters of Charity is telling us that it is essentially gifting the land to the State. If it is genuine about that, why not go the full distance and simply gift the land to the State, as opposed to gifting it to a private charity? What is the reason for this? I do not buy the argument that the need for integrated patient care is the reason the St. Vincent's Healthcare Group will not gift the land to the State. That does not make sense. It only makes sense if one wishes to have some level of control. For that reason, it arouses a suspicion that is genuine, real and profound, and to which the Minister must respond. We need a resolution to this, and the resolution can only be public land, a public hospital, public ownership and a hospital governed by the State for the women of the State.

Deputy Réada Cronin

I welcome the opportunity to support the motion proposed by the Social Democrats. It would be a great start for children to be born in a national maternity hospital that is owned and run for the State, by the State and by the rules of the State, without any sleight of corporate hand or torture of language and logic as to ownership and ethos. The St. Vincent's Healthcare Group's statement last night that the group must retain ownership of the site for the delivery of integrated patient care on the Elm Park campus is mysterious. We have had too much mystery, and decades of sorrowful mysteries in the treatment of women's and girls' health and in their reproductive lives. Quite simply, the nuns must gift or sell the site to the State and to us, the people who will be using the hospital, funding it and running it, without any corporate or incorporated detours through holding companies.

The State has a rotten history in how it treats women and girls in pregnancy and in childcare, most of it caused by professional and institutional devotion to the Catholic church where men made the rules, even those who did not wear the trousers. Other men in suits and white coats, with stethoscopes around their necks, did their bidding and oversaw barbaric practices such as symphysiotomy. In ensuring their physical capacity to reproduce, women were reduced to breeding beasts. For those damaged by those shameful practices, there was a veterinarian quality to their treatment, although the veterinarians I know would have been a great deal more compassionate.

In speaking about how women were treated in the past, I wish to speak up for women in the present as well, particularly the women who have written to me, some of whom were 40 weeks pregnant and counting, to tell me that in labour they faced an invasive and unnecessary internal examination, not for a clinical reason but to confirm established labour so their partners could be admitted for the delivery of the child. Again, this bovine treatment is unmistakable. Women are put upon to fit the system as opposed to the system fitting their needs when they are at the limits of their coping and at their most vulnerable. Chosen birth partners are not visitors and they are not an accessory to the process of pregnancy. The Minister said we need a revolution in women's healthcare. Absolutely, and he will not be alone at the barricades in that regard.

Frankly, it is farcical that in 2021 we are tiptoeing around the ownership of our national maternity hospital with a religious order. The gift should not be to a company but to the State, which will pay for and run the hospital for the public good and for women of every faith and none as well as for the good of our children.

From the moment we give birth to our children, the church and State must separate. The Government must be out of its mind allowing a private holding company to have an input into women's healthcare and all that entails. The hospital must be owned and run by the State.

Deputy Donnchadh Ó Laoghaire

As a State we have, unfortunately, made a virtue - perhaps that is the wrong word - or certainly a strong tradition of devolving essential public services and the State abdicating responsibility for them. That did not start with the Minister. We have a long history of that. We see it in education and all sorts of areas. We see it very strongly in healthcare.

If we are going to take a step away from that, as we should - the State should intervene in places that it is not directly involved in such as childcare - this is an essential part of that process. It is right and proper. The objective should be a publicly funded and run healthcare system. A national maternity hospital should be at the heart of that. The dangers here are obvious.

I note the commitments given by the hospital group yesterday, which I welcome. Let us move forward ten or 15 years. Let us suppose a controversy arises because a woman is denied a termination or tubal ligation, or there is some change in legislation and SVHG refuses to go along with it because there has been a change in the internal politics of that group or whatever. The commitments given ten or 15 years prior will no longer stand. The Government of the day will say there is not much it can do about that, it is afraid the State does not own the site and it cannot intervene or that it has contacted the hospital group to try to see if the matter can be resolved. The strength of the hand of the Government will have been severely weakened by decisions being taken here and now. It is right and proper that at the heart of our public healthcare system is a national maternity hospital that is well funded and publicly owned.

Ar an ábhar sin, tá sé fíorthábhachtach go mbeadh an t-ospidéal seo i seilbh an phobail agus go mbeadh sé ag rith ar an mbunús sin. Níor chóir go mbeadh aon eagla faoi aon bhaol sa todhchaí faoi na polasaithe a bheadh san ospidéal.

I listened with interest to the Minister's interviews over the past few days on the restrictions in maternity hospitals. It appears to me that he is now listening, which I welcome. I welcome in particular the emphasis that he has put on the full duration of labour. As Deputy Cronin just said, the arbitrary decision about how dilated a woman is should not dictate when she gets care. It should only be a start. The Minister and Mr. Paul Reid need to be on top of the hospitals to make sure they are implementing that.

We also need to deal with all of the key appointments, in particular, but not exclusively, for women who are at high risk or are experiencing pregnancy loss. As well as that, after birth is a crucial time for partner support. We should not be talking about this in terms of slots for visitors. Of course there needs to be policies for all of that, but partners are an essential support. They are not visitors. That applies to all appointments as well as after birth. This needs to be just the start. The Minister needs to stay on top of this and I will keep an eye on it. I welcome the fact that he is listening, in particular around the difference between established labour and labour. There is just labour. That message needs to go out loud and clear.

Deputy Violet-Anne Wynne

The maternity sector in this country has been critically and consistently understaffed for many years. We have one of the lowest levels of consultant obstetricians and gynaecologists in the OECD, which is shameful. Maternity services have been pockmarked by multiple investigations and inquiries into care, standards and practices. Sadly, the development of a new and improved national maternity hospital has been in the pipeline since the 1990s. Since 2013, it has been in each programme for Government which in and of itself is telling of how much of our priority maternity services are to this and previous Governments.

In 2017, my party moved a motion that received unanimous support to ensure that the new national maternity hospital remained entirely within public ownership, and rightly so. Despite support from every side of the Chamber, its provisions were never implemented and here we are today.

The public rightly want clarification from the Government about who, in effect, will run this hospital. The motion notes that nearly four years after the Religious Sisters of Charity committed to departing St. Vincent's Healthcare Group it remains the sole shareholder. Why is the ownership of the capital lands being transferred to a proxy church charity rather than being handed over to the State? What has been going on within the engagement?

