The National Maternity Hospital: It Is Time for the Government to Get Tough

Ireland clearly needs a new National Maternity Hospital. The current, ancient building in Holles Street, Dublin is not fit for purpose. But the attempt to move to a shared campus with St. Vincent’s Hospital, initiated by the board of the NMH, has turned into a complete shambles.

That the Board of the hospital have put the State in a very difficult position by agreeing terms with the Sisters of Charity – and their proxies in the St. Vincent’s Hospital Group – that would afford a major say in the running of the hospital to a religious group is not in dispute. Increasingly, however, it has been dawning on Government politicians that this is a very bad idea indeed.

The issue was thrust back into the national spotlight recently, when the Sisters of Charity said that they would not sell the land on which it is proposed to build the new National Maternity Hospital to the State.

Here, we answer 25 questions asked by A Citizen, who wants to understand what’s really going on. While we’re at it, we take the opportunity to offer what we hope will be useful advice to the Government on how they might best play their hand, in order to deliver a fully secular National Maternity Hospital that is wholly owned by the State.

Over to you, Mr. Citizen...

Thank you. I hope you don’t mind me saying it, but I thought this had been settled a while ago. What’s gone wrong?

The former Master of the National Maternity Hospital, Peter Boylan, has been saying it for a long time: the negotiations that have taken place to date have been far too accommodating of the entrenched position taken by the Sisters of Charity, who own the land off the Merrion Road, where St. Vincent’s Hospital is located. Peter Boylan also insists that the board of the National Maternity Hospital did not properly grasp the issues; and that they rolled over far too easily, in their desire to accelerate what is a necessary move away from Holles Street. That view is now gaining much wider currency among both politicians and the public.

Dr. Peter Boylan, 13th April, Dublin 2018. Copyright Miguel Ruiz

I get the impression from the media that the nuns hold all the cards...

The nuns, or their proxies in the St. Vincent’s Hospital Group, may believe that they have the Government over a barrell. It has to be demonstrated to them that this is not the case.

It comes down to a simple question. Are the Government going to allow themselves to be bullied or not? This is an issue of huge strategic national importance. In making decisions about it, the Government have a responsibility to the citizens of Ireland, long into the future. They must not get it wrong and leave another mess for a later generation to clean up.

I’m guessing you don’t want the nuns – or the St. Vincent’s Hospital Group – involved at all.

The idea that any private group, and in particular any religious group, should exercise control over the running, or the ownership, of the National Maternity Hospital is completely unacceptable. In the modern era, the State must own the hospital, and run it as a secular institution, completely free of any form of religious ethos.

Forgive my ignorance, but who exactly is paying for building the hospital?

The State is footing the bill. The current estimates are that the Government will spend €800 million on the project. And they are being offered a lease that lasts a mere 99 years. Even if it can be extended by an optional 50 years, as we’re told, that is not good enough.

What have the nuns – or the SVHG – really got against parting with the land?

For a start, forget the facade that the Sisters of Charity – so called – have erected that they are no longer involved. In their dealings with the Government, they have opted to hide behind a complicated set of company vehicles. But it is the nuns who are at the centre of this: they currently own the land. And it is, therefore, the Sisters of Charity who are playing games with the State in relation to ownership and control, insisting they must own the land, and have effective control of the board.

Have they offered any explanation?

The excuse they have given for their hardline stance is that they must retain ownership of the site for “clinical, governance and operational reasons including the provision of a safe integrated system of care for patients between hospitals.”

This makes no sense. Patients are transferred every day between hospitals – in Ireland, and elsewhere – that operate under different ownership and management arrangements, often on the same grounds. To imply that this might compromise the provision of a ‘safe integrated’ system between St. Vincent’s and the National Maternity Hospital, is thoroughly disingenuous.

Are the Sisters of Charity saying that St. Vincent’s Hospital is currently compromising the safety of patients transferred to it from other Irish hospitals? If so, someone should step in immediately and wrest control of the hospital from the people who are running it.

It really doesn’t sound very convincing...

I’ve heard it argued by people taking the nuns’ side that it would be impossible to decide where on a particular corridor between St. Vincent’s Hospital and the National Maternity Hospital one regime ended and the other began. That makes no sense to me either. The nuns are saying that, while the Government or the HSE would not own the land, they would own the new hospital building. They are also claiming that the National Maternity Hospital would have complete clinical independence.

So the issue about where on a particular corridor one regime ends and the other begins will have to be resolved whatever ownership arrangements apply.

So can you then explain, please, what this is really all about?

The only possible answers are money and power. So let’s talk about power, and what that might mean in relation to the ethos of the hospital and its governance.

