Summary:
- The Sisters of Charity have not yet completed their full divestment from St. Vincent’s Healthcare Group – they remain as sole owners of SVHG, with religious ethos intact.
- No religious control in day-to-day running of new National Maternity Hospital – clinical independence has been assured, but legal process to deliver this not yet completed.
- Archbishop of Dublin still technically remains as ex-officio Chair of the Executive Committee (Board) of the National Maternity Hospital.
- New National Maternity Hospital at Elm Park will not be in public ownership or control – the land will still be owned by SVHG and leased to State at peppercorn rent.
- SVHG will own the hospital building, but with a lien on it so it can’t be sold or secure loans, the building will be fully publicly funded and its operation funded by the State.
- Despite agreement reached in spring 2017, still no sight of completed governance structure in public domain.
The debacle over ownership, control and ethos at the new National Maternity Hospital has the key ingredients classic Irish pickle: Land, public money, church, and women’s healthcare. Let’s try and unpick the key governance, control and ethos issues which have hindered the progress of this key healthcare infrastructure.
Despite assurances from all parties involved, the public still aren’t 100% clear about religious influence and control at the hospital and its layered governance structures.
Will the new National Maternity Hospital be publicly owned and controlled, and will religious control or influence be involved? It’s a complex issue, requiring an indepth look into the governance structures of two long-standing healthcare providers – the National Maternity Hospital, and St. Vincent’s Healthcare Group (both private companies). The third party in this pickle is the Department of Health.
Everyone agrees a new National Maternity Hospital is long overdue – the current facilities at Holles Street are not fit for purpose for 21st century healthcare delivery. Like most hospital building projects in this country, it has a long and complicated history, and the longer it goes on it more it costs the taxpayer.
First announced in 2013 with an indicative budget of €150m, five years later the budget had doubled to €300m of public money and likely to be significantly more before it’s finally operational.
It’s been agreed that the new hospital will be built on the St Vincent’s Hospital campus at Elm Park. That’s on land owned and provided by the St Vincent’s Healthcare Group. SVHG was incorporated in 2001, and currently operates under updated constitution under the 2014 Companies Act as a private company (DAC) limited by shares with charitable status. Its sole shareholder are the Religious Sisters of Charity, who appoint the board, (which currently has 10 directors – 9 men and 1 woman).
In their Constitution (Memorandum and Articles), the Purpose of the company states : ‘the continuance and furtherance of the ethos, aims and purposes of the Congregation of the Religious Sisters of Charity.’ Under its Objects, Object 2 states: ‘to conduct and maintain facilities in accordance with the Health Care Philosophy and the Ethical Code of the Religious Sisters of Charity.’
Now the Sisters have stated that this will change and this Purpose and Object will be removed when a new holding company is formed, which I’ll come back to later.
Some historical context of the governance of hospitals and healthcare is useful to understanding how we got here:
St. Vincent’s was originally founded in 1834 by the Sisters of Charity. A century later in 1934 it purchased land at Elm Park for £25,000. It now has two hospitals on that site – the public St. Vincent’s University Hospital, and St. Vincent’s Private.
The National Maternity Hospital was established in 1894, and in 1903 received its Corporation Charter from the Crown. In 1936 the Charter was amended when the National Maternity Hospital was rebuilt with public money. It’s this 1936 Charter that the NMH still operates under for the purpose of its corporate governance, 4 years after the Irish Eucharistic Congress, and just months before the newly minted Constitution came into effect – a time where the Catholic Church was flexing its muscles in the fledgling Irish State, with increasing control and influence on healthcare, education and social care in general, and specifically the chilling implication for women’s rights.
The New 1936 Charter provided for up to 100 governors of the NMH, who would establish an Executive Committee or Board to manage its affairs. The Governors elect the ordinary members of the Board at each AGM and the Master once every 7 years.
Governance is devolved to the Board – they effectively run the hospital, with management further devolved to the Master. Unusually for the time, the charter also made specific provision for there to be a minimum quota of women on the board.
There are a number of governors who are ex-officio – by virtue of their position – and there are also a number of places on the Board that are ex-officio. These 4 positions are: The Archbishop of Dublin (who also is automatically appointed Chair); The Lord Mayor of Dublin (Vice Chair); The Master; and the parish priest of Westland Row. Alongside these ex-officio positions, there are 2 nominations of Dublin Corporation (DCC); 2 nominations of the Minister for Health, and 21 ordinary members who bring clinical and medical as well as legal, business and other technical skills to the board. There are currently about 79 governors (members) and 28 on the Board.
In 1930’s Ireland the Catholic church was most definitely seeking to stamp its authority and influence on the governance of the NMH. Nowadays, the Archbishop doesn’t exercise his right to chair, and isn’t involved in the board, but is still kept informed of significant developments. The effective chair of the board is the Deputy Chair who is elected at the first board meeting after each AGM.