The Minister, Deputy Donnelly, spoke on the radio earlier and essentially tried to deny the relationship between who owns land and the governance of the hospital. That is not good enough. The Mulvey agreement that emerged as a resolution in 2016 is not fit for purpose. The State must own the land. A 100-year lease is not good enough. Follow-through is required and action needs to be taken to ensure the respect and independence from religious influence that is now needed for our mothers and babies.

Deputy Louise O'Reilly

It is four years since Sinn Féin got unanimous support for our motion on ownership of the new national maternity hospital. I spoke during that debate and said, and it remains true today, that for an order that takes a vow of poverty, chastity, obedience and service to the poor, the Religious Sisters of Charity appear to have a fixation with land and property that would make a property speculator or vulture fund blush. I do not know why we keep having to have these conversations, but I will tell the Minister one thing. He will have the unanimous support of the House in his dealings with the religious orders. He has a very important job to do and there are two issues that concern me.

When I thought about the motion and came to the Chamber, I was reminded of the photograph of the majority of elected Fianna Fáil Deputies and Senators holding "Vote No" posters, making their position on women's rights and the right to reproductive healthcare very clear. That worries me because I worry the Minister will not get support at the Cabinet table. Some of those people now sit at Cabinet, which is a concern. The Minister will have the support of Sinn Féin and, I hope, the majority of Members.

The second person I thought about when I came in here today was Sheila Hodgers, who, along with her baby, died in 1983. She was a friend of my parents and I knew her. We could argue all day about what caused her death and the clinical reasons, etc. I believe that Sheila's life could have been saved were it not for the religious convictions and persuasions of the people involved in delivering her care. When we reflect on what is needed, we need to remember people such as Sheila.

This is not a zero-sum game. This is important. Access to healthcare for women is important. Healthcare free of religious influence has to be paramount. Nuns and priests have no business in our hospital. Why they want to own this land, or profess to say they need to own this land, baffles me because there is no good reason for it. What we need to do, and we pledge our support for this to the Minister, is ensure that the hospital is built on public land and is entirely free of any religious influence whatsoever. We will support him in that. It is important work and needs to be done.

Deputy Alan Kelly

I thank my colleagues in the Social Democrats for bringing this forward. The Minister has been handed a hospital pass, pardon the pun. It has been handed down to him by bad advice from officials and his predecessors. He will have to, in some way, manage to take that pass and turn it around for the people of Ireland because he has no other option.

The letter from the St. Vincent's Healthcare Group yesterday was two fingers to the Minister.

I spoke to the Taoiseach yesterday in this Chamber and asked him straight up what was happening. He said the Minister for Health would be negotiating and talking with the hospital group as regards ensuring that the site would hopefully be gifted to the State. That is what I took from what he said, to be fair. I believed what the Taoiseach said was accurate and I believe that was the Minister's intention. I can see the Minister nodding. I accept it. I genuinely feel the Minister has been left in a situation now where he has very little options.

After the contributions made in the Chamber yesterday, and after the coverage in the media, the hospital group then decided to issue this statement, which gives two fingers to the Minister and to the Irish people. It basically said the Minister is not entitled to do those negotiations and it will not negotiate in good faith. The critical line refers to point 5, for the avoidance of doubt, which states that, "for the delivery of integrated patient care on the Elm Park Campus, SVHG must retain ownership of the site”.

The most important question to be asked in the Chamber today is "Why?" In fairness to him, I can guarantee that is also the Minister's question. Is it for the national maternity services of Ireland, as part of the greater national maternity strategy, of which I am a huge supporter? Or is it because the hospital group does not want to relinquish control? It is the latter. The documents, which the group had to release, in fairness, because my colleague, Senator Bacik, who has fought on this for years, submitted a freedom of information, FOI, request, demonstrate that.

This also demonstrates huge failures of the Department of Health and its officials in the way in which this was dealt with, which are nothing to do with the Minister. It completely missed the thinking of the Irish people and what the Irish people would tolerate.

Four years ago at our national conference, when this story broke, I stood up and got an emergency motion passed. We have been fighting on this for years, taking the advice of people like Dr. Peter Boylan, Dr. Gerry Burke and many others. There has been historic failure here. When one looks at what the Religious Sisters of Charity said it was going to gift to the State, under the transfer of holdings, one can identify when it got the permission of the Holy See. It got its letter of grant, as it is called, which stated:

The provisions relating to the validity and lawfulness of alienations, found in Canons 638-639 and Canons 1292-1294 of the Code of Canon Law and in Proper Law, are to be observed.

Canon 1293 requires the congregation to have "a just cause, such as urgent necessity, evident advantage, piety, charity, or some other grave pastoral reason" to make the transfer. That is the foundation of what we are talking about here. No hospital group with such a delineation and those conditions attached can be in charge of the national maternity hospital, full stop. If the foundations are wrong then the hospital cannot be built. I believe the Minister knows that in his heart and soul.

We are now scrambling. I would also like to know why St. Vincent's Hospital Group, which is willing to give a 149-year lease, is not willing to gift the site? Why is it such a big difference? That is another critical question because of what I just read out regarding Canon Law.

This is a crossroads for our country with regard to the influence of the Catholic Church, particularly, over hospitals, healthcare, education - over everything. The Minster has to make the right decision. I believe he wants to make the right decision. We will support him in doing so. The programme for Government, though, is deadly weak on this. It does not actually commit to it being a hospital in public ownership. It states that it will "Conclude the governance arrangements and commence the building of the new maternity Hospital at St Vincent’s Hospital, Dublin." It does not say it will be fully owned by the Irish people, its governance will be dictated by the State and the land will be owned by the State. It does not say that. The Minister will have to go further than the programme for Government commitments.

Options A, B and C as regards what was going to happen here have all failed. We are now down to option D. The Minister needs to have backbone here. He needs to have leverage. We do not have any options. Our options are either to acquire the site by means of compulsory purchase order, CPO - I say "we" because it is all of us - or else look at St James's Hospital or Connolly Hospital Blanchardstown. This has to be co-located for best clinical needs. After all the work that has gone into it, however, why should we move?

