Leaders' Questions | The National Maternity Hospital

04 May 2022

I too want to raise the issue of the National Maternity Hospital. I welcome the decision by Cabinet last night to delay, as I understand it, by at least two weeks, the making of any final decision. I welcome the Minister's commitment to appear before the Oireachtas Joint Committee on Health, as we had asked. Indeed, I welcome the ongoing publication of documents on the HSE website. I read the documents that were up last night. I note another one this morning. That is important but the concerns around ownership, control and governance of the new national maternity hospital remain, notwithstanding the changes and the publication of those documents.

In particular, the key question everyone is asking is, if this is public ownership in all but name, why not move to public ownership? If a 299-year lease amounts effectively to State ownership, why do we not see a gifting of this site to the State, so that it is truly and beyond doubt within public ownership rather than this Byzantine series of legal arrangements?

I have waded through these documents and they are complex. We have seen legal counsel previously describe these as labyrinthine complex arrangements, making it difficult to establish with certainty the issues of control and governance. These are legitimate concerns that have been raised, including concerns raised by two members of the HSE board. We understand they are legitimate concerns raised by women at the Cabinet table, as a result of which we are seeing this delay. These are legitimate questions and we are asking why we simply cannot move to public ownership.

Why can we not request or require the site on which the hospital is to be built to be gifted to the State or, indeed, move to compulsorily purchase it? We in the Labour Party have been calling for a compulsory purchase order to be considered as an option since as long ago as 2017. That is five years ago. Had the State moved at that time, the site would now be in public ownership and we would not see these ongoing and real concerns around governance and control. There are valid concerns emerging from those documents on governance and control. There are valid and substantive concerns around the control issue when we look at who the directors will be and when we see that the landlord, the St. Vincent's Healthcare Group, will have the right to appoint three directors to the new national maternity hospital designated activity company and, indeed, under the terms of the constitution of that company, will therefore have the right to appoint a chairperson in three years' time on a rotating basis. That means the landlord will have a very strong influence in how the tenant runs its affairs. That is a valid concern arising from the documents.

There is also a valid concern around governance when one looks at the key phrase "clinically appropriate". It is in there twice in the constitution of the new company. It is also included in the operating licence and yet it is not present in the clause around the golden share of the Minister, clause 5.3 in the constitution which states the Minister's golden share is to ensure that the obligations are complied with and that any maternity, gynaecological, obstetric and-or neonatal services which are lawfully available in the State shall be available in the new national maternity hospital. Let us see that phrase used elsewhere and those qualifying and conditional words, "clinically appropriate", removed from the document. Otherwise we are going to continue to have these concerns around ownership, control and the governance of women's healthcare access.

The Taoiseach

Those words, "clinically appropriate", were imposed by the HSE in the legal document to make sure it would not be a cardiology hospital, a neurology hospital or whatever else. That is all that means.

Deputy Ged Nash

Nonsense.

The Taoiseach

It is not nonsense. The Deputy cannot just shout "Nonsense" across the floor. That is the reality. The golden share empowers the Minister to enforce the reserved powers within the constitution and the articles of association in terms of all available services. Do you think that Dr. Rhona O'Mahony, for example, a former master of Holles Street Hospital, is making this up? Do you think that Dr. Cliona Murphy, the clinical director of the HSE's national women and infants help programme, is making it up?

Deputy Paul Murphy

Is Dr. Peter Boylan making it up?

The Taoiseach

They are articulating very strong support for this. Or Mary Brosnan, director of midwifery and nursing at the National Maternity Hospital. Up to 52 clinicians who work in Holles Street are saying this should go ahead.

Deputy Jennifer Whitmore

They are clinicians.

The Taoiseach

They are saying this deal-----

Deputy Jennifer Whitmore

They are not lawyers.

An Ceann Comhairle

The Taoiseach without interruption, please.

The Taoiseach

I think women would trust clinicians maybe more than lawyers in terms of a maternity hospital. I do not want to get into an argy-bargy across the floor of the House. My point is that clinicians are saying that we cannot tolerate any longer the substandard physical accommodation in Holles Street. All of us are saying that we all want it to happen quickly but not just now, let us go another few years, and do a CPO. How long would that take? Is the Opposition seriously suggesting that 300 years at a cost of €10 per year somehow impedes or undermines the clinical independence and financial independence of the hospital? It does not.

