National Maternity Hospital: It Is Time For A Rethink At The Top

Most of the time I agonise over what to say in The Message. And over how to say it. I edge towards a theme. I allow things to simmer. I read some. Think about it. Then I read some more.

I am looking for additional facts. For statistics. For hard information. I want to see if there are twists or turns in anything that has been said, or done, whether by this side or that in a debate or argument, which might lead to a deeper insight. The objective is to try to go beyond the obvious. To understand the nuances. To get as close as possible to the heart of the matter.

You could say that I have an agenda and I have. To one degree or another, we all do.

Over the years we develop a set of political and philosophical beliefs and commitments. For me, these include the conviction that the role of public policy must be for the State to do everything reasonable within its power to achieve the greatest possible equalisation between citizens across all levels of society, in terms of education, opportunity, income and wealth.

It should treat all of the children of the nation equally. It should embrace difference and diversity. It should not bake privilege into arrangements. It should not – it must not – favour one religion over another. Or over a rejection of all religion. People are entitled to their beliefs. They are not entitled to have them privileged at the expense of others, in the operation of national or State institutions.

The republican ideal is to create a society of equals, in which we all have a say via the ballot box. Over the age of eighteen we have a vote that we can cast in a democratic exercise that ultimately leads to the formation of a Government.

In this regard, we are lucky in Ireland. We have a particularly balanced and representative electoral process. The Irish system of multi-seat constituencies and proportional representation – which allows voters to express their preferred choices in a sequence from first down to last – may not be perfect. On occasion, it delivers quirky results. Winning and losing candidates can be separated by as little as a few votes.

But, in terms of representing fairly and accurately the collective will of the people, it knocks into a cocked hat the hopelessly unbalanced first-past-the-post system used for General Elections across the UK; and even more so the crazy electoral college system, which completely skews the results in US Presidential elections, to the extent that a resounding majority for a Democratic candidate in the popular vote can  still result in a significant defeat, as happened when Donald Trump was elected ahead of Hillary Clinton.

Conservative, largely rural places like Montana, Nebraska and Utah are grossly over-represented in electoral college votes. Liberal, coastal states, with big populations, like New York and California, are totally under-represented. Everyone with a brain knows this. And they also know that this grotesque distortion is just the start of it. That at every level, the way the system works in the US, the incumbent regimes in individual States can stack the deck in their favour.

They can gerrymander to their heart’s content, re-drawing electoral boundaries in a way that, for example, excludes blocks of African-American or other minority voters. And, if the opportunity arises, they can pack the courts with ideologically-driven judges, whose only interest is in following a particular political or religious line.

They are doing it now. The seminal Roe vs Wade decision, which allowed abortion in all states as a federal matter is almost certain to be overturned. And women’s right to control their own fertility will, as a result, be under immediate threat in 26 states.

It is important, therefore, to acknowledge that – in many respects – we have it good here in Ireland. And don’t let anyone try to convince you otherwise.

PUSHOVER AGREEMENT

In a sense, this is what makes what has been cooked up behind closed doors between the HSE, the Department of Health, the Religious Sisters of Charity and the St. Vincent’s Hospital Group so baffling – and so sickening. Compared to other countries we have the democratic fundamentals right. So why is the Government hell-bent on pushing us into a completely ham-fisted, undemocratic set of arrangements in relation to the National Maternity Hospital?

Let’s be fair to everyone involved on the Government benches. They were plunged into a mess that had been created in the first instance by the-then board of the National Maternity Hospital. Honestly, the naivety of the initial negotiating team, in relation to the terms on which the hospital would be moved from its current location in Holles Street to the campus owned and run by the Religious Sisters of Charity, off the Merrion Road, on the south side of Dublin, beggars belief.

We don’t know how well the Department of Health and the HSE were briefed on these discussions as they were progressing. Either way, the initial agreement reached effectively handed control over the hospital to the nuns and their allies. It was monumentally stupid and wrong, and entirely unsustainable. When that was first pointed out, the vested interests – particularly on the nuns’ side – tried to railroad the plan through as a fait accompli. It was a done deal. It had to proceed.

The board of the National Maternity Hospital had succeeded in handing the initiative – and an entirely unmerited claim on future ownership – to the Religious Sisters of Charity.

The State should have pulled out then. Walked away. Let the nuns and the St. Vincent’s Hospital Group know that, as set out in the Sláintecare programme, the Government would be providing a public hospital on public land, entirely free of religious influence or private control. And that if they had a proposal as to how an entirely secular, fully State-run hospital might be accommodated on the campus in Elm Park, then they were perfectly free to put them forward.

Tallaght would be a very good location for the National Maternity Hospital. But one suspects that this might seem too far to travel in the morning for some of those who were involved in the negotiations. And maybe a little bit unsavoury. A ‘nice’ place like Donnybrook certainly suits some people in the medical profession a lot better than Tallaght. But that neither was, nor is, a good reason to land the hospital in a location that is far more difficult for huge numbers of people from around the country to access, than a hospital just off the M50.

