This is not personal, it’s about women’s healthcare
Former Master of Holles Street Dr Peter Boylan is vehemently opposed to the new maternity hospital in its current form – and with his sister-in-law on the other side of the debate, he claims...
ON THE shelves of Dr Peter Boylan’s home office, which he shares with his wife Jane, there are dozens of books and annual reports that relate to the subject he is most passionate about — Ireland’s national maternity hospital, Holles Street.
It’s where he spent six months as a medical student, enjoying the experience so much that he decided to go into obstetrics. He started his career there in 1975, and apart from two separate four-year stints working in London and the US, it’s where he stayed until his retirement in 2016.
He was considered by many to be an unapologetically liberal force for good. At the start of his tenure as Master, which he served from 1991 to 1997, he allowed the widespread use of epidurals — any woman who wanted one could have it.
His decisions sometimes got him into trouble, like the time he was hauled in front the then Archbishop of Dublin Desmond Connell for introducing sterilisation procedures at the hospital, for the purposes of family planning, an episode he now describes as simply ‘frustrating’.
‘I just told him no, that I was going to keep doing it and that was the end of that,’ says Boylan. ‘I was able to say that to him because of the [governance] structure.’
Many of his books and periodicals have little blue stickies, to mark important passages or statements, which he can then find quickly whenever called upon to share his thoughts and opinions.
It’s a regular enough occurrence — indeed, Boylan has become something of a ‘celebrity medic’, a familiar media presence since lending his substantial support to the Repeal the Eighth movement in 2018.
His measured, calm and quietly authoritarian demeanour was effective in delivering a divisive message that many questioned or struggled with. There’s little doubt he helped sway the opinions of those who may have otherwise voted against the introduction of abortion in Ireland.
Now, once again, he’s thrown himself into the middle of another bitterly divisive debate, another one that’s very close to his heart — the building of the new National Maternity Hospital.
THIS particular controversy has raged for about a decade, ever since it was first mooted that the NMH be built on the same site as St Vincent’s Hospital in Dublin 4. While the plan to co-locate it with an established acute hospital was broadly welcomed, questions were immediately raised about the ownership and governance of the new NMH.
The lands on which it would be built were owned by the Religious Sisters of Mercy, and given Ireland’s troubled recent past with religious orders, it’s not surprising that there was anger from some quarters at the idea a Catholic charity could possibly end up overseeing our national maternity service.
In 2017, the Government attempted to reassure the public that the new NMH would not be subject to interference by any religious body, and that a new company would be established to make sure it was run with ‘clinical and operational independence’. But it did little to silence the critics. The row has erupted several times again over the last few years, in quite dramatic fashion in April 2017, when Boylan quit his position on the board of the NMH.
Since then, it’s rumbled on. Finally last week it was announced that the Religious Sisters of Charity had transferred their shareholding in the company that owns the land at the Elm Park site, to a charitable trust, St Vincent’s Holdings CLG (SVHG).
Those in favour of the plan, including the Department of Health, must have thought things had been sorted to an acceptable degree, and a press conference that was clearly supposed to announce the go-ahead was held on Tuesday afternoon.
Instead, Health Minister Stephen Donnelly, flanked by grim-faced senior clinicians from Holles Street, announced that it had been decided to delay the approval by two weeks because of ‘genuine concerns’ about its clinical and operational independence.
He also announced that all the legal documents between the State, the National Maternity Hospital and St Vincent’s would be published later that night, so that people could be reassured the new hospital would have full independence.
On Wednesday, the matter was discussed in the Dáil, with Taoiseach Micheál Martin defending the proposals, explaining that the arrangement to lease the land for 300 years at a rent of €10 per annum amounted to ‘public ownership’.
He insisted that all concerns were comprehensively addressed in the newly released legal documents, which showed that religious ethos would have ‘no hand, act or part’ in the new hospital.
The issue, which the Government has made very clear it is determined to get signed off, will come before ministers again in about ten days.