My suggestion is that if it is not willing to gift the site, the Minister should acquire it with a CPO. Why only speak about acquiring this piece of the land with a CPO? We all know we need to invest in our national hospitals post Covid. Why not acquire the whole site with a CPO? I am sure that will make St. Vincent's Hospital Group think about what it is saying to the Minister and the Irish people after the two fingers it gave to everyone last night. Why do we not acquire the whole lot with a CPO and turn it into one national campus for everyone, which will be fully owned by the State, including the public, private and maternity parts - everything? I am sure that will give the Minister leverage. I am sure watching this debate will make the St. Vincent's Hospital Group think. We need to build up leverage here because this is completely unacceptable. What was done by the Department of Health here was so weak and wrong. The Minister has now been left to pick up the ball.

On behalf of the Irish people, I ask him please to make a decision. Either acquire the site with a CPO, or in my view, the best option here is to acquire the entire thing with a CPO. As the Minister knows, I have always believed in this. I am not being different in my approach; I have been saying it for years. Given what has happened the last 24 hours, this scenario has confirmed my view that that is the best solution to this situation.

Acting Chairman (Deputy Alan Farrell)

I thank Deputy Kelly. I call Deputies Smith, Gino Kenny and Barry on behalf of People Before Profit. The Deputies have eight minutes.

Deputy Bríd Smith

I am sharing time with Deputy Barry. I thank the Social Democrats for the motion. It is really important that we discuss this. No doubt lots more facts, figures and realities will emerge over the next period. After all, it is only less than a week ago when, to the alarm of everybody, we discovered that the Government shared the concerns of the Opposition on this issue. Much has emerged since then. I want to say to the people of Ireland, however, that anyone who shares the concerns of the majority of this House should now see their role as really pushing this issue over the next period and should join us in protest outside Leinster House this Saturday at 1 p.m. I am aware that is also Pride day. I take the opportunity to wish everybody a very positive and happy Pride day. The protest takes place at 1 p.m. outside Leinster House, however, which leaves plenty of time for people to party with their gay community afterwards.

As I said, a week is a long time in politics and we know much more now than we did a week ago. When one finds oneself on the same page as senior Ministers in Fianna Fáil and Fine Gael, it feels a bit uncomfortable to say the least from my point of view. Nevertheless, we are living in extraordinary times when we see what is going on here.

To play devil's advocate, let us say we take the Religious Sisters of Charity at its word when it says it is withdrawing from healthcare and does not want to have any involvement in the ethos. Then, let us look at the detail. One week ago, we were told by the St. Vincent's Healthcare Group that this land was being gifted to the people of Ireland. Then, after a closer look at the detail, one finds that it is not being gifted to the people of Ireland but to a private charity. Nobody is denying that now, including the group itself.

One week ago, we had a 99-year lease. We now have a 149-year lease without any religious ethos or influence involved. However, a search of the charities register today shows us that St. Vincent's Holdings Group still holds the charitable purposes of Mother Mary Aikenhead. How, therefore, can the Minister reconcile these two opposing positions?

I believe yesterday's statement from the St. Vincent's Holding Group was deeply flawed and disingenuous. It was not just insulting to the women of Ireland. After the likely outcome of this debate today, when the vast majority will agree to the motion, the insistence of the board on maintaining ownership of the land is deeply insulting to the democratic will of the people of this country.

The St. Vincent's Healthcare Group has said it must retain ownership of the land for clinical governance and operational reasons but why is that the case? This makes no sense at all. When required, patients are routinely transferred from one hospital to another all over this country and this has been the case for decades. This is not rocket science. The group refers in its statements to the golden share of the Minister for Health but why should we have to rely on extensive and complex legal agreements and commercial terms when it comes to an asset that the State will pay for fully with taxpayers' money. That includes the workers and investors in this country. Why should there be any ambiguity and why should the State invest in an asset of a private company?

The only answer is that the State is not fully committed to shifting away from the privatisation of healthcare and removing healthcare from the hands of religious orders. In particular in this case, we are talking about reproductive and maternity health. This is not good enough. It is not about the integrated needs of women and babies. It is not the reproductive needs of this cohort that is driving this approach. This is about the integrated investment interests of the St. Vincent's Healthcare Group and the Sisters of Charity.

Mr. Fintan O'Toole tweeted today a chart published by the St. Vincent's Healthcare Group on 14 May, which was very recently, demonstrating the hierarchy of private control of the healthcare system. Ultimately, it demonstrates that the St. Vincent's holding group will have the power to sell, mortgage and do its bidding as a commercial entity with this hospital. It is big business interests versus the interests of our health services. Public services, particularly health and education, should be removed from the grasp of the church. The slogan of separating church and State will gather momentum.

It is really important the people of Ireland get behind this. We have shown time and again with the likes of the same-sex marriage, repeal of the eighth amendment and water charges that what changes the course of history is not what happens in this House on its own but what happens on the streets, in our communities and in our workplaces. It is people power combined with the democratic will of the House that will bring forward these changes. We should not put up for another minute with any more of this nonsense that the St. Vincent's holding group can determine the future of women's health in this country.

Deputy Mick Barry

It is time to take off the gloves with the Sisters of Charity. Let us remind ourselves of who we are dealing with. The Sisters of Charity were heavily involved in the illegal adoptions racket. The St. Patrick's Guild that they ran handed over files to Tusla in 2016, leading to the discovery that the guild was involved with 126 illegal adoptions. However, this is unlikely to have been the entire story and experts reckon there may have been as many as 10,000 illegal adoptions in the State. How many of these involved the Sisters of Charity? That is unknown but nobody believes it was limited to 126.

St. Vincent's Hospital moved to Elm Park in 1970. Did funds from the illegal adoption racket help to fund the arrangements at that location? The Sisters of Charity owe the State redress money of €5 million, which is a paltry amount, given the crimes the order is linked with from the past. I stand to be corrected but the latest information I could obtain indicates less than half of this - a mere €2 million - has been paid and no payment has been made for the past eight years.

The Minister will be mandated by the House to tell the Sisters of Charity that the hospital will be owned and controlled by the State and that it will be built on State land. While he is at it, he should feel free to tell the sisters that there are Deputies in the House who would like to go much further and who favour the confiscation of the wealth of the Sisters of Charity, with compensation to be paid only on the basis of proven need. These Deputies stand for the separation of the church from the State and will participate in the protest demonstration this Saturday. They will argue for ongoing and much larger protests if the matters at stake now are not resolved satisfactorily and quickly.

