Dáil debates

Tuesday, 17 May 2022

National Maternity Services: Motion [Private Members]

 

6:00 pm

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

I move:

That Dáil Éireann:

notes that:

- in its report entitled "Report of the unannounced monitoring assessment at the National Maternity Hospital, Holles Street, Dublin", the Health Information and Quality Authority (HIQA) noted that "the infrastructure of the hospital, despite numerous and ongoing renovations and refurbishments, was not in line with recommended guidelines for maternity care facilities";

- in the report entitled "Overview report of HIQA's monitoring programme against the National Standards for Safer Better Maternity Services, with a focus on obstetric emergencies", HIQA noted that:

- 15 of the 19 units or hospitals inspected had an outdated physical infrastructure that did not meet the recommended design standards and specifications for modern maternity services;

- only four maternity units and hospitals were compliant with the national standard relating to physical environment; and

- therefore, staff in these 15 maternity units and hospitals were providing services and care in substandard physical environments that were in need of significant upgrading and refurbishment;

- gynaecology waiting lists have increased by 45 per cent since March 2015, from 24,825 patients on active waiting lists to 36,027 in March 2022; and

- the number of people waiting longer than 12 months on gynaecology waiting lists has increased by 67 per cent since March 2015, from 4,127 patients to 6,889 in March 2022;

further notes that:

- the Minister for Health has brought forward a proposal for the relocation of the National Maternity Hospital (NMH) at Holles Street to the Elm Park Campus of St Vincent's Healthcare Group (SVHG);

- on 22nd April, 2022, the divestment of the Religious Sisters of Charity (RSC) from SVHG was completed;

- the proposal for relocation is in the form of a 299-year lease of the site, and any buildings erected thereon will be owned, in freehold title, by SVHG, at the end of this lease whether in 299 years or at a sooner date due to the forfeiture or termination of the lease;

- leasehold interest does not confer the comfort, control, or unencumbered rights which are inherent to freehold ownership;

- the permitted use of the site under the proposed leasehold agreement is subject to the undefined and ambiguous "clinical appropriateness" test, which many clinicians, legal professionals and women have raised concern over due to its ambiguity and the potential for Court action by the landlord or by a third party which may disagree with the Health Service Executive (HSE) or NMH's interpretation at some point in the duration of the 299-year lease; and

- all activities at the new NMH at Elm Park are subject to a convoluted governance arrangement, involving Directors appointed by SVHG, the NMH Chartered Trust, and the Minister for Health, three separate companies with three separate constitutions, Boards and sets of Directors;

furthermore, notes that:

- two eminent members of the HSE Board, Professor Deirdre Madden, a Professor of Law specialising in Medical Law and Ethics and Deputy Chairperson of the HSE Board, and Dr Sarah McLoughlin, the Patient Advocate on the Board, have expressed a concern that "in the interests of public trust and confidence in this new project there should be absolute clarity of the separation of Church and State. This would be better achieved if the State owned the land on which the hospital was built, in line with the recommendations of the Day Report (2018),";

- Professor Madden and Dr McLoughlin further expressed that "the statement from SVHG that they must retain ownership for the delivery of integrated patient care is unsatisfactory" and further, that "the advantages of co-location could be achieved by contractual terms ... without any detriment to patient care";

- the Taoiseach, in March 2021, stated in the Dáil that "I am of the view that hospitals which are predominantly or overwhelmingly funded by the State should be in State ownership. That is my view. The State now essentially supports these hospitals in all manner and means through current and capital funding ... With regard to the National Maternity Hospital, my view is the ownership, control and ethos of it has to be informed by State and Government policy";

- the Tánaiste, in 2019, stated in the Dáil that "It is our policy that the hospital will be publicly owned and that the land it is on will be in public control"; and

- the Leader of the Green Party, in 2017, stated in the Dáil that the new NMH "should involve not the creation of a lease arrangement but rather the transfer of ownership of the site to the State so that there is no uncertainty or lack of clarity on the ownership";

recognises that:

- in 2020, €338.8 million, or 67 per cent, of SVHG's revenue came from the HSE for the provision of public healthcare;

- in 2020, €72.8 million, or 86 per cent, of NMH's revenue came from the HSE for the provision of public healthcare; and

- the State, via the HSE, will pay for the construction of the new NMH building; and

calls on the Government to:

- pursue the full realisation of the promise that was made by the RSC to gift the land to the people of Ireland;

- engage, at the highest level, with the new ownership group behind SVHG, St Vincent's Holdings CLG, to secure full public ownership of the site and new building, with all necessary safeguards, wayleaves, and guarantees to ensure the integrity, integration and highest quality of care on the site;

- resource the National Maternity Strategy and increase capital funding, for the upgrading and refurbishment of maternity hospitals and units which are in dire need of works to meet clinical and safety standards for patient care; and

- ensure the full provision of the range of legally available sexual and reproductive health services across all relevant HSE facilities, and the advancement of accessible community-based services in this field.

I wish to share time with some of my colleagues. I will take seven and a half minutes.

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Is that agreed? Agreed.

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

I will first outline what I want to see arising from this motion, which I understand will not be opposed by the Government. I will get to that in a few moments. I want to see a resourcing of the national maternity strategy. I want to see modern, fit-for-purpose maternity hospitals with modern, fit-for-purpose maternity suites for women right across this State. I want to see it for all women. I want to see investment in all of our maternity hospitals right across the State.

The Minister will be aware that while I accept Holles Street is not fit for purpose, and while some of the comments about the state of Holles Street may have been exaggerated, I certainly agree with him that it is not a hospital that is fit for purpose and we need a new national maternity hospital. Equally, the Rotunda Hospital has difficulties and challenges, as the Minister knows, and has for many years been fighting for resources to increase capacity and to make it a better maternity hospital for the women who use it. I could give many more examples of maternity hospitals across the State where we know buildings are antiquated and the services are not what they should be. We should all commit to better resourcing maternity services as we go forward.

I also want to see a new national maternity hospital. I want to see it built by the State, managed by the State and owned by the State, including the land. Why? I will go back to what the Minister said to me last week when I asked him this question. He stated; "My position...has always been that I would prefer public ownership and to own the freehold." That is what the Minister said when I asked him that question last week. His preference was for public ownership. He also said at the time that he had engaged in discussions with the St. Vincent's Healthcare Group on the ownership issue and that is something he had put on the table. Unfortunately, that is not what was said to us at the health committee yesterday. What was said to us, in the words of the chair of the St. Vincent's Healthcare Group, was that there were no meaningful discussions over the course of the last five or six years on the ownership of the land issue. It strikes me that while the Minister, the Tánaiste and the Taoiseach said that was their stated objective, in reality the Government raised the white flag on the ownership issue and just accepted what the St. Vincent's Healthcare Group wanted, as opposed to standing up for taxpayers and citizens and getting the best outcome. Simply because St. Vincent's Healthcare Group tells us what its best outcome is, does not mean that is the end of the matter, when it is after all the taxpayer who foots the bill, and who will also fund the day-to-day running of the hospital for decades and generations to come.

I genuinely believe that the decision that was made today by the Cabinet is the wrong decision. That is the case because we have now signed up to a legal framework that is very complicated, complex, convoluted and in my view unnecessary. It is all a product of the fact that we are proceeding to build, for the first time since Sláintecare, a hospital that will not be in full public ownership, and that will be run by an independent charitable company, as opposed to a HSE hospital. I do not believe it is beyond us as a people in the 21st century to build hospitals that are publicly owned, run and managed in the interests of the public and of patients. For me, that is a very clear policy objective that should be met.

We also heard an awful lot of commentary in recent weeks and months, if not years, to the effect that the Sisters of Charity were not interested in or did not have a preference to gift the land to the State, despite at one point them saying they wanted to gift the land to the people of Ireland. We know now what happened: the land was transferred to St. Vincent's Healthcare Group. We have been told that the Sisters of Charity have divested all of their interests in the land, which I do not dispute, and the sole owner of the land is now the St. Vincent's Healthcare Group. We had some very lengthy discussions with the board of the group at the health committee yesterday. All of the questions about ownership were put to its members. We put very straight questions to them. Who owns the land? They said: "We do."

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

They did not. They said the State does.

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

They said they do. They said the landowner, the landlord. The Minister can go back and check the record. I was in the room. The Minister was not. They said the landlord is St. Vincent's Healthcare Group.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I watched it very carefully

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

When I asked them who owned the land, they said the St. Vincent's Healthcare Group.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

They said the State.

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

They said there was a lease arrangement.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

They said the State.

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

They did not say the State.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Deputy Cullinane should check the record.

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

With respect, if it is not questions and answers and over and back, I would prefer if the Minister did not interrupt. I would give way to him if that was allowed. My point is that I had those discussions with them. I put very direct questions to them, and they were very clear that the landowners were St. Vincent's Healthcare Group and that there was a lease arrangement in place between the HSE and St. Vincent's Healthcare Group. I put it to them very directly. Who owns the freehold? They said St. Vincent's Healthcare Group. That is a fact. No matter how many times the Government tries to spin it, that is a fact and that is what they said.

They also said that they were not going to gift the land to the State. If they are telling us they are not going to gift the land to the State, and that in fact they had no meaningful discussions on that issue recently, then what is the issue? The Minister is telling us that we own the land. He and they are also telling us that they will not gift us the land. It cannot be both. The reality is that they are the landowners and they have not gifted the land to the State, and if they did, we would not need to establish the company, the National Maternity Hospital at Elm Park, because we would be building a HSE hospital on public land. We would obviously have to have arrangements in place between the hospitals on the campus and the HSE hospital - different sorts of arrangements - but we would not need a company to be established that would then have directors coming from different sources.

That would be completely unnecessary. That company would not need to be formed. Then, of course, it would not be a subsidiary of the St. Vincent’s Healthcare Group. None of that would happen. The Minister therefore cannot credibly come before the House and say there are no contractual issues, no legal issues, we own the land and yet a company has been established to run and manage the hospital with a lease arrangement with St. Vincent's Healthcare Group. The complications and legal contractual issues, constitutions, licenses and leases are all in place for one reason and one reason only, which is that we do not own the land.

I asked the Minister and the Taoiseach several times over the last number of weeks about what efforts are being made to persuade St. Vincent Healthcare Group to gift the land to the State. It transpires from yesterday, from the words of the chair of the St. Vincent’s Healthcare Group, that there was no communication from the head of Government, the Taoiseach, with the St. Vincent’s Healthcare Group. That is just absolutely bizarre. In fact, it is unbelievable given the importance of this.

We are going to lock ourselves into a legal framework for generations to come. It was not the right decision. I will finish on this point. It is deeply cynical not to oppose a motion while at the same time having no intention of supporting it.

6:10 pm

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Deputy’s time is up.

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

If the Government is not going to oppose it then it should vote against it. If it is going to support it, then it should implement it. It seems to me that is not what the Government is going to do.

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

The Minister of State, Deputy Butler, is here. I invite her to correct the record on what is and what is not a Nightingale ward. I hope she has brought herself up to speed on that basic piece of information since our last debate.