In a week that celebrated the International Day of the Midwife and over in the US the Supreme Court voted to overturn abortion rights, it seems more than a little timely that this ongoing row over where the new National Maternity Hospital will be located, might finally be coming to a head.
Boylan remains optimistic that things can be resolved in a manner that he and others would be happy with. Keen to stress that he’s no lone wolf in this campaign, he points out how several ministers, all female, voiced concerns this week. It’s believed Heather Humphries, Helen McEntee, Hildegarde Naughton and Catherine Martin all sought assurances that all legal services, including abortion and sterilisation, would be available at the new NMH.
THERE’S a huge amount of public concern, and concern around the cabinet table, which is very justified,’ he says. ‘There is a solution, which is, one: nuns, honour what you said you’d do, gift the site to the people of Ireland; and two: make sure the National Maternity Hospital remains in the ownership and trust of the governors.’
He makes it all sound so simple, which of course it’s not. Indeed, the twists and turns in this saga would make you dizzy. But Boylan is seemingly unflappable, a good trait for a medical consultant, and lays out his arguments in a low-key and methodical manner.
His serene disposition is interesting, because at times this debacle has become very personal, not least because one of his most vociferous opponents is his sister-in-law, Dr Rhona Mahony, also a former Master at Holles Street. Boylan is married to Mahony’s older sister Jane, who works in publishing.
Although they worked together, and presumably have spent time in each other’s company outside the hospital, he claims he has no idea why she supports the proposals.
‘I tried to get to the bottom of it
many, many times at board meetings in Holles Street,’ he sighs. ‘At one stage she was vehemently opposed to any involvement of the sisters, she held a town hall meeting with a lot of different people to see how we could get the nuns out of this involvement. What does he think changed? ‘I don’t know, it’s a puzzle and I’ve never been able to figure it out,’ he says. ‘She espoused liberal causes and she worked in support of the Eighth Amendment appeal, and she does terminations in the hospital, so I don’t know.’
Later I ask him if it has made life at home at all difficult. ‘No, not in the slightest,’ he replies. ‘My wife supports 100% what I’m doing.’
Those who want the new National Maternity Hospital to go ahead as it is, have made it very clear they believe ‘misinformation’ has led to public distrust of the move.
‘Lots of unkind things were said at the time of my resignation from the board of Holles Street,’ says Boylan. ‘There’s always references to misguided statements from people who don’t understand what’s going on, which I think are references possibly to me, if not probably. But that’s fine, I don’t mind that really.’
Since Tuesday’s press conference, he’s made himself available to do interviews and has been making his way through the newly released documents. Although retired since early 2017, he feels a sense of duty to remain involved in the debate about where the new National Maternity Hospital will be located.
‘It’s what I spent my life doing,’ he says. ‘I’m not alone in this at all, and it’s not a personal thing, it’s about women’s healthcare,’ he continues. ‘I’m expressing the views of an awful lot of people.
‘Most of the people who want it [to go ahead] seem to be from St Vincent’s and Holles Street. The National Women’s Council has a problem with it, female members of the board of the HSE have a problem with it, females TDs have a problem with it, Ivana Bacik for example.’
He points to the Mulvey Agreement as the point when he first really became concerned about the proposal. The 2017 report by mediator Kieran Mulvey was commissioned by the then Health Minister Simon Harris and laid out the terms of the agreement between the National Maternity Hospital and St Vincent’s Hospital Group (SVHG).
Under the deal, the new NMH would be operated by a new company, The National Maternity Hospital at Elm Park DAC, which would be a 100% subsidiary of SVHG. At the time, the SVHG was owned by the Religious Sisters of Charity.
‘It goes back to that Mulvey Agreement, when the idea was that the Sisters of Charity would own the new hospital,’ says Boylan. ‘That was suggested by Rhona Mahony and Nicky Kearns [a former High Court president] who was the deputy chair of the NMH board at the time. There was never going to be any problem with the Religious Sisters of Charity owning it, that was the mantra. That just didn’t make sense.