Deputy Michael Lowry

One thing is certain, and it is that Ireland needs a new national maternity hospital. This seems to be the only aspect of the current plans that is not shrouded in uncertainty. Plans to provide a modern maternity hospital at Elm Park date back to 2013 and at that time, the project had an estimated cost of €150million. The following years were dominated by disputes over governance of the new hospital and this included a frustratingly long period during which legalities moved at snail's pace as the Sisters of Charity waited for permission from the Holy See on transferring the shareholding to the newly formed St. Vincent’s Healthcare Group.

We now know that despite the efforts of the Government to purchase the site, St. Vincent’s Healthcare Group is insisting on retaining ownership of the site. The Mulvey arrangement was put on the table as the solution in 2017 but why did it take so long for the penny to drop in Government circles that this formula was unacceptable to the Government? Here we are eight years later still in stalemate.

Despite efforts by the Tánaiste to remain focused on the fundamental issue of ownership of the site, the public and media debate has now switched focus to what range of services will be provided at the new maternity hospital. I fully understand the correlation and the concerns about future services but until we have finality on the site we do not have a hospital to provide services of any kind. Other matters of importance must not overshadow this fact. Until this matter is successfully concluded and concerns on safeguarding public investment are addressed, the new national maternity hospital will remain, as it has been for years, an architect's drawing.

As with the national children's hospital, nobody is disputing the absolute need for a new national maternity hospital. These purpose-built, modern and vital facilities are needed. The mothers of Ireland deserve modern accommodation, high-tech equipment and top-class support services. Despite the clear need, they cannot be provided at any cost, financial or otherwise. They cannot start out at one figure and then double, triple and quadruple as time goes on. They cannot be built on sites that may result in legal wrangles for future generations.

Based on the lessons we have learned and continue to learn from the children’s hospital, we must ensure our successors are not standing here again in years to come grappling with issues arising from a national State-owned hospital standing on charity-owned ground. This is the primary matter that needs to be set in stone before we concentrate on the provision of services that we have already been assured will be provided at the State-owned hospital. The horse must remain in front of the cart if we are to progress this project.

Issues such as those that arose with the national children’s hospital and those that have emerged in relation to the new national maternity hospital beg the question as to why we struggle in this country when it comes to the delivery of major projects. Why are they permitted to drag on in an open-ended fashion, causing frustrating delays and alarming cost overruns without serious repercussions, after years of procrastination and prevarication? After years of dancing around the ownership issue, we are now back to the crossroads. We are told that the cost of the project has shot up to €800 million. It really is a mess and an embarrassing saga that reflects poorly on the competence of our national administrators.

Why are we so inept at delivering State-funded facilities? Our abject failure to address the alarming issues of responsibility and accountability is a damning indictment of our procurement structures and procedures.

Deputy Peadar Tóibín

I move amendment No. 1:

(a) To delete the following:

"— women’s reproductive healthcare would be put at risk and their safety endangered if subject to Catholic ownership and ethos;"

and

(b) To insert the following after "the new hospital be fully owned and governed by the State":

"and further:

— commits to no private healthcare services being carried out on the site of the new National Maternity Hospital, pursuant to the Private Members' Motion on National Maternity Services [Vol. 983, No. 8] brought in June 2019 by then Fianna Fáil Opposition Spokesperson on Health Stephen Donnelly, who is now the incumbent Minister for Health;

— calls on the Government to explain the reasons why, on occasion, in cases of medical negligence, brought against the National Maternity Hospital, the State has also provided, at a financial cost, legal defence to private clinics named alongside the National Maternity Hospital as defendants in certain court cases and to commit to ensuring that this does not happen going forward;

— criticises the continued spikes in cost of the National Maternity Hospital project, rising from an initial estimate of €150 million to €350 million, and now to in excess of €800 million, and calls for the Minister to come before the Dáil to explain the more than 500% increase in the projected cost of the new Hospital; and

— calls for the full provision of financial estimates and figures to the Oireachtas Public Accounts Committee and the Joint Oireachtas Committee on Finance, Public Expenditure and Reform, and Taoiseach."

Yesterday in the courts, liability was admitted by the defendants in a case taken by a couple whose healthy unborn baby was aborted in the National Maternity Hospital after they were wrongly told their son had Edwards syndrome in March 2019.

Every party member who has spoken in the House today on the National Maternity Hospital has been completely silent about this case. Over the past two years, I have heard of no other political party raising this case in the Dáil. These parties need to ask themselves why they have remained silent. Christopher's parents were incredibly courageous in fighting against all the odds for justice for their son. They have been treated shockingly by senior staff in the National Maternity Hospital and two Ministers for Health. For two years, Christopher's parents did their utmost to simply identify this threat to public health to ensure the necessary changes were made to make sure this would never happen again. I have raised this in the Dáil over and over again with the Taoiseach and Ministers; none of them delivered on the simple request to have an investigation regarding what happened to Christopher. They have not carried out the necessary changes to ensure that more couples do not find themselves in this situation. I now call on the Minister to hold a full public investigation into what happened.

It is also astounding that the couple was referred for a test from the National Maternity Hospital to the Merrion Fetal Health clinic, a private clinic run by the obstetricians themselves. It is stranger still, and this is an incredible situation, that the State announced at the time it would cover the legal costs, not just for the public hospital but for the private hospital too, which is an unprecedented move. It is imperative that the new national maternity hospital in St. Vincent's is a fully public hospital. We should not just have separation of church and State but separation of the State from private facilities operating on those grounds.

I also raise a point about the language used in the motion. It may not have been purposeful, but it happened nonetheless. The Social Democrats motion states that the Catholic ethos is a threat to the health of women. This is a gross insult to millions of practising Catholics in Ireland. Some of this language, not necessarily used by the Social Democrats, but by others, including the media, has bordered on significantly intolerant and sectarian. I ask Members to moderate their language. Last week, teachers came before an Oireachtas committee and stated that practising Catholics in schools are being singled out for bullying at the moment. Many people around the country who are Catholics feel Ireland is becoming a cold place for them. As a State, we are celebrating a whole sector of society being taken out of the closet. We should not seek with our language to put another sector of society into the closet in this particular debate. The Republic of Ireland should be pluralist, a republic where everybody, no matter what their colour, creed or orientation, should be able to be who they are to the full extent, without fear or favour.