The Minister knows what the concerns are. He has heard them. I will quote from a tweet. Maybe given the circumstances and the trouble on Twitter I should not mention it, but I will go there anyway. Gavan Reilly, referencing the Minister, said:

it ‘simply wouldn't be possible’ for circumstances to arise that a woman would be denied an elective termination... if it were to arise, [the Minister for Health] could ... exercise 'golden share'.

The thing that cannot happen might happen and, if it did, this is what would happen. The Minister will see why there might be some ambiguity and some concern in that sentence, which says, “This thing is not going to happen, but if it does happen, the thing that is not going to happen, then I will step in”.

For far too long, women in Ireland have had to go to the courts to access healthcare. They have had to petition their politicians. They have had to get down on their hands and knees and beg or get onto their feet on the streets and demand that healthcare. However, the Minister is saying now that is there is a form of healthcare that should be available to women. He says it will be available to women, but just in case it is not, he will do this other thing. Sentences like that do not help. When people say that they are concerned, the Minister cannot dismiss them by saying, I have this in hand, it is not going to happen, but if it does happen, I will do this other thing. I am sure that the Minister can understand why people are concerned.

Equally worrying is the fact that one in ten GPs are offering abortion care. Nine in ten maternity units are offering abortion care. This is under the Minister’s watch. He is telling us to trust him. He is saying to trust him, he will sort this out in the event that any woman is being denied an elective termination. However, he has not sorted out the situation in nine of the maternity units. There are issues of trust here. That is why we are here to debate this motion. That is why we need the assurance and the certainty that comes with ownership. A leasehold is not ownership. In fact, the leader of the Green Party in 2017 - this is in the motion - said that the new NMH “should not involve the creation of a lease arrangement but rather the transfer of ownership”. Nothing has changed since that time. He was dead right then and he is right now.

I hope that the Minister understands where the issues around trust have arisen. Some of the things that the Minister has said have not helped in that regard. In fact, they have been counterintuitive. That gives women pause to be very concerned.

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

Over the last week there has been a lot of whitewashing. Ministers and backbenchers who previously had their doubts had those doubts swept away by a letter that contained no guarantee that the full range of health options for women would ever be safeguarded. Maybe written on that page was a coded message not to rock the boat, to turn a blind eye to women's rights and to keep their noses firmly out the truck and out of the business of vested interests. I am bitterly disappointed that the Cabinet decided today to drive a coach and four through the clear wishes of right-thinking people.

Everyone I speak to is baffled as to why we cannot own the land and the hospital. We have heard much about this transaction being compared to buying an apartment. This is a disingenuous attempt to discredit anyone who opposes this sell-out. We now have a dodgy, intentionally fake contract that could see the rent jump from €10 per year to over €250 million over the lifetime of a lease.

The Irish people have made it quite clear in recent referendums that we are a secular State and that religion is a private matter. What happens if the HSE is unable to stay for the duration of the tenancy or if, for some unforeseen reason, the State needs to purchase the freehold site? The Government parties have a long history of pandering to vested interests. Healthcare should be for the good of patients and service users and not for profit. The Government should not have approved this deal in its current format. There were no meaningful or serious discussions in five or six years, according to St. Vincent’s Healthcare Group at yesterday's committee. Deputy Cullinane has spoken to the Minister about that.

At the very least, the Minister should have removed the phrase “clinically appropriate”. There is a broad consensus that this could be removed. There is no legal impediment to gifting the land. The Government yet again is failing women and has serious questions to answer. The solution is simple. We must have a public hospital that is built on public land. Anything less calls into question the Government’s commitment to Sláintecare. I understand that some Green Party Deputies are wrestling with their consciences. I appeal to them in particular now to draw a line in the sand and to support this motion.

Photo of Denise MitchellDenise Mitchell (Dublin Bay North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I fully support the calls for a new national maternity hospital to be publicly owned and to be built on public lands. Unfortunately, the Government is ploughing ahead. For decades, the women of Ireland have campaigned for healthcare that is free from outside influences. They need to have confidence in the type of healthcare that they get. Their concerns could have been addressed. Concerns around a complex legal deal could have been knocked on the head if the Government had kept its word and if it had bought the site into public ownership. The Government said that it wanted the land to be gifted to the State. Yet, yesterday at the health committee, we found out that there was never any meaningful discussion under this Government and this Minister around the purchase or gifting of this site. Was the Government ever serious about owning the site? It does not look like it was.

The argument against public ownership seems to be that it will cause delays. Nobody wishes to see this delayed further, but we are discussing building a hospital at the cost of €1 billion. The Minister for Health, the Taoiseach and the Tánaiste could have resolved this issue. It is absolutely shameful that the Government decided to sign off on this plan this morning. The Minister will have to stand over that. He will have to explain that to his constituents. Nothing changed since it was paused. It therefore seems that committee hearings were basically a box-ticking exercise.

Tonight should have been a chance for every Deputy to cast their vote. Yet, the Government will cynically not oppose the motion. It will speak out of both sides of its mouth yet again. The women of Ireland want a maternity hospital. We want a maternity hospital that is publicly owned and that is built on public land.

Photo of Sorca ClarkeSorca Clarke (Longford-Westmeath, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

After decades of women campaigning, fighting and, in some instances, begging for healthcare, we are standing here today with a Government that has signed off on a deal that fails to deliver a public hospital on public land. Instead, it has signed us up to a convoluted lease that will run for 300 years. It is obvious to the most uneducated person in economics out there that the investment of €1 billion would have been much better protected by ensuring that we owned the land that we were spending that money on. However, yesterday we learned that despite the fact that the Taoiseach, the Tánaiste and the Minister had been asked to sit down with the St Vincent’s Healthcare Group to negotiate that transfer, no meaningful engagement happened to do that. Despite the Government’s stance that the transfer of land was some form of legal quagmire, we also learned that the Sisters of Charity did that without precondition.

There was no legal barrier. Is it any wonder that women are so concerned about this agreement when neither the Taoiseach nor the Minister for Health has made any serious attempts to have this land transferred, while telling this House that transition was not possible? We all want this hospital. Lord knows, the women of Ireland need this hospital. However, the real issue here is the failure of the Government to secure the land for public ownership.

The phrase "clinically appropriate", which caused so much concern to so many stakeholders up to yesterday, seems to have completely disappeared off into the ether because the Cabinet understands its meaning. There is now no need for legal guarantees. The Cabinet is saying trust it, take another leap of faith and forget all the horrors that have happened in women's healthcare to date because the Cabinet understands. I do not know one woman who is willing to take another leap of faith with their healthcare - not even one - while barriers still exist out there. The Minister well and truly knows that they do.

6:20 pm

Photo of Pauline TullyPauline Tully (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I am very disappointed the Cabinet agreed earlier today to sign off on the national maternity hospital going ahead on non-publicly owned land. The question as to why the land could not be gifted to the State has never been answered. We have been told the 299-year lease at nominal rent is ownership in everything but name but why can it not just be signed off and given at a nominal fee in order that ownership can be made without question? The State will build a state-of-the-art hospital at a cost of €800 million and upwards. As that is a major investment of taxpayers' and people's money, they have the right to an assurance that the land in which the money will be invested will remain in public ownership. The fact the hospital will be built on land not in State ownership is very worrying.

The leaders of the three Government parties have all stated in recent times they believe the land should be publicly owned. The Taoiseach said in March last year, "I am of the view that hospitals which are predominantly or overwhelmingly funded by the State should be in State ownership". In 2019, the Tánaiste stated in the Chamber, "It is our policy that the hospital will be publicly owned and that the land it is on will be in public control." The leader of the Green Party stated in the Dáil in 2017 that the new national maternity hospital, "should involve not [just] the creation of a lease arrangement but rather the transfer of ownership of the site to the State so that there is no uncertainty or lack of clarity on the ownership". No wonder constituents accuse politicians of promising one thing and delivering something else.

One of the key recommendations of the Day report of 2018 was that when the State is paying for a hospital, it should own the hospital outright as this avoids complicated governance arrangements, any chance of limited services and guards the State's investment. We need a clean transaction whereby the Sisters of Charity gift the land directly to the State. It is as simple as that. This would copper-fasten the State ownership of the hospital and allay public fears. This makes infinitely more sense in protecting women's healthcare and the State's investment than a bizarre 299-year lease agreement. For too long in this country, women's healthcare, particularly reproductive healthcare, has been neglected. We all agree this hospital is needed urgently. It has been discussed and considered for almost a decade, yet this Government has still failed to get it right and women deserve better.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I apologise to colleagues as unfortunately, I must leave straight after this speech but the Minister of State, Deputy Butler, will be here.

It has been agreed by all sides that we urgently need a new, state-of-the-art, secular, public, co-located national maternity hospital that provides all healthcare services to women and infants. This morning, that is exactly what the Government agreed to. The new hospital will radically improve access to the best possible healthcare. It will provide specialist care for women via a physical corridor to St. Vincent's University Hospital. It will have single occupancy en-suite rooms for all women, with space for partners to stay. It will have single-cot neonatal intensive care rooms and will increase the number of cots from 35 to 50. It will increase the number of delivery rooms from 11 to 24. It will increase the number of operating theatres from two to five and the number of gynaecology beds from 18 to 31. It will have appropriate bereavement facilities. It will be home to a range of important community-based healthcare services.

The new hospital will be entirely secular. Its founding rules, which are the constitution of the NMH, state there can be no religious ethos. It also states not only can the new hospital provide all services, it must provide all services. The State, via the Minister for Health, will have the power to directly intervene if the hospital fails to meet these requirements. The State will own the hospital and the land for the next 300 years. This has been confirmed by the HSE, the National Maternity Hospital, St. Vincent's Healthcare Group and the Attorney General. The Government added three decisions today in response to the concerns raised and discussed over the past two weeks. First, there will be an annual report on the operation of services at the new national maternity hospital for five years from when it opens. Second, I will request the clinical director of the national women and infants programme to scope out and bring forward a proposal on a centre of excellence for women's health and, third, the term "clinically appropriate" allows the new hospital to provide all legally permissible procedures in the areas of maternity, gynaecology, obstetrics, neonatology and gender recognition.

The term "clinically appropriate" was added to the agreement by the HSE. Colleagues opposite me in the Chamber are asking for an HSE-run hospital. It was the HSE that insisted on this phrase. It wanted this phrase to protect and future-proof women's health services. For years, these services have been squeezed by other services in hospitals. When pressure comes on for urgent access to facilities, such as diagnostics, beds and operating theatres, doctors will tell you it is often things like gynaecology lists in operating theatres that get cancelled first. We are determined to put an end to that. We are absolutely determined the new hospital will be for healthcare services for women and infants, which cannot be pressurised and pushed to the side by pressures from other services. We all agree we have incredible healthcare professionals working in women's healthcare in community and hospital settings, and in maternity, gynaecology, mental health, oncology, screening, well-being and many more. I have met many of them over the past few years. I know that colleagues have also met many of these healthcare workers. We have seen with our own eyes the fantastic work they do. We have also seen the daily pressure they are under and the difficulties they face because of inadequate facilities.