To re-state the obvious: when a minimum of €800 million is being spent on the hospital, by the people of Ireland, then control of it should be exercised fully and completely by the State on behalf of the citizens who are paying for it. I wonder what part of that concept the Sisters of Charity don’t understand?

Do the Irish hierarchy have a role in relation to this?

That’s a good question. You’d have to assume that it is within their power of the hierarchy of the Roman Catholic Church in Ireland to exert sufficient influence on the nuns – or indeed on the Vatican if that is what’s required – to achieve the desired result of full State ownership and control. But they have chosen instead to sit on their hands and say nothing.

Sorry, maybe I’m missing something. Why exactly do the nuns, or the St. Vincent’s Hospital Group, want to have a say in the governance of the National Maternity Hospital?

There is only one potential reason. They want to exert an influence – to whatever degree is possible – over the decisions that can and will be taken in relation to the provision of services and treatments on any and all issues to do with gynaecology and reproduction. I hope that’s not too much of a mouthful.

Keep going. What kind of an influence might that be?

The nuns – or their spokespeople – have claimed that all medical procedures that are in accordance with the laws of the land are available in its hospitals, including terminations, tubal ligation and gender reassignment, and that this will be the case in the National Maternity Hospital.  But – and this is the true heart of the matter – as anyone with a bit of cop knows, the availability of any treatment is only the starting point. So this is what the Government has to ask itself:

• What advices may be given before a treatment is decided on?
• What pressure might be applied?
• Will obstacles be put in the way?
• What restrictive interpretations – or indeed misinterpretations – will be put in place?

Ah, come on. Is that not a bit paranoid?

Sadly, it isn’t. The nuns, and those who are providing the front for them, are clearly thinking along these lines. The Superior General of the order, Sr. Patricia Lenihan, has acknowledged as much, in comments made last year.

“We are confident,” she said, “that the St Vincent’s Healthcare Group board, management and staff will continue to provide acute healthcare services that foster Mary Aikenhead’s mission and core values of dignity, compassion, justice, equality and advocacy for all into the future.”

I think I know where this might be heading...

They are giving florid and liberal-sounding language here to an old-fashioned religious ethos. Advocacy for “all into the future” in the religious handbook fashioned by the Roman Catholic Church will, inevitably, emphasise what they call ‘the unborn’. There is no point in rehashing all the grim debates that took place in relation to abortion here since the disastrous 8th Amendment to the constitution was put to a referendum in 1983. We don’t need to. The dogmatists of the Catholic Church place an exactly equal value on the life of the mother and the foetus. And they regard it as their sacred duty, in every case, to do anything in their power to prevent termination taking place, except where the life of the woman who is pregnant is demonstrably at the gravest possible immediate risk.

And if you’re in charge of hiring and firing, you can impose your ethos in relation to abortion...

That and more. The power brokers in the Vatican, and the bishops here in Ireland who do their bidding, are against elective sterilisation. They are opposed to gender reassignment. They regard the use of the morning after pill as a form of abortion. They are antagonistic even to the simplest form of contraception. They believe that every sexual act should hold within it the possibility of the woman becoming pregnant. And in any and every way they can, in whatever institutions they have hand, act or part in running, including schools and hospitals, they will attempt to infiltrate that view of women’s fertility into the way in which people are taught, advice is given and medical decisions are framed and taken.

That’s not the picture that was painted in the Mulvey Report, is it?

That’s why it is important for Micheál Martin, Leo Varadkar, Eamon Ryan and Stephen Donnelly to listen to the critics of the plan. And for anyone else who is in a position to influence the decisions being taken by government. It explains why the nuns are insisting on direct representation on the board of the National Maternity Hospital. It explains why they are playing hardball. The Church will exercise its influence insidiously if necessary. At every opportunity, the Church’s appointees will interpret what is ‘legal’ in the way that is as close as possible, to the Catholic version of the core values outlined by Sr. Patricia Lenihan. If and when it suits, they will potentially encourage conscientious objection. They will do everything in their power to tilt things in a Roman Catholic direction. That is what they do. This is what matters to those in charge of Catholic Church affairs: exerting their power and their influence.

Is that something you’d always oppose?

The nuns are perfectly entitled to do this in any private hospitals they run. But what the Government has to take on board is that they cannot be allowed next or near the levers of power in the National Maternity Hospital.

Would you not trust the Church to stay out of all that in 2021?