My colleague, Deputy Matt Shanahan, asked me to raise the incredible ongoing situation of partners of mothers still being unable to attend appointments, or the birth of their children, in certain hospitals in this State. It is absolutely wrong that this debate has been going on and on for months, without the Government getting it together. Let this go no further.

Deputy Mattie McGrath

The national maternity hospital project was first announced in 2013. That is now eight years ago. Like the national children's hospital, the real scandal of the development are the skyrocketing costs. In 2018, the original cost was in the region of €150 million. In 2017 and 2018, the costs had risen by over 100% to an estimated €350 million. In 2021, last Friday in fact, we were told by the Minister for Health that the building infrastructure costs have been priced at €500 million. Further commissioning costs, including fit-out and transferring an entire hospital to a new site, will be a further €350 million. That is €800 million, which is four times the original estimate.

We have to look at the utter lack of competence of the Government, and official Ireland, to manage major projects, such as the children's hospital, broadband and everything else. The ineptitude is frightening. We will have to get some foreign authorities in, I mean outside people, who will oversee this and bring it to book. It is disgusting and is just madness. Any business would not survive a week if it behaved like that. As I said, this is the real issue surrounding the national maternity hospital.

Taxpayers will once again be left to carry the can, as always. They are sick, sore, sorry and tired of this. How, eight years on, can building work on the site at St. Vincent's campus in south Dublin still be at a preliminary stage? You can blame the Religious Sisters of Charity all you like; it has nothing to do with them. Meanwhile, each year, more than 8,000 women continue to give birth in wholly unsuitable, crowded conditions in the Victorian-era building at Holles Street.

Government politicians rehearse the same arguments that have failed to deliver the project from the beginning. It is the very same mantra. Under the plan that was once a statement of the State's ambitions for modern healthcare, and for a messy compromise rooted in a century of official neglect in the same area, the Government will build an €800 million hospital on this site, if it ever gets to build it. This is where the problem is. I am very concerned.

Only yesterday, Tuesday, 22 June, the St. Vincent's Hospital Group stated it must retain ownership of the site the new national maternity hospital will be built on. This means the hospital group is happy to proceed with the arrangements with the Religious Sisters of Charity. I heard the Minister say on radio last Sunday, and on "Morning Ireland" this morning, that he was going to meet them. When will he meet them? Why not sit down and talk to them rather than bashing them up and down the country and everywhere? Why not meet them, sit down and respect them for what they are and what they have done for this country?

Clearly, this announcement from the hospital can be viewed as a direct message to Government parties to stop playing politics with this issue. That is what the Government is doing. In a statement, St. Vincent's Hospital Group stated it is "more than willing" to meet the Government to discuss the relocation of the hospital from Holles Street. However, it added: "For the delivery of integrated patient care on Elm Park Campus, [St. Vincent's Health Group] must retain ownership of the site." That is their position. Why not meet them and talk to them? As I said, the whole saga this week is now more to do with the by-election in Dublin Bay South. It is a sad state of affairs that we can kick the Sisters up and down the street and all over the country and bash them.

Deputy Tóibín is right. There is an apartheid, a bigotry and hate speech here, which we are jumping up and down every day of the week talking about. Horrible things were done by some members of different orders and by priests. Are we still going to bash all the rest, the good ones, forever? These are good people that have given so much service to educate our people and run the hospitals. When the matrons ran the hospitals they were clean, there was no MRSA and they were run properly, not like the shambles of a health service we have now. It is appalling the way language has been used, the way the Sisters have been harangued, bullied and sullied, and that the Minister will not sit down to meet them.

Members of the Government would rather try to gather votes in the by-election. They delay and procrastinate while the good Sisters, up and down the country, who educated most of us, have their good names tarnished and destroyed. I have no truck with the bad ones; they should be rooted out and dealt with. Anyone who suffered abuse, and I met someone outside today, should be compensated and helped. However, the bashing of religious orders in this House makes me sick to my core. It is a Christian country but the unchristian attitudes to our religious are shockingly disgusting. The Taoiseach, Tánaiste and everybody else has engaged in it. The Tánaiste started this off because of the Dublin by-election. There was a big repeal vote in that constituency, around 70%, and this is the electorate they are playing to. It is so sad they have dumped the Sisters under the bus but, worse than that, have allowed women give birth to babies in hospitals that are totally unfit. Why does the Government not go and buy a site elsewhere and leave the Sisters alone? It should buy a site, compulsory purchase order, CPO, it or whatever, and move on.

Deputy Michael Healy-Rae

I will speak about the matter at hand, which is the national maternity hospital and the fact that this project was first announced in 2013, almost eight years ago. Like the national children's hospital, the real scandal with this development is the skyrocketing costs. In 2013, the original cost was in the region of €150 million. The cost has risen by-----

Acting Chairman (Deputy Alan Farrell)

I am sorry to interrupt Deputy Healy-Rae but I have to ask him to remove his hat.

Deputy Michael Healy-Rae

I am sorry. I will take it off and put on my own. I want to support the fishermen who are here today from our coastal communities.

Acting Chairman (Deputy Alan Farrell)

The Deputy is entitled to do so, as he is well aware, but not with a hat.

Deputy Michael Healy-Rae

Thank you. I am sorry. I neglected it as I was rushing.

The costs have risen by more than 100% to an estimated €350 million. That was by 2018. In 2021, last Friday, we were told by the Minister for Health that the building infrastructure cost had been priced at €500 million. Further commissioning costs including fit-out and transferring an entire hospital to a new site will be a further €300 million.

That is €800 million, over four times the original cost or an increase of over 400%. There seems to be another lack of competence by the Government to manage major capital projects. How can we be assured, I ask the Minister, considering the runaway train that has been the budget for this project, that it will even stop at this sum and that it will not continue to escalate? Do we really think the taxpayers can be treated in this way? When we talk about the State and the State's money, there is no such thing. It is the people's money. It is the people's taxes that keep this country and the wheels rolling underneath it. I feel outraged on their behalf. This is a real issue surrounding the National Maternity Hospital and the taxpayers will, once again, be left to carry the can.

