Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

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

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

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

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

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

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

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

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

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

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

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

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

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

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