Dáil debates

Thursday, 12 May 2022

National Maternity Hospital: Statements

 

1:05 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)

I might be sharing time with the Minister of State, Deputy Rabbitte.

The proposed new building for the National Maternity Hospital is probably the most important investment in women's healthcare in a generation. It is widely agreed that the midwives, nurses and doctors in Holles Street provide great care and that they are leaders in advancing women's healthcare. After repeal, Holles Street was one of the first hospitals to provide termination services. It was one of the first sites for the new specialist menopause clinics. It has been involved in many of the new services rolled out around Ireland last year and this year. It is involved in the advances in midwifery-led maternity care, gynaecology, genetics, endometriosis, fertility, mental health and much more.

It is also widely agreed that the building in Holles Street is no longer fit for purpose. The vision of the national maternity strategy is one in which women are treated with dignity and respect in an appropriate modern environment. The facilities at Holles Street simply cannot provide that environment. Women occupy Nightingale-style accommodation, sharing wards with up to 13 other women and with only a thin curtain separating the beds and inadequate shower and toilet facilities. It increases the risk of infection and compromises the privacy and dignity of patients, who are forced to queue in public corridors to use bathroom and shower facilities.

The new building will meet the needs of these women. It is about having enough beds, theatres, diagnostic facilities and day-care facilities. It is about having appropriate bereavement supports. While the new building will meet these needs, it will do much more. Every woman will have her own en suite room and there will be many more maternity beds. There will be separate and appropriate space in the tragic cases of bereavement. Instead of 11 delivery rooms, there will be 24 modern delivery rooms. Instead of 18 gynaecology beds, there will be 31 beds. Instead of 35 neonatal intensive care cots in shared spaces, there will be 50 individual-room neonatal intensive care cots. The new neonatal intensive care unit has been designed in a way associated with reducing the stay for neonates. All parents want and need to be by their baby's side day and night, especially when the baby is critically ill. Parents will be able to room in with their sick or premature babies. This enhances mother–baby bonding and breastfeeding rates. This new building means the teams in Holles Street will be able to expand services for women, to make sure there is rapid access when it is needed, and to do it all in a modern hospital.

It is also widely agreed that co-location is important. Every year, hundreds of pregnant women need to be transferred to St. Vincent's University Hospital, as inpatients or outpatients, for treatment they cannot get at Holles Street. Every year, a number of critically ill women are transferred to St. Vincent's, often for life-saving interventions and intensive care. The midwives and doctors are telling us that, as maternity care becomes more complex, the need for access to the services in a large adult hospital is continuing to grow.

It is widely agreed — indeed, it is demanded — that all healthcare services must, under law, be provided at the new hospital. This demand is absolutely correct and appropriate and must be met. The new hospital is being set up to do exactly that. The new hospital's constitution guarantees its clinical and operational independence in the provision of any maternity, gynaecology, obstetrics or neonatal service that is lawful in the State. However, we have gone much further than that. Not only is independence guaranteed to provide all services but the hospital will be required to provide all services. This includes terminations, tubal ligations, gender affirmation and everything else permitted under law. Added to that, if for some reason the hospital were not to provide all services, the State, via the Minister for Health, would have the power to intervene directly to direct it to provide all services.

It is also being demanded, quite rightly, that there be no religious influence in this new hospital. Ireland has a dark history when it comes to the church and women's reproductive health. I fully understand and fully acknowledge the deep sense of mistrust of many people in Ireland on this issue. I fully agree with the demand for a fully secular hospital. The new national maternity hospital will be fully and completely secular. There will be no religious influence; there can be no religious influence. The hospital's constitution explicitly states the services must be provided "without religious ethos or ethnic or other distinction". This is stated six times in the hospital's constitution. As with the provision of all services, the State, via the Minister for Health, can directly intervene to ensure there is no religious ethos in the provision of any services.

St. Vincent's is also a secular, voluntary, not-for-profit healthcare provider. Dr. Rhona Mahony, a member of St. Vincent's board, has pointed out that the board has been working for years to create a secular healthcare provider.

Citizens with very understandable concerns were outside the Dáil yesterday with signs that demanded that the National Maternity Hospital not be handed over to the nuns. That is what was written on the signs. Several colleagues here were outside with the concerned citizens. I want to be absolutely clear: the nuns are gone. They stopped their active involvement five year ago and in the past few weeks transferred all their shares to St. Vincent's. In fact, I waited until that share transfer was completed before bringing any proposals to the Cabinet or the Oireachtas for consideration. There is no mechanism for any religious involvement, now or in the future, in St. Vincent's or the new national maternity hospital. I would never propose a new maternity hospital that had or could have any religious influence. Dr. Rhona Mahony, Professor Mary Higgins, Ms Mary Brosnan, who is the director of midwifery, and the midwives, nurses and doctors in Holles Street, who are begging for us to listen to them, would never agree to anything other than a fully secular hospital. These clinicians are the women and men providing all services in Holles Street today. They will be providing all services in the new hospital.

