Richard Bruton (Dublin Bay North, Fine Gael) | Oireachtas source

I am grateful for the opportunity to participate in this debate and I thank the Minister for the time he is giving to help us to understand this.

I think it was Shakespeare, in King Lear, who wrote, "Striving to better, oft we mar what's well." More of us might say that the best is the enemy of the good. There is no doubt that this is not a perfect arrangement. If we were given a blank sheet of paper and were starting to design our health service from scratch, this is not how we would design it. However, in Dublin the only adult hospitals with the specialisms we would need to have to give a world-class maternity service are both voluntary hospitals, namely St. Vincent's and the Mater. That is the reality. I respect those who say that it would be better if that were not the reality, but it is. Best care is only going to be provided in the new national maternity hospital if we have that integration. The new national maternity hospital will give women dramatically better care, with single rooms, double the number of theatres and delivery rooms and massively increased access to new specialisms.

What must be said though, in recognition of the many concerns articulated by the Opposition and by some Government backbenchers, is that it is very understandable that if one puts the Catholic Church and women's health into the same sentence, a red mist descends for an awful lot of people. They remember the very painful history and that is extremely understandable. I can understand why this debate generates so much feeling among many people and that feeling is very genuine. However, our job is to look in detail at the partnership that is to be forged between an adult specialist hospital with a huge range of specialisms and the new national maternity hospital. That is what we are trying to do in this process. The first thing to say is that the church will have absolutely no role. A lot of people outside the House do not appreciate that this is the case - that the nuns have given over all of their interest. What remaining interest in the land that they held has now been transferred to a secular trust, operated under Irish charity law and with no role whatsoever in relation to the running of the hospital.

The second thing that strikes me is that the new hospital is going to be obliged to deliver all lawful abortions, sterilisations and other interventions, not only by its constitution which we have seen published, but also by the licence it operates under from the HSE, by the public interest directors who make up its board and by the golden share operated by the Minister. This is not just a triple lock, which we know of in other circumstances, but a quadruple lock that is being provided. It is far, far more than is the case with the current National Maternity Hospital, it has to be said.

I would have been among those who would have liked to see outright ownership, but ownership under a 300-year lease is ownership. Anyone who buys an apartment in this State knows that and that is the reality. We may question why St. Vincent's Hospital Group wants to retain a lease and not surrender full ownership. It has said that is an absolute requirement of its partnership in this project. The reasons it is offering are understandable at one level. These hospitals will have shared corridors and shared staff and are going to be wholly integrated on a site that has many other operations. One can see from St. Vincent's point of view why it would want to protect its wider operations on the site by having a lease arrangement and not outright ownership. To be fair, under pressure from Ministers, the group has come a long way in terms of the way the lease has been drawn up.

It must be borne in mind that the idea of a CPO, involving going to the courts, would be very hostile to any partnership arrangement. Also, it is very difficult to CPO something that is not going to be a detached hospital on its own grounds. This is going to be an integrated hospital, with shared corridors and so on. It would be very difficult to procure this by CPO. The outcome would be uncertain and it would certainly wreck the concept of partnership that is at the heart of this project.

I have listened to Deputies and to Deputy Bríd Smith in particular, whose views I might not agree with but I always respect the sincerity with which she expresses them. Her position is that we should not start out from here. I do not want to be putting words into her mouth but there are many who hold the view that there should be no private medicine in the Irish public health service, that there should be no non-State ownership and no voluntary trusts of this nature, but that is not the health service that we are trying to adapt to provide care for women who need it urgently and who are currently being treated in unsafe arrangements. It is really important that we start from what is possible, not from what is the ideal. As I said at the outset, the best is the enemy of the good.

I would like to ask the Minister to clarify a couple of things, the first being why it is necessary for the national maternity hospital to be a subsidiary of St. Vincent's Hospital Group. It is not clear to me why that condition is there. Like others, I would like the phrase "clinically appropriate" to be clarified. Reference has been made to the fact that there are limited specialisms going to be available in this particular hospital, which is understandable, that services evolve over time and that we want to protect the maternity and neonatal service but I agree with other Deputies that some clarifying statement around that phrase would be useful. There is a recognition that the Minister's words, when these arrangements were put in place, would carry considerable weight when anyone is looking at this subsequently, in a legal context.

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