‘Clinically appropriate’ phrase will be retained in NMH agreement - Taoiseach

Kieran Mulvey says contentious wording not in original 2017 deal

Taoiseach Micheál Martin has confirmed that the deal to move the National Maternity Hospital (NMH) to the St Vincent's Hospital campus will go to Cabinet unchanged.

Mr Martin said no alterations have been made to the legal documents and asked if the phrase “clinically appropriate” would remain in the agreement, he said that it would.

The plans to move the NMH from Holles Street were brought before Cabinet by Minister for Health Stephen Donnelly two weeks ago but a decision was deferred until this Tuesday amid concern from some Fine Gael and Green Ministers at the proposals.

After a fortnight of intense debate on the proposals are now due to be brought to Cabinet again.

Critics of the move have raised concern at the phrase “clinically appropriate” being included in the agreement amid fears it potentially dilutes the range of services that will be available at the hospital.

Defenders of the plan have said the phrase merely refers to ensuring that all the services expected to be provided at a maternity hospital will be.

Speaking to reporters Mr Martin said: “We haven’t made changed to the legal documents.”

“All lawful services will be provided by the new hospital - of that there will be no question”.

He said that the advice from the Attorney General was very clear on this point and added: “That is the understanding of all three [COALITION]parties.”

Asked if any changes had been made in the last two weeks, Mr Martin said: “The legal documents stand.”

He reiterated his view that a 300-year lease was “effective ownership” of the new NMH site.

Earlier, the man who brokered the deal for the new hospital, Kieran Mulvey, had said he would recommend the removal of the wording "clinically appropriate" from the agreement.

He said it was better to stick to the wording stating that the NMH would provide treatments allowed under “the laws of the State” which was the language in the original 2017 deal.

There has been considerable controversy over aspects of the plan formulated since then to move the NMH from Holles Street to the Elm Park campus of St Vincent's Hospital.

An order of nuns, the Religious Sisters of Charity (RSC), last month transferred its shareholding in St Vincent's Healthcare Group (SVHG).

James Menton, the chairman of SVHG told the Oireachtas Committee on Health on Monday that this was "the last formal step in reaching the Board's objective of becoming a truly secular organisation free of any religious influence".

However, critics of the proposed move of the NMH to the St Vincent’s campus remain concerned that lingering religious influence would mean abortions or fertility treatment would not be allowed take place at the new hospital.

One issue highlighted by many is the inclusion of the phrase “clinically appropriate” in the new NMH’s constitution.

The Government and doctors involved in the relocation have, like Mr Martin, responded to these concerns by pointing to protections in the deal to ensure that all procedures legal in the State can be carried out at the new hospital.

Government approval may stipulate that the “clinically appropriate” phrase be further defined in the agreement underpinning the move although the Taoiseach’s comments tend to suggest that this will not be the case.

The Irish Times understands such an approach would not stop Cabinet approving the move on Tuesday with tendering and final sign-off for the business case of the hospital still outstanding.

Raised concern

Mr Mulvey - a high profile mediator - has raised concern at suggestions that the procedures to be allowed at the hospital might be listed as part of an effort to alleviate concerns over the “clinically appropriate” phrase, saying this could leave them open to “delisting” at a later stage.

He told RTÉ Radio's News at One that the agreement he had brokered in 2017 guaranteed the independence of the new hospital.

He said the laws of the land would apply and all procedures carried out at the NMH in Holles Street would be carried out in the new hospital at Elm Park. It had been “clear and unequivocal” that there would be no “falling back” from the current services.

The phrases “clinically appropriate” and “legally available” had not been included in the document in 2017, he said and he added that he understood that wording had been requested by the HSE.

He said he would support the removal of the “clincically appropriate” phrase.

Mr Mulvey said what was important was the care of women and that services be available to them. It was now six years since negotiations had commenced “and they haven’t laid a brick.”

At the Oireachtas Committee on Health Mr Menton told TDs and Senators that the phrase “clinically appropriate” was sought by the HSE.

Donal O'Raghallaigh - a partner with McCann Fitzgerald Solicitors who was a legal adviser to SVHG on the NMH project - said that the phrase was not inserted at the behest of SVHG.

He said the phrase, as explained by Minister for Health Stephen Donnelly relates to “the type of procedures you would find in a maternity hospital as opposed to a broad range of procedures that you would find in different types of hospitals”.

Mr Menton said Mr Donnelly has been reflecting on concerns about the phrase but SVHG has not yet heard from the Department of Health and the HSE on the possibility of deleting the phrase, offering further definitions for it or maintaining the status quo in the deal.

Asked by Sinn Féin TD David Cullinane if it was possible that changes could be made before Cabinet if all parties in the deal agreed Mr Menton said: "We believe so yes".

Mr Menton said there have been “various discussions” about removing the phrase or adding an addendum but added: “We haven’t been asked formally or otherwise to state our position.”