Some commentators – and politicians – have been moaning about the fact that this has been under discussion for almost a decade. But this is why: the Religious Sisters of Charity – and subsequently their proxies – wanted ownership and control. If they hadn’t fought tooth and nail to achieve that aim, it could have been sorted in a matter of months.

It should, obviously, have been made clear from the outset that the State would have to own the hospital and the land on which it is built. It would have to have complete control over every aspect of clinical policy and patient care. And its structures would have to be entirely secular, with neither religious interference nor private ownership clouding either the governance of the hospital – or its freedom to carry out any procedures of any kind that are legal – at any time now or in the future.

That is a very simple, straightforward and entirely justifiable position, and it is the duty of the officers of the State – including TDs and Senators, members of the Cabinet, and staff at the HSE and the Department of Health – to put it into effect. Instead, the-then board of the National Maternity Hospital allowed the Religious Sisters of Charity, and St. Vincents Hospital to believe that, because they owned the land, they could dictate the terms. In the initial draft agreement, the board conceded ownership of the hospital to the nuns (or their proxies), despite the fact that the State was going to foot the bill for the construction. They also conceded control, by agreeing that St. Vincents would have a majority on the board.

I don’t mean to be unpleasant, but that amounted to an appalling dereliction of responsibility by highly paid individuals working for, and being paid by, the State. The old Irish way was to shrug and say “Ah, sure, it’ll be grand.” And the vested interests would get on with doing things their clandestine way. Well, it was not grand. It never would have been grand.

I heard Rhona O’Mahony, who was the Master of the National Maternity Hospital during at least some of this process, speaking on The Pat Kenny Show during the week. I have nothing against her. She sounds like a nice person. But she has absolutely no credibility in relation to this issue. She was happy, in effect, to hand over the keys to the nuns. Had Peter Boylan – also a former Master of the NMH – not shouted stop, Rhona would have walked us all into a nightmare mess, which would have led to all sorts of conflicts and compromises, and impacted very badly on Irish women – and on Irish families – for decades to come.

The new structures that have been negotiated are certainly an improvement on that original pushover agreement. It’d be stupid to imply otherwise. But that does not make them acceptable or right.

RELIGIOUS INTERESTS THINK THEY ARE ABOVE THE STATE

In situations like this, you have to ask: why?

– Why, really, are the St. Vincent’s Hospital Group – and behind them the Religious Sisters of Charity – so insistent that they should be the owners of the land, and therefore in a position to use that dominant position to exert pressure on the State?

– Why have they inserted a clause that will enable them to increase the rent from the €10 per annum – a figure which gives them, and indeed the Taoiseach, licence to claim that the land is “as good as owned by the State” – to €850,000 per annum if they have issues with the “clinical appropriateness” of decisions being made or treatments being offered in the hospital?

– Why would the State agree to this utterly preposterous arrangement, handing a very big stick to the St. Vincent’s Hospital Group that can be wielded in who knows what way at any time in the future?

The SVHG has insisted that they must own the land for operational reasons. But this is nonsense. If services that are available in St. Vincent’s Hospital are needed by women giving birth in the National Maternity Hospital, or their babies, then they can be treated in the same way that emergencies are treated in hospitals generally. You put the patient first. It is as simple as that.

– The contract also requires the State to provide an area of the hospital – called “the Landlord Area” – where the writ of the nuns’ proxies will run in perpetuity. So what is this room or corridor over which the SVHG insist must they have absolute control? It is just another bizarre provision in what is a thoroughly weird set of arrangements, the totality of which makes no sense.

There is another big WHY.

– Why has the Vatican agreed to all of this? Everyone knows that the Roman Catholic religion is opposed to abortion in all circumstances – even medical abortion, including the morning after pill – unless a surgical operation is so badly needed to save the life of the mother that the loss of life of the foetus can be deemed accidental. So why would the Vatican agree to the location of a maternity hospital in which abortions will – must – take place for other reasons on land owned by the nuns?

I can only speculate.

It has agreed to it because it offers the possibility of leverage and influence that can be exerted in ways that are more or less covert or insidious. It will be in a position to have a say in the appointment of three board members. It will then be in a position to cultivate access. To get in the ear of whoever is in charge of appointments. It will be able to insidiously position individuals sympathetic to the Catholic position on abortion on the staff. It will be able to attempt a take-over by stealth. The plan wil be to reduce the incidence of abortion to just that which is acceptable under Catholic dogma.

But what about assurances that all procedures deemed legal within the State will be carried out in the new hospital? They won’t come clean and say it – but they can satisfy themselves that they are telling the truth here, or fulfilling their obligations, even if the only time abortions happen is “to save the life of the mother.”

People like to dismiss this as far-fetched stuff, but it isn’t. Look at the way that religious fundamentalists and the Republican Party are currently operating in the US. They are consciously infiltrating the administrative apparatus in different states, placing willing stooges in positions of influence over electoral boundaries. Over healthcare issues. And over abortion rights.