When I took office I ensured women's healthcare was a top priority for this Government. Our first ever women's health action plan was published earlier this year. The national maternity strategy is now fully funded and includes hundreds of additional posts in maternity services throughout the country. We are seeing new infrastructure improvements with theatres refurbished and home-away-from-home suites added to many of our maternity units. We are hiring lactation consultants to provide breastfeeding supports nationally. We are building a new national network of healthcare services. Between last year and this year, we will open six specialist menopause clinics, a national network of 20 see-and-treat gynaecology clinics and six regional fertility clinics. I hope to get funding in the Estimates next year to start providing publicly-funded IVF treatment for the first time. We are opening six specialist endometriosis clinics. We are rolling out free contraception, starting this year with young women aged 17 to 25. We are setting up new mental health teams, including for eating disorders and perinatal mental health.

The new national maternity hospital is absolutely central to this ongoing vision. It is the biggest investment in women's healthcare in the history of the State. All the guarantees we have been discussing over the past few weeks regarding clinical and operational independence, no ability for any religious interference, state-of-the-art facilities and all services being provided is why midwives, nurses and doctors in the NMH, and throughout the country, are speaking publicly and asking us all as legislators to support this very important new hospital.

The task now is to get the new hospital built as quickly as possible. I very much look forward to engagement with colleagues on an ongoing basis. We can all agree we have a history in this country of taking too long to build hospitals. Indeed, it was pointed out to me this morning that the procurement process alone for one of the hospitals in recent times took two years. We have a big advantage here. Planning permission is already in place, the detailed design is done, the legal frameworks are in place and the business case, which will be externally validated, is being developed. What I want to see and want to work with colleagues on is pushing this forward, while genuinely respecting everyone's views.

That is why we added three new decisions to the memo this week that were not in the memo two weeks ago. I hope we can all work together to push and ensure that this hospital gets built as quickly as possible.

6:30 pm

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I begin by echoing the Minister’s comments regarding the Government’s commitment to the development and improvement of women’s health services. We know the infrastructure of our maternity hospitals leaves much to be desired and that there are deficits in women’s health services, in the choice of experience available to pregnant women, in the availability of mental health supports, physiotherapy, services for endometriosis and menopause, as well as difficulties with gynaecology waiting lists. We know this is the case and there is no point in hiding from that. However, in terms of our commitments to women’s health, we have put our money where our mouth is and have provided the investment needed to see those commitments through.

For example, for the first time since its launch in 2016, we have adequately funded the national maternity strategy. In 2020 just €1.5 million was allocated to implement this strategy. This Government increased that figure to €7.3 million in 2021 and again to €8.6 million in 2022 to ensure a renewed impetus to the implementation of the strategy.

As raised in today’s motion, HIQA’s overview report highlighted a number of areas where work is required to meet the standards. I note in particular the concerns regarding deficiencies in maternity infrastructure. The HSE is working on a plan to address the infrastructural issues across our maternity services and to ensure the physical environment of our hospitals and units are in line with both HIQA’s standards and the vision of the national maternity strategy.

Improving women’s experience of and outcomes in the health service is of course much wider than maternity. As mentioned earlier, €31 million has been provided this year for a range of developments around women’s health. Some of these have already been referred to but they include an additional €5 million for the dedicated women’s health fund and the roll-out of a free contraception scheme for those aged 17 to 25 later this year. In addition, a further €16 million to support women's health is embedded within other new measures for 2022 within the health Vote in areas such as cancer, mental health and social inclusion budgets. In mental health we now have 19 perinatal mental health midwives in place, who are in every maternity hospital in the country. There are 75 staff working in perinatal mental health. I recently met the team in the Rotunda. Some 9,800 women presented to the hospital last year to give birth and 2,000 needed and received the support of the perinatal mental health team. It is a really important initiative.

I have participated in and listened to the intensive debate on this topic over the past two weeks. I am fully confident that there will be no religious ethos at the new national maternity hospital and all legally permissible services will be provided there, as they are in the current hospital at Holles Street, and that the State’s investment in this hospital and the provision of public healthcare services are fully protected.

Following on from the Cabinet’s decision today, let us now is the time to move on towards the delivery of this much-needed new maternity hospital.

Photo of Mairead FarrellMairead Farrell (Galway West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Twelve years ago, the Office of the Comptroller and Auditor General identified some of the key risks posed by this deal. A chapter of its report was called “Protecting the State's property interest” and identified several alarming details These included the existence of "a fixed charge over the entire St Vincent's Hospital site" and "a floating charge over all of the undertaking, property and assets of SVHG both present and future". The Comptroller and Auditor General’s worrying conclusion was that the St. Vincent's Healthcare Group had "pledged publicly-funded assets in return for bank finance for the development of its private hospital". In other words, the land on which we are going to build this hospital has been used as collateral for other transactions. It was used as collateral to raise debt and for the development of St. Vincent's private hospital and commercial car park. As a result Bank of Ireland now holds a charge on this land. Therefore, not only is the Government proposing to build our new national maternity hospital on land that we do not even own but the group which owns the land has a charge on it held by Bank of Ireland, which is a potential risk to the State.

The Day report of 2018 recommended that when the State is paying for a hospital, it should own it outright. That is the best outcome and way to safeguard state investment, option agreements notwithstanding. Two members of the HSE board also expressed concern about governance if the State does not own it outright.

Thomas Hubert reported in The Currencythat St. Vincent's Healthcare Group was granted a temporary reprieve from non-compliance with its debt covenant but this was pandemic relief and it is about to come to an end. This deal is so bad that I cannot believe it has got to this stage. I am outraged that it has got to this point and that we have had to raise it continuously. So many women and activists have done for so long. It is fraught with risks and uncertainties. It is unnecessarily complex and disregards established policy designed to protect State investment. It is a bad deal for women and for the taxpayer. It creates risks for women's health and the taxpayer. Finally, for parties which consider themselves to be so pro-business, they are terrible at doing business themselves.

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

The journey so far on the provision of a national maternity hospital that has got to this point has been long and convoluted. It has become unnecessarily mired in controversy. The existing maternity hospital in Holles Street is not fit for purpose. The decision to relocate to a new site eight years ago that could offer patients improved modern facilities, as well as better care, was not before time. However, since that decision was made, the process has been beset by delays and reasonable concerns over ownership, governance and control. For such an important and major health project, it is hard to fathom that after almost a decade of work, there is very little to show for it apart from escalating costs in construction. A project that was originally to have costs around €150 million is now being put at €500 million with a further €300 million for commissioning costs including fit-out costs and transfer to the new site. The cost of the hospital has gone from €150 million to €800 million. It is another example of gross overspending on a hospital project. There have been legitimate concerns raised by concerned citizens and medical professionals. These have not been sufficiently addressed. They continue to causes friction and needless controversy.

It is important that the national maternity hospital has a secular ethos and that both the hospital and the site on which it resides are fully owned and managed by the State. That the site is supposed to be transferred to a charitable entity called St. Vincent's Holdings has also raised concerns for many who are worried that the hospital will be unduly influenced by a religious ethos. There is also fear that the hospital's legal framework, which talks about "clinically appropriate treatment" is already being shaped by a religious ethos. People are rightly concerned that the new hospital will fail to deliver healthcare that is not approved by the Catholic Church. The new maternity hospital, its administration, operation and oversight must be represented by a secular body and that is best achieved under full State ownership.

Photo of Réada CroninRéada Cronin (Kildare North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

What a desperate disappointment this cynical Government is for the women of this State and what a desperate disappointment it is for anyone who is interested in public healthcare. The ownership of this land for our new national maternity hospital was there within our grasp but this disappointing and cynical Government did not fight for it. Now we hear the chair of the St. Vincent's Healthcare Group is to be hauled in to correct the record after he said that the Government had no serious or meaningful discussions to push for full public ownership. However, at the same time, the women of Ireland and women Government Deputies are supposed to accept a letter of comfort from the same source on their health and, more importantly the future health of their children, their daughters and granddaughters. The degrading Government is not opposing our Private Member's motion. This floor show is brazen, cowardly and cynical. A billion euro of public money is being spent to build a hospital on private land. Mná na hÉireann are heard but not heeded. In the uniform of the patriarchy, the leaders of Fianna Fáil, Fine Gael and the Green Party tell us that they know better than us, that they know what is good for us and they carry on regardless. The Government has shown contempt for public health reform and their sisters in society by doggedly pursuing its belief that it knows best, that it knows more and that women should just put up, shut up and move on.

Except the women and men who have stood by us, who campaigned against this fudge, who rejected this ambiguity and who are incensed by the insult and uncertainty of "clinically appropriate" will not move on. Some 100 years of Fianna Fáil and Fine Gael was not enough for the Government; it seems to have tied us into a lease for 299 years. The resistance and spirit of the repeal campaign will not be quenched. For some the repeal campaign only represented a veneer and a desire to be popular but for mná na hÉireann who were involved in "Tá For all Mná", repeal was fundamental. Déanaim comhghairdeas leis the Government; it heard us but it ignored us but I can tell the Government that we are watching. As most of the men on the other side of the House will know, women do not forget.

6:40 pm

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I want to start off by talking about the legacy of mistrust in respect of religious orders having any connection with women's healthcare. I want to talk about the historical abuse suffered by women at the hands of religious orders. I also want to talk about the connection between church and State that led to this abuse of power. I am a member of the Committee on Children, Equality, Disability, Integration and Youth that has been working through legislation on historical abuse, whether that was in the mother and baby or homes or with institutional burials, including the bodies of children being dumped in septic tanks. We listened to the heart-rending testimonies of witnesses on forced adoptions. As women and children were treated as commodities by the church and the State in baby factories, if this Government cannot see the upset that building a maternity hospital on land that is owned by a religious order has caused, then it is more out of touch than I thought.

During Leaders' Questions today the Taoiseach reaffirmed the Government's position that leasing the land from a religious order is effectively owning the land but this is nonsense. A lease is a lease. If I rent my home I do not own it; the landlord does. The Religious Sisters of Charity, in the guise of St. Vincent's Holdings CLG, is the owner and therefore it is the landlord of the land the national maternity hospital will be built on. There is a yearly payment and this is not ownership of land. We are talking about a €1 billion investment in taxpayers' money being spent on this hospital and the State should own it outright. The Religious Sisters of Charity previously promised to gift the land to the people of Ireland and that means a public hospital on public land. The Government needs to make this happen. The control of the land is important and with this massive State investment should come full ownership.

