Dáil debates

Thursday, 20 January 2022

National Maternity Hospital: Motion [Private Members]


6:55 pm

Photo of Joan CollinsJoan Collins (Dublin South Central, Independents 4 Change)
Link to this: Individually | In context | Oireachtas source

I move:

That Dáil Éireann: notes that:
— in 2013 a decision was made to move the National Maternity Hospital (NMH) from Holles St to the Elm Park site to co-locate with St. Vincent's University Hospital (SVUH), which was to be part of the construction of four new co-located maternity hospitals; and

— this led to a dispute with the St Vincent's Hospital Group (SVHG) who rejected co-location and demanded full ownership of the NMH under SVHG;
further notes that:
— SVHG is a private company owned by the Religious Sisters of Charity (RSC) and a section 38 body fully funded by the State, and the RSC have now set up a new private company, St Vincent's Holdings (SVHs), into which they have said they will transfer their shares in SVHG though this has not yet happened;

— the RSC apparently have Vatican approval for this along with approval from the Irish Catholic Bishops Conference, as under canon law SVUH is the property of the Catholic Church; and

— the construction of the new National Maternity Hospital is currently estimated at a cost of €800 million, with the original estimate in 2013 being €300 million, while the day to day running of the hospital will be fully funded by the Health Service Executive (HSE);
insists that the new National Maternity Hospital is fully owned and controlled by the State and rejects any agreement with SVHG, SVHs or the RSC which does not achieve such State ownership and control of the facility; and

calls on the Government to acquire the Elm Park site through a Compulsory Purchase Order by the HSE with the approval of the Minister for Health.

I am disappointed that the Minister is not present to respond. I mean no disrespect to the Minister of State, Deputy Rabbitte, but the ownership and control of our national maternity hospital is an important issue that has been rumbling on for ten years. There were two Private Members' motions last June, one from Deputy Connolly and the other from the Social Democrats, that called on the Government to ensure the public ownership and operation of the new maternity hospital. The Minister did not oppose those motions.

I thank my personal assistant for assisting me in drawing up and working on this motion. I thank Uplift, which commissioned the legal opinion on the compulsory purchase order, CPO, options for the national maternity hospital and engaged Mr. Stephen Dodd, SC. From the ospidéal campaign, I thank Ms Marie O'Connor, who worked hard to put together the briefing that was emailed to all Deputies yesterday. I also thank Dr. Peter Boylan. All of these people have given of their time and energy to support this motion and the compulsory purchase of the grounds at Elm Park.

I welcome the fact that the Government is not opposing the motion. However, it is not clear whether this means that the Government is in favour of proceeding with a compulsory purchase order, CPO, is keeping a CPO as an option while continuing to negotiate with St. Vincent's Healthcare Group, which I strongly suspect is the case, or is not even contemplating using a CPO.

It is now abundantly clear that the St. Vincent's Healthcare Group has not moved an inch from the position it has adopted since the original proposal to co-locate the new national maternity hospital with St. Vincent's at the Elm Park site. Its position is clear, in that it has rejected co-location and, in effect, demanded that the national maternity hospital be fully integrated into its group. That is what will happen if the State agrees to lease the site under conditions laid down by the group.

We are facing a key test of this State. We should not be in any doubt about what the issues at stake are. St. Vincent's Healthcare Group is a private company owned by the Religious Sisters of Charity, a Catholic religious institution. The Religious Sisters of Charity have set up a new company – St. Vincent's Holdings – into which it intends to transfer its shares in St. Vincent's Healthcare Group. It apparently has approval for this from the Vatican and the Irish Catholic Bishops' Conference but the transfer will only go ahead if it gets its way on the national maternity hospital. It should be noted that, under Canon Law, the assets of the Religious Sisters of Charity constitute church property.

It is not just a question of the State handing over the management of a public hospital, to be built at a cost likely to exceed €1 billion and to be fully funded on a day-to-day basis by the State at a cost of approximately €60 million per year, to a private company. That in itself would be a travesty but there is also the question of the range of services for women that would be provided in such a scenario. The ethos of the Religious Sisters of Charity, St. Vincent's Healthcare Group and St. Vincent's Holdings is clear. Under Canon Law, the assets of the Religious Sisters of Charity are church property and cannot be disposed of without the consent of the Vatican. It is inconceivable that the Vatican would agree to any arrangement that would allow abortions or other services forbidden by Catholic doctrine to take place in a hospital owned by a Catholic successor organisation to the Religious Sisters of Charity and built on land owned by such an organisation. There is not a single hospital anywhere in the world built on Catholic-owned land that allows procedures such as elective sterilisation, IVF, genetic testing, abortion and other procedures that are specifically forbidden by universal Catholic teaching. This would compromise patient safety. The national maternity hospital is to act as a tertiary centre for complicated pregnancies. Miscarriage can occur in up to 20% of pregnancies. Catholic teaching cannot be allowed to compromise the treatment of sepsis, as in the case of Savita Halappanavar.

Despite repealing the eighth amendment and the subsequent legislation, abortion services are limited in this State. Only ten of the 19 maternity hospitals or units provide pregnancy termination and only one in ten GPs provides abortion services. Although the numbers have reduced, women must still travel outside the State. One of the hospitals providing abortions is the current national maternity hospital at Holles Street. This provision would be ended if the hospital came under the control of St. Vincent's Healthcare Group or St. Vincent's Holdings.

The only way out of the mess that the State finds itself in and to achieve co-location for the national maternity hospital with an acute hospital is to CPO the Elm Park site. The campaign group Uplift commissioned legal advice on the pros and cons of a CPO. The advice it received from Mr. Dodd, SC, was that a CPO would have an excellent chance of surviving a legal challenge through the courts. He carried out an extensive review of case law in Ireland and the EU alongside the constitutional issues involved. Articles 40.3.2oand 43 cover issues such as the right to private property, the common good and the rights of religious institutions. Property rights are protected by the Constitution but subject to the common good, provided that the action proposed is appropriate and an important development in the public interest. The building of a maternity hospital to modernise and update healthcare for pregnant women is certainly in the public interest. The State controlling such a hospital and the services it provides is also appropriate. Article 44.2.6oprotects the property of religious institutions against diversion. However, that is subject to necessary works of public utility and on payment of compensation. It is the opinion of Mr. Dodd that the national maternity hospital would clearly constitute works of public utility in the broad sense of the public use. He also believes that a narrow approach to the meaning of "public utility" is unlikely to be adopted by Irish courts.

A legal challenge to the CPO would obviously mean a further delay, but an appeal to the High Court must be exercised within three weeks of the confirmation of the order, and an issue of such public interest would likely be heard quickly. This issue has in, any case, been ongoing for almost ten years. There is very little guarantee of a successful negotiation within the short term.

The minutes of the HSE board meeting on the national maternity hospital, held on 25 June 2021, state:

The issues of concern can be summarised under three objectives in terms of the proposed ethos of the hospital and the service it will provide (on which we understand further discussions are under way), protection of state interest in assets (ownership structure), and especially the proposed ... structures of the hospital.

