Dáil Éireann

DÁIL ÉIREANN

AN COMHCHOISTE UM SHLÁINTE

JOINT COMMITTEE ON HEALTH

Dé Céadaoin, 14 Iúil 2021

Wednesday, 14 July 2021

Tháinig an Comhchoiste le chéile ag 9.30 a.m.

The Joint Committee met at 9.30 a.m.

Comhaltaí a bhí i láthair / Members present:

Teachtaí Dála / Deputies Seanadóirí / Senators Colm Burke, Lorraine Clifford-Lee, Cathal Crowe, Martin Conway, David Cullinane, Alice-Mary Higgins,* Stephen Donnelly (Minister for Health), Annie Hoey, Bernard J. Durkan, Seán Kyne. Neasa Hourigan, John Lahart, Róisín Shortall, Bríd Smith,*

* In éagmais / In the absence of Deputy Gino Kenny and Senator Frances Black.

Teachta / Deputy Seán Crowe sa Chathaoir / in the Chair.

1 JH New National Maternity Hospital: Discussion

Chairman: I welcome Deputy Bríd Smith, who is substituting for Deputy Gino Kenny, and Senator Higgins, who is substituting for Senator Black. I welcome the witnesses from the Department of Health, who will provide an update on the new national maternity hospital. In light of recent developments, the Department has accommodated the request of the committee to also discuss certain aspects of the public health measures relating to indoor dining, but the main focus of the meeting is the new national maternity hospital. I welcome the Minister for Health, Deputy Donnelly; from the Department of Health, Ms Tracey Conroy, assistant secretary, acute hospital policy division; Mr. Fergal Goodman, assistant secretary, health protection division; and Mr. Paul Ivory, assistant principal officer, acute hospital policy division; and from HBS Estates, Mr. Paul de Freine, chief architectural adviser.

Before we hear opening statements, I point out to our witnesses that there is uncertainty par- liamentary privilege will apply to evidence that is given from a location outside the parliamen- tary precincts of Leinster House. Therefore, if they are directed by me to cease giving evidence on a particular matter, they must respect that direction.

I call on the Minister for Health, Deputy Donnelly, to make his opening statement. He has five minutes.

Minister for Health. (Deputy Stephen Donnelly): I thank the Chair and members of the committee for inviting me today to discuss the new national maternity hospital. I welcome the opportunity to discuss what we all agree is a critical and nationally important project for women’s healthcare. It is fair to say that every member of the committee shares the same goal, that is, delivery of the best possible healthcare for women and for babies. The Government has set out its position in that regard by committing to improving women’s healthcare right across the board. As I have said previously, we need a revolution in women’s healthcare.

This year we are providing a very significant investment in services, and pushing a renewed focus on maternity care with a real focus on the national maternity strategy. The funding allocated in the budget for this year includes more than €7 million, specifically for the implementa- tion of the national maternity hospital. It is the single biggest investment in the strategy since its publication in 2016. To put it into context, the investment allocated for this year is five times greater than previous annual investment. We are taking this very seriously and we are looking for real progress.

Improving women’s healthcare is a priority for me, for Government and I am sure for the committee as well. The additional funding allows us to hire more staff. It facilitates further development of community midwifery and specialist services, which are so important. Some of the positive initiatives happening across the system right now include: an expansion of the endometriosis centre at Tallaght University Hospital; the expansion of existing and the setting up of new “see and treat” gynaecology clinics; the setting up of two new regional fertility hubs; funding to hire 24 additional lactation consultants; and funding for a GP clinical lead for women’s health.

It is, unfortunately, an inescapable fact that many of our maternity hospitals are housed in antiquated buildings that are no longer fit for purpose. This is unfair on women, babies and on our phenomenal and very hardworking staff. I worry sometimes that these facts can get lost in the debate around the new national maternity hospital.