‘There was this very complicated, byzantine legal arrangement that was going to be put in place. For years at the AGMs and when I was on the board, we were all told, “we’re almost there, we expect to have the final legal agreements within weeks”.
‘That’s been going on for years. It has taken them an awful long time to arrive at a legal agreement that is designed to protect the delivery of women’s healthcare. That shouldn’t have been the case. If there are no problems, why has it taken so long to devise these legal arrangements?’
HE says he knows how it can all be fixed. ‘The whole thing would be solved if the current ownership and governance structure in the NMH moved with the physical building,’ he says. ‘The question has to be asked, why must the new company be owned by a successor company to the Religious Sisters of Charity? One which is approved by the Vatican and whose directors and shareholders are committed to upholding the values and vision of the Religious Sisters of Charity, which are understandably Catholic.’
In a letter to the Taoiseach this week, Boylan detailed how the Sisters were ‘obliged under Canon Law to seek the permission of the Holy See for the transfer of their shareholding to St Vincent’s Holdings’.
‘As a Catholic religious order, they are governed by the Congregation for the Institutes of Consecrated Life and Societies of Apostolic Life in Rome,’ he wrote.
‘In the absence of the full correspondence with Rome being made available for public and/or parliamentary scrutiny, it is clearly not possible for the Government to make any commitment or promise that Catholic ethos will not govern St Vincent’s Holdings and therefore the operation of the relocated National Maternity Hospital which will — as the plan currently stands — be owned and controlled by St Vincent’s Holdings.’
THIS is not about nuns being involved in the running of the hospital, he clarifies, it’s about Catholic ethos. ‘When religious congregations run out of new recruits and have to withdraw from active service, what they all do, all over the world, is transfer their assets into lay organisations with a Catholic ethos.
‘When the value of the transaction is [above a certain amount], they need the permission of the Vatican. The nuns initially said they didn’t need the permission of the Vatican, Holles Street said they didn’t need the permission of the Vatican. I kept saying, they do. And they did. Talk about misinformation.
‘It’s stretching credulity to suggest that the Vatican has approved the transfer of hundreds of millions worth of assets in order to facilitate the building of a hospital in which procedures directly contradictory Catholic teaching will take place.’
He has other issues, the make-up of the board for instance, where three representatives will come from the new NMH, three from St Vincent’s and three independents appointed by the Government.
‘It’s designed for conflict,’ he claims. ‘It’s a very risky situation and you have this ridiculous thing, the Minister having the “golden share”. So is the Minister supposed to determine clinical practise?’
As convincing and incredibly confident as Boylan sounds, you cannot ignore the fact that many eminent medics and experts, many who currently work in Holles Street, desperately want this proposal to go ahead. Indeed, several legal experts have also this week insisted that, as it now stands, there will be no issues with the services the new NMH can offer.
‘I can understand my colleagues wanting a new hospital,’ says Boylan. ‘But they haven’t done the research to see how these things work internationally. What happens when a Catholic religious congregation withdraws, what do they do with their assets?
‘I’ve done a massive amount of research; I’m retired and I have the time. My colleagues are extraordinarily busy and shortstaffed, they obviously haven’t sat down or got anyone to investigate what actually happens in these situations around the world.’
What about the need for a new maternity hospital, one advocates and patients say is long overdue?
‘Patient satisfaction [in Holles Street] levels are at 95%, that was in their last annual report,’ replies Boylan. ‘The clinical results are as good as you’ll get anywhere in the world, so it is not dangerous.
‘OK, there is one 14-bed ward, and yes the facilities, what people call the hotel facilities, certainly could do with improvement, but there has been huge investment in the hospital in recent years.
‘I support the building of the new hospital, a massive amount of work by the people of Holles Street has gone into the design of the building, and that deserves to be recognised. But it’s the ownership and governance that is a concern.’
Whether or not the new project is approved in less than two weeks’ time, remains to be seen. But one thing is for certain, Peter Boylan won’t be giving up on this latest crusade any time soon.