The HSE board is therefore seriously concerned about this. The HSE board minutes of the meeting of 29 October state:

Discussion around the ownership of the site took place. The Board raised concerns regarding the ultimate ownership of the site which is being provided through long term lease rather than by means of being sold to the state.

We have gone through May 2017, when the then Minister for Health, Deputy Harris, promised we would have a legal framework in the coming month. In 2019 the then Taoiseach, Deputy Varadkar, assured the House that the details of the legal transfer would be resolved over the following weeks. The current Minister for Health, Deputy Stephen Donnelly, gave similar assurances last year when we discussed Private Members' motions and has come out today in a newspaper article saying something similar. This charade came to an end last year when Deputy Varadkar finally admitted the obvious, that is, that the deal is potentially fundamentally and fatally flawed. Will we have to wait another ten years before we see a national maternity hospital built on public land and in public ownership?

I call on the Government to act now. This has gone on too long. The way the Sisters of Charity are dealing with it, it will go on a lot longer. I call on the Minister to move to obtain legal advice on behalf of the Government and the HSE on acquiring the site through CPO without any further delay. The women of Ireland deserve better. We have debated this issue over recent weeks. This is about our health rights and our legal rights. It must be dealt with and cannot go on any longer. If the Government were to impose a CPO on the site, if the Sisters of Charity are not pushed about this and if land ownership is not the issue, they would welcome that move and negotiate with the Government on it. We have to move on it.

7:05 pm

Photo of Marian HarkinMarian Harkin (Sligo-Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

Tonight the House is saying for the third time that the new national maternity hospital must be fully owned and controlled by the State and that it rejects any agreement with St. Vincent's Healthcare Group, St. Vincent's Holdings or the Religious Sisters of Charity, RSC, which does not achieve such State ownership and control of the facility. Deputy Joan Collins has said the Government will not oppose this motion, and I will be pleased if that happens. However, not opposing something and taking action are two very different things, and tonight we are asking that action is taken.

Last June, after the previous debate in this House or around that time, I tabled a written question to the Minister, Deputy Stephen Donnelly, to ask him if the proposed national maternity hospital would be in public ownership. In his response he talks about planning permission, etc., but then goes on to state, "The ownership and governance arrangements are more complex." That sentence alone raises all kinds of issues. He then goes on to refer to the Mulvey agreement and what it does and to the draft legal framework put in place. He finishes by stating:

I have been very clear that I will not bring anything to Government unless it provides assurances around all legally permissible services being provided in the new ... [national maternity hospital].

He further states:

In that context, as I have recently stated, I intend to engage further with both St Vincent's Healthcare Group and the Religious Sisters of Charity, as we move toward the finalisation of the arrangements.

That is the kicker. If the Minister were satisfied with the legal position, he would not need any further engagement. I apologise for reading that out in detail, but it matters very much because those are the Minister's own words. As I said, he starts his answer by saying the governance and ownership arrangements are more complex and finishes by saying he intends to have further engagement. Where, precisely, are we now in this process of further engagement? Have we the assurances and guarantees to which the Minister referred?

This has gone on far too long. In the final analysis, the national maternity hospital must be in public ownership, a 100% publicly owned hospital - no ifs, no buts, no maybes and no "complex" situations. This whole debate has nothing to do with any argument about services; it is simply that the women of Ireland, the people of Ireland, must have full and unequivocal access to all legally permissible services. We should not even be talking about it here. This should be an absolute given. We are all waiting to see how this will happen. I support the motion. I supported the other two motions. It is past time we dealt with this matter. On 23 June this House passed a motion calling for the new maternity hospital to be fully owned and governed by the State. Tonight we are again delivering a very simple message: we need a publicly owned, publicly funded and publicly run national maternity hospital. While I am glad to see the Minister of State here and I know she is listening carefully to us and is fully engaged, the Minister for Health, as Deputy Joan Collins said, has responsibility for this. He should be here. This is the third time we have had to debate this in this House. This should not be happening. We should have the clarity we need. The Minister should not be hiding behind the "complexity" of the situation. I know that the Minister of State will deliver this message loud and clear to the Minister.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
Link to this: Individually | In context | Oireachtas source

I thank my colleague, Deputy Joan Collins, for bringing forward this very important motion on the ownership of the proposed new national maternity hospital. I welcome the fact that the Government will not oppose this motion calling for the compulsory purchase of the site. I take this opportunity, however, to strongly urge the Government to change its position and to acquire the national maternity hospital site by CPO as soon as possible. It is one thing not to oppose a motion; it is another thing to actually do something to make it a possibility. I know, if I may say so, that if it were up to the Minister of State who is here, this would be done, but the Minister, by not being here, shows what is likely to happen.

Hospitals should be state-owned and state-operated. We have to end the constant privatisation of our services. The new national maternity hospital is being constructed with public money. It will be built on publicly owned land. It must be in public ownership. It is our money so it must be our hospital. It poses the question why the State would invest €800 million of public money in a new national maternity hospital and not establish who owns the site. I know that this Government would love to privatise all services in the country in order that it would no longer be accountable for anything, but when we hand over leases to outside bodies and let them run our essential services, we give over control over how they are run and what services are provided. We have seen time and time again the failure of private bodies to provide adequately the services we need in this country. When it comes to healthcare, we run the risk of allowing other bodies to decide to be selective as to which healthcare services will be offered.

That is completely unacceptable. I have very serious concerns about who the hospital will be leased to and I am completely opposed to the suggestion of it being leased to the St. Vincent's Healthcare Group or to any other religious or private group. The possibility of the Catholic ethos overriding legislation is very concerning. I cannot stress enough that the church has no place in women's healthcare. We have given the Catholic Church in this country far too much control for far too long. We can no longer allow it to have a say in our healthcare or in anything else. This country has experienced enough pain at the hands of the Catholic Church. Such an agreement would only be a step backwards. Women, in particular, have suffered enough and the church still has much to answer for regarding the violence it perpetrated against women and the decades of hurt and shame that it created.

Despite the fact that the St. Vincent's Healthcare Group has stated that there will be no religious or Vatican influence, we know well that should it be given the lease for this hospital, it will not provide full healthcare to women. We know this because out of the many hospitals on land owned by the Catholic Church throughout the world, there is not a single one that provides abortion services. The church not only opposes the provision of abortion services, but it also opposes the provision of the likes of IVF and surrogacy services. Dr. Peter Boylan, the former master of the National Maternity Hospital, posed a question. He stated: "Give me just one example, anywhere in the world, of a hospital built on Catholic-owned land that provides abortions, IVF and gender reassignment surgery and other procedures absolutely prohibited worldwide by the Church's universal healthcare directives?" I pose the same question. Four years after posing that question, Dr. Boylan is still waiting for an answer. Why? It is because no such hospital exists.

To not provide these services would deny women the full and safe access to healthcare that they are entitled to in this country. No religious ethos must be allowed to interfere in the medical decisions made by our doctors and by women in respect of their own bodies. This country decided that those days were well over when we voted to repeal the eighth amendment in 2018. I urge the Government not to put us back to a time when women did not have those reproductive rights.

