Q&A: Why is the National Maternity Hospital moving and why are people concerned?

Uncertainty on whether hospital will be run by State and provide abortions has caused concern

The National Maternity Hospital in Holles Street. The hospital’s relocation project has been beset by controversy, in particular relating to concerns over ethos. Photograph: Bryan O’Brien

The National Maternity Hospital in Holles Street. The hospital’s relocation project has been beset by controversy, in particular relating to concerns over ethos. Photograph: Bryan O’Brien

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Why is the National Maternity Hospital relocating to St Vincent’s?

Back in 2008, consultants KPMG recommended the co-location of maternity hospitals with acute general hospitals to provide quick access to complicated care when needed. The National Maternity Hospital’s (NMH) Holles Street campus in Dublin 2 was becoming dilapidated and the time was deemed right.

In 2013, then minister for health James Reilly announced the NMH would move to Elm Park and co-locate with St Vincent’s hospital. The estimated cost was €150 million. In 2016, a dispute emerged over governance. Talks took place and agreement was reached that November on a new company with clinical and operational independence being set up.

Was that the end of the concerns?

No. In April 2017, it emerged that the Religious Sisters of Charity would be given ownership of the State-funded NMH, by then estimated to cost €300 million. The congregation was to be the shareholder of the St Vincent’s Healthcare Group, which the Department of Health said would be the “sole owner of the new hospital”. This resurrected concerns about a Catholic ethos at the new hospital. Dr Peter Boylan resigned that month from the NMH’s executive board, saying it was “blind to the consequences” of transferring ownership of the hospital to the group.

What happened next?

In May 2017, the Sisters of Charity announced it would end its involvement in the St Vincent’s Healthcare Group and not be involved in the NMH. A year later, the Eighth Amendment was repealed in a referendum, paving the way for access to abortion services in Ireland. There was slow progress on the exchange of legal documents throughout 2018.

What did politicians say?

In November 2019, then taoiseach Leo Varadkar said the NMH would be a State-owned building on State land. “We need to sort out the details of the legal transfer over the next couple of weeks.” The legal framework is still being worked on.

Why the extended delay?

The Sisters of Charity had to wait for permission from the Holy See to transfer its shareholding to St Vincent’s Holdings Group, which will own the hospital. When it got the Letter of Grant, it stated “provisions relating to the validity and lawfulness of alienations, found in canons 638-639 and canons 1292-1294 of the code of canon law and in proper law, are to be observed.”

Boylan told TDs in a briefing document that canon 1293 is “particularly relevant”. He says this requires the congregation to have “a just cause, such as urgent necessity, evident advantage, piety, charity, or some other grave pastoral reason” to make the transfer.

It emerged last May that Catholic Primate Eamon Martin had told the Vatican he supported the congregation’s request to surrender ownership of St Vincent’s Healthcare Group because Ireland needs a modern maternity hospital. However, he said he would publicly oppose abortions taking place there.

Where do we stand now?

Minister for Health Stephen Donnelly is finalising the legal framework for the move but campaigners are worried it will not be subjected to full political scrutiny. The concern is centred around the role of St Vincent’s Holdings Group, which will operate the hospital.

Campaigners say that the “values” section of the proposed St Vincent’s Holdings constitution is similar to the stated values of the current healthcare regulations of the Sisters of Charity. Furthermore, that company will lease the new hospital facility to the HSE for 99 years, calling into question political pledges that it would be a State-run hospital on State land. Ultimately, they fear that some procedures such as abortions could be prohibited on the site.

Do the campaigners have a point?

Lawyers for St Vincent’s wrote to the Department of Health last summer and said the hospital would be bound by Irish, rather than canon, law. The constitution of the new company “makes no reference to canon law and canon law shall have no impact on the company,” the letter stated.

Campaigners are not convinced and some legal experts agree. Jason O’Sullivan, principal at J.O.S Solicitors, said uncertainties “need to be formally addressed” by the Government and Minister for Health.

He said the Minister “needs to provide clear assurances . . . and if possible, a firm commitment to introduce legal guarantees on the NMH’s independence from all non-medical influence in clinical operations to ease such concerns, owning to the historical context and the recent comments made by church leaders”.