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The new NMH is planned to be co-located with St Vincent's hospital in Dublin 4. Department of Health

Q&A: What are the issues surrounding the National Maternity Hospital moving to St Vincent's?

A range of questions are hanging over the relocation plan.

LAST UPDATE | 7 May 2022

QUESTIONS AROUND THE ownership of the site of the new National Maternity Hospital have again come to the fore this week as Cabinet looks set to approve the relocation of the crucial healthcare facility in the weeks ahead.

The relocation to a site on the grounds of St Vincent’s Hospital in Dublin has proved highly controversial as, until recently, the site was owned by the Religious Sisters of Charity.

The religious congregation has now transferred its ownership and if the relocation plan goes ahead the State would lease the land for 299 years.

Why are people concerned about the ownership?

Last week, St Vincent’s Healthcare Group (SVHG) completed the legal transfer of the Sisters of Charity’s shareholding in the group to the new company, St Vincent’s Holdings CLG, paving the way for the maternity hospital to be built at the Elm Park site.

Campaigners and opposition political parties have raised a number of concerns about the proposed deal. 

Some say the fact that the land is owned by a company connected to a religious entity means it could fail to deliver elements of healthcare, such as abortion and IVF, that are legal in Ireland but not approved by the Catholic church.

The structure of the deal has also been criticised with various queries raised, including why the site is being leased and whether it could be bought with a compulsory purchase order. 

The history of abuse scandals involving religious orders, particularly regarding institutions such as Magdalene Laundries and industrial schools, has led others to say that religious organisations should have no involvement in the provision of women’s healthcare.

The Department of Health has repeatedly stated that all procedures that are currently provided at the National Maternity Hospital under Irish law will be provided in the new NMH if it relocates to the Dublin 4 site.

This includes termination of pregnancy, provision of contraception services including tubal ligation, fertility services and gender reassignment procedures.

Who are the Religious Sisters of Charity?

The group was set up early in the 19th century with the aim of serving the needs of the poor in Dublin.

Over the course of 200 years, it grew to have around 150 communities spread across four continents. The group is involved in healthcare, education and charity work with homeless people and asylum seekers.

The Sisters live in the local community to which they are assigned and the order remains centrally governed from Dublin.

The Sisters were involved in five industrial schools and two Magdalene laundries.

They were one of the religious orders included in the Ryan Report (the Commission to Inquire into Child Abuse). The report, published in 2009, detailed vast amounts of abuse at religious institutions over the course of decades.

The report notes that the Sisters of Charity have never issued a general public apology in respect of child abuse. However, the order has issued three specific apologies relating to the criminal convictions of staff members.

Have they paid redress for involvement in institutional abuse?

A total of 18 religious congregations have offered to pay €480 million of the €1.5 billion costs of the institutional child abuse redress scheme set out in the Ryan report.

Under an agreement worked out in 2002, the Sisters of Charity were to transfer three properties (worth €11.8 million) to help pay the costs. One of those properties has yet to be transferred.

The congregation has also paid €2 million in cash and €3 million in waived legal fees.

Will the nuns be involved in the operation of the hospital?

As this controversy has rumbled on over the course of several years, health ministers, civil servants, masters of the National Maternity Hospital and SVHG (which operates St Vincent’s and other hospitals) have all insisted that the religious order will have no input in the operation of the maternity hospital.

Health Minister Stephen Donnelly said this week that “multiple layers of legal governance protections and structures” have been put in place to ensure that all lawfully permitted procedures, including abortion, will be allowed at the hospital.

hospital 368 A protest in favour of state ownership of the National Maternity Hospital outside Leinster House in Dublin. Sam Boal Sam Boal

The Department of Health also insisted that no representatives of the Sisters of Charity would sit on the board of the hospital.

However, former NMH master Dr Peter Boylan has continuously raised objections about the ownership structure.

This week he wrote to Taoiseach Micheál Martin to again raise concerns, including that the Vatican would have had to sign off on the Sisters of Charity transferring their shareholding in the hospital site to a new charity, St Vincent’s Holdings.

Dr Boylan argues it is “clearly not possible” for the government to make any commitment that Catholic ethos will not govern the hospital.

This view has been disputed by Minister Donnelly, the Department of Health and SVHG.

While SVHG acknowledged that the Sisters of Charity sought approval from the Vatican to transfer their shareholding in the group to St Vincent’s Holdings, it said the Vatican had no say or influence in the establishment of the new company, the appointment of its directors or how it will operate.