As Ailbhe Smyth, among others, has pointed out, the answer is no. Honestly, the Church cannot be trusted. We have seen it repeatedly. In relation to child sex abuse. In relation to mother and baby homes. In relation to magdalene laundries. In relation to redress. The institution and its so-called values come first. What they have they hold.The reality is that reassurances in relation to governance from anyone in authority in the Roman Catholic Church are of no value whatsoever. Why? Because, under the doctrine of mental reservation, it is completely justifiable for a priest, bishop or nun – or their surrogates – to deliberately mislead whoever they are dealing with, if they believe that they are serving some higher moral purpose, as defined by the Roman Catholic Church.

I heard something about ‘mental reservation’. That’s a bit of a  quare one, isn’t it?

It is, indeed, a quare one. The former Archbishop of Dublin, the late Cardinal Desmond Connell, was able to excuse – or try to excuse – the fact that he had misled people in relation to what he knew about instances of clerical child sex abuse by members of the clergy on the basis of ‘mental reservation’. But that acknowledgement only occurred because he had been caught ‘in flagrante’. This soft shoe shuffle is going on all the time. High ranking members of the Church hierarchy do what they have to, to stay as close as they can to the levers of power. And if ‘misleading’ is required then that’s what happens. Over and over again, they have put the preservation of the interests of the institutional Church, and crucially of its assets, before the truth. This is what they will do in relation to the National Maternity Hospital. That is why they are so determined to secure a position inside the tent. And, therefore, no reassurances that they give – legally or otherwise – are of any value whatsoever.

Sounds like we’re in a right shaggin’ mess. So what can be done now?

The first thing is to be absolutely clear with the nuns and the St. Vincent’s Hospital Group, that if necessary the State will move the National Maternity Hospital to the Tallaght Hospital campus; that new laws will be enacted to expedite all of the relevant arrangements; and that nothing will be allowed to stand in the way of a speedy execution of the new plan.

That’s be a start, I suppose...

There is another issue that needs to be addressed. The Catholic Church, and its religious orders, are among the biggest land-owners in Ireland. These various lands-banks are increasingly being controlled, and then sold, by newly created third party vehicles. So why are these companies – like the St. Vincent’s Hospital Group – being accorded charity status, when the only real function they fulfil is to make as much money as possible for the orders, and for the Church? These land sales and transfers are business deals. Plain and simple.

Is that what you were talking about earlier, when you mentioned money?

I have heard it said that any profits from the sale of these lands should be taxed in the same way they would be in the case of any other fantastically wealthy corporation – which is what the Catholic Church really is.

I had an idea the Church was treated as a charity. But what about the Moonies?

Somehow, I doubt that the Moonies are given equal treatment to the bigger Churches – which I’m sure they see as being discriminatory. The important point, however, is that the whole issue of the charitable status accorded to certain religions should be re-examined. That might have made some kind of sense when the State was busy handing over far too many of its vital functions in health and education to the Vatican. But Ireland has changed. The people are no longer in awe of the clergy. As the results of the referendums on Same Sex Marriage and Abortion confirmed, they want to see clear blue water between Church and State. Rome rule is over. There is, therefore, no reason to believe that a consensus exists now that religious institutions shouldn’t have to pay their fair share of tax.

Which I suspect brings us back to land...

The Roman Catholic Church, and the various religious orders, are sitting on vast wealth in the form of unused land. Where they do this in cities, like Dublin, they are acting as an impediment to houses being built where they are most badly needed. Why are they allowed to do this, and at the same time to not pay taxes? Why should the unproductive hoarding of land be rewarded? There is widespread agreement now that this is a bad idea, and that a new tax should be levied on any and all land or property left idle. This tax should be levied on the vast tracts of land that religious orders, and other religious organisations, own in Dublin – and which they are currently selling off at the glacial pace that suits them, on the basis that just by holding onto it, the land increases in value.

Is that all?

Not quite. There is also the outstanding issue of unpaid redress. These are the kind of issues that might usefully be discussed with members of the hierarchy in the context of the controversy over the ownership and running of the National Maternity Hospital. The last I heard, there were still very significant amounts of money owing from religious orders in relation to different redress schemes, including the one relating to the abuses that occurred in the magdalene laundries. Why is that money not being pursued with the vigour that would be applied to any other outstanding debt to the State? Why is interest not charged at the same punitive rate as applies to outstanding tax payments? And why, in general, has the Government – or the Department of Justice – taken a softly softly approach to the issue of just how much the various religious orders should contribute to the costs overall? That has to end.

So the State might not have such a bad hand after all?

To be honest, I think a lot of people are completely fed up with the nuns’ messing around here. It needs a far tougher approach by the Government. They will be completely right, if they insist that the State must have full control of a new, fully secular National Maternity Hospital. There is an easy, straightforward way for the nuns to enable that to happen. But in the long run, nothing less is acceptable.