Tony O’Brien: Ma­ter­nity hos­pi­tal at risk of sink­ing into quag­mire:

The dooms­day warn­ing from the hospi­tals is not shroud-wav­ing. It is jus­ti­fied and must be heard

The Irish Times - - Front Page - Tony O’Brien Tony O’Brien is the for­mer di­rec­tor gen­eral of the Health Ser­vice Ex­ec­u­tive

Ire­land is in the throes of an over­due and much-needed wave of con­sti­tu­tional change. The caul­dron of pub­lic dis­con­tent, long sim­mer­ing with dis­sat­is­fac­tion and anger to­wards the re­li­gious es­tab­lish­ment, is at last bub­bling over.

In two his­toric land­slide ref­er­en­dums in as many years, the peo­ple have loudly sig­nalled their in­tent to walk a pro­gres­sive, mod­ern and sec­u­lar path.

While we are un­doubt­edly tak­ing pos­i­tive steps for­ward, dis­en­tan­gling the mod­ern Ir­ish State from its found­ing Catholic roots is a com­plex process.

How­ever sat­is­fy­ing hack­ing off the last cling­ing ten­drils of the church might seem to some, the fact re­mains that many of our pub­lic in­sti­tu­tions are funded and pa­tro­n­ised by re­li­gious or­ders, in­clud­ing about 90 per cent of our schools and many of our health and so­cial care ser­vices.

Dis­pos­sess­ing the church of these priv­i­leges and trans­fer­ring them to sec­u­lar gov­ern­ment is not as sim­ple as hand­ing over the deeds. The money to fund these es­sen­tial ser­vices has to come from some­where, and the State, which foots the bill for most other things, has vir­tu­ally none to spare. Prac­ti­cally speak­ing, there clearly must be some sort of com­pro­mise.

We must also be in­tel­lec­tu­ally hon­est in our de­bate about the role of the church in Ir­ish so­ci­ety. Re­li­gious or­ders have played a piv­otal role in the de­vel­op­ment of health­care in Ire­land. Many of to­day’s lead­ing hospi­tals were orig­i­nally founded and largely run by the re­li­gious on a vol­un­tary ba­sis. This legacy should not be dis­missed or de­val­ued be­cause re­li­gious ob­ser­vance has de­clined.

It is against this chal­leng­ing back­drop that the fu­ture of the Na­tional Ma­ter­nity Hos­pi­tal has con­tin­u­ously oc­cu­pied cen­tre stage in pub­lic and po­lit­i­cal de­bate. The Holles Street move to the cam­pus of St Vin­cent’s Univer­sity Hos­pi­tal, first planned a decade ago and ap­proved in May 2013, came into sharp fo­cus in the highly charged run-up to the cam­paign to re­peal the Eighth Amend­ment, which was used by some to high­light the role of the church in lim­it­ing re­pro­duc­tive choice.

A fear re­mains, er­ro­neously, that the ma­ter­nity hos­pi­tal’s own­er­ship and gov­er­nance model, and its per­ceived Catholic in­sti­tu­tional ethos, will limit ser­vices that are nec­es­sary to fa­cil­i­tate pub­lic pol­icy and in­di­vid­ual re­pro­duc­tive choice.

Moral­ity

St Vin­cent’s was founded and owned by the Sis­ters of Char­ity. In 2002, it was trans­ferred to a not-for-profit com­pany, St Vin­cent’s Health­care Group (SVHG), which is lim­ited by guar­an­tee and reg­is­tered with both the Revenue Com­mis­sion­ers and the Char­i­ties Reg­u­la­tor.

While the Sis­ters orig­i­nally re­tained the right to ap­point the mem­bers of the SVHG board, there is no re­cent ev­i­dence of the im­po­si­tion of Catholic moral­ity on clin­i­cal prac­tice in SVHG; in­deed, they are un­der­stood to have now com­pletely sur­ren­dered that right un­der both civil and canon law.

A writ­ten agree­ment bro­kered by labour re­la­tions ar­biter Kieran Mul­vey guar­an­tees the ex­ist­ing ethos of Holles Street. Con­tin­u­ing to al­lege other­wise is ei­ther mis­guided or wil­ful de­cep­tion. Still, some con­tinue to de­mand that the Gov­ern­ment buys the site for the new hos­pi­tal, but the health ser­vice is so short of cap­i­tal fund­ing that pay­ing for land that is avail­able for free is non­sen­si­cal.

With the ar­gu­ment around own­er­ship now a non-starter, pol­i­tics must be put aside and ac­tion taken. A crit­i­cal pro­ject mile­stone is im­mi­nent. Two vi­tal con­struc­tion con­tracts await sig­na­ture. If they are not signed this month, the pro­ject will be in deep trou­ble. New EU-wide reg­u­la­tions come into force on Jan­uary 1st, 2019. These con­tracts can­not be signed un­der the new rules. Both time and money are at stake. We can­not af­ford to waste ei­ther. The dooms­day warn­ing from the hospi­tals is not shroud-wav­ing. It is jus­ti­fied and must be heard.

An ap­par­ent dis­en­gage­ment by the Depart­ment of Health from the joint pro­ject group, fol­low­ing Holles Street ini­ti­at­ing an ul­ti­mately suc­cess­ful court chal­lenge to a min­is­te­rial di­rec­tion given to Hiqa, has caused con­cern. What­ever

the mo­ti­va­tion, this is clearly a prob­lem. It is hard to be­lieve that any Minister or depart­ment would act vin­dic­tively, as some have sug­gested, but such a with­drawal is hard to un­der­stand and looks bad.

The Minister has now also said there should be a pub­lic in­ter­est mem­ber of the board.

Pri­or­i­ties

In re­cent years, the board of SVHG has been in dif­fi­culty over its ap­proach to com­pli­ance with pub­lic pay pol­icy and other non-clin­i­cal as­pects of its re­la­tion­ship with the State. Against this back­drop, the idea of a pub­lic in­ter­est board mem­ber looks to­tally rea­son­able. Such a con­cept may even emerge as a gen­eral prin­ci­ple, for vol­un­tary hospi­tals, from the work of the In­de­pen­dent Re­view Group.

It may there­fore be more pru­dent to wait for pub­li­ca­tion of its re­port, es­pe­cially as there will be many fur­ther op­por­tu­ni­ties for the Minister to in­sert this re­quire­ment. A re­fusal by the hospi­tals would be dif­fi­cult to sus­tain given the to­tal de­pen­dence on the tax­payer.

The new Na­tional Ma­ter­nity Hos­pi­tal must be pro­gressed – the ex­ist­ing hos­pi­tal is un­sus­tain­able. Be­ing pa­tient-fo­cused means set­ting aside bureau­cratic and ide­o­log­i­cal con­sid­er­a­tions.

Rather than sink into a quag­mire of pol­i­tick­ing and moral­is­ing, it is time to fo­cus on sim­ply get­ting the job done. If this can­not be done de­spite the clear ev­i­dence jus­ti­fy­ing the con­struc­tion of a new ma­ter­nity hos­pi­tal, then we need to ask our­selves what our pri­or­i­ties are.

We must be in­tel­lec­tu­ally hon­est in our de­bate about the role of the Catholic Church in Ir­ish so­ci­ety

PHO­TO­GRAPH: CYRIL BYRNE

St Vin­cent’s hos­pi­tal in Dublin: re­li­gious or­ders have played a piv­otal role in the de­vel­op­ment of health­care in Ire­land.

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