Eight years on, the building work on the site at the St Vincent's campus is still at a preliminary stage. I believe that one of the reasons this is becoming such a hot potato these days is because of the by-election that is going on here at present. It is wrong to treat people in this way. The people who need to avail of proper maternity services in a state-of-the-art facility should have it in a timely fashion but not at a cost that is allowed to run away like a train with no brakes.

Acting Chairman (Deputy Alan Farrell)

I call the Independent Group. Deputy Joan Collins and Connolly are sharing an eight minute slot.

Deputy Joan Collins

I intend raising this issue with the Taoiseach later and I will be looking for a clear, direct answer. If the situation remains as it is with the St. Vincent's Healthcare Group refusing to sell the site to the State, is the Government preparing to compulsory purchase order, CPO, the site, and if it is too costly and if it is too lengthy is the Government preparing to abandon the St. Vincent's Hospital site and begin the process of looking elsewhere? Women have to draw a red line on this. It cannot go on. This would obviously create a new problem as there is an urgent need for a new up-to-date national maternity hospital but the Government must make its position clear. The day when religious institutions or, in this case, their proxies can dictate to the State and to the women of this country while enjoying 100% State funding are over.

I commend the Social Democrats for tabling this parliamentary motion in a timely fashion. I am pleased the Government is not opposing it but it will still not solve the problem.

The decision to locate a State-built, State-funded and much needed modern national maternity hospital without clarification as to the ownership of the site and the governance and ethos of the hospital has resulted in the present mess, and mess it most certainly is. The situation could only arise because the public service is a mess.

What we have is a public health service grafted onto an inherited system from the 19th century based on the ideology of the Poor Law and the provision of health for the poor as a charitable act provided, in the main, by the Catholic Church. In 2015, while I was a member of the committee which drew up the Sláintecare report, research showed that, of a State health budget of €13 billion, €3.6 billion went to non-statutory agencies. Fifty-three per cent of this went to acute voluntary hospitals and 47% to non-acute agencies. Section 38 and 39 agencies, numbering at least 3,000 different agencies, received some €3 billion. The level of outsourcing of essential services to charities and NGOs is simply mind-boggling. They should be directly employed by the HSE.

The current impasse on the National Maternity Hospital is a consequence of the fact that the political parties which have dominated the State for the past 100 years, the mandarins in the Department of Health, the leadership of the HSE and particular sections of the medical profession have all been happy to live with the situation, and that leaves aside the role of the Catholic Church in demanding a leading role in the provision of essential public services, such as health and education.

The situation in relation to the National Maternity Hospital is a test. Are we to have high quality free-to-use public services as a right for all in a modern secular Republic or will there be a shabby compromise with the State spending at least €800 million to €1 billion to build a hospital on land it does not own with the State funding 100% of the cost of staff, the board of governors nominated by a private charity and absolutely no certainty that all the medical procedures legal in the State will be provided to women who need them? Rights are exerted; charity is bestowed.

I want to make a point about what has happened in the past week. We had a statement from the Sisters of Charity to say they were going to gift the site to the Irish people. It then transpired quite clearly that the intent was that they were going to gift it to, in fact, a charity - their own holding company. Then we had the Tánaiste and Minister for Enterprise, Trade and Employment, the Taoiseach and the Minister stating that the land must be in public ownership and that the governance should be in State control. Then we had the Sisters of Charity issue a statement saying that the ownership of the land was not an issue and the Government never raised it before - we know, in 2017, the then Minister, Deputy Harris, did. Then we had the statement yesterday from St. Vincent's Healthcare Group saying it must retain ownership of the land for clinical governance. We must as a State publicly own the land. We must retain the ownership of the land for clinical, governance and operational reasons, including the provision of the safe integrated system of our care.

I hear the Minister say this morning that he will meet the Sisters of Charity privately. I thought they were out of the equation since 2017.

Deputy Catherine Connolly

Tá sé breis agus 70 bliain ó a forógraíodh an tír seo ina Phoblacht. Roimh an bhforógra sin, agus faraor, tar éis an fhorógra sin, níor cuireadh mórán béime ar ghuthanna na mban nó ar chearta na mban. Faraor, sa 21ú aois, táimid fós ag brath ar chomhlacht príobháideach agus ar charthanacht chun seirbhísí bunúsacha ó thaobh máithreacha agus leanaí a chur ar fáil dúinn. Nílimid chun glacadh leis sin. Sin an teachtaireacht láidir uaimse, ó na Daonlathaigh Sóisialta agus ó fhormhór na Dála. Nílimid chun glacadh leis sin níos mó.

We are here almost 70 years after we declared ourselves a Republic and we certainly have a long way to go before we make that a reality. Approximately the same period of time has elapsed since the mother and baby home debacle, already referred to by Deputy Cairns. Here we are in the 21st century and the Minister is telling us that he will rely on assurances from a private company - a charity - that it will provide all of the services that we need and that are guaranteed by law. I do not want the Minister's assurances. What I want is a national maternity hospital on public land fully owned and operated by the State for the people of Ireland.

I thank the Social Democrats for bringing this motion and for allowing their Private Members' time to be used in this manner. This is the second motion within three weeks where we put the spotlight on national maternity services.

The Minister talks about a revolution in maternity care that is needed. That was supposed to have been done with the national maternity strategy that has not been implemented.

If we look at the topic under discussion today, May 2013 jumps out for some reason. In May 2013, the then Minister, James Reilly, announced co-location. That was following a report from an accountancy firm in 2008 which stated co-location was the way forward. In May 2016, we had mediation through Mulvey. We had a ridiculous outcome of that where the Government would be satisfied with a golden share. In 2017, there was outrage, and rightly so, from the people of Ireland and the Religious Sisters of Charity told us they were withdrawing. Why the Minister would be needing to meet the order, as my colleague has said, is beyond me because it has withdrawn out of it. Fair play to it. It said it withdrew out of it. In May 2020, the order told us it was giving the site as a gift to the people of Ireland. That now is also not accurate. We know it is going to a specially set-up company.

In between, of course, we have had so many things. We must remember that St. Vincent's rejected the co-location. It was totally against it in 2014 and, obviously, proceeded in that manner with the collusion of different Governments which sought to facilitate that situation where there would not really be co-ownership but a taking over of the hospital.