The State has been in the grip of Governments controlled by Fianna Fáil and Fine Gael since the inception of this State over 100 years ago. The reason we need a new national maternity hospital now is a lifetime of underinvestment in women's healthcare by both parties. We need a complete separation of church and State when it comes to women's healthcare and in fact, we need a complete separation from Fine Gael and Fianna Fáil when it comes to women's healthcare. Today the Government signed off on a deal to pass this through and yet it will let this motion go through so that it will not be forced to vote on it and add to public outcry. This is the Government talking out of both sides of it mouth and the public is seeing through it. This is not the first time; it has happened with child and adolescent mental health services, CAMHS, and other motions that have been put forward by the Opposition. The Government sits over there, nods it head, lets things go through and has no intention of putting things in place. It is a con job and the Government needs to cop on.

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

At some indeterminate point last week it became clear that the Government was spinning its wheels on what was supposed to be an open and inclusive consultation on the various documents. For me it was clear during a meeting of the Committee on Health last week that the Government was just stalling for time and playing us out. It was like the end of "Mr. Smith Goes to Washington" with the Minister, Deputy Stephen Donnelly, coming to briefings, to the Committee on Health and to the Dáil and just talking the clock and the days down until this moment.

We wonder why people feel so cynical about politics and politicians and this has been thrown across the floor from Opposition to Government and from Government to Opposition. In recent months, I have been on the Business Committee and I have seen multiple attempts to block statements and debate on this issue. We had to come up with a special arrangement for a Thursday sitting a few weeks ago and during that special arrangement, the Minister said that when the documents were released and the lease was ready, we would have a full debate. Then two weeks ago he marched into Cabinet seeking to push this through at which point it was stopped and it was decided to give it a couple of weeks and to have an open debate on it. That debate did not really happen. We had chats but the debate certainly was not open. We saw it in previous months in the Business Committee and we are seeing it now in the fact that this motion will not be opposed and that there will be no vote on it. To extend the cynicism, we saw the Minister, Deputy Stephen Donnelly, on social media a couple of hours ago with a video extolling the virtues of this deal that was retweeted some 200 times in the space of a couple of minutes by what looked like bot accounts. This is crazy stuff. Why did that happen? It happened because the Minister and the Government know they do not have the support of the women and people of Ireland on this issue. The gas thing is that no one will be looking one way or another at how many retweets a tweet gets but it just shows the insecurity the Government has in its stand on this.

We are clear in our position and we have been for a number of years and we desire to see the land compulsorily purchased. We asked how many of the three Ministers who were in power asked for the advice of the Attorney General on that and we did not get a clear answer. The Minster, Deputy Stephen Donnelly, said that he sought the advice of the Attorney General but we did not get any indication as to what that advice said, never mind what the previous two Ministers asked from their Attorneys General. Despite all the talk in this Chamber, in the Committee on Health and elsewhere in recent weeks and months the Labour Party still has massive concerns about the ownership, control and governance of the new national maternity hospital. We are not the only ones; we are not the only ones in this House and we are not the only ones in politics who have concerns. Across the legal and clinical profession we have the likes of Dr. Chris Fitzpatrick of The Coombe Women and Infants University Hospital who came out in recent days and said that he felt that clinicians will not have the necessary guarantees that they would be able to carry out the various procedures that are legally permissible in this State.

Where are we now? It has gone through Cabinet and the Minister has said the design is done and that we are going to push through to procurement. Here we are with an imperfect ownership situation. No matter what way the Government tries to dress it up, it is not perfect. When the Taoiseach was in opposition he said he wanted fully public ownership of the land and we do not have that, which is a fact. We have the 300-year lease and that is imperfect. We have a golden share model, which means that 300 years into the future every woman in Ireland will have to hope that the incumbent Minister for Health is pro-choice and that he or she will never have to use his or her golden share. If anyone thinks that is a perfect model and is something that should be used now or should ever be used again, then he or she is living in fantasy land. We have imperfect ownership and a model that means that every woman in Ireland will have that concern and worry in their stomachs that this golden share will have to be used. We only have to look at the United States in recent weeks to see how the situation can change in a matter of moments.

Photo of Ivana BacikIvana Bacik (Dublin Bay South, Labour)
Link to this: Individually | In context | Oireachtas source

Earlier today, on behalf of the Labour Party, I expressed our strong disappointment to the Taoiseach at the decision that has been taken by Cabinet. As I have said and as my colleague, Deputy Duncan Smith, has said, in Labour we continue to stand firm in expressing our strong concerns about ongoing issues with the control, ownership and governance of the new national maternity hospital. We thank the Minister, Deputy Stephen Donnelly, for the engagement we have had in the last two weeks and we acknowledge the need for a new national maternity hospital to be built to provide women with the healthcare we so badly need. We are disappointed that the engagement and two-week delay did not lead to any change or substantive improvement in the deal that was on offer and we should have learned by now that there is a need to get this right because we have such a long legacy in Ireland of church and State interference in the exercise of women's right to reproductive healthcare. Many of us fought for decades to see the eighth amendment repealed and when we finally achieved that in 2018, only four years ago, we were able to introduce legal abortion in Ireland.

We know from experience, our own bitter experience and experience elsewhere, that these hard-won gains for women's rights and women's reproductive rights can be reversed or undermined all too easily. Indeed, we have seen that clearly in recent weeks with the awful prospect that the pro-choice landmark Roe v. Wade decision could now be overruled by the US Supreme Court. A whole new generation of women in America face the prospect of fighting again for pro-choice rights that were won there decades ago and may now be overturned.

Apart from that real and valid fear that we have about the reversal of rights won, we also have the principle of putting €1 billion of State money into a facility that will not be constructed on State-owned land. Ireland has a long legacy of investing public money into building up the infrastructure of voluntary hospitals and schools on sites that are owned by religious orders or their proxies or successor companies. I have spoken before in this House about the well-established practice where religious orders divest their assets from their own ownership and into the ownership of lay-run trusts, which can often have a more hard-line approach to negotiation with the State than the religious orders which preceded them. That is the context in which we distrust this deal. That is the context for ongoing concerns. That is the context for our real and pressing need to see this national maternity hospital built on publicly owned land.

The two-week delay has not resolved our concerns. Indeed, our engagement has strengthened our resolve that the Government should have retained the leverage power of the compulsory purchase order, CPO. I spoke today with the Taoiseach about figures I just got from An Bord Pleanála about the length of time it takes to resolve a CPO. The average number of weeks this year to dispose CPO cases is 20.4 weeks, less than five months. In a context where we have now waited nine years and we have undoubtedly seen incremental improvements in the deal on offer, the State has removed from itself the option of a CPO and therefore has removed that bargaining power.

The Government has now taken this less-than-optimal deal, the imperfect deal, as Deputy Duncan Smith said. We know it is less than optimal and less than perfect because we know from what the Minister, Deputy Stephen Donnelly, and others have said that the Government wanted the site to be in public ownership. At least one Minister for Health sought the Attorney General's advice on the merits of a CPO. However, that was not pursued and instead the Government settled for this less-than-optimal deal. As a result, we are letting down women in Ireland and we are letting down the principle of church-State separation.

We have got conditional ownership. It is ownership of a sort but it is not outright ownership, not freehold ownership. It is leasehold interest and however long a leasehold is, it remains conditional ownership. The conditions are clearly set out in the legal documents: the conditionality of appointment of three directors; the right to appoint three directors from St. Vincent's Healthcare Group; the right to have a rotating chair every three years; the right to have a penalty rent; and the phrase that so many of us have picked up on and are concerned about of "clinically appropriate" which clearly qualifies the availability of all legally permissible services.

These are the conditions consequent on the leasehold arrangement and these are the reasons why we continue to have such valid, solid and substantial concerns about the deal that has been done. That is why at this very late stage we are still calling on the Government to go back and seek a better deal, as has been done before. This is a better deal than was previously on the table from St. Vincent's Healthcare Group, so it can be improved upon. If the Government were to go back to the St. Vincent's Healthcare Group there would be a united Opposition who all want to see this hospital built on publicly owned land in the interests of women's reproductive healthcare.

6:50 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

I call Deputy Cairns who is sharing time with Deputy Shortall.

Photo of Holly CairnsHolly Cairns (Cork South West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

We have had incarceration, mass graves, forced family separation, physical, psychological and sexual abuse. The history of partnerships between church and State concerning maternity and women's healthcare represents some of the darkest parts of our past. It is a tragically recurring pattern when men in positions of power collaborate to make decisions about women's bodies. This oppressive regime was often subtle and invisible. It was enforced by social norms wrapped up in caring language and it was found in the limitation of medical procedures. Most importantly, concerns, questions and objections were disregarded, denied and shouted down.

While this Dáil still debates legislation relating to the legacies of that cruel and twisted system, today it is abundantly clear that the Government has learned nothing from our history. That gifting our national maternity hospital to St. Vincent's, set up by the Religious Sisters of Charity, is even up for discussion disregards and compounds the suffering that many thousands of people have experienced at the hands of the church and State. In addition, genuine concerns of mothers have been dismissed as misinformation. Medical practitioners and legal experts have been disregarded. People have been labelled as conspiracy theorists for asking questions. Deputies who supported the campaign to repeal the eighth amendment to the Constitution seem to think this somehow shields them from any kind of criticism. From the outset, the Government's handling of the national maternity hospital plan has been contradictory, confusing and inconsistent.

Despite all the Government spin and claims, three fundamental questions have not been resolved. First, why is the Government gifting a €1 billion hospital to a private company? On that point alone, this deal should not be going ahead. Second, why are the Religious Sisters of Charity not giving the site over to the State as promised? We have been told that a 300-year lease is essentially transferring the land. Why are we not just doing that? What is their reason or motivation for retaining ownership? Third, what is meant by clinically appropriate? That there has been so much debate about how this could be interpreted is of itself evidence that it could be interpreted in many ways. It is unbelievable that that key term remains ambiguous. These questions have been asked repeatedly by Members of the Opposition and in particular by female leaders.

I am raising gender because it is deeply relevant. The State has an horrendous record on women's health, even up to this Government, when it was required to have a Dáil motion seeking an implementation plan for a national maternity strategy. The women of Ireland, the people who will be using this hospital, are being ignored. This is another Government that knows better than women. Patriarchy and misogyny run so deep in this society that people often cannot even see it. Women have won the right to control their bodies. It was a long and hard-won battle, opposed by politicians and religious orders. That should never be put in doubt again, but today with full knowledge of all the concerns, all the unanswered questions and all the legal and medical ambiguities, the Government decided to plough ahead because it knows best. It knows what is best for women and not women themselves.

Government Deputies and Ministers have received countless emails and messages on the issue from women and mothers, as have I. Do they stop for even one second to think they may have a point before those of them who take the time to reply tell them all the ways they are wrong?

This decision is wrong on so many levels. Like so many bad decisions, because things have gone on for too long it is being used as an excuse. The approach is not to reflect on how badly this has been handled by successive Ministers for Health, Deputies Varadkar, Harris and Stephen Donnelly, but rather to accuse those raising legitimate concerns of delaying things. That argument will not cut it this time. People see through it and most importantly the girls and women of Ireland see through it.

