Statement by Minister Donnelly to Dáil Éireann on the National Maternity Hospital

Check against delivery

The proposed new building for the National Maternity Hospital is probably the most important investment in women’s healthcare in a generation.

It is widely agreed that the midwives, nurses and doctors in Holles Street provide great care and are leaders in advancing women’s healthcare. Post Repeal, they were one of the first hospitals to provide termination services. They were one of the first sites for the new specialist menopause clinics. They are involved in many of the new services being rolled out around Ireland last year and this year, in midwifery-led maternity care, gynaecology, genetics, endometriosis, fertility, mental health and much more.

It is also widely agreed that the building at Holles Street is no longer fit for purpose. The vision of the National Maternity Strategy is one where women are treated with dignity and respect in an appropriate environment. The facilities at Holles Street simply cannot provide that appropriate environment. Women occupy “Nightingale” style accommodation – sharing with up to 13 other women, with only a curtain separating beds, and with inadequate shower and toilet facilities. This increases the risk of infection. It compromises the privacy and dignity of patients who queue in the public corridor to use bathroom and shower facilities.

It's not only about privacy and dignity of course. It’s about preventing infections. It’s about having enough beds, theatres, diagnostics and day facilities. It’s about having appropriate bereavement spaces and supports.

The new building will meet these needs, but it will also do much more. Every woman will have her own ensuite room and there will be far more maternity beds. There will be separate and appropriate space in the tragic cases of bereavement. There will be 5, rather than 2, operating theatres. Instead of 11 delivery rooms, there will be 24 new, modern delivery rooms. Instead of 18 gynaecology beds, there will 31 beds. Instead of 35 neonatal intensive care cots, in shared spaces, there will be 50 individual room neonatal intensive care cots. The new Neonatal Intensive Care Unit will be designed in a way associated with a reduced length of stay for these neonates. For all parents, but especially when a baby is critically ill, parents want and need to be by the baby’s side, day and night. Parents will be able to room in with their sick or premature baby, enhancing mother-baby bonding and breastfeeding rates.

This new building means that the teams in Holles Street are going to be able to expand services for women, make sure there’s rapid access, and do it all in a modern hospital.

It is widely agreed that co-location is important. Every year hundreds of pregnant women need to be transferred to St Vincent’s University Hospital as inpatients or outpatients for treatment they can’t get in Holles Street.

Every year a number of critically ill women are transferred to St. Vincent’s, often for life-saving interventions and intensive care. The midwives and doctors are telling us that as maternity care becomes more complex, the need for access to the services in a big adult hospital will grow.

It is widely agreed, indeed demanded, that all healthcare services must be provided at the new hospital. The new hospital is being set up to do that. The new hospital’s constitution guarantees its’ clinical and operational independence in the provision of any maternity, gynaecology, obstetrics and/or neonatal services which are lawfully available in the State. But we’ve gone much further than that. Not only is independence guaranteed to provide all services, the hospital is required to provide all services. This includes terminations, tubal ligations, gender affirmation and everything else. Added to that, if for some reason the hospital were not to provide all services, the State, via the Minister for Health, can directly intervene to ensure all services are provided.

It is also demanded, quite rightly, that there can be no religious influence in the new hospital. Ireland has a dark history when it comes to the Church and women’s reproductive health. I fully understand and acknowledge the deep sense of mistrust many people in Ireland have on this issue. I fully agree with the demand, therefore, for a fully secular hospital.

The new NMH will be fully secular. There will be no religious influence. There can be no religious influence. The hospital’s constitution explicitly states that services must be provided ‘without religious ethos or ethnic or other distinction’. This is stated 6 times in the hospital’s constitution. And as with the provision of all services, the State, via the Minister for Health, can directly intervene to ensure there is no religious ethos in the provision of those services.

St. Vincent’s is also secular, something Dr. Rhona Mahony, a member of St. Vincent’s Board, has pointed out that the Board has been working towards for years.

