A trainee midwife in the National Maternity Hospital, in Dublin, was massaging Melissa Thornton’s shoulders and urging her to imagine she was lying on a beach in the Maldives when Phil Doyle, Thornton’s husband, noticed gaps in the ceiling above, where tiles had fallen off. The midwife was using these methods to ease Thornton’s labour pains as the palliative air-and-gas pipe over the bed was broken.
Minutes later, the nurse was shouting “push, push, push”, trying to make herself heard over the sound of a builder’s drill next door, while Thornton gave birth to the couple’s second child, Eloise.
“Despite the dreadful facilities, the staff were phenomenal,” said Doyle, who tweeted a photo of a four-legged stool in a corridor beside the nurses’ station where the couple waited for six hours for a scheduled induction last month. “They’re working in very tough conditions.”
Since 1998, successive governments have discussed relocating the National Maternity Hospital (NMH) from its Victorian building in Dublin’s Holles Street to St Vincent’s hospital campus in Elm Park. The move was officially announced in May 2013 by James Reilly, who was then health minister. Rhona Mahony, the hospital’s master, had declared the Holles Street building, where nearly 10,000 babies are born every year, “intolerable” and “not fit for purpose”.
The intention was to apply in 2015 for planning permission for a 33,000 sq m maternity hospital. It would feature rooms with en suite bathrooms, plus five theatres and 24 delivery rooms. The new maternity hospital was expected to be operational by 2019. That €150m plan stalled last year. St Vincent’s Healthcare Group (SVHG), which owns the public and private hospitals in Elm Park and St Michael’s hospital in Dun Laoghaire, refused to allow plans to be submitted to An Bord Pleanala until the maternity hospital consented to dissolve its corporate structure and be subsumed into St Vincent’s.
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Two mediation attempts have failed. While the second was in progress, the Health Information and Quality Authority published a report on health and safety standards in Holles Street. It found that delivery rooms were too small to accommodate essential equipment; narrow corridors were being used for storing theatre trolleys; there were waste containers on the stairwell; a delivery room was used as “a thoroughfare for staff and visitors”; a patient’s bed was in a lobby; and there was overcrowding in the neonatal intensive-care unit.
“This infrastructure does not facilitate patients’ dignity, confidentiality or privacy, and does not facilitate effective infection prevention and control,” the report said.
Despite the findings, the relocation deadlock has become more acrimonious. On Friday, James Menton, SVHG’s chairman, wrote to the Department of Health. “While our offer remains open for the time being,” he said, “it seems pointless and futile in present circumstances to engage in meetings on detailed project planning.”
The healthcare group has said its proposal “does not extend to ownership or control of the identity or assets of NMH” and claims it is in line with a review of maternity services by accountant KPMG in 2008 “that led to the project”. But the maternity hospital, as well as sources in the HSE and the Department of Health, claim the report has been superseded by more recent ones on maternity services in Galway and Portlaoise hospitals, and by the national maternity strategy, which was announced in January.
The healthcare group says the maternity hospital would have two or three directors on the board, a chief executive and a clinical director or master. However, there would be an oversight committee — and the master would not sit on it. The maternity hospital claims this spells the end of its traditional mastership and would create “at least four management layers from the board of SVHG”. In its position paper for mediation, it described the group’s demand as “no less than a complete takeover of NMH by the Religious Sisters of Charity”.
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The nuns, two of whom sit on the board, are the sole shareholders of the healthcare group, a private limited company that has charitable tax status and fixed assets of more than €531m. The maternity hospital is owned, in trust, by governors. Diarmuid Martin, the Catholic archbishop of Dublin, is its chairman, but does not attend meetings as he considers his automatic appointment “anachronistic”.
“The contention that SVHG’s proposal does not extend to ownership or control of NMH is a gross misrepresentation of the facts,” the hospital paper said. “Despite numerous discussions, we remain unclear why SVHG maintain that there cannot be two independent legal entities on the campus.” The maternity hospital noted that Breast Check, a cancer-prevention service owned by the HSE, is an independent body already on the Elm Park site.
According to Róisín Shortall, a former junior health minister, it matters who owns the new maternity hospital. “For reasons of ethos and public accountability to the taxpayer, the NMH must operate independently of the SVHG,” she said.