The solution has always been incredibly simple, a State-owned and controlled national maternity hospital built on State lands and through the use of State funds. Not only is this the proper way to conduct healthcare projects, never mind €1 billion of taxpayers' money, but it removes any possible doubt about governance and medical procedures. Most importantly it ensures that the will of the women in Ireland will be respected. Why is it so hard for the Government to accept?

When the issue inevitably arises, where will the Minister be? He cannot say he did not know. He cannot say he was not warned. The real hard truth is that the women and girls of Ireland will bear the brunt of his mistake. They again will suffer because the Government thought it knew better than they did. That will be his legacy - another government making wrong healthcare decisions for women.

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

I welcome this Sinn Féin motion. The Government is displaying incredible disrespect for this Parliament and for democracy by its actions. We have already had three Private Members' motions calling for full public ownership of the new national maternity hospital.

The Government has voted in favour of those motions. Today's is the latest. The Government is faced with a motion which states that we must pursue the full realisation of the promise that was made by the Religious Sisters of Charity to gift the land to the people of Ireland and engage at the highest level with the new ownership group behind St. Vincent's Healthcare Group, St. Vincent's Holdings CLG, to secure full public ownership of the site and new building. It is the height of hypocrisy that on the very day that the Government has rammed through a Cabinet decision to plough ahead with this proposal, it sits back and pretends it supports this motion.

7:00 pm

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

Hear, hear.

Photo of Holly CairnsHolly Cairns (Cork South West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

Hear, hear.

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

Is the Government not ashamed of that? What have matters come to that the Government is behaving in such an utterly disrespectful way?

I wish the Minister was here. I do not where he is. He is probably doing more media appearances. He is completing undermining this Parliament and our democracy. We were told two weeks ago that there was going to be a pause and an opportunity to address the key issues of public ownership and the phrase "clinically appropriate", which nobody understands.

We know after yesterday's meeting of the Joint Committee on Health that the Government has never, on any occasion, seriously approached St. Vincent's with a view to purchasing the site or getting St. Vincent's to gift it to the State. That was confirmed yesterday. It was confirmed today that in spite of all the promises, including those made by the Minister of State, Deputy Butler, that people would be reassured and there is no problem with the phrase "clinically appropriate", several people who are proponents of this project have said they are not sure exactly what it means. We have heard three different interpretations of the phrase. Last Thursday, the Minister of State, Deputy Butler, was beside the Minister when he accepted that we had a point. He said he would reflect on the issue and consider it over the weekend. There was endless spinning going on last weekend about some kind of definition, removing the phrase or adding a codicil, ridiculously. None of that meant anything and the proposal was today rammed through Cabinet.

The Government has said it will add a note to the memorandum to Cabinet. Adding a note, a letter from the Minister or a letter from anybody, carries no weight whatsoever in contract law. We have a number of legal documents which contain the phrase "clinically appropriate". Unless there is a definition of it, the meaning will continue to be highly ambiguous and will undoubtedly be challenged in the years ahead.

Where does this Government stand with regard to its supposed commitment to public healthcare and to Sláintecare? All the Government has been doing is paying lip service to that. Its decision today shows that it is not at all serious about Sláintecare and that it is engaged in the same thing St. Vincent's is engaged in, namely, promoting private healthcare. The Government has commissioned its own reports. The report of Dr. Donal de Buitléir came down strongly in favour of the separation of the two elements of public and private healthcare. Dr. Catherine Day also submitted a report. The Government is completely disregarding those significant reports.

The Government is now entering a contract with an organisation, St. Vincent's Holdings CLG, about which we know nothing. The Religious Sisters of Charity had to get approval from the Vatican to transfer its shareholding to that organisation. We know the Vatican agreed to the proposal, or petition as it is called, and we know nothing about what was contained in that petition. The Government is highly irresponsible in what it is doing. We are going to pay an enormous price for this in the future.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

It is hard to know what is left to be said about this debacle, other than for me to be very critical of how the Government has behaved over the past two weeks. The Government brought us into this Chamber, into repeated committee meetings and into media debates under a pretence. That pretence was that it was willing to engage and listen to the concerns of the Opposition, the women of Ireland and those of us who marked out the movement to repeal the eighth amendment. The Government has not listened to anything. The aim of all of this was to talk down the clock and drag matters out. The Government pretended it was going to give the Opposition some kind of change to this very convoluted and complex document, and to assuage the fears of the Opposition about its wording, including "clinically appropriate", while arguing about the ownership of the land.

What I have found remarkable throughout this whole process, and I have been involved in all of the debates, is the fact that the Minister can sit there happily and say, "Black is white." I could pick up a document and tell him that what he is asserting is not what St. Vincent's Holdings has said; that St. Vincent's is saying, "Black is black." Even in that circumstance, the Minister will get up and say, "Black is white." The Minister of State, Deputy Butler, has done that today. The speeches of the Government Deputies have done that. The Minister started his contribution by saying that we now have an urgently needed secular, public and co-located hospital. It is not co-located. It is fully integrated with St. Vincent's Healthcare Group. It belongs to a group that has public and private hospitals, and St. Michael's Hospital. That is clear from the documents and the business case that St. Vincent's Healthcare Group has made. It is also being paid for by public money, provided by the taxpayers, who are struggling today, and will be struggling tomorrow and next week, to make ends meet in this era of hyperinflation. Those people are watching this unfold. An enormous chunk of taxpayers' money is going to fund private suites for consultants in a public hospital. It is outrageous. This is being done under a cloud of secrecy and doubt. People's concerns, bearing in mind the legacy of the Catholic Church and, in particular the Religious Sisters of Charity, have been dismissed. To do that is utterly disgraceful, and it is Government hypocrisy.

I know the personal position of the Minister of State, Deputy Butler, because she led an active campaign to try to secure a "No" vote in the repeal referendum among members of her own party. She led that campaign personally and, obviously, her position on the question of choice has not changed. This is the worrying thing. We are moving forward into a new era. Let us say that Sinn Féin continues to top the polls, sweeps the next election and trumps all other parties-----

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

Hear, hear.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

-----and we attempt to form a left Government. That Government, because of this document, will never be ale to take full control and ownership of a hospital that was built with public money. It will never happen because one of the clauses accompanying the reduced level of rent states that St. Vincent's Holdings will never be challenged by the State and taken off the pitch. I ask the current Government to bear that in mind. It should also bear in mind that people more conservative than the Minister of State, Deputy Butler, on the question of reproductive rights could some day be in control and could challenge the meagre legal rights we have gained through the repeal of the eighth amendment.

I will point out one other hypocritical act. We were told that we cannot apply a compulsory purchase order to the lands because it would delay the process. It is also put in a context that suggests it was us in Opposition who caused a nine-year delay. That delay was the fault of St. Vincent's Healthcare Group and the Religious Sisters of Charity who were utterly determined to hold onto ownership of that land, whether it was morally right or legally possible or not. The Government has stated we cannot apply a compulsory purchase order. There is a compulsory purchase order on St. Vincent's Lands in Elm Park from the National Transport Authority, NTA. The NTA is compulsorily purchasing land from the nuns to build BusConnects. That has been done, and will be done, without a whimper, but we could not do the same on behalf of the women of Ireland. That is disgraceful.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

To say the past two weeks have been a sorry saga is an underestimation. In the past nine years, successive Governments have had a chance to get this right but have got it very wrong. We all agree that maternity services in the places where women have children are antiquated. We all agree with that. Those services need to be modernised.

The heart of the debate, and not only in the past nine years, has related to religious interference in healthcare. Such interference has a sorry past. We must look at the past, the present and the future. The past, as I said, has included religious interference in women's healthcare. It has been a sorry past.

In the present, we have a two-tier system, private and public, which causes fault lines across society.

People who live in certain parts of Ireland still cannot get access to abortion services. That is a fact.

We do not know the future and that is why there is some ambiguity regarding the 300-year lease. What we do know is that this generation has thrown the yoke of Christian doctrine away, as well as all of the inequality that existed previously. It has the shape of marriage equality and Repeal, and this generation will accept nothing less than the separation of church and State. Time will tell whether the Government has made an enormous mistake. People may look back in ten or 15 years and ask why the Government handed that land over to a private entity.

7:10 pm

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
Link to this: Individually | In context | Oireachtas source

Breathtaking cynicism has characterised the Government's ramming through of this proposal. The height of that breathtaking cynicism will be seen this evening when the Government votes in favour of a motion that calls on it to secure full public ownership of the site and new building on the very same day that it has done the very opposite. It is a disgusting level of cynicism. Government Deputies are all used to telling untruths at election time and then breaking all of their promises. Look at the Green Party and what it will do today. To hand over the land and the hospital in the morning and then in the evening vote in favour of a resolution to do the opposite is absolutely incredible.

Just because the Government keeps saying that what is proposed is equivalent to ownership does not make it so. If one looks at the legal documents, it is clear that this is not ownership in any way whatsoever.

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

The chair of the St. Vincent's Hospital Group, Mr. James Menton, told the Joint Committee on Health yesterday that the St. Vincent's Hospital Group is a secular organisation. This is the St. Vincent's Hospital Group still has St. Vincent in its name. Does it not still have religious statues and icons in its grounds and in its hospital? At the same time as that contribution was being made, a quick check on the Sisters of Charity website yielded the following statement: "health care is provided in an atmosphere of Christian love and compassion, operating according to the values of the Sisters of Charity." Is this a lay Catholic successor organisation or a secular organisation? The answer to that is pretty clear.

Fianna Fáil might have calculated the odds here, cynically, and figured that its voter base tends to be older and more conservative and the party will not lose much ground as a result of this decision. There is no Fine Gael Deputy in the House at the moment that I can see but I think that party's voter base might be a little bit different. Abraham Lincoln once said-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

The Minister of State is a member of Fine Gael.

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

Ah yes, the Minister of State, Deputy Feighan. Abraham Lincoln once said: "You can fool all the people some of the time and some of the people all the time, but you cannot fool all the people all the time.” I hope I have that right but the Deputy knows the quote to which I refer. Fine Gael jumped on the Repeal bandwagon very late in the day but it will be lot clearer to the people who gave the party a degree of support around that issue where it really stands on the struggle to separate Church and State in this country and on issues like Catholic control and influence in other hospitals around the country.

Finally, on the Green Party, it used to be said of the Labour Party that it wrestled with its own conscience but the Labour Party won in the end. The same is true of the Green Party today. The Government's cynical decision to support the motion might get if off the hook of the embarrassment of Deputy Hourigan voting against the Government but the people who voted for the Green Party in 2020 will see what is going on here and will remember the stance of the party on this issue come the next election.

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

From the outset I want to reiterate that the Aontú policy is to build public hospitals on public land. We believe that both the children's hospital and the maternity hospital should have been tri-located with a hospital on the periphery of the M50. It is a big mistake for both of these hospitals to be located on the sites chosen. We also believe that these hospitals should be run by the State but we are in a situation where the Government has to make a decision on the basis of an organic system that has grown over decades. At this stage, we need to go ahead and build a new national maternity hospital as soon as we can.