We still have a very long way to go when it comes to women's healthcare in this country and we continue to fail women every single day. We need to be taking further steps to ensure that women's healthcare is prioritised and not overlooked. We cannot afford to let things continue the way they are going now. Certainly, we cannot allow ourselves to take any backward steps. Catholic misogyny and religious control no longer have a place in this country and we cannot allow them to have any future place in this country. Only full public ownership and governance can guarantee a full service of reproductive healthcare. I cannot stress enough that the new national maternity hospital must be public and secular. That is what this motion intends to deliver.

7:15 pm

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I wish to thank the Deputies for raising this important issue regarding the national maternity hospital. It is important to put on the record that I am speaking on behalf of the Minister for Health, Deputy Stephen Donnelly, who, I am told, is currently meeting with NPHET. The Government will not be opposing the motion.

I think it is fair to say that every Member of this House shares the same goal, that is, the delivery of the best possible healthcare for women and babies. This Government has set out its stall in that regard by committing to improving women's healthcare across the board. This year, building on funding provided in 2021, we are providing significant investment in services, and continuing our focus to implement the national maternity strategy. That strategy sets out a vision for future maternity services, where women are treated with dignity and respect in an appropriate physical environment. Linked to this point, the practice of having stand-alone maternity hospitals, as is the case in four of our maternity services, does not reflect best international practice. Ensuring that mothers and babies have access to the full range of medical and support services, should the need arise, is of paramount importance. It is widely accepted that the best way to achieve this is to co-locate maternity services with adult acute services. That is why it is Government policy, as reiterated in the national maternity strategy, to co-locate the remaining stand-alone maternity hospitals with adult acute hospitals.

It is acknowledged that the buildings at Holles Street are no longer fit for purpose. The new national maternity hospital is planned to be the first of the four remaining stand-alone maternity hospitals to be co-located. The new hospital is a vital piece of infrastructure, and one that will help underpin the development of maternity services and the implementation of the national maternity strategy into the future. As has been stated by the Minister for Health on numerous occasions, the Government is committed to the development of the new national maternity hospital, as set out in the programme for Government. That being said, the Government is also very aware of concerns voiced regarding the new hospital. As set out in the motion we are discussing, those concerns centre on the ownership and clinical independence of the new hospital, and today's motion reflects that in calling for a compulsory purchase order of the site for the new hospital.

When it comes to the new national maternity hospital, howsoever achieved, we all ultimately want the same outcome, which is to ensure that all legally permissible services are provided in the new hospital. This is an absolute requirement. We must also ensure that the State's significant investment in the facility is protected. The Government understands the concerns regarding ownership and governance, and recognises that they must be addressed. It is important to note that significant work has been undertaken in this regard. This includes the appointment of Kieran Mulvey, by the Minister for Health in 2016, to intercede between the hospitals. The resulting Mulvey agreement was finalised following an extensive mediation process between the National Maternity Hospital and the St. Vincent's Healthcare Group. The agreement was subsequently published and noted by Government in 2017. The Mulvey agreement provides for the establishment of a new company which will have clinical and operational, as well as financial and budgetary, independence in the provision of health services.

Following on from the Mulvey agreement, a draft legal framework has been developed which aims to copper-fasten these arrangements. In doing so, the legal framework will also address the State's core objectives which are as follows: to ensure that all clinically appropriate services that are legally permissible are provided for women who need them in the new national maternity hospital; to prevent any undue influence, religious or otherwise, in the operation of the new hospital; and to protect the State's investment in relation to capital, revenue and service provision at the new hospital for the public good.

As to the draft legal framework, as I understand it, there has been further engagement with stakeholders, and this process will continue as we work towards the finalisation of these legal arrangements. However, as the Minister for Health has previously said, he will not be making any further comment on the nature of this engagement until it concludes. What I can say definitely is that the Minister for Health has been very clear that he will not be bringing any proposal to Government regarding the new national maternity hospital unless it provides assurances around all legally permissible services being provided in the new hospital, as well as affirming that the State's investment is safeguarded.

Concerns continue to circulate regarding the potential involvement of the Religious Sisters of Charity in the new national maternity hospital. As such, the Minister for Health wishes to make it absolutely and unambiguously clear that the Sisters of Charity will not play any role in the governance or operation of our new national maternity hospital. I am advised that the Sisters of Charity has resigned from the St. Vincent's Healthcare Group board and its shareholding is to be transferred to a new charitable entity, St. Vincent's Holdings CLG. Under the terms of the service level agreement, St. Vincent's Healthcare Group requires the consent of the HSE to the share transfer. This consent has been sought by the St. Vincent's Healthcare Group and it is anticipated that this matter will be addressed in the context of the finalisation of the draft legal framework.

Let me restate that we all want the very best of care for the women and babies of this country and we want to see them treated in the best possible environments. The planned move of the National Maternity Hospital to the Elm Park campus is a key part of achieving that aim and providing the state-of-the-art facilities that women not only need, but deserve. Therefore, I would ask all Members of the House to support the Government in its continued commitment to women's health and progressing the necessary relocation of the National Maternity Hospital to an appropriate physical environment, as envisaged in the national maternity strategy. This Government's commitment to the new national maternity hospital falls very much in line with our broader commitment to delivering better health outcomes for the women of Ireland.

As demonstrated in the previous two budgets, we are investing significant funding in women's health services to ensure improvements are made and outcomes for people using the services are enhanced. This commitment is reflected in budget 2022, for example, in the allocation of €31 million for new development funding to specifically support women's health. This includes significant investment to further progress the implementation of the national maternity strategy and gynaecology service developments as well as a further €5 million for a dedicated women's health fund.

In keeping with the Government's focus on women's health, we must redouble our efforts to bring the national maternity hospital project to the next phase but with all of the necessary assurances on the services to be provided for women. Doing so will help us to provide the necessary infrastructure and environment to realise our common goal, which is woman-centred, modern, safe and quality healthcare for women and their families that is delivered with compassion, dignity and respect.

7:25 pm

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

There comes a point where words fail me. The Minister of State is in an extremely difficult position. Let me say openly that it is totally unacceptable that the Minister, Deputy Donnelly, is not here and that she has had to read out this speech, which is an insult to the women of Ireland. I will speak strongly on what I have heard, and that somebody would write a speech for the Minister of State to read out calling on all Members to support the Government in its continued commitment to women's health. I will try to remain calm on this.

This is the third motion in seven months. The Government has accepted each motion. I am not sure whether the Government is able to read or understand what these motions call for. Perhaps they are nuanced. They call for the new national maternity hospital to be publicly owned and operated on a site owned by the State. It is crystal clear. If the Minister of State agrees to this then we need a speech that deals with it. I will not personalise this. I have seen the Minister of State work extremely hard along with her colleague, Deputy Butler, and I have paid tribute to her. In this case, when it comes to reading out this speech, there comes a point in the life of a Minister of State to say that something is simply not acceptable.