Concerned citizens were outside the Dáil yesterday with signs demanding that the new NMH is not handed over to the nuns. The nuns are gone. They’re gone. They stopped their involvement 5 years ago. And in the past few weeks they transferred their shares to St. Vincent’s. I waited until that share transfer was completed before bringing any proposal to Cabinet. There is no mechanism for any religious involvement, now or in the future, in St. Vincent’s or the new National Maternity Hospital. I would never propose a new Maternity Hospital that had, or could ever have, any religious influence. Dr. Rhona Mahony, Professor Mary Higgins, Director of Midwifery Mary Brosnan, the midwives, nurses and doctors in Holles Street, who are begging the country to listen to them – they would never agree to anything other than a fully secular hospital. These are the women and men providing all services in Holles Street today. They will be providing all services in the new hospital.

The nuns are gone, and we are not ‘handing over’ our National Maternity Hospital, we are not ‘gifting’ it, to anyone else either. This is a partnership between the State, St. Vincent’s and the National Maternity Hospital. The NMH will provide the staff and run the new hospital. The State will fund and own the hospital building. St. Vincent’s will provide the land for 300 years, giving the State leasehold ownership, in the same way as people own the apartments they buy. Each party will appoint 3 directors to the Board of the New NMH. The NMH will in turn appoint to the Board of St. Vincent’s.

The 2 hospitals will be physically connected to ensure seamless access to care for patients, including critically ill patients. Both hospitals will provide shared services to be used across the healthcare campus. Many clinicians will work across both hospitals.

A structure was agreed in the 2016 Mulvey Agreement whereby the shares in the NMH charitable company will be owned by the St. Vincent’s Healthcare Group charitable company. This provides St. Vincent’s Healthcare Group administrative rights for things like accepting annual accounts at general meetings and approving the appointment of auditors.

The NMH will be fully clinically, operationally and financially independent, have its own constitution and its own operating license with the HSE.

It’s worth comparing what will be in place before and after. Today, the land under Holles Street is in leasehold ownership to the Earl of Pembroke. The State owns neither the land nor the building. There are 2 priests on the Board, including the Chair, who is, and has always been, the Catholic Archbishop of Dublin. In the new NMH, the State will own the building and the land under leasehold ownership for the next 300 years. The State appoints 3 of the 9 directors. The Minister for Health has broad powers to intervene and direct the hospital. All services must be provided. There can never be any religious influence. And of course, healthcare services for women and infants will be modernised and greatly expanded.

While more and more people are concluding that there will be no religious influence, and that all services will be provided, some are demanding that the State’s ownership of the land should be freehold, rather than a 300-year leasehold. St. Vincent’s have been clear from day one that freehold would not be considered. The reason they give for this is the ongoing management of the healthcare campus. They point out that there needs to be 1 owner to ensure it’s managed for the multiple services on site. This includes St. Vincent’s University Hospital, St. Vincent’s Private, the new NMH, Screening Programmes, G.P. Day Care, Research facilities and the UCD Education Centre. They point out that shared services on this site are provided via single integrated systems, including heat, power and essential piped gases vital for patient areas, that service corridors for the whole SVHG campus run through NMH Building, and that the new development includes facilities for shared services for the overall campus.

Some do not accept this and are seeking that the State would attempt to CPO the land. But this might well collapse the partnership, ending cooperation on co-location. The courts may well rule against the State, as we already have lease ownership for the next 300 years. A CPO could take years, due in part to the complexities involved, given that this is a site in the middle of an existing health campus requiring shared access and sharded services. Imagine trying to CPO land in the middle of Intel’s manufacturing plant in Leixlip for your own factory. The new hospital building would be compromised as the current design includes relocating part of SVUH. The building work could take years longer, as it would be more difficult for 2 separate owners to work through multiple highly complex areas including shared services. Future clinical care could be higher risk as separate owners of lands would require ongoing access to each other’s facilities for shared services, some of which are critical patient services. And there would be a high cost to the State, including legal costs, purchase costs, and delays in building costs.

It is not reasonable to put the project at risk in such a way, to potentially delay it for years, or derail it entirely, in order to move from leasehold to freehold ownership.

Women’s healthcare has never been sufficiently funded, nor sufficiently prioritised in Ireland. We’re changing that. This year a new national network of services is being put in place. Contraception is becoming free, starting with women aged 17 to 25. Next year I hope to have secured funding to start publicly funded IVF. More HSE hospitals this year are starting to provide termination services. This hospital is a critical part of this change, part of making sure that women’s healthcare in Ireland provides what is needed. We’ve been talking about this hospital for 9 years. It’s time to act.