So neither the current National Maternity Hospital Holles Street nor St Vincent’s are in public ownership, though both receive the majority of their operational funding from the public purse, and operate under licence from the HSE.
Apart from the usual building delays with projects of this cost and complexity, it’s the wrangling over a new governance structure for the new hospital at Elm Park site, between these two healthcare organisations and the Dept that has hampered its progression.
Negotiations reached an impasse in 2016, as the NMH wanted to retain a separate board and its mastership model; and St Vincent’s wanted all the hospitals on the campus to be run by one board with the NMH having 2 seats on that board.
Kieran Mulvey helped the two parties reach an agreement in April 2017. The new NMH at Elm Park would be run by a new company, which would be a 100% subsidiary of SVHG – so still in private control – and ultimately owned by the Sisters of Charity as sole shareholders.
The new company – The National Maternity Hospital at Elm Park DAC has yet to be fully constituted. However, under the Mulvey agreement, this will the structure:
- The company will retain the identity and ethos of the current NMH, with clinical, operational, financial and budgetary independence, without religious, ethnic or other distinction.
- Its independence is assured under its reserved powers, with a ‘golden share’ held by the Minister of Health.
- There will be 9 directors: 4 appointees of SVHG; 4 appointees of the NMH including the Master, and one international expert in obstetrics and gynaecology.
- 2 of the NMH directors will also sit on the SVHG board.
In August 2017, planning permission was granted by An Bord Pleanála.
So at that stage, it could be summed up as proposed clinical independence for the NMH, with no religious influence day-to-day; BUT ultimately the company would still be in private ownership of a religious order. Which led to huge protests that the government were essentially handing over €300m of public money and our new National Maternity Hospital into the nuns’ hands – generating understandable unease about access to healthcare which is at odds with Church doctrine including abortion care, sterilisation, and access to IVF.
The Sisters of Charity responded by committing to end their involvement in St Vincent’s Healthcare Group and no longer being involved in the ownership or management of the new National Maternity Hospital. They stepped down from the board of SVHG, and stated they would form a new holding company with charitable status – St Vincent’s Holding CLG – that would ultimately own SVHG and its assets. Crucially they also stated that their ethos would no longer form a part of the new company’s purpose or objects, and that the clinical independence of the NMH would be enshrined in its Memorandum and Articles:
“Upon completion of this proposed transaction, the requirement set out in the SVHG Constitution, to conduct and maintain the SVHG facilities in accordance with The Religious Sisters of Charity Health Service Philosophy and Ethical Code, will be amended and replaced to reflect compliance with national and international best practice guidelines on medical ethics and the laws of the Republic of Ireland.”
All well and good indicating there will be no religious control or influence in either SVHG or the NMH. Except it hasn’t happened…yet. The public haven’t had sight of the new constitution of the holding group, or the constitution of the new NMH. It took 18 months for the legal document giving effect to the Mulvey deal to be circulated to the parties, and now the Minister of Health is seeking an additional Public Interest Director be appointed to the new NMH board, which would bring the number of board members to 10.
And the land? Well, the site apparently can’t be ceded or sold to the government as SVHG has loans secured with it, so it looks like the Minister is now seeking a 99 year lease on the site at a peppercorn rent. The building itself will have a lien on it so it can’t be sold or used to secure loans by SVHG.
And the urgency now? Well, if contracts allowing the commencement of key building work at the site are not signed by the Department of Health by December 31st, the entire project is in jeopardy, as new EU regulations come into effect on Jan 1st 2019, requiring zero energy standards for publicly-run facilities. If the project is delayed, plans will have to be redrawn, the costs will certainly rise considerably.
If the Sisters of Charity deliver on their commitment, I think it’s highly unlikely that there will be religious control or influence in the day-to-day running of the NMH, or effecting the experience of the people using its services. We need to see a timeline for when these changes will come into effect.
However, the New National Maternity Hospital will still not be in public ownership or control, and without change to its Charter or Constitution, the Archbishop of Dublin and the Parish Priest of Westland Row will remain as Governors whether they choose to be actively involved or not. It’s not only the governance at SVHG that needs to be altered, but also at the NMH.
Church and State are still intimately interwoven in our healthcare system, and this debacle only demonstrates the deep complexities of untangling the two.
We’re not looking for a Christmas miracle, just for the respective organisations and the department to get the legal details and governance structures finally and fully resolved. They’ve had years to work on this, we can’t lose our new national maternity hospital over it. #OurMoneyOurHospital
Sign the petition here: https://my.uplift.ie/petitions/make-the-national-maternity-hospital-ours
Listen to Social Democrats co-leader Roisin Shorthall on NMH ownership on Sean O’Rourke