This is the third motion on this topic. We have a choice here. It might be better if each of us stood in silence for ten minutes. It might be a more effective way to get through to the Government on the democratic process. All the Dáil is unanimously stating the State should own the national maternity hospital and own the site. The Minister has not shown up tonight and a speech such as this was written in a week that we have focused on the tragic and unacceptable death of Ashling Murphy. We have had statements on how unequally women have been treated in our society during which each and every Deputy has spoken. I want to stay away from politicising it. It is in the context of the debate on inequality. Today we debated legislation on access to records. Once again it is slow and we are still not emerging from the patriarchy. The Adoption Act 1952 was closed and secretive and it is beginning to open up.

The national maternity hospital has been on the cards since 2008 following a KPMG report. We then had the 2013 announcement by the then Minister, James Reilly, on co-location. For a civil servant or somebody to write a speech for the Minister of State giving us a lecture on the importance of co-location is insulting and unacceptable. The decision on co-location was accepted by all governments and Deputies from 2013 onwards. What is not accepted are the Byzantine Kafkaesque arrangements going on behind the scenes on religious ethos. The nuns might be gone but not those believing in the philosophy of Mary Aikenhead. Fair play to them; I have no problem with that as long as it is not being imposed on a public hospital. This is the difficulty.

From when the then Minister, James Reilly, announced it in 2013 until today we have had all sorts of suggestions, including that the nuns were gifting it to the people of Ireland. It is some gift. We then had a 999-year lease, a 99-year lease and now a 299-year lease. We speak about operating licences. We speak about St. Vincent's holding group, the health group and the designated activity company Byzantine does not cover it. I will try to stick with a simple message because I know where the Minister of State's heart is but I would like to know what her views are on this. Who will stand up and make language mean something? A national maternity hospital has to be owned by the State for the men and women of Ireland in future generations. There is no going back on this.

We have had four male Ministers. That is fine but we have had different messages from each of them in turn. I cannot remember what James Reilly said when he was Minister. When Deputy Harris was Minister he said we would have a public hospital on a site that was leased. When the Tánaiste was the Minister he said we would have a public hospital on a public site. Instead of going forward on that, we now have the Minister, Deputy Donnelly, who cannot be here tonight giving us reassurances. I do not want reassurances as a female Deputy. I am sure my colleagues who are male do not want reassurances. We want a public hospital on public land. If we go back to the gift from the nuns let us make it a reality.

I am looking at this period in women's lives and the parallel efforts, deaths and suffering that led to the national maternity strategy that is being boasted about. The strategy came 100 years after the 1916 Proclamation. It was forced on the deaths and suffering of women. We have had Portlaoise, Portiuncula and Savita Halappanavar in my city. We have had report after report highlighting the inadequacy of maternity services throughout the country, notwithstanding the wonderful staff. Let us not do this. I am not giving out about staff; I am giving out about the lack of resources and the lack of commitment and services run on a charity basis.

We look at all of this and what have we achieved? We are here getting reassurances. Out there while we are in here, another secret deal will be negotiated, notwithstanding the overwhelming demand from people in Ireland as demonstrated by those who protested in Dublin, the constant representations we get and the fantastic work of Dr. Boylan, Marie O'Connor and many others. There is also Uplift, which paid for and organised a senior counsel's opinion. There is no reference to it in the speech from whoever wrote it. I would love to know whether the Minister wrote it. If he did, I would like him to be in here to stand over it. It is an opinion and other opinions can be sought but I would like to hear whether the Department got other opinions on it.

Uplift commissioned an opinion on our behalf. It points out there are possible obstacles to a compulsory purchase order but they can be overcome. At the end of the day it comes down on the side of there being no obstacle. It is quite possible under the Constitution to use a compulsory purchase order on the land if necessary. The only thing I have ever heard from the Tánaiste on this is that it would delay the project unnecessarily. I stand here and ask all of the other Deputies to confirm that we do not mind a delay. We do not want a delay and a delay is unacceptable but if that is the strongest reason the Tánaiste can come up with for not using a compulsory purchase order on the site, it is totally unacceptable.

A compulsory purchase order would put it up to the entities involved. It is worthy of a mystery novel at this stage with the number of entities out there for a public national maternity hospital. A compulsory purchase order would not be necessary if these entities agree. All we want is for the Government of the day to listen to the overwhelming voices of the people in the Dáil on behalf of the people of Ireland who say enough is enough.

We have said that in other contexts this week, on gender and domestic violence, the fundamental right of access to records without hurdles and various steps from a patriarchal society or management which thinks it knows best. The Minister of State knows enough is enough. We are speaking of a national maternity hospital.

We are more than halfway through the national maternity strategy, Creating A Better Future Together 2016 – 2026. An implementation plan was only published just before Christmas as a consequence of pressure from the Dáil and a motion I and others introduced on the implementation of the strategy. When we talk about a strategy, one has to ask how it is being implemented. The Health Information and Quality Authority, HIQA, did a report in 2020 on it which stated that progress was slow, patchy or absent and nobody knew who they were reporting to. This is the strategy being crowed about in this debate.

Chun deireadh a chur le mo chúpla focal, tá mo dhóthain agam. Tá sé thar am beart a dhéanamh de réir ár mbriathar agus brí a thabhairt d’fhocail agus don chóras daonlathais.

7:35 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I commend the proposers of the motion and thank them for giving us the opportunity, for a third time, to discuss and debate this important issue in the Chamber. I have debated and discussed this issue with the Minister for Health at the Joint Committee on Health a number of times. I have had private conversations with him by telephone and we have had discussions and debates in the Dáil Chamber as well. I concur with Deputy Connolly that it is completely unacceptable that the Minister is not here. I will always give fair dues to a Minister because there may be a good reason not to attend the House but from listening to the Minister of State, the Minister's rationale for not being here is that he is still involved in discussions on this issue. That is not an acceptable excuse for his absence.

The question of ownership of the national maternity hospital is very important. It matters and it is vital that we get it right. For this reason, I will support this motion. There is no justification for leaving the ownership and governance structures in the hands of a private company when the State is making the investment and will be paying the bills. I imagine many women listening to this debate and, I hope, a majority of men will be saying that this is another case of déjà vuin terms of how the State sees, values and treats women and with respect to the lens through which the State and public healthcare system views women’s healthcare. There can be no justification for the State building a maternity hospital that it is does not own or for the convoluted governance structure for the hospital when many people are asking serious questions about potential interference in healthcare, including women’s healthcare in maternity services. These are deeply held and legitimate concerns being raised by many people.

I have two primary concerns about the current proposal for ownership of the site. First, the State’s investment must be safeguarded. This project is going to cost hundreds of millions of euro. It is not radical to ask that the State would own the hospital once it is built. It is reckless to proceed with building a hospital when the State will not own the land at the end of the process. Far from this being a radical proposal by members of the Opposition, it is a sensible one that is about safeguarding the investment of the taxpayer. Without doubt, the more significant concern is the potential for interference in the running of the hospital. There are good reasons for that concern based on the history of this State when it comes to how it treats women and women’s healthcare. I do not have to remind the Minister of State of the many failings and issues, even in more recent times, where women were failed in the Irish healthcare system.

