Alice-Mary Higgins (Independent) | Oireachtas source

I will take the reverse of the approach of the previous speaker, even though there are very many interesting aspects of the national women's health strategy, many of which I hope to tease out in the future. I will specifically note one point in respect of breastfeeding. I encourage the Minister to lend his support to the proposals currently being considered by the Minister, Deputy Catherine Martin, with regard to bans and restrictions on the advertising of formula milk. However, I am going to focus on the national maternity hospital.

I will focus on the fact that many of the concerns were not addressed. In fact, they were heightened. It is really regrettable that the time was not taken to review or make any change whatsoever to the proposed legal paperwork to reflect the concerns that were not resolved, but heightened, over the course of the two weeks of hearings in the Joint Committee on Health, in which I participated. With regard to the language used regarding delay, we should be very clear that the primary delays in this project to date have come from those with whom the Government has been negotiating. For example, three to four years passed while Vatican sign-off on the transfer of lands was awaited. Let us be clear, those were the cause of delay in the project rather than those activists who pushed and who were pressing many years ago for the hospital to be publicly owned and for things like a compulsory purchase order, which could have been activated at that time but were not.

It is astounding to me that the key issue I want to highlight was not addressed. I refer to the phrase "clinically appropriate". Over the course of the two weeks, we heard multiple interpretations of what that might mean, including multiple interpretations from legal advisers.One of the core phrases in the context of the leasehold agreement is "permitted use". Is it all clinically appropriate and legally permissible healthcare services or is it all clinically appropriate or legally permissible services? This is a double test and is really important. We also heard that this was to make sure that it would only be services related to a maternity hospital but there already was a line which said that it would be legally permissible healthcare services provided by a maternity, gynaecological, obstetric and neonatal hospital. Again, that was already specified.

The phrase "clinically appropriate" which is not defined and has an ambiguous meaning, was left hanging. One may well say that legally permissible services are there but if they are subject to a double test, for example, of clinically appropriate, then the question is not just what services are available but when they are available, how they are available and whether they are available on an elective basis. To simply say all services will be provided is not enough. Abortion was available in Ireland even while the eighth amendment still stood but it was only available if a woman was dying and even then, doctors had to determine how close to death the woman was. We all heard in the committee about such determinations - is the risk of death 20% or 40%? Similarly, we also know that some of the services in St. Vincent's Healthcare Group such as sterilisation were made available when clinically necessary for other reasons but not solely for the purposes of birth control. Symphysiotomy was clinically indicated in Ireland at times by certain physicians. These things matter.

Over the course of the hearings the National Maternity Hospital, St. Vincent's Healthcare Group and Mr. Mulvey himself suggested the phrase "clinically appropriate" be either deleted or defined but the Government did not choose to seek a definition or a deletion. In the lease that phrase is interpreted by the landlord, St. Vincent's Healthcare Group. The group was asked directly about its values, not about its religious ethos but its values as expressed in its new constitution which includes references to things like human dignity. I asked if this is human dignity as set out in the Universal Charter of Human Rights, which is from birth, or as set out in the declaration on human dignity by the Dignitatis Humanae Institute, which is from conception to natural death. Which definition is the St. Vincent's Healthcare Group's definition and how does that apply to its interpretation, as the landlord, of "clinically appropriate"? These questions were not answered.

The decision was made to rush through with an ambiguity which will be the subject of potential debate and interpretation for many years. This will have significant financial consequences because the State has also managed to reach a deal in which it has no exit clause. If this hospital expires after 70 years, as we have been told it will, the State will have to build another one and then another one because if, at any point, there is not a hospital on that ground, the rent reverts to €850,000 per year. St. Vincent's Hospital Group can throw us out if we do not have a hospital on that ground but the HSE's own legal adviser, when I asked what would happen in 70 years, said that if we do not want a hospital there after 70 years we could build something like a shopping centre or an apartment block and force St. Vincent's Healthcare Group to terminate the lease. We will have to try to get ourselves thrown out. In terms of the business case, is it four hospitals that we are building? The business case has not been answered and if the State cannot get a good deal on that and cannot even get first right to purchase the site if it is put up for sale after 30 years, how are we are going to be in a good position in terms of the negotiations we are facing for the next 299 years on the board of this hospital? Again, a disservice has been done to future generations.