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Leaders' Questions | The National Maternity Hospital

15 July 2021

Deputy Ivana Bacik:

Go raibh maith agat, a Leas-Cheann Comhairle, and I thank the Tánaiste for his warm words last week following my by-election result. I am deeply honoured to be here to represent Dublin Bay South in the Dáil. It is a great honour indeed.

Following yesterday's health committee meeting, I wish to raise the pressing matter of the proposed new national maternity hospital, which we might say is both a local and very much a national issue. During the by-election campaign the issue of women's health and maternity healthcare was raised with me many times. I heard from women who were due to give birth and who were deeply concerned about the ongoing unduly restrictive practices being adopted in many maternity hospitals and from partners of pregnant women anxious about their exclusion from labour wards. We urgently need to ensure better and more consistent provision for women's healthcare and maternity hospitals. In that context I also heard deep frustration from many people about the tortuous legal negotiations which have been ongoing for so many years surrounding the proposed new national maternity hospital. I heard about the many serious and valid concerns which remain about the ownership and the clinical independence of the proposed hospital. All of us absolutely accept the need for a new national maternity hospital. We agree it should be co-located with an adult acute service. However, without State ownership of the land on which the new hospital is to be built, valid concerns will remain about the clinical independence and the ethical governance of the hospital. We saw an all-party consensus emerge on this in the Dáil in the motion passed on 23 June. The key question I have is what the Government has done since 23 June to ensure that the hospital will be built on State-owned land and that these concerns will be met. We did not get an adequate answer on this at yesterday's health committee hearing.

As someone who campaigned for many decades for repeal of the eighth amendment, I was so glad that in 2018, with repeal, we finally got to a situation whereby women here in Ireland could access the legal abortion and reproductive healthcare we need. However, that progress within our laws with repeal is not reflected in the negotiations on the new maternity hospital, especially, I fear, not in the structures around the Catholic successor company into which ownership of the site is to pass. I have called this syndrome whereby religious entities pass ownership of their assets into an ostensibly lay company the developer's wife syndrome, whereby we see male developers handing over ownership of assets to their wives or spouses in order that the legal liability will no longer attach to the person who holds the assets. My serious concern is that this legal device will be used in this transaction with the national maternity hospital and we will see a Catholic successor company continue to hold ownership even for a long lease. In the eyes of the church, 149 years is not a long time. I am deeply concerned, therefore, that without State ownership we will not have the clinical independence and guarantees that women will have access to all the services we need.

An Tánaiste Varadkar:

It might be said that she played the long game, and sometimes that is the most successful strategy to adopt. I am also very pleased as a Trinity graduate to welcome her to the House and sorry to lose her from the Seanad's Trinity constituency. I am sure there will be an interesting contest for that by-election. I believe it has already begun.

As for the wider issues, as Minister for Health, one of the things I am very proud and privileged to have been able to do was to make sure that Ireland for the first time had a national maternity strategy to ensure we had the highest standards of care for pregnant women and neonates. That strategy is being implemented and funded. I am glad to see that is the case and I am determined to keep a watching eye over that as Tánaiste. We also have new guidelines on partners visiting maternity hospitals. It is the view of the Government and the HSE that partners should be able to attend a labour ward or ICU if their newborn is there and should be able to attend for important scans, such as anomaly scans. I understand that is not the case in a small number of maternity units for local reasons and I am disappointed that that is the case, but we need to allow local infection control managers and clinicians to make local decisions in certain circumstances.

As to what is happening with the national maternity hospital project, an engagement is, as I understand it, under way or at least about to be under way involving all the partners involved, that is, the HSE, the Department of Health, St. Vincent's and the National Maternity Hospital itself. What we seek to achieve is the co-location of the new national maternity hospital on the campus of St. Vincent's. This is the best option for women and children. I have no doubt about that. I know people talk about alternative sites. There is not a better alternative site that provides co-location with an adult hospital with the facilities and standards St. Vincent's has. Going down that route, I think, would case a delay, and nobody can say how long that delay would be. It is therefore the right decision to co-locate the hospital with St. Vincent's, and I am determined we should go ahead with that. The Government has red lines and these have moved on since the Mulvey report. We are insisting that we own the hospital, that we own the building. We are insisting that there is a cast-iron legal guarantee that any service that is legal in this State should be provided in the hospital, whether gender reassignment surgery, terminations or assisted human reproduction. These are absolute red lines. I think we have achieved that. There is still issues around the governance, representation by the State, by the people on the board and the lease. It is by far our preference that we own the land, but it is a little like Lesotho being surrounded by South Africa. It is not as straightforward as people may think. The site is a piece of land surrounded more or less on all sides by St. Vincent's Hospital and its campus. We need to make sure that any arrangement we have around any lease is one that we are satisfied with and that is long enough.

Deputy Bacik:

I thank the Tánaiste for the kind words and the response but it is simply not good enough to say the Government would prefer to own the land yet not be able to do something about it. We have a compulsory purchase order process. That should be used if St. Vincent's will not pass the land to the State. The question remains why St. Vincent's Holdings CLG will not simply gift the land to the State and why it is so anxious to retain ownership. Without a sufficient answer we risk simply sleepwalking into the default position we have had for so long with our education and health institutions in this State, whereby religious orders or Catholic successor companies continue to hold the long-term asset, the land, yet the State pays - in this case €800 million - to invest in a new building and the salaries and running costs of that new building, a building which will be on land which will ultimately revert into the ownership of religious entities or religious front companies.

That is simply not good enough for women's healthcare in Ireland in the 21st century. That is why I am asking for clarity in regard to the State not simply preferring to own the land but that something urgent will be done by the Government to ensure the State will own the land on which the new hospital is to be built.

An Tánaiste:

It is important to say that negotiations are still under way and are about to resume soon. We are not ruling out CPO as an option but we need to understand that the outcome of a CPO process is not guaranteed and would certainly result in delay, with additional costs, if it is successful, on top of those the Deputy mentioned. Sometimes the perfect is the enemy of the good, and we need to have an open mind as to what the best option is with regard to the governance arrangements, the lease arrangements around the land and the ownership of the land.

One issue that is probably not well understood in this State is that across the world, even in places where there is a strong public health service, such as in the UK, with the National Health Service, NHS, or in Germany or France, it is not unusual for hospitals to be owned by a voluntary body, a charity or a private company. It is the case that parts of the NHS are still governed by royal charter, private companies and charities. We need to ensure we do not lose the opportunity to build a world-class national maternity hospital because of issues such as this.