To avoid any potential complications which could arise for any number of reasons, the full ownership of the site by the State is in the best interests of women and the people of this State. This is a principle which must underpin public expenditure on major capital projects, particularly in healthcare, where organisations with a religious ethos are involved.

As I said, I have discussed this issue privately with the Minister. I and members of my party have raised it a number of times in the Dáil and at Oireachtas committee meetings. An Teachta O'Reilly raised it when the Minister for Health was in opposition raising concerns very similar to those the Opposition is now raising. The Minister for Health seems to be taking a different position now that he is in government and a Minister from the position he strongly articulated when he was an Opposition health spokesperson.

In the past number of months and again this evening in the written script delivered by the Minister of State in the Chamber, the Minister for Health has given us some assurances, as he would see it, regarding protections against any interference in the management and running of the new national maternity hospital. It has to be said that those assurances are simply not good enough and many people simply do not believe them. I do not need to remind the Minister or the Minister of State of the importance of ensuring there is no religious interference in the running of any maternity hospital. The reasons for that are obvious. The guarantees the Minister has given us are not sufficient for us to back him. Like the previous speaker, I will not support the Government's approach to this matter unless I see a fundamental shift.

There are fundamental issues with the proposed arrangements. This mess dates back a number of years and the periods in which Dr. James Reilly, the current Tánaiste and the current Minister, Deputy Harris, were Ministers for Health, yet the controversy has trundled on unresolved. This is a mess of Fine Gael’s making and that party must take ownership of it.

This issue comes down to two simple facts. The taxpayer is paying for it and I have yet to be convinced that there is no potential for healthcare services which are entirely legal in this State to be curtailed on non-medical grounds. I do not doubt for one minute the ability of clinicians in St. Vincent’s University Hospital or in the National Maternity Hospital, Holles Street, in their determination to deliver the high-quality services their patients need. I have listened to many in those hospitals and read newspaper articles and letters to the editor submitted to national newspapers by people who work in those hospitals in which they have also set out assurances. I do not doubt the effectiveness of the voluntary public hospital model, from St. Vincent’s and Holles Street hospitals to St. James's Hospital and Children’s Health Ireland, because this governance model has served us well. In fact, I would argue that it should be a model used to roll out regional health areas because of the accountable autonomy nature of voluntary hospitals. I do not doubt the sincerity of the people who work in the system and of those who work in any of the maternity hospitals. However, their ability to deliver top class healthcare is not what concerns me. I have every confidence that they can deliver the best healthcare. It is the behind-the-scenes politics, which could infringe on women’s healthcare, the rights of women and the future of maternity services, that concerns me.

The last time we had a debate of this matter was shortly after the St. Vincent’s Healthcare Group stated the land could not be gifted or sold to the State because it would disrupt integrated patient care on the site. I did not buy that then and I still do not buy it. Similar arrangements are in place for the Mater and Rotunda hospitals, two different hospitals on two different sites which have a relationship. It can, therefore, be done.

I am looking at the script of the Minister of State in which she stated that concerns continue to circulate regarding the potential involvement of the Religious Sisters of Charity in the new national maternity hospital. The script goes on to say that the Minister for Health wishes to make it absolutely and unambiguously clear that the sisters will not play any role in the governance or operation of the new national maternity hospital. It refers to the sisters resigning from the board and transferring their shareholding to a new charitable entity, St. Vincent's Holdings CLG. With all due respect, why are the Religious Sisters of Charity going down such a convoluted road? If they are genuine and sincere about relinquishing all control, why not simply gift the land to the State? Then there would be no issue. There would be no need for a compulsory purchase order or to set up this convoluted structure where there is a distant relationship between the management of the hospital and the HSE and the State. Indeed, it would resolve the ownership issues.

That is why there is suspicion. It does not make sense that, on the one hand, the Religious Sisters of Charity are saying the order will not have any role, does not want to have any say and essentially is gifting the land to the State but, on the other hand, the sisters are going to do it through this convoluted process of setting up this charitable group rather than, as most reasonable people would want, the land being gifted to the State. I am not convinced by anything I heard from the Minister on the last occasion we debated this issue at the Oireachtas health committee, in any private conversations I have had with him or in this Chamber. It is regrettable that, in a week when women's rights, women's healthcare and the safety of women were tragically brought into sharp focus, the Minister is not here for this debate, given the seriousness of the issue.

7:45 pm

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

There are two reasons I wished to make a small contribution to this debate. One is to state that I absolutely accept that we need a new maternity hospital. We needed one in 1995 when my daughter was born in Holles Street. Indeed, I well recall being wheeled back from the labour ward and the bed being still warm because the woman ahead of me had just vacated it. My grandson was also born in Holles Street and we certainly needed one in 2015, so I accept that we need a new national maternity hospital. We want it to be built. We understand co-location. With the greatest respect, explaining it to us is not necessary. We understand why it is important.

However, the main reason I want to speak this evening is to recall Sheila Hodgers. Sheila died in 1983, in a hospital run by an organisation known as the Medical Missionaries of Mary. Both she and her baby died. We can debate this all day, but I can say with my hand on my heart that it was the ethos in that hospital that contributed significantly to her death in her 20s and to the death of her baby. She died in agony. She had been denied pain relief for fear that it would in some way harm a pregnancy that was not viable. Her husband, Brendan, who I know well as he is a former colleague of my father, recalls going to see her in the hospital and seeing her screaming in agony. She could not get pain relief. I know what caused that, and the Minister of State knows as well. I echo what was said, that it is regrettable that the Minister for Health is not present. It speaks volumes to anybody who wants to listen, and I do not mean that in a disrespectful way to the Minister of State. I thank her for being here and for her words. I respect that the script she was given is the one she has delivered, but she will also understand that those words will be cold comfort to anyone who remembers Sheila Hodgers.

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

It is difficult to follow Deputy O'Reilly talking about somebody who died in that way. However, I thank Deputies Joan Collins and Pringle for bringing this motion forward. It is not the first time we have debated this topic but I hope it will be the last. I am aware that the Minister of State is taking this debate instead of the Minister, Deputy Stephen Donnelly.

The new national maternity hospital is yet another hospital building project on which there is gross overspending. The construction costs are currently estimated at €800 million. The original estimate in 2013 was €300 million. It is now heading for three times the original estimated cost. I am not naive and I understand that the cost of materials is rising but this is ridiculous.

We must insist that the new maternity hospital is fully owned and controlled by the State and reject any agreement that does not achieve State ownership and control of the facility. It is necessary for the Government to acquire the Elm Park site through a compulsory purchase order by the HSE with the approval of the Minister for Health. There are real concerns about the ownership of the site, as well as about the hospital governance. Everybody would accept that we do not want any outside influence or interference in the running of any hospital, but especially not the national maternity hospital. The best option would be for the Religious Sisters of Charity to gift the land to the State. They are saying this is essentially what is being done with the establishment of an independent private charity. Deputy Cullinane referred to this too.

The new national maternity hospital must be built as quickly as possible. It is already seven years behind schedule. It would be better to have a public hospital built on public land and governed by the State but, unfortunately, this Government does not do planning very well. The Government must engage extensively with the Religious Sisters of Charity and the St. Vincent's Healthcare Group to find a solution. All options must be on the table.