The National Women’s Council said it was “alarmed” that the project had stalled. It shares concerns raised by the Institute of Obstetricians and Gynaecologists of Ireland that the nuns’ Catholic ethos might “negatively impact women’s access to reproductive services, such as IVF or access to abortion under the already very restrictive Protection of Life during Pregnancy Act”.
A supporter of St Vincent’s position rejected talk about religious ethos as a red herring. “The Sisters of Charity are very much in retirement mode,” he said. “They are not actively involved. This is not 1956, it is 2016. The country has moved on.”
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A spokesman for SVHG said: “There is no prohibition on any medical procedure, whether elective or emergency, that is clinically indicated, and that includes vasectomy and tubal ligation.” In a letter to staff on Tuesday, Menton dismissed as sensationalist the “tale of nuns attempting to control Irish maternity services”. However, a healthcare source who did not want to be named claimed St Vincent’s did not allow elective vasectomies or tubal ligations for optional sterilisation.
“This is like walking into a Dan Brown novel,” he said. “Nuns don’t have a great record at looking after pregnant women, as we saw from the report on the Magdalene laundries. I accept most of them are retired but they still control the hospital by proxy. They tend to appoint people to the board who reflect their ethos.”
In supporting letters attached to the maternity hospital’s position paper, Peter Boylan, the obstetrics institute’s chairman, said: “Were the NMH to become a constituent part of SVHG, the hospital would come under the direct control of the Religious Sisters of Charity. Catholic church-controlled hospitals refuse to provide contraception, sterilisation, IVF services or gender reassignment surgery to women, under the direction of the Vatican. Catholic-church control of NMH would create major difficulties for the provision of these services.”
A spokesman for Leo Varadkar said the health minister had told St Vincent’s that he favoured independent governance for the maternity hospital. SVHG denied Varadkar said this.
Krysia Lynch, of the Association for Improvements in the Maternity Services, Ireland, said: “We would have grave concerns should a Catholic ethos be used to influence the unbiased, evidence-based care that all women should receive as part of their maternity service.”
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On Tuesday, Chris Fitzpatrick, a former master of the Coombe maternity hospital and a member of the NMH-Vincent’s campus project board, also expressed support for Holles Street. “With the greatest of respect, St Vincent’s Hospital has no track record in providing maternity or neonatal services,” he said. “The NMH has consistently articulated its position that its competence and clinical independence should be maintained on the St Vincent’s campus. The 2008 report is null and void. It is no longer government policy.
“In the interests of patient safety, of mothers, of women and of babies, St Vincent’s Hospital should support the NMH in its advocacy to have an independent corporate and clinical entity.”
Yesterday, the Department of Health said: “Government policy is to co-locate the NMH on the [SVHG]campus with each hospital retaining its own identity.”
SVHG is not without support. “I think their offer is a pretty fair one. It seems to meet every requirement Holles Street would have,” said Tom Lynch, chairman of the Ireland East Hospital Group, which includes St Vincent’s and St Michael’s among its hospitals. “The minister parked the mediation process until after the general election and the formation of a government. It is essentially on the desk for whoever the next minister is.
“I have twice visited John Radcliffe Hospital in Oxford. It is an adult University of Oxford teaching hospital, a children’s hospital and a maternity hospital, all with one board. It works very well. All Vincent’s are saying is there should be one corporate structure but operational, budgetary and clinical independence.”
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In reply to a Dail question from Shortall last week, Varadkar said: “As both hospitals are voluntary independent hospitals, a solution cannot be imposed upon them.” Shortall believes the state’s “unacceptable” financial arrangement with SVHG “must be disentangled before there is any question of NMH sharing the campus”.
St Vincent’s University Hospital receives annual state funding of more than €200m, and Holles Street gets about €40m. After the revelation that SVHG used St Michael’s hospital as collateral for a new St Vincent’s private hospital that opened in 2010, Tony O’Brien, the HSE’s director-general, told the Dail’s public accounts committee that the private hospital had a “parasitic dependence” on the public one. At a meeting in April last year, he said he was considering appointing forensic accountants to examine the financial relationship between the two hospitals.
“It’s about time the Department of Health stood up to the SVHG board,” Shortall said. “The responsibility is clearly on the minister to ensure that public facilities are not controlled by private interests.”
Meanwhile, the likelihood of a new national maternity hospital being open in 2019 continues to recede.