In between, thanks to Dr. Peter Boylan, thanks to ourselves and thanks to the Social Democrats, different facts have emerged. I thank Dr. Peter Boylan for his effort.

It cannot have been easy for him. It is not easy for him and still he has persisted. He asked a specific question on the legal arrangements and he was told they were complex.

I will finish on time as I am always giving out to others for not doing so. I have no hesitation in supporting the motion. I want to see action from the Government. I want no more patronising comments or promises.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Deputies for tabling this motion. The contributions that Deputies have brought to this topic are testament to how critically important the new national maternity hospital is. When I spoke on the topic of maternity services recently, I noted how the attention and investment in those services are commensurate with the importance that we, as a society, place on women and babies. I reaffirmed the commitment of this Government to delivering better health outcomes for the women of Ireland, as well as our determination to ensure that the success achieved so far in women’s health is built on for generations of Irish women and girls into the future.

What we are talking about today is a huge part of that ongoing work. It is worth remembering that the new national maternity hospital will be the single greatest investment in maternity and women’s healthcare in the history of the State. It will provide state-of-the-art facilities for the provision of modern healthcare for generations of women and families to come but it is more than just a hospital. It is an investment in our services and in the dedicated people who provide those services. Most importantly of all, it is an investment in the women of this country. That investment is long overdue.

We all want to see modern, safe and compassionate services delivered with dignity and respect to those who use them. To ensure we can deliver on that aim, the Government has provided a significant increase in funding for women’s healthcare in 2021, reflecting our commitment to improve services in this area. The €12 million that has been allocated to the national maternity strategy and to gynaecology services this year, and the additional €5 million provided to the women’s health task force, will ensure there is a renewed focus on delivering the best possible care for women and babies across the country.

I can reassure the Deputies that delivering improved outcomes for women will remain our core aim. The National Maternity Hospital’s move, as planned, to the Elm Park campus is a key part of achieving that aim. The development of modern hospitals, co-located with adult teaching hospitals, will ensure we can provide the best possible healthcare to women and babies, delivered by the right person at the right time and in the right place. The new hospital is, therefore, a vital piece of infrastructure and one that will help to underpin the development of maternity services and the implementation of the national maternity strategy into the future.

We know that concerns have been raised regarding the ownership and clinical independence of the new national maternity hospital. These concerns are not surprising, given the chequered history of women’s experiences of care in this country in the past. However, as the Minister has outlined, a considerable amount of work has been done to address these issues and to ensure the new hospital will remain in State ownership to serve women and families for years to come.

Several Deputies who proposed the motion have stated that the Government is gifting the hospital to the Religious Sisters of Charity. This is inaccurate, untrue and misleading. The corporate and clinical governance arrangements for the new maternity hospital are set out in the Mulvey agreement, which was agreed between the National Maternity Hospital and St. Vincent’s University Hospital in 2016. A key element of that agreement and a core objective in the subsequent negotiations around the legal framework was the need for the new national maternity hospital to have clinical and operational, as well as financial and budgetary, independence. This means that the full range of health services available at the new hospital will be provided without religious, ethnic or other distinction.

As the Minister for Health stated earlier, the other core objective in this project was and remains that the State’s significant investment in the new hospital must be appropriately protected. In this regard, as part of the initial negotiations in 2017, the then Minister for Health, Deputy Harris, sought the outright transfer of the site for the new hospital. Following extensive engagement between the HSE, the National Maternity Hospital, St. Vincent's Healthcare Group and the Department, the current position is that St. Vincent's Healthcare Group has agreed to lease the site to the State for a period of 99 years. There is the potential to extend this lease for a further 50 years. Lest there be any confusion, I reiterate that neither the Government nor the Minister will be gifting the national maternity hospital to anyone. Language is extremely important here. The finalisation of the draft legal framework and associated arrangements are still ongoing, with a view to ensuring the safeguarding of women’s healthcare services and the State’s investment are affirmed beyond doubt for the public and for women in Ireland.

In terms of the governance of the new hospital, as set out in the Mulvey agreement, a new company, the national maternity hospital at Elm Park designated activity company, DAC, will be established, which will operate the hospital under licence from the State. The Minister has received assurances that the positions on the board will be filled solely on the basis of competency. Furthermore, in addition to the four directors nominated by the National Maternity Hospital and St. Vincent's Healthcare Group, respectively, the Minister will also nominate a public interest representative to the board.

The Religious Sisters of Charity will not have any role in the governance or operation of the new national maternity hospital. The Minister has been absolutely clear about this previously, and clarified the situation once again today. The Religious Sisters of Charity have resigned from the St. Vincent’s Healthcare Group board and will be transferring their shareholding to St. Vincent’s Holdings company limited by guarantee, CLG. It is also clear that the constitution of St. Vincent’s Holdings CLG makes no reference to canon law and that canon law will have no impact in the provision of care at the new hospital.

I would like to reiterate to the House that this Government remains fully committed to its focus on the development of maternity and women’s health services in this country. We are investing more in these services to ensure that developments are achieved, improvements are made and outcomes for people using the services are enhanced. The relocation of the National Maternity Hospital is a significant part of that development. I reiterate what the Minister said. He will not countenance developing any new maternity hospital where there is any risk that religious or other influence will put women's reproductive healthcare at risk or endanger their safety. This is a commitment from the Minister on the floor of this House. He can assure Deputies that the clear legal advice provided to the State is that the ownership and clinical and corporate governance structures ensure that all legally permissible medical services will be provided in the new hospital.

I want to respond to an accusation that was made here earlier. In case there is any concern on the part of Deputy O'Reilly, Fianna Fáil fully supports the new national maternity hospital being built on public land and in State ownership. The Minister has the full support of Fianna Fáil on this. However, language is important and any attempt to demonise the Catholic faith for political gain is unnecessary and disappointing. Unfortunately, we have seen this happen more and more recently. The Minister and the Government remain committed to progressing this critical project, and to providing the highest quality infrastructure and environment for it, with all of the necessary assurances, to enable the delivery of modern, safe and quality health services for women and babies for many years to come.

Deputy Gary Gannon

I begin by bringing into the Chamber the words of the American poet, feminist and lesbian activist, Adrienne Rich, who said, "Every built thing has its unmeant purpose."