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

There appears to be an endless saga with the new national maternity hospital as it continues its long, involved journey to completion. It has been beset by a series of incidents from its conception almost ten years ago, when it was planned to relocate the hospital from its current location on the Holles Street campus to a new site. The story of the National Maternity Hospital is one of a project long in planning but beset by delays, complications and justified concerns about its governance and ownership. That has stalled progress on the project for years. Experienced mediators have been brought in to try to find a way through the muddle and put the project on a clear path to completion.

Adding to the concerns about governance arrangements at the hospital is the eye-watering escalation in the cost of its construction. The project was originally to have cost approximately €150 million. The cost of the building infrastructure is now being put at €500 million with an added cost of €300 million for commissioning costs, which are to include the fit-out and transferring the hospital to a new site. All told, the cost of the hospital has gone from the original target of €150 million to €800 million.

The site is to be transferred to a charitable entity called St. Vincent's Holdings. This has raised concerns about the potential for a Catholic ethos governing the hospital, which could inhibit the new hospital carrying out procedures that are contrary to Catholic teaching. It is reasonable to argue that it should be owned by the State to protect and maintain the hospital's secular ethos. The Government has to protect its investment and it must be able to justify the expenditure of such enormous sums of public money on this major project by ensuring that the hospital's administration, operation and oversight reflect both the values and inclusiveness of a secular State body. To do any less could potentially lead to unfair and prejudicial treatment of people as well as creating a hierarchy of patients. We cannot allow this to happen. We cannot allow one viewpoint based on a religious ethos to supersede that of a secular State. The Government must ensure that this never happens.

Photo of Chris AndrewsChris Andrews (Dublin Bay South, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I commend the Independent Group on tabling this motion. The ownership and governance of the new national maternity hospital are issues of national importance. They are also of great local interest to the community in Dublin Bay South. For decades the National Maternity Hospital has been based in Holles Street, in the heart of inner city Dublin. The local community has an enormous sense of connection to the hospital. Many in the community took their first breath in that hospital, and I am one of them. A large number of people from the community either work there or have members of their family working there. From talking to these people I have heard first-hand accounts of the difficulties staff are facing. It is a very tight site in which they are trying to run a big operation.

There is an urgent need for a new and more modern building to give staff and mothers the support they need. The new national maternity hospital will be based not far from Holles Street on the Elm Park campus of St. Vincent's University Hospital. This new maternity hospital will be a costly investment for the State and see the provision of state-of-the-art equipment and a much-needed modernised building. However, this process cannot be rushed through and we must ensure this large-scale State investment is protected from outside interference. The best safeguard of all is to ensure the full public ownership of this new maternity hospital.

There are many people deeply concerned about potential interference by religious orders at this new maternity hospital. Concerns that the governance and religious ethos of St. Vincent's could limit the procedures at the new site are understandable. Safeguards must be put in place to ensure patients can freely access the treatments they require. The possibility that organisations separate to the State might interfere to prevent certain treatments cannot be allowed. The State must guarantee that any lawful service the hospital is expected to provide will not be restricted on any non-medical grounds, and the best guarantee of all would be full public ownership of the new national maternity hospital.

7:55 pm

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour)
Link to this: Individually | In context | Oireachtas source

I commend Deputies Joan Collins and Pringle and the Independent Group on moving this motion. I will start by saying the practice of the Government not opposing motions is starting to wear a little thin. The motion is not being opposed but that is not because the Government agrees with it. Sometimes a motion comes to the House and the Government, understandably, does not oppose it because it might be a motherhood and apple pie motion. This motion, however, calls for something specific and it is very clear the Government does not support it. I refer to the compulsory purchase order for the land, because the Government is not going down that road. By not saying it or putting this to a vote, necessitating voting against it as is its position, it is a dishonest way of putting forward that Government position.

This really must stop. Perhaps the Government wants to save its backbenchers a difficult weekend or longer in their constituencies. It may be a product of the culture of using screenshots of voting on social media, and maybe that is something for which we should all take responsibility in how we practise our politics. It is not right with a motion like this because the Government does not support it or agree with it. The Government did not agree with the Social Democrats or Sinn Féin motion on it, it did not agree with Deputy Kelly on the matter when he raised it during Leaders' Questions, and it did not agree with Deputy Bacik when she raised the topic during one of her first contributions in the Dáil. She made contribution during Leaders' Questions and the Tánaiste, Deputy Varadkar, responded. The Government does not agree with the motion and it should be honest about it and stand over its position. It should be honest with the people and give the Parliament the respect it deserves on a matter of such importance.

Going back to last summer, in June an all-party motion was agreed and the Government allowed it to go through. In his response to Deputy Bacik, the Tánaiste said we needed to move ahead on this and there would be a delay with a compulsory purchase order. He argued that a compulsory purchase order process was not guaranteed either and we should not let perfection be the enemy of the good. Sometimes the good is not good enough, however, and that is what we have here. Nobody has convinced anybody in this House, including people on the Government benches, that the new national maternity hospital will be free from religious ethos, whether that is in the termination of pregnancies, assisted human reproduction or IVF treatment. No guarantees have been given on that. We cannot even get guarantees there will not be religious iconography on the walls, as there currently is in the National Maternity Hospital not a couple of hundred yards from where we are now.

This is not an idle motion but rather the exact opposite. This has been going on for ten years, particularly for the five years since Deputy Harris was Minister for Health when this really became a live issue, with decisions having to be made. It has been clear the Government is going down the path of least resistance, taking a gamble at a time when we are four years on from repealing the eighth amendment and we still have women having to travel.

There is an assisted human reproduction Bill that is going nowhere. The general scheme was published nearly five years ago now and a draft Bill apparently has been somewhere in the Department for the past three years but it has not been brought to this House. There are people all over this country waiting for that Bill. They are people waiting for surrogacy, gay couples and widows with the gametes of their deceased partners, which is all they have left and which are in the freezers of private fertility clinics. These people are waiting for guiding legislation on what can be done. These are the harrowing stories we hear day in and day out from people waiting for legislation relating to women's health. It is interlinked and almost crystallised in this debate about the national maternity hospital. It is really annoying that this happens again and again when the matter comes before the House.

This motion has been debated in an intelligent and even-tempered manner, like previous motions and contributions on the matter. I believe there is a critical mass within the Government that knows this is the right thing to do. The Government is not doing it, however, and it is going with the good over the perfect. It is taking a massive risk. Quite simply, it is a very basic ask in having a State-owned and run national maternity hospital in 21st century Ireland and that we cannot guarantee it is a sad indictment of how far we still have to go. This debate would not be happening in any of our sister democracies in Europe. We would not have such a debate once, never mind multiple times over recent years.