The nuns are gone, and we are not handing over our National Maternity Hospital. We are not gifting it to anyone else either. This is a partnership between the State, St. Vincent's and the National Maternity Hospital. The National Maternity Hospital will provide the staff and run the new hospital. The State will fund and own the new hospital building. St. Vincent's will provide the land for 300 years. This gives the State leasehold ownership in the same way as people own the apartments they buy. Each party — the State, St. Vincent’s and the National Maternity Hospital — will appoint three of the nine directors to the board of the new national maternity hospital. The National Maternity Hospital will in turn appoint directors to the board of St. Vincent's.

The two hospitals will be physically connected to ensure seamless and rapid access for patients, particularly critically ill patients.

Both hospitals will provided shared services to be used across the healthcare campus. Many clinicians will work in both hospitals.

A structure was agreed in the 2016 Mulvey agreement whereby the shares in the national maternity hospital charitable company will be owned by St. Vincent's Healthcare Group charitable company. This provides St. Vincent’s Healthcare Group administrative rights, for example, for accepting annual accounts at general meetings and approving the appointment of auditors.

The new national maternity hospital will be fully clinically, operationally and financially independent. It will have its own constitution and its own operating licence with the HSE.

It is worth comparing the National Maternity Hospital today and the new national maternity hospital that is being proposed. Today, the land under Holles Street, the freehold ownership, is with the Earl of Pembroke. The State owns neither the land nor the building. There are two priests on the board of the National Maternity Hospital today, including the Chair, who is, and has always been under its articles of association, the Catholic Archbishop of Dublin. In the new national maternity hospital, the State will own the building and it will own the land under leasehold ownership for the next 300 years. The State appoints three of the directors. The Minister for Health will have broad powers to intervene and direct the hospital. All services must be provided, there can never be any religious influence and, of course, healthcare services for women and infants will be modernised and greatly expanded.

While more and more people who are partaking in this discussion about the new hospital are concluding based on all of this that there will be no religious influence - indeed, there can be no religious influence - and that all services not only can but must be provided, some are demanding that the State's ownership of the land should be in the form of a freehold ownership rather than a 300-year leasehold ownership. St. Vincent’s has been clear from day one that freehold would not be considered. Regardless of what any of us may think, that has been its position. The reason it gave us for this is the ongoing management of the healthcare campus. It points out that there needs to be one owner to ensure it is managed for the multiple services on site. This includes St. Vincent’s University Hospital, the private hospital, the new national maternity hospital, screening services, GP day care, research facilities, the UCD education centre and, quite likely, more in the coming years. It points out that the shared services on this site are provided via single integrated systems, including heat, power and essential piped gases vital for patient areas. It points out that the service corridors for the entire campus run through the new national maternity hospital building and that the new development includes facilities for shared services for the overall campus. I was in Texas recently, at the biggest healthcare campus in the world. It is a not-for-profit healthcare campus and it has many providers. It is huge. There is the world's leading cancer centre and many other providers. However, the entire site is owned and managed by one company, the Texas Medical Centre.

Some do not accept this. They do not accept the position being put by St. Vincent's. They do not accept that 300-year leasehold ownership is enough and they are demanding freehold ownership. To this end, many have accepted that St. Vincent's will not do that voluntarily and are saying, therefore, we must engage in a compulsory purchase order, CPO. What if we engage in a CPO? It might well collapse the partnership, which would end co-operation on co-location. The courts may well rule against the State and I would imagine could point out that we already have lease ownership of 300 years. A CPO could take years, due in part to the complexities involved given that what we are looking for here is a site in the middle of a larger health campus. Imagine the complexities involved in a CPO if the State were to look to CPO land in the middle of Intel’s manufacturing plant in Leixlip. The new hospital building, which has been agreed and which we have planning for, would be compromised as the current design includes space that currently St. Vincent's is on and some of St. Vincent's current university hospital has to be knocked down and provided for the new building. The building works, under a CPO, could also take years longer, as it would inevitably be more difficult for two separate site owners to work through the highly complex areas, such as shared services. Future clinical care could become higher risk as separate owners of lands would need to participate, for example, in the upgrading and fixing of services that are on each other's parcels of land. There would, of course, be a much higher cost to the State, including legal costs, a purchase cost - would that parcel of land be worth €50 million, €100 million or €150 million - and there would very likely be additional costs due to ongoing delays in the building works. It is not reasonable to put a project as important as this at such risk, to delay it potentially for many years or derail it entirely, in order to move from a leasehold ownership to a freehold ownership.

Women’s healthcare has never been sufficiently funded. It has never been sufficiently prioritised in Ireland. We are changing that. This year a new national network of services is being put in place. Contraception is becoming free, starting with women aged 17 to 25. Next year I hope to secure funding to start publicly-funded in vitrofertilization, IVF. More HSE hospitals this year are beginning to provide termination services. The new national maternity hospital is an essential part of the change, improvement, modernisation and investment in women's healthcare. We have been talking about this hospital for nine years. It is time to act.

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