The former Master of the National Maternity Hospital has told the Oireachtas Health Committee that "it is not credible" that values upheld by the Sisters of Charity are compatible with services such as elective abortion.

"Concern about Catholic ethos is too acute to proceed unless and until there is full scrutiny of all correspondence between Ireland and Rome," Dr Peter Boylan said.

The land should be owned by the State and the Government should directly ask why the land is not being gifted - and whether this is a result from an order from the Vatican, Dr Boylan said.

He described the phrase 'clinically appropriate' as "a major red flag" and said "providing healthcare on the basis of this test removes autonomy from women and gives the sole decision-making capacity to doctors".

"These words qualify access to services and enshrine justification for refusing legally permissible treatments," he said.

Dr Boylan cited a letter from Minister for Health Stephen Donnelly in response to a parliamentary question, which said that St Vincent's Hospital does sterilisations when they are "clinically required", but "not for the exclusive purpose of sterilisation".

Dr Boylan said it is important to clarify whether terminations that have been carried out in St Vincent's Hospital have taken place under a 2018 law or under older legislation for terminations when a patient’s life was at risk.

Dr Peter Boylan (File image)

Dr Boylan said he thought "the golden share is more of a liability than an asset" as there is no "there is no security against a future conservative Minister for Health from appointing three conservative State directors".

"This is not independence," he added.

Dr Boylan said he was "reliably informed" that the HSE believes the cost "is rising by more than €10m every month".

He warned that there is a risk in locating the hospital in south Dublin as indications are of higher birth numbers in north and west Dublin and surrounding counties, adding that the current proposals "are flawed and in view of deep public and political disquiet, more time is needed to get this project right".

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Dr Boylan said St Vincent's Hospital Group should gift or sell the land to the State.

He said if this does not happen, it should be asked "why they will not honour their commitment to gift to the people of Ireland?".

Fine Gael Senator Martin Conway said: "You cannot buy something that's not for sale".

"I think it's time we stood up for ourselves as a people, faced down the church and said we need that land," Dr Boylan said.

'Clinically independent, publicly funded, and self-governed'

The master of the National Maternity Hospital at Holles Street, Shane Higgins, has said that the 299-year lease for the proposed new facility conveys effective ownership.

He told the Oireachtas Health Committee fears that St Vincent's will have control over the ethos or operations of the new National Maternity Hospital are misplaced.

Dr Higgins said leasehold is an ownership form used across both the city and country for campus developments where there is mixed use or ownership.

Dr Higgins listed college campuses, IDA parks, Dublin Airport, the Central Bank at Dublin Landings, Capital Dock, and Connolly Quarter as examples

He said that the current maternity hospital had no constraints on its procedures and that would continue when it relocates to Elm Park.

"The hospital will remain a clinically independent, publicly funded, self-governed organisation with a board composed of nine directors with a fiduciary duty to the NMH and a shareholder split, with the most important share – the Golden Share - belonging to the Minister for Health of the day," Dr Higgins said.

On concerns around the use of the phrase "clinically appropriate", he said the wording serves as future-proofing, to ensure that the new hospital cannot be converted into any other type of hospital in the future.

"It would be a sad day if the unambiguously supportive views of 52 senior NMH clinicians in a letter to the Taoiseach last February were to be drowned out in the public debate by relentless claims that services offered at the new hospital will be curtailed by religious ethos," he added.

Dr Higgins has said he has no issue with the removal or definition of the phrase "clinically appropriate".

He said it would require the agreement of the three stakeholders.

Dr Higgins said any definition would have to be "a non-exhaustive list of clinically appropriate procedures offered in the timeliest of fashions".

Solicitor concerned with 'clinically appropriate' wording

Solicitor Simon McGarr told the committee that ambiguity has been caused by the phrase "clinically appropriate".

He said the State should remove the phrase from the deal.

"If it is not removed, it should be defined by way of a list of controversial procedures which are presented as being 'including, but not limited to'," he said, adding it would allow for "the evolution of medical technology".

Simon McGarr said the term 'clinically appropriate' goes to core of how the hospital will operate

Mr McGarr said that the minister's golden share "has been placed too far down in the stacked hierarchy of rights and obligations".

He added that the term "clinically appropriate" is placed "so highly" in the hierarchy of the principle object of the company that it is the "fulcrum upon which the entire set of agreements rests".

"It goes to the very core" of "how the hospital will operate in the future", he said. He cautioned that that could proceed "in a very different way" to how the State envisages it.

Green Party TD in 'difficult position'

Meanwhile, a Government TD has said that it would be "very difficult" for her to remain part of the Coalition if the Cabinet proceeds to agree to the new hospital next week.

Green Party TD Neasa Hourigan said that she wished to see the phrase "clinically appropriate" changed.

She told the RTÉ News Your Politics podcast that she hoped the Cabinet would move its position as there were "valid concerns" that were "easily addressed".

When asked if she might move to the independent benches if the Government proceeds to agree to the plan, she said: "It is very hard for me I am a repealer, that is why I got into politics.

"I'm not really sure where I go from there. It puts me in a very difficult position."

Maternity hospital CPO bid 'may collapse project'

The Minister for Health has said that an attempt to force a purchase of the site for the new hospital could collapse the project.

Speaking during Dáil statements on the new hospital, Mr Donnelly said a Compulsory Purchase Order might also be refused by the courts given the existing lease of 300 years.

He said a CPO could take many years due to the complexities involved as the site was in the middle of a larger healthcare campus.

The minister said future clinical care could become higher risk as separate owners of land would need to participate in agreements on services.

He also said there would be higher costs due to legal fees and the purchase price, as well as increase construction costs due to delays.

"I don't believe it's reasonable to put a project like this at risk, to potentially delay it for many many years or derail it entirely in order to move from leasehold to freehold," Mr Donnelly said.

National Maternity Hospital model

Govt decided against CPO - Tánaiste

Earlier, the Tánaiste told the Dáil that the Government did consider buying the site for the new National Maternity Hospital at the St Vincent's campus through a CPO but decided against it.

Leo Varadkar said if a CPO was used there would be "definitely higher costs, definitely further delays and it might fail".

He said when the Government applies for a CPO it has to show there was not an alternative site. He added if the State did CPO the site, it would lose the co-operation of St Vincent's.

St Vincent's was "very clear with us they do not want to sell this site" as it was in the middle of the hospital's existing campus, he added.

Mr Varadkar was responding to Labour leader Ivana Bacik, who said the "optimal" approach was to acquire the site freehold.

She added that successive ministers for health had called for the site to be gifted to the State. The State had a history of using CPOs and it was a "realistic option", she said.

Ms Bacik added: "It is time we stood up to the religious orders on this."

Key questions about the new National Maternity Hospital

The Taoiseach said that he has not seen a clear explanation as to how a leasehold of "300 years" impacts the independence of the hospital.

Micheál Martin, who was attending a meeting of Oireachtas Committee Chairs, said that the issue has been ongoing for years.

Chair of the Oireachtas Committee on Health Seán Crowe said politicians had not been given sufficient time to examine the deal.

However, Mr Martin said that the issue "has been exhausted". He said that the Cabinet decided to publish documents related to the deal last Tuesday week.

The only objective of Government was to "provide 21st century care".