Even the clinicians in favour of the move to Elm Park know they cannot provide these guarantees. They are pragmatists, however, and may be non-political. They just want to get on with it but they know they cannot provide those guarantees. They have said it to us. There is this sense of the unknown and risk but there does not have to be. We could follow what this and other motions from the Opposition have called for consistently, intelligently, passionately but in a calm manner. We want to go to a process of compulsory purchase order, and although it would be disappointing and difficult if it delayed the project, we would ultimately get a national maternity hospital suited to the majority of people in this country in terms of their politics, women's healthcare and what they need and desire in the years ahead.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

At the outset I commend Deputies Joan Collins and Pringle on bringing forward this motion. It is a very good and timely motion because we have been waiting many years for movement on a new national maternity hospital. This was first announced in 2013 and there have been three Ministers for Health since. Issues started to arise in 2016 and I have lost count of the number of parliamentary questions I have asked and the number of Dáil debates that have taken place on this. Every time a parliamentary question is put in and we ask for the updated position on the proposed new hospital, we are told legal documents are being finalised and will be completed shortly. That has been the reply for approximately five or six years.

The Government got itself on a hook when it decided it would co-locate the new national maternity hospital with St. Vincent's University Hospital. It did so not taking into account the question of ethos, with a hospital essentially controlled and many of us would say owned by a religious order. There will clearly be a major problem relating to ethos and the curtailment of services available under the law in this country. They are unlikely to be available in a religious hospital. No Catholic hospital in the world provides the full range of women's healthcare services and there is no reason to think Ireland is going to break the mould in that respect. It just will not happen and that is the reality. That is the first concern.

One must ask why on earth, in 2022, this is happening. Consider all of the difficulties in the past where responsibility was outsourced to the religious for schools, care facilities and healthcare, and all of the attendant difficulties associated with that, and that the State funded all of these services and facilities and has no way now of taking ownership of them. Given all of those problems and all of the problems associated with the kind of control that the religious too often exercised over women and children in this State, why in heaven's name would the Government, of all types of hospitals, fund and hand over our national maternity hospital to religious control? It is outrageous when one thinks about it.

The Government commissioned its own report, the Dr. Catherine Day report, which looked at all of these issues relating to section 38 and section 39 organisations and the handover of vast amounts of public infrastructure to religious orders. Dr. Day found that State-funded facilities should, of course, be in State ownership. It is only a couple of years since the Dr. Catherine Day report came out but the Government is ignoring its own commissioned report. There is no doubt that if this arrangement, as currently proposed by the Government, goes ahead there will be severe restrictions on the services that are available to women. Even though this is denied we are aware that up to the last year so - it may well still be the case - there are plenty of examples where the St. Vincent's Healthcare Group has advertised for staff. There is a requirement to follow the religious ethos of the owners of that hospital. That is the first point. I really believe that the Government and successive Ministers have been in complete denial about this. A lot of new information is coming to light in recent times. Ms Marie O'Connor in particular has done extensive work on this, where it is quite clear that the constitution and the operational values of the hospital are intended to be based on the original values and ethos of the Religious Sisters of Charity, who have been running St. Vincent's Hospital for so long. It is beyond argument that this would be the case.

On the principle of it, why would the State fund a hospital to the tune of €800 million and hand it over to a religious organisation? There is no logical justification, on any grounds, for that. From the taxpayers' perspective, why would the State invest in a major piece of public infrastructure in the shape of a national maternity hospital, plough €800 million into that and hand it away or give it away to private interests? Why would one do that? It shows a complete disregard for the need to protect the public purse. Why are we repeating the mistakes of the past? It does not make sense on any grounds.

It seems that the Minister does not understand the corporate structure entailed in this proposal, or he is just choosing to ignore it. The corporate structure is about St. Vincent's, which is wholly owned by the Religious Sisters of Charity. It is wholly owned by them at the moment. They are proposing to transfer their shareholding into a holding company. That holding company does not exist yet, but we were told some years ago that this is what would happen. It is proposed that this holding company would then own the new national maternity hospital which would be the national maternity hospital company, DAC. We would have a situation whereby the ground on which the new hospital is to be built would be owned by the St. Vincent's holding company and the company operating the hospital would be a wholly-owned subsidiary of the St. Vincent's holding company. It would transfer - in its entirety it would appear - to the ownership of the St. Vincent's Hospital holding company. This just does not make sense on any level whatsoever.

There is a requirement for a business case - or three business cases - under the public spending code. Those business cases have not yet been prepared. There is a difficulty in preparing them because this does not stack up financially. The HSE's own audit and risk committee has turned down this proposal on six different occasions. This proposal stinks on a number of fronts. It cannot be proceeded with. It would be a dereliction of the duty of this Government, in ethical terms and in financial probity terms. It cannot go ahead.

8:05 pm

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
Link to this: Individually | In context | Oireachtas source

Ten years ago Savita Halappanavar died in an Irish hospital. Four years ago, the Irish people voted overwhelmingly for change. The Government, however, seems to be very slow to get the message. Half of Ireland's maternity hospitals still do not provide abortion services and just one in ten GPs provide abortion services, but the situation with this proposed new national maternity hospital takes the biscuit. Will the Minister clarify whether the press reports we have read are true? Is the Government seriously considering allowing three directors onto the board of our national maternity hospital from the St. Vincent's proxy organisation for the Religious Sisters of Charity? Is the Government seriously considering allowing the site to remain in the ownership of this proxy organisation? Is the Government aware of any country anywhere in the world where a Roman Catholic religious institution has allowed abortions, in vitrofertilisation, or sterilisation procedures to take place in a hospital sited on their lands? It is as though the Government has learned nothing. It is as though the Government has paid no attention to the changes that have taken place in our society, including those taking place before our very eyes this week.

I believe that we need a people power campaign on the national maternity hospital issue, because no faith can be placed in the Government given its track record on this issue in recent months and years. I will support this motion. I favour the compulsory acquisition of the land and nationalisation of the land rather than a lucrative compulsory purchase order. The motion is clear on the issue of the need for 100% State ownership, and on that basis I support the motion.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source

In closing, I thank the Deputies for tabling their motion. I fully recognise the importance of Government and the Opposition thoroughly scrutinising the issues under consideration. The level of interest in the development of the new national maternity hospital is a clear reflection that everyone, right across politics and across our health service, shares the same goal when it comes to the vision of our maternity and women's healthcare. As stated earlier, the goal is best summed up through the vision of the national maternity strategy: that women and babies have access to safe, high-quality care in a setting that is most appropriate to their needs; that women and families are placed at the centre of all services and are treated with dignity, respect and compassion; and that parents are supported before, during and after pregnancy to allow them to give their child the best possible start in life.

In the context of that shared vision, I reiterate that the Government remains fully committed to the development of maternity and women's health services in this country. In that regard, we are bringing a greater focus to women's health and are investing more than ever before to ensure that the progress achieved in women's health is consolidated and expanded for all women and girls into the future.

The relocation of the National Maternity Hospital is also a very significant part of the Government's objectives in this regard. We remain committed to providing the highest quality infrastructure and environment to facilitate the delivery of a modern, safe and quality maternity service for women and infants for many years to come.

It should be noted that clinicians at the National Maternity Hospital have publicly expressed support for the move, including in a letter to The Irish Timeslast June. These people are on the front line delivering babies and supporting women, and they understand how important and necessary this new facility is. It is recognised that the buildings at Holles Street are no longer fit for purpose, which underlines the importance of moving forward and developing the new national maternity hospital to facilitate the delivery of maternity and related services that are in keeping with the vision of the national maternity strategy.