It should be a source of celebration that the Irish State and people should be getting a modern maternity hospital, free of Nightingale wards and with single-room occupancy. The fact that hundreds of millions of euro will be spent to provide the highest standard of healthcare should be a cause of celebration in a modern republic. Yet the dark clouds of an old Ireland once again start to gather because we will not own that hospital. We will not own the site on which it is built. Rather, the hospital will be owned by the St. Vincent's Hospital Group which has been set up by the Religious Sisters of Charity whose legacy is clear in my constituency of Dublin Central. One can walk up the road from the Convention Centre to Seán McDermott Street and see a big building in which they once incarcerated women who committed no crime. That is the legacy of the Religious Sisters of Charity I see when I walk through my constituency.

Those same people want us to believe their control of that hospital will be benign, they will have a hands-off approach for 99 years and they will not get involved or dictate in any manner. They have provided assurances in which I have no faith. The people of this country who have suffered at the hands of such organisations have no faith in their assurances. That is why we are bringing forward this motion that our new national maternity hospital should be publicly owned, on public lands and provide the highest standard of healthcare to women and people in this country, without any risk of ethos interfering in the treatment they would be given at any point in the future.

We need this hospital so badly. The people of this country need our maternity hospital so badly. That fact has been weaponised. Every built thing has its unmeant purpose. For the St. Vincent's Hospital Group, the Religious Sisters of Charity or the hierarchy of the Catholic Church, in terms of who one has to answer to, the unmeant purpose is clear. It is about control. It is about the long game of Catholic control, which it will not concede in this country. It is the dark shadow it will not unclench its grip from.

That is not a demonisation of people of the Catholic faith in this country. Let me be very clear, the people of the Catholic faith in this country suffered more at the hands of the hierarchy than anybody else. A lease of 99 years is nothing to an organisation which has existed for thousands of years. There is a battle for our new national maternity hospital, one which strikes to the very heart of what it means to live in a modern, secular republic. We have fought too hard to concede an inch here.

Like many people of my generation, I knocked on doors with women who had to outline their stories, hurt and grievances just to get access to basic healthcare. Before that, I knocked on doors with people from the LGBT community who were asking to be able to marry the people they loved. When we did that, we stood on the shoulders of people who came before us and suffered a substantial oppression and showed courage beyond what they should have to, in terms of contraceptive trains and those who were incarcerated in Magdalen laundries, suffered the horrors of the asylums and were kept in mother and baby homes.

Those legacies are still there. That pain is still there and we will not concede. Do we honestly believe, given half the chance, the hierarchy of the church would not do exactly the same thing again? To those naive enough to believe that, I point them in the direction of Poland, or even closer to home, our schools. Deputies talked about it being a cold place for those of the Catholic faith in this country, but if one goes into any school or class in this country one in five teachers of the LGBT community cannot profess the manner in which he or she loves, for fear it would prohibit his or her career advancement. This has been a cold, dark place for people in the LGBT community and that ethos still exists in our schools. I will not be fooled into believing it will not exist in our hospitals, given half the chance. We stand wholly against it.

I ask the Minister to demonstrate the courage expected. When he walks into the room with the Religious Sisters of Charity, he should not be deferential. We owe them absolutely nothing. Nothing. The history of this country is 90 years of Fianna Fáil and Fine Gael conceding ownership of the basic public amenities of healthcare and education to the church. We will stand for that no more. When the Minister walks into that room, he should not be deferential. He should remember who is talking to and the legacy of hurt, pain and trauma which they have inflicted and which is still being inflicted on and experienced by people in this country today.

Deputy Róisín Shortall

I thank all Members who contributed to this debate. I also thank the cross-party Oireachtas group, which was formed last month, for helping to put this issue centre stage in politics. I wish to acknowledge and thank Dr. Peter Boylan for the important role he has played and the assistance he has provided. He has been a tireless advocate for women's healthcare. I also thank and acknowledge the role of the campaign against church control of women's healthcare, as well as the National Women's Council, for their help and campaigning on this vital issue.

These and other efforts have resulted in some in government - belatedly - sitting up, taking notice and facing up to the fact that what is proposed for the new national maternity hospital is simply not acceptable. It is not acceptable because it fails to protect the public purse. It fails to achieve public ownership and governance. It fails to guarantee the full range of women's healthcare services and ignores the strong public demand to separate church and State.

In a statement yesterday, St. Vincent's made a number of claims, some of which are simply untrue and do not stand up to any kind of scrutiny. Its claim it was imperative it retained ownership of the site for the delivery of integrated patient care at Elm Park is nonsensical. The comments and contribution from the Minister for Health has been extremely disappointing. He continues to be in denial and seems to think he can hide behind the phrase that "it is my preference". He needs to spell out exactly what he will do to address this mess before us and the fundamental issues at its core. He must address ownership of the site, but he must also address the issue of ownership of the national maternity hospital company. It cannot become a subsidiary of St. Vincent's, wholly owned by St. Vincent's. That is what is proposed in the Mulvey agreement. The Mulvey agreement is the problem. It is not the solution.

The new national maternity hospital must be publicly owned and governed. It must be a public hospital. I am calling on the Minister to bring proposals for the future, much needed new national maternity hospital to this Dáil for debate, prior to the Government signing off on any proposals. It is the least we deserve.

I talked earlier about issues of ownership, property and money, issues which arose with St. Vincent's in the 1970s. I could also have talked about similar issues in the 1990s, when St. Vincent's mortgaged the public hospital to fund its private hospital. It is an issue which has created a toxic public-private mix and all of what goes with that.

The nuns have understood the importance of ownership and control of their own hospitals since the 1930s. Why has our Government, in 2021, failed to learn that fundamental lesson? This has gone on long enough. It must stop now, and not just for us, but for future generations of Irish women. The Government has said it will not oppose our motion. That is not enough by the Minister, and it is not enough by the Taoiseach.

This Government must actively support the principles of this motion and make a solemn promise to the people of Ireland. That promise must be that it will not give away ownership or control of another hospital. Nothing else will suffice.

Amendment put.

An Ceann Comhairle

Insofar as a vote has been called, it is deferred until division time later today.

Dáil Éireann díospóireacht - Wednesday, 23 Jun 2021

National Maternity Hospital: Motion [Private Members]

Dáil Éireann díospóireacht -
Wednesday, 23 Jun 2021