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Commercial realities, not Catholic ethos, may be the real stumbling block to securing the hospital’s future,

Commercial realities are the real stumbling block. Dearbhail McDonald

THE narrative of the Religious Sisters of Charity embarking on a naked power grab to take control of the State’s largest maternity hospital in a bid to control Irish women’s reproductive autonomy is a potent one.

Our collective reaction to the prospect of the nuns, the owners of the St Vincent’s University Hospital Group (SVHG), imposing its Catholic ethos on Irish women while refusing to pay its share of a redress scheme for institutional abuse is real and visceral. And it is entirely understandable in the wake of Church scandals such as the discovery of the remains of babies and small children in septic tanks at a former mother and babies home in Tuam.

However, I wonder if the real reason why the SVHG insisted on the National Maternity Hospital coming under its control was less to do with Catholic ethos and more to do with its toxic relationship with the HSE and its €150m debts.

If you really want to be angry at St Vincent’s and its shareholders (the nuns), consider this outrage. The SVHG is a private limited company with charitable tax status that used the State-funded public hospital — “our hospital” — on its Elm Park campus as collateral for the building of its private hospital and car park. In short, SVHG used a public facility to guarantee its private debt — some €118m of it and counting, all due within the next five years or more. You couldn’t make this stuff up. As a result, it is the banks that arguably own St Vincent’s.

The private hospital’s financing liability and bank loans relating to the private hospital are secured by Bank of Ireland by a first priority mortgage over the investors’ interest in the new private hospital, together with fixed and floating charges over “certain assets” of SVHG Limited. In addition, bank loans from Ulster Bank are secured by a fixed and floating charge over Pianora Ltd — the private car park — and by a guarantee from the SVHG.

The issue, therefore, is primarily commercial, not religious. It always has been.

When the Mater Hospital (owned by the Sisters of Mercy and no stranger to controversies relating to women’s wombs and Catholic ethos) offered to receive the National Children’s Hospital on its site, the nuns’ lands were offered to the State on an unencumbered basis. But St Vincent’s, which never really wanted the new NMH to co-locate to its site in the first place, is up to its neck in debt — it cannot give up lands that banks and others have multiple charges over, even if it wanted to.

It would have been ideal and in compliance with the State’s own national maternity strategy, had the NMH transferred — as intended — to St Vincent’s as a stand-alone legal, corporate and clinical entity. Instead, after years of torturous negotiations and successive rounds of mediation, a compromise was reached. Under the deal, a new company would be formed and would be wholly owned by the SVHG. The NMH’s mastership system of independent clinical and corporate governance would be retained and the new company would have its own board of directors with powers specifically reserved to enshrine its independence from SVHG. The NMH’s ethos would be continued by embedding it in the constitution of the new company. Moreover, the Minister of Health will hold a socalled “golden share” to guarantee the new hospital’s independence.

Hand on heart, I have concerns about the deal, even with its triple lock to guarantee the autonomy and governance of the relocated NHM. The composition of boards matter, as does the independence of the chair. And I have genuine fears about leaving the future of women’s healthcare in the hands of government ministers who are vulnerable to swings in public mood.

But I honestly believe that, in the circumstances, this was and is the best deal for Irish women.

The alternative, no hospital or another 20 years of delays, is just too horrific to contemplate.

Why not just build the hospital on a greenfield site, you might ask? Precisely because expectant and birthing women in need of critical care need to be adjacent to acute, intensive supports and national specialities to ensure their safety.

There is a reason why it is government policy to co-locate the three major Dublin maternity hospitals (the NMH, the Rotunda and the Coombe) on tertiary sites.

But the co-location options are limited. St James, which has no problem with its neighbour the Coombe co-locating (as opposed to coming under its control) is not an option as it is also set to be the home for the new children’s hospital. The Rotunda is due to co-locate to the Connolly Hospital campus in Dublin 15. Blanchardstown is a fine hospital but it’s not a tertiary facility. Where else can the NMH, 50pc of whose consultants already work between it and St Vincent’s, go?

We can blather on about greenfield sites, but what do we do at 3am when an expectant woman has a major vascular or other medical crisis and has to be hauled across the city to secure the life-saving surgery she and her foetus may require or cannnot have on or near site access to that expertise?

We can rail against the nuns, but the next time a woman dies because she did not have access to the gold standard of integrated, co-located maternity care, can we really comfort ourselves that at least the Sisters didn’t hold the underlying shares?

Don’t get me wrong, I’m as angry as many of my fellow Irish citizens about the prospect of a religious order owning public hospitals and controlling their ethos.

Conscientious objection can be accommodated for individuals in our healthcare system without denying women and young girls the healthcare they need.

Faith-based medicine is here to stay: one in six hospital beds in the US is in a Catholic institution. But if you’re a medical facility that is funded by the public purse, you forfeit your right, in my view, to impose your private beliefs on the general population.

It seems so straightforward. But such is the complex accident of history that gave birth to much of our education and health services, the conscious uncoupling of religious orders from our public services is proving to be difficult. What angers me most is how women and children have become collateral damage in a war of attrition between the State and the voluntary hospital sector in general and the HSE and St Vincent’s in particular.

The death knell for the co-location of the NMH on St Vincent’s war arguably sounded two years ago when Health Service Executive Director General Tony O’Brien described as “parasitic” the dependence that Vincent’s Private Hospital has on the publicly-run Vincent’s University Hospital.

The maternity talks got back on track but have been punctured by high-profile rows between the HSE and St Vincent’s over a host of issues, including consultants’ pay.

And it is women and infants who have been caught in the crossfire. Now St Vincent’s is threatening to walk away from the deal entirely, a move that would deliver a calamitous blow not only to the 10,000 women who give birth each year at the NMH, but also for the State’s maternity strategy that is now lying in ruin. The ownership issue, widely known last year by the way — although there were no viral petitions or protests then — represents a difficult compromise. But it is one that protects women and infants. It would be a tragic irony if we, as women, bring the curtain down on the one thing — high-quality maternity and reproductive care — we desperately need by conflating Catholic ethos with the money trail and the realpolitick. In the name of God, we can’t allow that to happen.

‘It would be a tragic irony if we bring the curtain down on the one thing we need’