Dr. Peter Boylan:

I thank the Chairman for the opportunity to attend the committee here today.

The Sisters of Charity’s transfer to St. Vincent’s Holdings, SVH, required them to apply for Vatican permission under the mandatory Canon Law procedure in Canon 1291 for “alienation”. Vatican permission was conditional on the Sisters observing certain specified canon laws. The main objects of the St. Vincent’s companies bind them to uphold the values and vision of Mother Mary Aikenhead and the directors and shareholders are committed to the values of Mother Mary Aikenhead. It is not credible that these values include the provision of services such as elective abortion that are directly contradictory to Catholic teaching. The concern about Catholic ethos is too acute to proceed unless and until there is full scrutiny of all correspondence between Ireland and Rome. I have appended note E to the opening statement supplied for a schedule of documents.

The plan is contrary to the recommendations of the 2019 report of the independent review group established to examine the role of voluntary organisations in public healthcare that the State should own the land on which the hospital is built and if this is not possible that “any capital investment by the State should only be provided subject to prior agreement on the services that will be delivered”.

The Government should directly ask the new owners of St. Vincent’s Holdings why they cannot gift, as the Sisters of Charity said they would in 2017, or sell the land to the State. Specifically, do the conditions set down by the Vatican preclude St. Vincent’s Holdings from gifting or selling the land?

Prior agreement on the services must include a specified list of procedures including but not limited to abortion according to the 2018 Act, elective sterilisation, assisted fertility and gender realignment surgery and any procedure that becomes legal in the future. It is incorrect to suggest that the constitution of the national maternity hospital, NMH, would have to be revisited every time a new treatment or procedure becomes legally permissible.

The phrase “clinically appropriate” is a major red flag. Providing healthcare on the basis of this test removes autonomy from women and gives the sole decision-making capacity to doctors. These words qualify access to services and enshrine justification for refusing legally permissible treatments.

I attach a letter sent on behalf of the Minister, Deputy Stephen Donnelly, which is a perfect example of “clinically required” in action and that phrase is interchangeable in medical practice with "clinically appropriate" in denying patients legally permissible services. In a reply to a parliamentary question to the Minister of Health, Deputy Stephen Donnelly, it was stated, “St. Vincent’s University Hospital has carried out sterilisation procedures when it is clinically required to do so ..., but not for the exclusive purpose of sterilisation.”

NMH clinicians who say terminations take place at St. Vincent’s must confirm if those are under the terms of the 2018 Act or for clinical indication to save a patient’s life. The Minister, Deputy Stephen Donnelly’s response to the parliamentary question confirms that fewer than five such terminations occurred before October 2021 and that routine terminations do not happen at St. Vincent’s.

The original plan to co-locate the NMH as an independent stand-alone hospital at Elm Park has been shredded. The NMH would be one of four hospitals owned by St. Vincent’s Healthcare Group, SVHG, which in turn is wholly owned by St. Vincent’s Holdings.

On 29 May 2017, the chair of the board of St. Vincent’s Healthcare Group, insisted, after the Sisters had announced their intention to depart, that the move of NMH to the SVHG site will proceed only on the basis of existing agreements that give ownership and control of the new hospital to SVHG. That intent has been achieved under the current proposals.

The existing National Maternity Hospital would cease to exist, but the mechanisms to do this have not yet commenced. The NMH governors have not yet been asked to vote for the dissolution of the 1903 charter, nor the required Act of the Oireachtas passed. NMH staff would be employed by an NMH designated activity company, DAC, whose board would have minority NMH representation and be subsidiary to SVHG. The master would be relegated to one clinical director of four in the group. SVHG would own 99 NMH DAC shares. The Minister of the day would have one share. The NMH would have none. St. Vincent’s would nominate one third of members of the NMH DAC board, as well as the chair of that board on a rotating basis every three out of nine years.

There would only be three national maternity hospital directors, one of whom would be the master, as opposed to reporting to the board. For example, the CEO of the HSE is not a board member. There is no security against a future conservative Minister for Health appointing three conservative State directors. This is not independence. I should add that I think the golden share is more of a liability than an asset.

The HSE’s business case is undergoing review by the Department of Health as part of new rules to prevent a repeat of the huge overrun in the budget of the national children’s hospital. I am reliably informed that the HSE is unable to put a final figure on the cost but believes it is rising by more than €10 million every month. The Comptroller and Auditor General’s spending audit has not been completed. Delays to the project have been caused by St. Vincent’s withdrawing co-operation between 2014 and 2016, during which there were three mediation processes, of which the first two failed; delay in the Sisters of Charity completing the three stages of their alienation, that is, Canon Law application, civil law registration and HSE approval; and delay in producing the complicated legal documents which were released recently. There is also a risk associated with committing a flagship hospital to a catchment area of south County Dublin and the east coast for 299 years when the demographic evidence shows higher birth numbers in north and west Dublin and the surrounding counties.

In the last few years, there has been impressive investment in Holles Street, with a new labour suite, new neonatal intensive care unit, operating theatres, emergency room, foetal medicine unit and upgrading of post-natal wards. Patient satisfaction is at 95% and clinical outcomes are on a par with the best in the world. The current proposals are flawed. In view of deep public and political disquiet, more time is needed to get this project right.