Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

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All four stand-alone maternity hospitals, while they have incredible staff and provide a superb service, are now outdated.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.

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