I want to thank the National Maternity Hospital for organising a briefing for Opposition parties in Holles Street last week, where the Minister for Health and the master of the hospital were present to take questions. It is incredible that Aontú was the only Opposition party that attended that meeting. Given that this issue has consumed pretty much all of the bandwidth in this echo chamber for the last month, I would ask why Sinn Féin, the Social Democrats, People Before Profit and the Labour Party did not attend the Holles Street meeting to pose questions to the hospital itself.

The key question for us in all of this is the cost to the health of mothers for each year that the building of a new maternity hospital is delayed. That is a key issue. We want to know how many wards are operating at over-capacity right now in the National Maternity Hospital. What is the patient to doctor ratio, the patient to nurse ratio, and the patient to consultant ratio? How many babies are in the neonatal intensive care units relative to the actual capacity of the units? How long does it take to cross the city of Dublin from Holles Street to St. Vincent's Hospital in an ambulance on an international rugby match Saturday, if a mother is suffering a life-threatening medical emergency? These are the key questions. We also want to know how long it would take to start from scratch and build another maternity hospital in another location if this deal collapsed. There was a significant chance that this deal could have collapsed and if we had to go back to the drawing board, we need to know how long it would take before a hospital would be built. Is it ten, 15 or 20 years?

These are the critical, life and death issues that should be at the centre of the debate but they have not been at its centre over the last number of months. It never ceases to amaze me that if there is a choice between a bread-and-butter issue or health issue, on the one hand, or a culture war issue, on the other, most parties of the left will go to the culture war issue like a moth to a flame. The people I talk to at home are consumed by the fact that: there are 1 million people on hospital waiting lists, with many there for years; there are hundreds of people on trolleys every day; accident and emergency delays are now the worst on record, with seriously ill people having to wait 13 hours or more for admission; we have a mental health pandemic in this country; and hospitals faced claims for 105,000 mistakes last year. One would have to be on a pretty high income or have gold-plated health insurance for these health concerns to be relegated below the question of whether there is a crucifix in a hospital. One would have to be fairly well off and have fairly good access to healthcare for those issues to mean less than whether there is a crucifix in a hospital.

It is astounding that Peter Boylan's tweet last night made the big reveal that there is a chaplaincy in St. Vincent's Hospital and this chaplaincy provides information on the television channel on which patients can access mass, if they want. Is this where we are in Ireland in 2022? Forget about the 1 million people on hospital waiting lists. Hold the front page - there is mass in the chaplaincy in St. Vincent's. What is going on in this country at the moment is incredible. Just under the surface of much of these debates is an anti-Catholic invective. I have heard some of the language that has been used on the radio and television and in these Chambers in recent weeks, from Deputy Ó Ríordáin's desire to vet civil servants for their level of Catholic faith and his call to get them out of the schools, to the Social Democrat's motion which stated that the Catholic ethos is a threat to women's healthcare, to Solidarity, People Before Profit blaming the education in Catholic schools for violence against women. All of this is untrue, and much of it borders on hate speech. For hundreds of years in this country, the health service and the education service was provided by the Catholic Church and the volunteer work of men and women. Indeed, the chaplaincy that was attacked in Peter Boylan's tweet is one of the many chaplaincies and organisations which provided comfort and consolation, at great risk to themselves, to believers and non-believers during the darkest days of the Covid crisis.

We are reminded that the only profession not thanked at the official Government remembrance for Covid were the priests and nuns in the State who buried our dead and who consoled our families at great risk to themselves while the people who wrote those speeches were working from home at the time. It is an incredible situation. If one wants to find Catholic ethos in this country, look no further than Sr. Stanislaus Kennedy, Brother Kevin, Fr. Peter McVerry and Sr. Consilio. These are the people who are picking up the tab in areas of government neglect. Priests, parishes and religious people right across the country are moving mountains to help refugees fleeing Ukraine and are sending supplies to the Polish border.

There have been great wrongs carried out by the church in the past, but there has been great good delivered for generations too. For every wrongdoer there were dozens of good people doing the best they could for the right reasons. There is hardly a family in the State that has not benefited from Catholic healthcare or education in the last century. It must be remembered that in the darkest parts of our institutional past the State was equally culpable in those situations. Our healthcare service has grown organically into a pluralist model. Voluntary organisations with different ethos have, in the main, built the health service we have today. Ireland should be a pluralist republic. Catholics, Protestants and dissenters should have the right to be who they are without fear or favour from the State. Pluralism makes Ireland richer, stronger and more diverse.

I hear parties saying the ground should be gifted to the State. Sinn Féin has more than 100 properties in the State at the moment. I suggest that perhaps Sinn Féin gift some of its properties to the State. It is easy to be generous with other people's property. It is much too easy. People should not ask others to do what they will not do themselves. My whole worry about this issue at the moment is that the project could be delayed for another 15 years. It is right and proper to ask the questions. It is important we test this contract to the full extent. We see no evidence proffered as to why it should be stopped. If it is stopped, I believe the mothers and women of Ireland will suffer as a result.

There is one term with which I have a difficulty, and which has been cited over and over again in this debate and it is whether or not something is "clinically appropriate". What does "clinically appropriate" mean? It means a professionally recognised standard of medical care. All hospital decisions should be based on whether something is clinically appropriate or not. If we were to delete the words "clinically appropriate", it means an ideology or a religion or some other issue has to come in on top of it. The idea doctors should make ideological decisions and religious decisions, and should ignore the clinical appropriateness of the decision is absolutely hard to believe.

7:20 pm

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

Are you supporting our motion?

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

People are asking that clinically inappropriate decisions would be made in hospitals.

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

Are you supporting our motion?

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

As a State, we need to make sure the highest standard of science and medical knowledge is at the heart of the decisions we make. The truth of the matter is the doctors and healthcare professionals I have spoken to are really frustrated with the language that has been used about their ability to provide services. If one goes to anybody in the National Maternity Hospital, Holles Street or St. Vincent's, they are phenomenally frustrated at their professionalism being undermined wholesale and repeatedly in the debates over the past months on this issue.

Aontú is a human rights party. We believe first and foremost that the health of the mother and the life of the mother should be protected in every single circumstance. After that, we believe the lives and health of the sons and daughters should be protected as well, if possible. We are basically looking at a situation where some Fine Gael Deputies and Senators have been coming out to say they kind of oppose this deal. This is deeply hypocritical. This is Fine Gael's baby and has been promised for years. There are real questions the Dáil should be asking. Why are we talking about something that was first announced in 2008 and again in 2013? Why is there a cost increase from €150 million to more than €800 million on this particular project? Are the private clinics already attached to Holles Street going to be shifted onto the site? None of this information is being teased out properly because of the ideological predisposition in relation to this battle.

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

Are you supporting our motion? You never said.

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

I cannot.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
Link to this: Individually | In context | Oireachtas source

The National Maternity Hospital at Holles Street is overcrowded. We need a new hospital built to modern specifications. Let us get on with it and stop blaming the nuns for everything. The nuns are easy targets for populist left politicians to attack because they know the nuns do not have expensive public relations teams and are not in the business of doing media. It is important to point out the Religious Sisters of Charity are giving away land worth more than €50 million for free to build a hospital. They will have absolutely no say in the running of the hospital - in a way an objective that would be cause for positivity. In this case, however, the nuns have been under sustained attack simply because they are Catholic. They have been lambasted and targeted by critics who are more concerned with gaining lines in a newspaper or time on the airwaves than anything else. Why does the health committee have to delay the process even longer? After all, the St. Vincent's Healthcare Group does not want to sell this land but will give it to the HSE under a 299-year lease. This deal will take the new hospital into the 24th century before ownership would become an issue. Even then, it is unlikely any court would say the hospital should be removed. Who will own the hospital buildings? The HSE will. After 299 years of the leasehold, the hospital ownership will revert to St. Vincent's hospital. There is nothing to indicate that even then the nuns, if the order is still around, would have any say in its running. Is this argument common? Yes, absolutely. In fact, 99% of Irish apartments are purchased under a long lease agreement and ownership is not disputed. It is a very standard contract that has become, for whatever reason, a major political debate. Will the State, however, manage to control the cost of the building of this new hospital, given the massive overrun cost overrun of the new children's hospital at St. James's Hospital? The State will be seeking much tighter oversight this time around but the Government has a dismal track record when it comes to such projects. All indications point to this becoming another runaway costs project.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

If there are nuns listening, I would like to say something they have not heard in this Chamber until perhaps right now. Thank you very much. Nobody has said thank you, either in government, out of government or in opposition. All everybody has done is try to pick fault and find everything possible wrong with this because of this anti-religion agenda in Ireland at present. It is absolutely outrageous.

I was talking to an extremely intelligent person the other evening. He was watching this whole debate going on over the past couple of weeks. He was listening to all of the different political commentary. Of course he spoke about the hatred that seemed to be seeping out of certain politicians' mouths when they were speaking about the Religious Sisters of Charity. His comment was along the lines of, "Why did the sisters do it this way and why not that way?" Quite simply, it is because they own the land and they wanted to do it this way. It is extremely fair to have a 300-year lease at €10 per year. What part of that do people not understand? That is, in effect, gifting it to the State. If this is the way they want to do it, and if these are the rules they are laying down, is that not fine and well and good? Why can people not accept that? It is because people want to forget and ignore the good work done by the Catholic Church in Ireland. Of course bad things happened, and of course there were bad people. There were bad priests, but there were bad people in every walk of life. Think about the extremely kind and good people, young boys and young girls, who were devoted and gave up their lives for what they believed in, which was God. Of course, an awful lot of politicians cannot believe in God because they think they are God themselves.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

I am glad to get the opportunity to talk on this very important matter this evening. We certainly need a new maternity hospital in the city of Dublin, and for the country as well. I do not understand why the people who are objecting to this do not understand they are getting lands worth more than €50 million or €60 million, mostly free of charge or at a €10 per year for 299 years. How much is that when 299 years is several lifetimes?

I cannot understand it, and especially some of the people who are against this deal. The debate around the delivery of the new national maternity hospital and its relocation fails to take full account of the substandard maternity facilities in other hospitals and promises made by the previous few Governments to provide new and improved standards of care for women. In fact, four upgraded maternity hospitals have been promised but none has actually been delivered, and we are being critical now of the Government for providing a maternity hospital of the highest worldwide standards. That is what we want to ensure. I cannot understand it. Of course, as has been said by other speakers, there is a hatred of the Catholic religion. There is a hatred of nuns and priests and, yes, some of them did wrong in the past. However, many of them did an awful lot for young boys and girls and men and women around the country and they have to be appreciated for that.

7:30 pm

Photo of Richard O'DonoghueRichard O'Donoghue (Limerick County, Independent)
Link to this: Individually | In context | Oireachtas source

Maternity services have fallen short when it has come to caring for the women of this country, and will fall short for children who will be born here. I know many of the HIQA reports on our maternity hospitals are outdated. It shows how bad the infrastructure is. Is there another agenda here? Why would somebody go against this project? My duty of care is to the mothers and generations of children to come.

