Flawed agreement on National Maternity Hospital threatens independent ethos

April 27, 2017

The resignation of Dr Peter Boylan from the National Maternity Hospital board highlights serious flaws in the agreement reached over the hospital, Social Democrats co-leader Róisín Shortall said today.

Deputy Shortall said legitimate concerns about the deal between St Vincent’s Hospital Group and the National Maternity Hospital have still not been properly addressed.

“I remain concerned by many aspects of the deal when it comes to the ownership and governance of the new hospital. When you delve into the details of the terms of this agreement, the repeated reassurances we have heard about clinical independence ring hollow.”

Deputy Shortall’s concerns and questions on specific details of the published agreement document are set out below.

  1. Ownership – Why hand over a €300million hospital to a private entity?

The agreement says: “5.0: The SVHG will be the sole owner of the DAC (limited by shares), subject to the following: The Minister for Health will hold a “Golden Share”; with powers that protect the “Reserved Powers”; (Section 2.3), Constitution (Section 2.1) and Board Composition (Section 4.1). The State will require a “lien”; on the Hospital in accordance with whatever funding agreements are in place by the State for such capital projects.

Deputy Shortall says: “The new company running the hospital will be owned outright by St Vincent’s Hospital Group. We have still not been given any reason for the government’s decision to gift a publicly funded €300million asset to a religious order. How can this be justified?”

  1. The Board – Dominated by the Religious Sisters of Charity

The agreement says: “4.1 There shall be Nine (9) Directors of the ”National Maternity Hospital at Elm Park DAC (limited by shares)”, one of whom shall be the nominated Chair.

–       Four (4) Directors nominated by SVHG

–       Four (4) Directors nominated by the NMH Chartered Trust, two of whom shall sit on the SVHG Board (Section 6.2).

The Master shall be one of the Directors nominated to the Board of the NMH at Elm Park DAC.

One Director* shall be an independent international expert in Obstetrics and Gynaecology.

*The independent international expert in Obstetrics and Gynaecology will be chosen from a list of candidates drawn up by SVHG and the NMH Trust. They will be assessed by a Selection Committee, chaired by the SVHG Clinical Director, and the other members will include the SVHG CEO and a representative from the NMH Trust.

Any proposed nominee will be appointed by the Selection Committee after consultation with the SVHG Nominations Committee, and the NMH Directors on the Board of NMH at Elm Park DAC (limited by shares).”

Deputy Shortall says: “Four members of the 9-member board will be nominees of the St Vincent’s Hospital Group. The ninth member – the independent international expert – will be chosen by a Selection Committee weighted two to one in favour of the St Vincent’s Hospital Group. This means that the Sisters of Charity will have control over the appointment of 5 members to the 9-member board. How can this be called an independent board?”

  1. Clinical Governance – Is this what independence looks like?

The agreement says: “6.3 Clinical Governance Structure:

Deputy Shortall says: “This diagram clearly shows the Master of the new hospital reporting into a clinical governance structure dominated by St Vincent’s Hospital Group, and ultimately to the board of the St Vincent’s Hospital Group. Is this what clinical independence looks like?”

  1. Clinical independence and best practice – What about future laws for terminations?

The agreement says: “The following are the agreed “Reserved Powers” of The National Maternity Hospital at Elm Park DAC (limited by shares) in furtherance of the Principal I Subsidiary Objectives of The National Maternity Hospital at Elm Park DAC (limited by shares). These “Powers” to be exercised in an undiluted manner by all of the Directors of The National Maternity Hospital at Elm Park DAC (limited by shares) and in a manner that is designed to preserve the autonomy of The National Maternity Hospital at Elm Park DAC (limited by shares) in specific clinical and operational matters.

  1. a) Clinical and operational independence in the provision of maternity, gynaecology, obstetrics and neonatal services (without religious, ethnic or other distinction) in the hospital at Elm Park, Dublin and the provision of medical, surgical, nursing, midwifery and other health services at Elm Park, Dublin, including strategic planning in relation to the development of such services in the future in accordance with developing best practice.”

Deputy Shortall says: “What happens if best practice in the delivery of services is not compatible with the Catholic ethos? And why is there no power to ensure that future services will be available in accordance with future laws governing termination of pregnancy or assisted human reproduction?”

  1. Principal objectives of new hospital company – Why is religion of patients relevant?

The agreement says: “2.1 ‘Principal Objectives’…. b) to provide a range of health services in the community as heretofore, such operation and provision to be conducted in accordance with the newly agreed clinical governance arrangements for the National Maternity Hospital at Elm Park, (as set out in the diagram and as elaborated in Section 6 entitled “Corporate/Clinical Governance”) by providing as far as possible, by whatever manners or means from time to time available, for the health, happiness and welfare of those accepted as patients, without religious or ethnic or other distinction and by supporting the work of all involved in the delivery of care to such patients and their families or guardians, including research or investigation which may further such work.”

Deputy Shortall says: “The health services provided by the new hospital “as heretofore” are to be conducted in accordance with clinical governance arrangements which are in themselves problematic. The agreement says these services will be provided to patients regardless of the religious or ethnic or other distinction. This clause relates to the religious background of the patients, not the services they receive. Why does the agreement include such an objective when our equal status laws already protect minorities and others when it comes to receiving services?”

Read the Terms of the Agreement between the National Maternity Hospital (Holles St) and St Vincent’s Hospital Group here.