(Interruptions).

The Taoiseach

Explain how it does. It does not. Deputy Bacik, who is a person of far greater legal reputation and expertise than my good self, knows deep down that 300 years at a cost of €10 per year is essentially public ownership by another name.

Deputy Ivana Bacik

Why is it not simply in public ownership?

Deputy Brendan Howlin

Why is that arrangement there?

The Taoiseach

The real issue that was raised legitimately was the State's interest in this and guaranteeing that women will have access to all services that are legally permissible. That was a core issue that was raised some time ago around the whole proposal for co-location. That happened many years ago for the reason I have given, which is that people think that is the way to get the best outcomes. The issue of women being entitled to all services has been comprehensively guaranteed in the constitution of the new hospital, in the operating licence granted by the HSE, which imposes an obligation on the new national maternity hospital to provide such services and in the powers given to the Minister in the form of the golden share to enforce the reserved powers. The arrangement brokered by Mr. Kieran Mulvey only allowed for one public interest director where we are now providing for three ministerial directors to be appointed in the public interest, along with three from the maternity hospital and three from St. Vincent's Healthcare Group.

It is a far more advanced agreement now than was the case, having listened to what people said and responded to the concerns people legitimately raised. There is always balance and perspective in a debate-----

An Ceann Comhairle

Time is up, please.

The Taoiseach

-----and I think the balance has now swung very strongly in favour of needing to provide modern, state-of-the-art facilities for the women of this country.

Deputy Ivana Bacik

All of us want decent, proper, effective healthcare for women, and particularly for women requiring access to reproductive healthcare, maternity care and gynaecological care. I am not questioning anyone's bona fides and I do not think it is helpful to do so but legitimate concerns remain around ownership, governance and control. Positive changes have been made over the years, largely as a result of Opposition pressure and of pressure from activists and women seeking improvements in services and seeking to ensure we do indeed have a modern, world-class new national maternity hospital. Those concerns still remain, however. This State has an unfortunate and terrible legacy of failing women in our access to reproductive healthcare. It is only four years since we repealed the eighth amendment. Those of us who fought for decades to ensure women would have a right of access to abortion when we need it are very conscious that these rights can be very quickly reversed or overturned, as we are seeing in the US with the terrible news about Roe v. Wade and the potential overturning of that landmark decision for women's rights. That legacy, and the legacy of the State in investing a great deal of public money over the years in building up infrastructure through private hospitals owned by religious orders-----

An Ceann Comhairle

Time is up Deputy, please.

Deputy Ivana Bacik

We are all very conscious of the legacy of our schools and hospitals that have been funded by the State but remain in the ownership of religious orders or their successor or proxy companies. We are all very conscious of that. We need to do better with the new national maternity hospital and with the €1 billion of public money that is to be put into it. We need to ensure women, and all of us, have access to the healthcare we need in the 21st century. That is why we are putting forward these questions. We are doing so in order to be constructive-----

An Ceann Comhairle

Deputy, the time is up.

Deputy Ivana Bacik

-----and to improve healthcare for women in this country.

The Taoiseach

Women will have that access. That is my point. Women will have that access under these agreements. The Deputy has not pointed out how the 300-year lease at €10 a year will undermine the interests of women-----

Deputy Brendan Howlin

Why do they want it?

The Taoiseach

-----or the access women will enjoy to all these services under the agreements. It has not yet been explained to me how the 300-year lease agreement undermines the provision of those services-----

Deputy Ivana Bacik

It is the other way around.

The Taoiseach

-----or how it undermines the clinical, operational and financial independence of the new national maternity hospital. It does not.

Deputy Ivana Bacik

Why not simply move to State ownership?

Deputy Brendan Howlin

Why do they want it then?

The Taoiseach

The constitution of the hospital is very clear and the operating licence provided by the HSE to the new hospital is very clear about the obligation to implement and provide all services legally permissible under the law. It is not comparable to Roe v. Wade because the Oireachtas has acted here, and the people have acted via referendum.

Leaders' Questions | The National Maternity Hospital

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