The plan to relocate the National Maternity Hospital at Holles Street in Dublin to the St Vincent's Hospital campus was announced in May 2013.
I attended the official launch of the project at the time by then Minister for Health Dr James Reilly.
There have been three more holders of the office since, including the incumbent, Stephen Donnelly. But no new hospital.
In 2013, the cost of the project was put at about €150m, with building due to begin in 2016 and the new facility to open in 2018.
But it never happened and, even now in May 2022, there is debate about whether it should proceed, due to some concerns expressed about the nature of guarantees in the legal agreements over the provision of certain health services.
This week, Cabinet put on hold signing-off on the project, for around two weeks, to allow people time to examine the legal documents relating to the project and for political debate in the Dáil and by the Health Committee.
The need for the new facility has been well documented and no one disputes that fact. Holles Street is the busiest maternity hospital in the country.
"Some patients are being cared for in cramped conditions, 14 in wards and sometimes bleeding patients walk across shared wards"
The current Master of Holles Street, Professor Shane Higgins, said this week that the new facility will continue to provide all the services offered in the current hospital. This was backed up by the Director of Nursing, Mary Brosnan.
The former Master of the hospital, Dr Rhona Mahony, reminded people about some of the physical conditions at the National Maternity Hospital. She told of how some patients are being cared for in cramped conditions, 14 in wards and sometimes bleeding patients walk across shared wards. The new facility will have single en suite rooms.
After the original Government plan for the new hospital was announced in 2013, there followed controversy about governance and clinical independence at the new facility on the St Vincent’s Healthcare Group campus - and the role of the Religious Sisters of Charity there.
Some argued that due to the Catholic ethos, certain medical procedures, like termination of pregnancy and tubal ligation, would not be permitted.
Former Labour Court chairman, Kieran Mulvey was brought in to help secure an agreement and this resulted in the 2016 Mulvey Agreement, which said that the new National Maternity Hospital would have full clinical, operational and financial independence in the provision of maternity, gynaecological and neonatal services, without religious, ethnic or other distinction.
It proposed that a new company would be set up to which St Vincent's and the NMH would be parties to operate the new hospital.
Religious Sisters of Charity
A week ago, the Religious Sisters of Charity announced they were exiting healthcare and were transferring their shares in the St Vincent’s Healthcare Group (SVHG), to a new charity called St Vincent’s Holdings CLG (SVHCLG).
The Religious Sisters of Charity had sought approval from the Vatican to transfer their shareholding in the SVHG to the new charitable company.
The SVHG says that: "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."
The St Vincent’s Healthcare Group says it is a secular organisation and that there is no vehicle in the constitutions of SVHG or SVH CLG by which any religious authority or control can be exerted.
The new special purpose company, which will be set up to run the new hospital, will be the National Maternity Hospital at Elm Park DAC. It will be part of the St Vincent’s Healthcare Group.
The HSE Board agreed the new deal for the hospital recently, but not unanimously. All this paved the way for the Minister for Health, Stephen Donnelly, to go to Cabinet on Tuesday seeking Government approval for the deal.
A press conference at the Department of Health that evening was expected to hear the project had been given the green light, but instead a decision was paused.
It was instead decided that the key legal documents around the deal be published, so that they could be examined by politicians and the public.
Minister Donnelly is expected to attend the Oireachtas Health Committee next week to discuss the issue and it will be debated in the Dail too.
The Taoiseach has said that it is time to end the delays and proceed with the project.
The Minister for Environment, Climate Change and Communications, Eamon Ryan, described the situation in the current National Maternity Hospital as intolerable and said a new facility is needed. He said at this stage, it would not be completed until 2030.
Minister Ryan said that in his view, the legal structure for the new facility shows there will not be any religious interference there.
There has been no suggestion that the Government wants to re-open the proposed agreement.
Some have called for the land on which the hospital is due to be built to be the subject of a Compulsory Purchase Order (CPO), but this is not planned. The view is that the cost of a CPO could be very high and result potentially in lengthy court proceedings.
I asked Minister Donnelly about the CPO option yesterday and he said going with a CPO would break the co-operative approach to the project.
He also said the advice is it might not be successful as the Government would have to prove it must have the land. But it is already being given the land under the plan.
"The constitution of the hospital says it will provide all clinically appropriate and legally permissible healthcare services"
While St Vincent’s said some years ago it was gifting the site to the State, it’s not quite that simple.
The legal documents around the project were published last week by the HSE.
They include the constitution of the new hospital, the operating licence, the 299-year lease, a process for dealing with any default by either party and the arrangements for finalising and adopting all of the documents.
The constitution of the hospital says it will provide all clinically appropriate and legally permissible healthcare services.
It also says this will include the provision of medical, surgical, nursing, midwifery and other health services, without religious ethos, or ethnic or other distinctions.
So what’s the problem?
Dr Peter Boylan, former Master of Holles Street, has raised concern about what all clinically appropriate care means. He also says the new charity, St Vincent’s Holdings CLG, is a successor organisation to the Religious Sisters of Charity and is a Catholic organisation.
Dr Rhona Mahony has insisted that the words "all clinically appropriate" care are included in the constitution of the new hospital to make clear it will not be doing, for example, brain or heart surgery and that it is not a limiting provision that might prevent termination of pregnancy or other procedures.
She has insisted that the new hospital will have clinical, operational and financial independence.
Of course, the problem for the public is that they see two former Masters of Hollles Street taking totally different interpretations.
Dr Boylan says the €10-a-year lease depends on everything being done according to St Vincent’s requirements, including no change of use for the facility.
On RTE's Primetime on Thursday, he said there was some degree of progress with news that the National Maternity Hospital was willing to include a list in the documents of all of the specific procedures, like Termination of Pregnancy and sterilisation for family planning purposes.
Much has been made of the fact that the land on which the State’s €1bn new facility will not be owned by the State. Instead, it gets the land at €850,000 a year lease (and five yearly rent review), or €10-a-year, once certain conditions are met - principally that the State does not buy out the freehold of the land.
As I understand it, the reason St Vincent’s will not sell or give over the land is for operational reasons around the campus.
The concern is that if it sold the land on its campus, it would have no power over the land and what could be done on the site, including physical developments that might affect or disrupt the other parts of the campus, like the main St Vincent’s public hospital.
The process and documents for the planned new structure are very complex and this fact does not help with the easy assimilation of how it will all work. Indeed, it may also feed into some of the confusion, scepticism and difficulty bringing everyone on board.
In the end, everyone agrees that a new national maternity hospital, that can physically deliver 21st Century care, for women, babies and others, is badly needed.
The history of the Irish health service is that so many major public hospital developments get delayed, run over budget and often get mired in bitter controversy.
The new National Maternity Hospital happens to be another example of this. The biggest question is, when will the new facility be delivered?