It is important to point out that the Sisters of Charity are giving away land worth €50 million on a 299-year contract. The Government has buildings and schools around this country with 99-year leases and there does not seem to be a problem about that. This is for 299 years. We are here to live for today and look after the women and children of today and tomorrow. That is what we are here to do. It is a 299-year lease. Let us get this done. Let us look after the vulnerable and the people who want to make this happen. Why is it that everything has to go backwards to try to get media attention? When I am asked at a door what I am doing, the answer is that I am here to protect, represent and care for the people of today. We are here to care for the women, children, husbands and partners of this country, so let us stop the nonsense. Let us get this moving forward to care for the people of today.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

I am glad to be able to speak on this motion. We see the waiting lists across every walk of society but people are waiting 12 months for gynaecological services. Waiting lists have increase by 67% since March 2015. We see the furore over this site and the way it has exploded and mushroomed and there is not a mention of the children's hospital. Tá sé caillte. It is in a major hole somewhere not even being talked about; it is off the radar and on the Richter scale. It is three times the price and on the wrong site from the first day. We have a site gifted by the good Sisters of Charity with a 299-year lease. People wanted it. That Sinn Féin has 100 properties was referred to. I did not know it had that much property. Why does it not give away for free some of its sites? I have often negotiated leases with schools, boards of management, different organisations and GAA clubs. It is wonderful to get a lease of 30, 50 or 99 years but to get one for 299 years is unheard of.

Heinous crimes were committed by some members of the clergy, both male and female but they have done good all over the world. It is costing €5.5 billion now for our NGOs to go around the world. The nuns did it for free. They brought water, education, food and healthcare to people all over the world. They had a massive reputation in this country in the 19th and 20th centuries for delivering healthcare and all we can do now is demonise, bad-mouth, wreck and attack them. It is shameful because they have no voice to speak. They are quiet people of prayer, faith and good, by and large, and they do great work. I could name ten of them with whom I worked on boards of management and whatever. They are dedicated solely to the good of their communities. They had no families of their own and they went away. One of them from my area who gave a lifetime of service in Africa is being buried today in County Monaghan. That is what they did. They left their families. To be attacked and under siege here every day, even on Saturday when people were outside the gate attacking them, is sacrilege. It is disgusting, to be honest.

We will certainly be calling for a vote against this motion and if we are on our own, so be it. However, we are proud to stand on the record of the good work and reputations of the sisters of many orders and the priests and laity who helped out. This project must be delivered; get it done. They have given the site. It is all about abortion. It is not about services; it is about abortion. Front and centre, that is what it is about. It is a phony debate. That is what it is all about and nothing else.

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

I thank Sinn Féin once again for giving us the opportunity by tabling this motion. With regard to what Deputy Michael Healy-Rae said, I do not think I want to be God but if I was arrogant enough to go down that road, I would choose to be a goddess, maybe, and do it completely differently.

With regard to this matter, words fail me in relation to the hypocrisy. I am on record for praising the Minister of State, Deputy Butler, for her hands-on approach but on this issue, I fundamentally disagree with her. Two weeks ago, this was paused, ostensibly to give us a chance to reflect and see what would emerge.

I read all of documents as best I could. I am no expert and I struggled with them. They raised more questions than provided answers. What deeply disturbs me is the narrative that has come from the Government, with certain Deputies who were on the Joint Committee on Health, that played the man rather than the issue. I stayed late on Thursday - not as late as I should have but as long as I could - and I really witnessed a deplorable display of tackling the person as opposed to eliciting information. I am not here to tackle or to give out about nuns. I was educated by nuns. I am not here to even talk about nuns. I am here to talk about why we do not have a public hospital on a public site.

The response from St. Vincent's Healthcare Group that it needs ownership to have an integrated service is nothing short of pathetic and unacceptable to me as a woman and a female Deputy. That the Government would accept that is also unacceptable to me. Let us look at how we have gone around in a circle. Let us look also at what Mr. James Menton said on record back in 2017. On 30 May 2017, the day after the Religious Sisters of Charity announced its intention to depart the St. Vincent's Healthcare Group, Mr. Menton said that the move "will only proceed on the basis of existing agreements that give ownership and control of the new hospital to St Vincent’s Healthcare Group." "Ownership and control" is clearly stated. Fast-forward to 2022 and that is exactly what we are giving to a trinity of control. Little things have changed, such as changes with directorship in terms of numbers and a golden share. Nowhere is the process of that golden share outlined.

I am addressing the Minister in particular because he has strong opinions on this. I am asking him to look at that trinity of ownership. St. Vincent's Holdings CLG is at the top of the pyramid. The Government has absolutely no say or influence; it has nothing. St. Vincent's Holdings CLG owned 100% of St. Vincent's Healthcare Group. There is no input from the Government whatsoever except perhaps through a director who will come up from the new designated company, which was established less than two years ago, that will run the hospital. That will comprise nine directors, three of whom will come from St. Vincent's Healthcare Group. Can the Minister tell me why they have to be there? Can he tell me why three directors from the owning group have to be on the hospital? Can he tell me why the director has to come from that group every three years? Can he tell me why there is no documentation or clarification, only once again assurances regarding the transfer - not a gifting but a transfer - of the land or asset owned by the nuns to the new company St. Vincent's Holdings CLG? Why can we not have that documentation? Were there any conditions? If not, wonderful - that means they can hand the land now to the State.

I hear this sort of disingenuous argument going around that we are against the nuns or against religion. That may well be, but that is not the issue at all. The issue in the 21st century is a public maternity hospital on a public site. Why? The reason is that is what the Dáil wants. That is what it said in regard to Sláintecare.

It is what the reports of both Dr. Butler and Dr. Catherine Day recommended in regard to moving away from private care in public facilities. Both reports were ignored by the Government and were not even mentioned by it.

I would have thought the Minister might have done us the decency of going through these issues with us and telling us his opinion on that. It is a deeply hypocritical stance to debate this motion after making the decision earlier in Cabinet and not even to wait for democracy, or the illusion thereof, in action. As a woman, I will not accept this. I cannot change the Government’s mind, but I can place on record that we saw through its spin, and in particular that of the Minister for Health, because that is all it is. It is absolute spin. I see through it and I am telling the people who are listening to this debate and who also see through it that I share that with them. It is unacceptable.

7:40 pm

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

I thank Sinn Féin for introducing this Private Members' motion. I absolutely support it and agree with what it states. Unfortunately, however, it is irrelevant, just like the three other motions on the issue that have been moved in the Chamber, by the Social Democrats, Deputy Connolly and me, none of which was opposed by the Government. This tactic is being used increasingly by the Government to demonstrate its complete disregard for supposedly democratic procedures in the Chamber. The pause by the Government in rubber-stamping the deal with St. Vincent's Holdings CLG and St. Vincent's Healthcare Group for two weeks, supposedly to allow for scrutiny of the arrangement by the Joint Committee on Health, was nothing of the sort. It just needed a bit more time to get its ducks in a row. Deputy Hourigan is to be congratulated on maintaining her principled position but, obviously, she will not have an opportunity to vote freely on the motion. She, along with other members of the Green Party who had a very strong position on this, will have to make a decision about their place in their party.

The Government and the parties supporting it are a disgrace. Yet again, they have bent the knee to the powerful vested interests that have dominated this State since its inception and made the lives of women, and very often their children, an absolute misery. This was a test between the State and the Catholic Church and its proxies, a test the State has failed miserably. The Government is covering up for its actions by claiming it is acting in the interests of women’s health by getting the hospital built as soon as possible. Of course, the hospital is a much-needed modern facility, but these parties were in government in 2013, when St. Vincent's Healthcare Group arrogantly dismissed the idea of co-location. It was then that the process for a compulsory purchase order should have been put in motion. If that had been done, the hospital would have been built and would be operational on State-owned land, fully publicly owned and run.

We need to deal with the reality regarding the issues with the provision of abortion services in this country. Despite the repeal of the eighth amendment and the introduction of legislation following that, abortion services are not by any stretch of the imagination widely available. Half of the 19 maternity hospitals - eight of them State-owned public hospitals - do not provide terminations, while nine out of ten GPs do not provide such services either. As for the issue of fatal foetal abnormality, two doctors are required agree on a diagnosis, and there have been instances where a termination has been refused in one healthcare setting but agreed to at a different hospital. This is what "clinically appropriate" can mean. Savita Halappanavar was given what her clinician considered "clinically appropriate" care, rather than the appropriate care that would have saved her life.

The Catholic Church casts a long shadow, not least in the case of the medical professions. Leaving aside the question of Catholic ethos, a hospital costing up to, and probably more than, €1 billion to build, and then funded on a daily basis by the State, will effectively be part of the St. Vincent’s Healthcare Group, a private entity. Even if it is a secular entity, which I do not believe for a moment, why is the State handing over effective control, with questions over the ownership, to a private company? Why is the State prepared to enter a legal agreement with a private company deliberately set up through offshore arrangements to avoid scrutiny of its real nature and the basis on which it was set up?

This points to yet another miserable failure in the context of Sláintecare, the objective of a public national healthcare system, open to all regardless of ability to pay. The Government has bent the knee not just to Vatican officials but to the vested interests of private medicine. Sláintecare does not have a hope of ever being implemented or seeing the light of day. I believe the Government is wrong, although I hope I am incorrect in that regard because I hope we will never again see in the future what we saw in the past. I am just very angry.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am sharing time with the Minister of State, Deputy Feighan.

As someone who comes from a legal background, having spent more than 25 years dealing with leasehold and freehold titles, I am very much aware of the significance of a 299-year lease. Only one witness who appeared before the health committee gave evidence on behalf of the opponents of this project, and he admitted he was not a property law expert. Conversely, representatives of three law firms clearly set out that this was good title being handed over. It is a lease from the St. Vincent's Holdings CLG to the HSE, which will, in turn, give a licence to the national maternity hospital and the new group that will be set up.

Leasehold title is widely accepted as good title in this country. Let us take, as an example, our good friends across the House in Sinn Féin. Are they suggesting all the properties they own are held under freehold title? Many of their properties will be held under leasehold title. Are they suggesting their landlords tell them what they can or cannot do? I do not think so. This is good title, and clear evidence given to the health committee demonstrates that the State will own the property and that no other interest can mortgage or do anything else with the property without the consent of the HSE, which is getting the lease. That is very important.

Stephen Dodd SC has been quoted extensively in this context. In his published opinion, he accepts that if we were to use the Health Act 1947 to compulsorily acquire the land, the State would not succeed. It is clear we are getting good title in the lease being offered here for 299 years.

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

I fully appreciate the importance of this issue and the not insignificant concerns raised by many over recent weeks and months, and I am grateful for the opportunity to address some of those concerns. As the Minister for Health noted, we are all trying to achieve the same goal, which is best described by the vision of the national maternity strategy, whereby women and babies will have access to safe, high-quality care in the setting most appropriate to their needs, whereby women and families will be placed at the centre of all services and treated with dignity, respect and compassion, and whereby parents will be supported before, during and after pregnancy to allow them to give their child the best possible start in life.