Have Opus Dei gone away? The Knights of Columbanus? No more so than the Ku Klux Klan. Fifteen years ago, we might have imagined the Klan were a spent force. But they are back now peddling white supremacy, racial hatred and discrimination. Politics is always in flux. So what that says is that you have to do everything possible to systemically preclude undue influence.

The bizarre arrangements being made by the HSE and the Department of Health with the proxies of the Religious Sisters of Charity fly in the face of this requirement. They are a recipe for undue influence. And since the Catholic hierarchy and the nuns, and the Pope, all see women’s fertility as a key battle-ground, then they will work to achieve that undue influence in any and every way they can.

The Vatican has also agreed to it because there is a symbolic aspect to it: “Look,” they are saying, “we still have sufficient influence to ensure that the National Maternity Hospital is built on land that is owned by a Church-approved entity.”

Dr. Peter Boylan has provided the best, most informed, running commentary on all of this.

“Following the canon law process for their ownership transfer to St Vincent’s Holdings,” he wrote recently, “the RSC (Religious Sisters of Charity) have appointed three people to own St Vincent’s Healthcare Group (SVHG). These are Prof Michael Keane, Dr David Brophy and Sharen McCabe, all former members of the SVHG board. Prof Keane and Dr Brophy are clinicians at St Vincent’s.

“While the RSC are entitled to make whatever arrangements they wish for their own hospitals, I do not see what qualifies a respiratory physician, a radiologist and the managing director of a pharmacy chain to own the planned €1 billion publicly-funded new National Maternity Hospital in place of the 100 governors who currently own it in trust.”

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

Again, it comes back to a simple question: where the National Maternity Hospital is concerned, why would the State agree to an arrangement that involves these three individuals in ownership of any kind? And while we’re at it, have the potential conflicts of interest for Sharen McCabe ever been addressed?

Before a final decision is taken by the Cabinet, therefore, our representatives in the Oireachtas must insist on seeing the entire correspondence between any and all of the parties involved in the decisions which vest ownership in these three people. Correspondence, that is, between any of the three named individuals; the St. Vincent’s Hospital Group; St. Vincent’s Holdings; St. Vincent’s Hospital; any other companies associated with St. Vincent’s; the Religious Sisters of Charity; the hierarchy of the Roman Catholic Church in Ireland; the Holy See; the Vatican; and any other organisation representing or associated with the Catholic Church.

If they refuse to give our TDs and Senators access to these documents, the question has to be: why? What are they trying to hide?

I have said this before but I will say it again. It is a fact that religious vested interests cannot be trusted to do what they commit to in contracts with the State. In relation to primary education, they agreed a divestment programme with the Department of Education. The result? They have systematically stymied it at every turn, doing nothing if they can and generally operating at a snail’s pace. They knew that this was what they would do. They have no respect for contractual agreements. They pursue their own agenda anyway.

This highlights something fundamental. Bishops, priests, religious orders, and their proxies ultimately believe that they answer to a higher authority than the State. They answer to the Vatican. And – in the final analysis – they believe that they answer only to what they call God.

I have said this before too, but it is worth repeating. We saw the doctrine of Mental Reservation in action in relation to the failure of the Catholic bishops to report brutal child sexual abuse perpetrated by priests, of which they were aware. This is the doctrine that allows someone of faith to lie to the State, or to the police, if it serves the higher interests of the Church. And so they cannot be trusted. Their word is not their bond.

In addition, we know that religious vested interests cannot be trusted in relation to the treatment of women and their babies. We know that from history. So why on earth would the Government open the door to them being involved in that sphere, ever again?

WHAT MAKES A CHARITY A CHARITY?

While we’re here, there is one other very important issue that has received far too little attention to date. It relates to the “charitable status” accorded to various of the institutions and entities involved in the business of running hospitals, owning land, and selling land.

The Roman Catholic Church and the religious orders are currently sitting on vast tracts of extremely valuable land all over Ireland. This includes huge holdings in prime areas across Dublin. For example, the Religious Sisters of Charity currently own the Elm Park golf course, an extraordinarily valuable piece of real estate beside the St. Vincent’s Hospital campus. One recent estimate was that Church interests own approximately a third of all the vacant sites in Dublin. The religious orders are currently drip-feeding this property onto the market at a time when land on which to build housing is desperately needed.

In hoarding and then selling the land the Orders – and the Church – are engaged in what in any other context would be called profiteering. They are making vast fortunes on the sale of land, which was often bequeathed to them in good faith, for specific charitable uses that they have long ago abandoned. At the point where they sell the land, these organisations – and proxy owners like the St. Vincents Hospital Group – have no claim to the status of charitable institution.

They are land-owners, selling their land. So why is the profit on these transactions not subject to Capital Gains Tax, in the way that any other sale of land or property is? A conversation to this effect might be a very good idea right now.

In the end, there is no reason for the State to play second fiddle in relation to the National Maternity Hospital. To accept that status would represent a profound insult to the Irish people. It should not be allowed to happen.

Over to our politicians. It is time for a rethink at the top – or for brave back-benchers to take a stand.

A protest against the National Maternity Hospital plans is set to take place outside the Dáil at 2pm on Saturday, May 14.