Governance row stalls plan for new National Maternity Hospital
St Vincent’s offered site for Holles Street hospital on basis of single system of governance
The National Maternity Hospital, known as Holles Street hospital, has said the arrangement proposed by St Vincent’s would eliminate the maternity hospital as an independent entity and eliminate the “decision-making capacity at senior clinical and corporate level”, creating “unacceptable clinical risk”. File photograph: Eric Luke/The Irish Times
A site for the new National Maternity Hospital, next to St Vincent’s University Hospital, in Dublin, was offered on the basis that there would be a single system of governance for the entire campus, St Vincent’s Healthcare Group has said.
The comments came after it emerged that plans to move the National Maternity Hospital, Holles Street, to a new build on the shared campus, at Elm Park, southeast Dublin, have been stalled again over disagreement over who should control the governance of the new hospital.
The project was put on hold for two months last year over disagreement about governance, and when discussions resumed it was hoped an application could be lodged by the end of 2015.
Accommodation at the new €150 million hospital, first suggested in 1998, is to include ante- and post-natal care in mainly single, en-suite rooms, and birthing accommodation for 10,000 babies a year.
Planning approval has not yet been sought from An Bord Pleanála, which is to deal with the project under the fast-track, strategic infrastructure development procedure.
St Vincent’s, owned by the Religious Sisters of Charity, has said it cannot operate a large healthcare campus with competing systems of clinical and corporate governance.
It wants the recommendations of the 2008 report, Independent Review of Maternity and Gynaecology Services in the Greater Dublin Area, undertaken by KPMG for the Health Service Executive, to be implemented. That report recommended that co-located hospitals would operate under a single system of governance.
The hospital group wants the maternity hospital to shut down its board and be dissolved as a corporate entity, transferring its operation to the group.
It has said its proposal “provides for clinical autonomy” for the maternity hospital, with an independent budget for maternity and obstetric services, autonomous financial control, maintenance of brand, and separate management of human resources, finance, information technology, estates and operations.
A spokesman for St Vincent’s said the 2008 report reflected “best international practice” and it was on that basis that St Vincent’s had offered a site for the maternity hospital.
“Furthermore, SVHG (St Vincent’s Healthcare Group) does not believe that the 2008 KPMG report has been superseded by any other report on maternity services,” he said.
The National Maternity Hospital, known as Holles Street hospital, has said the arrangement proposed by St Vincent’s would eliminate the maternity hospital as an independent entity and eliminate the “decision-making capacity at senior clinical and corporate level”, creating “unacceptable clinical risk”.
“All services including tertiary maternity and neonatal services at NMH would come under the control of the SVHG board and shareholders,” a spokesman said.
He said all parties had “explicitly agreed” that the 2008 report was superseded by other reports and by the current national maternity strategy.
The national maternity strategy, launched in January by Minister for Health Leo Varadkar, said the three standalone Dublin maternity hospitals should be co-located with acute adult hospitals, but the “mastership system” of governance should be maintained.
The system, in operation in Ireland for 260 years, “has served the country well”, the strategy said. Under it, the “master” is both chief executive and lead consultant obstetrician and gynaecologist, with overall corporate and clinical responsibility, reporting directly to the hospital board.
A spokeswoman for the Department of Health has said the department “is aware of the difficulties in relation to the project and has attempted to mediate a resolution between the two hospitals”.
“However, as both hospitals are voluntary independent hospitals, a solution cannot be imposed. Ultimately, both hospitals will have to reach an agreement if the project, as envisaged, is to proceed,” she said.