In the context of discussions on the national maternity hospital project, queries have been raised regarding the State's investment and the estimated cost of the new hospital. Various figures have been referenced over the years since the move was first announced in 2013. However, it should be noted that the public spending code is designed to ensure that investment decisions are underpinned by clear policy rationale and that costs are well understood. As such, all capital development proposals, including the national maternity hospital project, must progress through several approval stages in line with the life cycle approach to the public spending code, including detailed appraisal, planning, design and procurement before a firm timeline for funding requirement can be established and approved by the Government. As a result, it would be premature for me to discuss potential costs for this project at this juncture.

The planned move of the National Maternity Hospital is a complex project and very valid concerns have been raised across a number of areas. However, I would like Deputies to know that many of those concerns were identified at an early stage and have been the subject of significant and protracted discussions over several years. The issues of governance, which have been raised today, and clinical independence have been at the core of those discussions. That is why so much time and effort has gone into developing a draft legal framework with the aim of providing the assurances we need regarding the hospital's ability to provide a full range of women's health services in accordance with the laws and policies of the State.

The bottom line is that the new hospital must, and will, provide the full spectrum of services without any undue influence that will put women's reproductive health care at risk or endanger any woman's safety. As the Minister of Health has stated strongly, that is a red line issue for him and this Government. The Minister has been very clear that he will not bring any proposal to Government unless it provides assurances around all legally permissible services being provided in the new national maternity hospital, as they are in the current hospital building. In addition, the safeguarding of the State's investment must also be put beyond doubt. In that context, there has been further engagement with stakeholders and the process will continue as we work towards the finalisation of these legal arrangements.

8:15 pm

Photo of Joan CollinsJoan Collins (Dublin South Central, Independents 4 Change)
Link to this: Individually | In context | Oireachtas source

It looks like we have been deserted tonight in regard to this debate. I want to concur with Deputy Connolly in terms of the response from the Minister of State. It is an insult, not just to me but to women in this country.

In setting up the legal entity and framework, the Mulvey agreement has spurred the Religious Sisters of Charity to continue on in the same vein. The project was about co-location; now it has changed to full integration. That is what the Religious Sisters of Charity and its holding group are looking for. The bugbear remains, and the minutes of the HSE board meeting of 29 October 2021 note that the board raised concerns regarding the ultimate ownership of the site, which is being provided through a long-term lease rather than by means of being sold to the State. That discussion will go nowhere because if the Religious Sisters of Charity and their lawyers are not going to agree to that, we will be here forever and a day. The Minister will never be able to bring a proposal to Government that will clearly state that the hospital and land will be under State control and ownership.

The Minister of State's reply was a bit insulting. In this House, we have always supported the Government in respect of the national maternity hospital project. What we are saying is that this discussion has been protracted and things have gone on for too long. How long more do we have to wait to agree legal discussions that are going nowhere because the HSE has said it will not deal with the project unless the site is sold to the State? The HSE has said that needs to be done, but the Religious Sisters of Charity has said it is gifting the land to the St. Vincent's Healthcare Group. The Government should be honest and say whether it supports that. In his reply, the Minister of State not once said the Government is in favour of public ownership of the site at St. Vincent's University Hospital. He referred to clinical needs, but did not refer to ownership even though the Government has supported two motions on this.

Dr. Peter Boylan, who resigned from the board of Holles Street, stated that the ownership of the land on which the hospital is to be built is the key issue from which all matters relating to clinical independence from inappropriate religious ethos, protection of the State's investment and appropriate governance flow. He believes that the project has stalled because the sisters are refusing to sell the land to the State, even though they said they would gift to the State or the Irish people, as they put it, and that, in the absence of ownership of the land, no amount of legal negotiation over years on leases, licences, etc., has been able to provide the State with security on these issues. That is the reality. The project is going nowhere unless this issue is resolved.

Dr. Boylan went on the say that the board of the HSE has expressed grave concerns about the project and the Comptroller and Auditor General is conducting an audit of it. He stated that a new development paves the way forward for the National Maternity Hospital in a way that will resolve all concerns.

Groundbreaking legal opinion commissioned by Uplift and published by Mr. Stephen Dodd, SC, has concluded that the State could present a compelling case to meet the test to justify a compulsory purchase order on the Elm Park site. His legal opinion is that as the hospital being built is a national maternity facility which is being wholly funded by the State, the State has an interest in ownership that substantially outweighs that of the Religious Sisters of Charity and St. Vincent's Healthcare Group. This opinion cuts through the current impasse.

He has scrutinised the current proposals and has described them as Byzantine and Kafkaesque. His legal opinion is:

The fact that a set of labyrinthine arrangements have to be devised, where the construction and implications of the same are contentious and doubtful is highly unsatisfactory. Considering the importance of the NMH and vast monies being expended by the State, there would seem to be a significant public interest in certainty in relation to these matters.

He concludes:

Arguably the matter is of such importance to the State, that there is a legitimate state interest in achieving certainty which could only be secured by the State having full control through ownership of the relevant land and assets.

I again ask where we are going on this. If the Minister for Health gets the legal briefing on acquiring the site by CPO, the Religious Sisters of Charity would need to agree to it and if they do not, it will go to court. We would then see whether the Religious Sisters of Charity are being genuine in what they are saying. We need that land. The State needs that land. The women of this country need that land because what we do not own, we do not control; it is as simple as that. If we are still going through the process of legal discussions etc., the land will not be handed over to us unless we demand it. The Minister of State and Government backbenchers should go to the Minister and argue strongly that we must move to acquire that land by CPO.

Over the last century, in mother and baby homes, it was mainly women who were treated abysmally. We have had the practice of symphysiotomy. We have had the cervical cancer screening crisis which happened to women. We have had a detailed discussion on how we have lived in this patriarchal society for years and yet when it comes to one of the most basic things we need, having a publicly owned and publicly controlled national maternity hospital, the Minister of State said, "I would ask all Members of the House to support the Government in its continued commitment to women's health and progressing the necessary relocation", which is just patronising.

The State must move on this. It cannot wait another year, two years or three years. By acquiring the land by CPO, we would at least be showing that we can actually start building on that site a maternity hospital that is in the State's control.

I thank the Ceann Comhairle for chairing the debate. I am bitterly disappointed with the response and bitterly disappointed that the Minister, Deputy Stephen Donnelly, is not here. It is not just me and others in this Chamber but also people on the streets who will continue to demand this. I put the Government on warning that people will not accept this long-term thing. I understand that the medical staff in Holles Street want to move out of a building which is ancient and difficult to work in. They want to move to a modern national maternity hospital, but that hospital must work under the legal demands of the State.

Question put and agreed to.

Cuireadh an Dáil ar athló ag 9.05 p.m. go dtí 2 p.m., Dé Máirt, an 25 Eanáir 2022. The Dáil adjourned at at 9.05 p.m. until 2 p.m. on Tuesday, 25 January 2022.