Public ownership does not guarantee access to free and safe abortion

Healthcare is provided by individual healthcare professionals, not buildings, land or legal documents. When I have a patient in front of me who needs care, it is irrelevant to me who owns the building we are in, or who owns the land it sits on. What I do care about is that can I provide the healthcare he or she needs in a safe and dignified setting.

Everyone who has an interest in the move of the National Maternity Hospital (NMH) to its new site, on the campus of St Vincent’s Healthcare Group (SVHG), would also like to see that women in the new hospital will always be able to get the healthcare they need, when they need it.

Unlike the hospitals run by the Health Service Executive that are publicly owned on public land, SVHG and the NMH are voluntary hospitals, set up and established by volunteers under their trusteeship. At the NMH our voluntary status is very important to us, and we value it highly, as does SVHG, but why should that voluntary status be important to the public?

There are 19 maternity units in the State. Three of them are voluntary hospitals like us and the rest are HSE hospitals, State-owned on public land. Of the 16 HSE units, eight still do not provide a full termination-of-pregnancy service, and women attending these units have access to abortions only in very limited circumstances.

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‘Complex reasons’

You may well ask: how can this be so?

My personal view is that this is likely to be due to some clinicians at these hospitals being unwilling to offer terminations for conscience reasons. When asked, the HSE told me the reasons these services are not offered in some HSE hospitals “are complex and particular to each site” and that “the HSE is working towards full implementation in all 19 units”.

Three years after it became legal to do so, this lack of service represents an abject failure of the ‘public owned on public land’ model of care to provide termination-of-pregnancy services. The voluntary maternity hospitals all provide a full termination-of-pregnancy service. What is absolutely crystal clear is that public ownership on public land does not guarantee access to free, safe and legal abortion. If that doesn’t then what does?

The guarantors of and the defenders of the provision of abortion, sterilisation, IVF, gender-affirmation services and women’s healthcare services in general are the individual clinicians willing to step up and provide these services, in a supportive environment with the correct legal backing.

The NMH as a voluntary hospital has that supportive environment, we have the clinicians and the legal structure in place.

We will bring that with us when we move to SVHG. While until two weeks ago it was owned by Religious Sisters of Charity, they have now formally ended their role by divesting, in its entirety, their interest in the hospital, and transferring all of their shareholding to St Vincent’s Holdings CLG, a new, secular, not-for-profit company with charitable status governed by Irish law.

James Menton, the chair of the St Vincent’s board, confirmed in a letter published in The Irish Times on May 4th that St Vincent’s is now a “secular organisation” completely free of any religious influence.

Unfortunately, doubt about potential religious influence has not been sufficiently assuaged or trust sufficiently established by the legal assurances given, or the assurances from clinicians such as me, to enable everyone to get over their fears that somehow religious influence could be sneaked into the legal structure by the back door.

Legal protections

Perhaps I can’t absolutely assuage everyone’s concern, but I can say that I have spoken at length with our own legal advisers and I am satisfied, as are all of the clinicians at the NMH, that the legal structure of the deal gives us all of the legal protections we seek and that are necessary for us as clinicians to do our jobs without fear of interference or influence of any religious ethos.

While the existing NMH is not publicly owned nor operated, the State and public interest is protected through our service-level agreement with the HSE. To all intents and purposes we look and feel like a public hospital, but our voluntary status gives us the operational and clinical independence to respond quickly to the changing clinical needs of our patients, without having to refer up a management chain to the top of the HSE for major decision-making.

This dynamism was recently exemplified during our rapid and effective response to the Covid crisis, and three years ago during the introduction of termination of pregnancy, in which we were the first hospital in the State to provide the full range of services.

The legal framework now published gives us the clinical, operational and budgetary independence to function as a full voluntary hospital on the SVHG campus in exactly the same way we do now on our current site.

The State and public interest are protected in two ways: first, by the 299-year lease to the HSE (longer than the expected operational life of the new building); and secondly with the new service-level agreement that we will conclude with the HSE to provide public services.

The clinicians of the NMH are unanimously satisfied that the robust legal protection we need is now in place to allow us to continue to provide, to defend and to guarantee the rights of access to public patients to get the healthcare they need when they need it.

I call upon you to support this project, because the reality of failure, due to however well-intentioned but misinformed doubts, is to condemn many generations of Irish women, girls and their children to the provision of healthcare in facilities universally acknowledged to be substandard.

Let’s not be the generation to let women down again.

Dr Roger McMorrow is the clinical director of the National Maternity Hospital