“No negotiations took place between SVHG, the Catholic Church or the Vatican and no
instructions (hidden; implied or otherwise) were conveyed to the SVHG board in relation to SVH CLG, nor would they have been countenanced,” it said in a statement.

If a Catholic ethos is impacting the care provided could the government take action?

The Department of Health says the Minister for Health will have the power to ensure that all legal procedures are available.

It says the constitution of the company that will run the hospital (NMH DAC – which is part of SVHG) states that the health minister “has the power to direct its Board to ensure that any maternity, gynaecological, obstetrical or neonatal service which is lawfully permissible in the State will be available in the hospital, without religious ethos or ethnic or other distinction.”

The constitution sets out that the Minister will own a ‘Golden Share’ in the company and will nominate three members of its Board of nine.

Dr Boylan is among those who have argued that this is not sufficient to ensure that all procedures will be available.  

What do we know about St Vincent’s Holdings CLG, the charity the Sisters transferred their shares to?

Last week, St Vincent’s Healthcare Group completed the legal transfer of the Sisters of Charity’s shareholding in the group to a new company, St Vincent’s Holdings CLG.

The new company is a not-for-profit group with charitable status. 

Its directors are Professor Michael Keane, respiratory consultant at St Vincent’s private hospital, Dr David Brophy, vascular and interventional radiologist at St Vincent’s Hospital, and Sharen McCabe, director of McCabes Pharmacy.

These directors hold the shares in St Vincent’s Holdings, which in turn owns its shares in SVHG.

The Sisters of Charity and the Department of Health said that the order will have no role in the future of the new charity or the new National Maternity Hospital.

Boylan argues that the charity is approved by the Vatican and has Catholic values.

SVHG says the independent directors are restricted in what they can do and they are legally required to act in the best interests of the Group.

“The Religious Sisters of Charity and the Vatican have no say in the appointment of Directors or anything to do in the operations of the Group,” SVHG said.

Can a compulsory purchase order be made on the site?

The use of a compulsory purchase order (CPO) has long been touted as a potential solution to the controversy surrounding the St Vincent’s site. 

As outlined in this explainer article from 2017, there are several obstacles that would have to be overcome if a CPO was to be used.

This includes lengthy delays due to legal proceedings, potentially going all the way to the Supreme Court, and compensation costs.

How much is the rent? €10 or €850,000?

Earlier this week the Taoiseach said the hospital would effectively be in public ownership due to annual rent of €10.

However, the lease defines the rent as: “€850,000 per annum or such revised rent as may be payable in accordance with the provisions of this Lease from time to time.”

It then says that the rent “shall be abated to €10 per annum”, as long as six conditions are met.

These are the conditions:

  • The HSE remains the tenant under the Lease;
  • The Lease is not assigned without the consent of the Landlord;
  • Fhere is no change to the Permitted Use without the consent of the Landlord;
  • The Premises is actively used for the provision of public health services save for any reasonable period of non-use due to repair reinstatement;
  • The HSE does not abandon use of a substantial part or all of the Premises;
  • The HSE does not exercise a right pursuant to the Landlord and Tenant Acts to (i) extend the term of the Lease (ii) acquire a reversionary lease or (iii) seek to acquire the Landlords interest.

Róisín Shortall has been among those raising questions about the potential for rental costs to increase dramatically.

National-Maternity-Hospital-Plans An artist's impression of the proposed hospital at Elm Park.

The Social Democrats co-leader asked in the Dáil: “If St Vincent’s Holdings is magnanimously offering an annual rent of €10, can the Minister explain why this punitive penalty clause exists?”

In response, Transport Minister Eamon Ryan echoed the Taoiseach’s line that €10 per year for 300 years was “akin to ownership”. 

When the lease ends, could the Sisters of Charity take back control of the site?

As with all such agreements, when the 299-year lease ends the land and any remaining building will revert to the freeholder.

However, that won’t roll around until 2321 and health officials say that is far in excess of the useful life of this hospital.

Why is the co-location of a maternity hospital with a regular hospital deemed preferable to a stand-alone maternity hospital?

In Ireland, there’s a long-term plan to co-locate all stand-alone maternity hospitals with adult hospitals.

A Department of Health spokesperson said the NMH is the first priority because the current facility on Holles Street, Dublin, is “simply inadequate in every respect”.

Women giving birth sometimes need emergency care and co-location helps facilitate this.

The spokesperson noted that every year, several hundred pregnant women are transferred to St Vincent’s Hospital for treatment that is not available at Holles Street.  

Up to 10 critically ill women are also transferred to receive intensive care that’s not available at Holles Street, on an annual basis.  

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