A significant part of delivering on that vision and achieving our shared goal relates to providing targeted investment in women's health services. The Government has prioritised women’s health comprehensively and invested heavily to ensure women and girls will get the quality healthcare they expect and deserve. Another significant element of delivering on our shared vision relates to the development of a world-class maternity hospital that will provide and perform for the women, families and babies of this country.

In the context of our history with regard to women’s healthcare, I appreciate that very valid concerns have been raised and I fully understand how sensitive the issue is. It is vital to point out, however, that those same concerns were identified at an early stage and have been the basis of significant and protracted negotiations over several years. In particular, the issues of governance and clinical independence have been central to those discussions, and it is no surprise people might find it difficult to trust assurances given about the services in the new hospital because they have been let down so badly in the past and reproductive rights were so hard won.

That is why so much time and effort has gone into developing the draft legal framework to ensure we have legally binding commitments from all sides. This is what provides the assurances. We are not talking about easy words but about agreed legal documents that have been drafted with the support of legal advisers and exhaustively examined. That is how we can have confidence in the new hospital's ability to provide the full range of women's health services in accordance with the laws and policies of the State.

The legal documents have all been published and there has been intense scrutiny. The absence of any religious ethos is crystal clear. The new hospital is not just allowed but obliged to provide all lawfully permissible maternity, gynaecological, obstetrical and neonatal services. There are mechanisms for intervention in the unlikely event that there is an issue. The Minister for Health of the day can, if needed, direct the board of this new hospital to provide all of these services. All lawfully permissible services will be provided and nothing will be prohibited due to religious beliefs or ethical codes.

It is very important to note and to remind the House that the current infrastructure at the National Maternity Hospital does not provide an appropriate environment for the realisation of the national maternity strategy's vision. Several hundred pregnant women require transfer to St. Vincent's Hospital as inpatients and a small number of critically ill women are transferred to receive intensive care not available onsite at Holles Street. This is not in keeping with best practice. The hospital also has many multi-occupancy wards, which increases the risk of infection and compromises the privacy and dignity of patients. By comparison, in the new national maternity hospital, all inpatient accommodation, including in the neonatal intensive care unit, will be in single rooms, increasing safety, privacy and dignity. The new hospital will also facilitate a modern campus approach to healthcare where a range of medical entities operate in close proximity to improve patient care, patient outcomes and patient experience.

It should be noted that clinicians at the National Maternity Hospital and beyond have publicly and very strongly expressed their support for the move. These are the people on the front line delivering babies and caring for women every day of the week. It is certainly noteworthy that, in a letter to senior Ministers, 52 clinicians at the National Maternity Hospital outlined the strong need for this new hospital. Along with all the assistant directors of midwifery, the director of midwifery at the hospital recently wrote to confirm her full support and to re-emphasise the need for this key project. The chair of the National Directors of Midwifery Forum also wrote, on behalf of the forum, to support the move to the St. Vincent's hospital campus at Elm Park. The chair of the medical board of St. Vincent's University Hospital wrote on behalf of the board, which represents more than 250 clinicians across the St. Vincent's hospital network, to outline its overwhelming support for the relocation project. These are the dedicated professionals who will be providing services in the new national maternity hospital. They understand how important and necessary this new facility is. It is very clear that they have full confidence in the agreements that have been brokered.

The very bottom line is that the new national maternity hospital is badly needed and that further delay will only serve to increase that need. We know that the hospital must, and will, provide the full spectrum of services without any undue influence. We know that the State's investment is very well protected as a result of the lengthy negotiations that have now carried on for several years. We know that the project has the overwhelming support of the clinicians, midwives and management that will provide care in the new hospital. It is time to get this hospital built so that we can deliver on the vision of the national maternity strategy sooner rather than later.

7:50 pm

Photo of Paul DonnellyPaul Donnelly (Dublin West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Everyone wants to see the building of the new national maternity hospital but it has been overshadowed by the Government's failure to listen to the concerns of so many people inside and outside this Chamber. The simple fact is that a national maternity hospital built by the State should, and must, be built on land solely owned by the State. Long-term leasing is not the same as full ownership. We have to nail the lie. Both Fianna Fáil and Fine Gael have had plenty of time over the years to build and provide a national maternity hospital on public lands.

There are two main reasons State ownership matters. The first is that it avoids these complicated governance arrangements and any chance of limited services. The second is that if safeguards the State's investment and avoids legal problems down the line if a big private company got involved in St. Vincent's, which is a possibility should it see a health-for-profit opportunity. It would also give the Government a bargaining chip because, at present, St. Vincent's Healthcare Group holds all of the cards.

Control of the land is of the utmost importance. With the State's investment should come full ownership. I do not believe that everything possible has been done to acquire the site and I do not accept that there is no option that involves State ownership of the land. The question of why the State cannot own the land has never been answered satisfactorily. Every effort should be made to acquire the land or to ensure the gifting of the land to the State, which was promised at the beginning of this process. The Taoiseach, the Tánaiste and the leader of the Green Party have all admitted to having concerns about the ownership. In government, Sinn Féin would insist on St. Vincent's Healthcare Group gifting the land and would work with the group to persuade it to do so. We would work with it to ensure the site's integration and cohesion is protected, delivering the best outcome for all. Again, the Government is shamefully engaging in a smoke-and-mirrors exercise in not opposing Sinn Féin's motion solely to stop Members on its own benches voting in favour of it.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank my colleague, Deputy Cullinane, for bringing forward the motion. This is the conclusion of the debate. We know that there are very serious concerns. These are not just the concerns of those of us in the Opposition, but of a great many women throughout the country. Unfortunately, these concerns arise from the history of the State's treatment of women. We have had several discussions in this Chamber on many issues in respect of women but particularly in respect of women's health. Some of these issues are not as historical as others. The CervicalCheck scandal is not so long ago in our history. There were also issues around breast cancer screening. The list is endless. My colleagues have made the point that this needs to be a State-run hospital. That is really important because many health services for women are just not adequate and not at the races. There have been discussions about menopause. It got to the point where there were discussions on the national airwaves. People had to ring into national programmes before there was any sort of recognition of the amount of work that has to be done. Women literally left without being diagnosed as perimenopausal and all of the other things that come with that.

I will also mention endometriosis, a very serious condition which many women suffer from. It is often misdiagnosed and not treated. Countless women have had difficulties and issues with the condition, which can seriously affect fertility and other things later in life if not addressed. Last year, when the Dáil was sitting in the convention centre, I told the story of somebody very close to me who was misdiagnosed for years. She was actually in a gown going for a gallbladder operation at the age of 25 when luckily somebody had the cop-on and common sense to suggest that a scan of the uterus be done. That had not been done up to that point. She was diagnosed with endometriosis. This person's gallbladder was about to be removed. She was in the gown, ready and fasted from the night before. That is the type of service that, unfortunately, women have got used to.

That should not happen. It is unacceptable and disgraceful. In not having a fully State-run and State-owned hospital, women are afraid this kind of treatment will continue. That is before we even get into the whole debate about the knock-on effect for the services arising from the successful repeal of the eighth amendment in 2018.

I am out of time. Women have been failed badly in this State. We have an opportunity now to have the first-class maternity hospital we all want and which we all know is overdue but that hospital must be State-run and State-owned.

8:00 pm

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

I thank all the Deputies on both sides of the House who spoke in this debate. I finish as I started by stating that I want to see a new national maternity hospital. I want it to be built as quickly as possible and to ensure it is a public hospital in public ownership. It is absolutely breathtaking and amazing to see the lengths to which the Government will go to sell what I see as a bad deal. The repeated assertion that black is white and that the State will own the land, when, clearly, the freehold of that land will be retained and owned by the St. Vincent's Healthcare Group, is quite amazing.

Those who make that argument know exactly the point we are making. The reason an HSE hospital will not be built is that the St. Vincent's Healthcare Group will retain the freehold and ownership of the land. A new company, National Maternity Hospital at Elm Park, is being established because St. Vincent's Healthcare Group does not want an HSE hospital operating on its land, co-locating with the public and private hospitals that are there. This, for me, goes completely against the spirit of Sláintecare. When asked for its reason for not gifting the land to the State, St. Vincent's Healthcare Group said it wanted an integrated model of healthcare, with all the hospitals co-located under the umbrella of the group and the establishment of a new company, which will run and manage the new maternity hospital.

It also is quite breathtaking that the Cabinet signed off on this decision today in the full knowledge that there have been no real, substantive talks with St. Vincent's Healthcare Group over the past number of months, nor, in fact, if the chairman of the group is to be believed, over the past number of years. No pressure was brought to bear on it, either by the Minister for Health or the Taoiseach. There certainly were no high-level talks in regard to the ownership of the land. Instead, the white flag was raised and all of the excuses have been rolled out as to why St. Vincent's Healthcare Group simply will not gift the land to the State.

As I have raised with the Ceann Comhairle on several occasions in the past, it is deeply cynical of the Government to say it will not oppose a motion and then not implement what is called for in that particular motion. We are being told the Rural Independent Group Deputies will call a vote on this motion, as is their right. If there is a vote, let us be clear about what it is for which people, including Government Deputies, are voting. They will be voting on the text of the motion, which commits the Government to "pursue the full realisation of the promise that was made by the [Religious Sisters of Charity] to give the land to the people of Ireland". It commits the Government to "engage, at the highest level, with the new ownership group behind [St. Vincent's Healthcare Group], St. Vincent's Holdings CLG, to secure full public ownership of the site and new building, with all necessary safeguards, wayleaves, and guarantees to ensure the integrity, integration and highest quality of care on the site". That is what Government Members will be voting on tomorrow, if there is a vote. They cannot speak from two sides of their mouth on this issue. They will have an opportunity tomorrow to vote in favour of this motion, which I hope they do. If Ministers and Government Members come in here tomorrow and vote in favour of the motion, which commits the Government to do very clear and explicit things, then those things need to be done. If they are not, it will amount to a deeply cynical move by the Government and it will further heighten the concerns people have about this arrangement.

Speakers on the Government side have made the argument again here today that the ownership of the land and other concerns have now been addressed and there is nothing overly complex about all of this. However, we have also heard the Minister once again try to explain the very difficult and complex legal and contractual arrangements that are being put in place. The new company that is being formed will have its own constitution and its own board. The directors will come from three different sources, as we know, and it will be a subsidiary of St. Vincent's Healthcare Group. The latter owns the freehold and it will have a lease arrangement and a licence arrangement with the HSE. That company is owned by St. Vincent's Holdings CLG. There is a huge amount of unnecessary complication around this. Why is that? It is because the company does not want to build an HSE hospital on that site. That is the bottom line and it is wrong. It is not the best way to build the new national maternity hospital.

Colleagues opposite will have their chance tomorrow to vote. If they vote for the motion, I guarantee that we will make sure to hold them to account in delivering on it.

Question put.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

In accordance with Standing Order 80(2), the vote is deferred until the weekly division time tomorrow evening.