2 14 JULY 2021 In a letter that was published in The Irish Times recently, a group of 42 senior clinicians expressed concern that misinformation and misunderstanding could delay what they described as a vital project to create a world-class maternity hospital for women and babies in Ireland. Professor Mary Higgins, a well-known consultant gynaecologist and obstetrician who works at the National Maternity Hospital and campaigned in favour of the repeal of the eighth amendment, wrote recently about just how badly we need this hospital. She said that, “We say on a near daily basis what a difference this will make to the people we care for.” She added that it is a “fantastic project.” It is important for all of us, as we endeavour to get the best possible result, that we do not lose sight of just how important it is for women and for babies that we get this hospital built, and what a difference it is going to make.

That said, as I have stated publicly, my preference is for the State to own the land on which the new national maternity hospital will be built. The State’s fundamental objectives are first to provide a world-class facility and to ensure all clinically appropriate services that are legally permissible are provided for the women who need them. We must also protect the State’s investment.

The proposed corporate and clinical governance arrangements for the national maternity hospital at Elm Park were set out, as the committee will be very aware, in the Mulvey agreement. This was finalised following a very extensive mediation process between the National Maternity Hospital and the St. Vincent’s Healthcare Group, and it was brought to Government in 2017. Following on from the Mulvey agreement, a draft legal framework has been developed which aims to copper-fasten these arrangements and work is ongoing in relation to this. I have been very clear that I will not be bringing any proposal to Government unless it provides assurances around all legally permissible services being provided in the new national maternity hospital, as well as affirming that the State’s investment is safeguarded.

There has been further engagement with stakeholders in the national maternity hospital project, as we move toward finalising the various arrangements, including the legal arrangements that will underpin it all. I want to reiterate that this Government remains fully committed to the development of maternity and women’s health services in Ireland. The relocation of the National Maternity Hospital is a very significant part of this work. We remain committed to providing the highest quality infrastructure and environment to facilitate the delivery of modern, safe, quality maternity services for women and infants for many years to come.

Chairman: Deputy Durkan has the first question. He has ten minutes.

Deputy Bernard J. Durkan: I welcome the Minister, Deputy Donnelly, to the meeting on this very important subject. I have a number of questions. Is the Minister satisfied that the Mulvey agreement encompasses and resolves all the concerns that were raised in relation to the independence of the new national maternity hospital? I have huge respect for Mr. Mulvey’s conclusions. Normally he is not a man to leave something undone, or something hanging to be dealt with at a later stage.

Deputy Stephen Donnelly: I thank the Deputy for the question. My understanding is that a huge amount of work was done over a significant period of time in that mediation, which was chaired by Mr. Mulvey. The agreement that was reached worked for the National Maternity Hospital and St. Vincent’s Healthcare Group. The question we are all asking is whether it works for the State. At this point it is fair to say that I have not brought any formal proposal to Cabinet. Indeed, the HSE’s board is reviewing in great detail the legal agreements underpin- ning the Mulvey agreement. My Department is doing exactly the same. There is ongoing en- 3 JH gagement with the various stakeholders and, as I said previously, I would like to see movement on the site and on the public interest side of this in terms of safeguarding the State’s investment and on the governance side. When we have a-----

Deputy Bernard J. Durkan: Did Mr. Mulvey not deal with that? Did he not deal with those issues in great detail and to his satisfaction and that of the State? What has changed in the interim?

Deputy Stephen Donnelly: I am not sure what has changed. The Mulvey agreement was put in place. It is being reviewed by the Department, the board of the HSE and this Govern- ment. It is an ongoing process. The broad outline, and much of the detail in the Mulvey agreement, is fit for purpose and will serve very well, but it is an ongoing process as to the final-----

Deputy Bernard J. Durkan: I disagree with that. This process has to come to an end at some stage. We have to address all the issues and determine when, and if, it is possible to proceed. There is not much sense having the Mulvey agreement, in having gone through a procedure and in having done so in great detail and after long and arduous debates and examination. There is not much sense having that if we are going to say we are going to review that now and somebody else will review the review. This could go on forever. I was a member of the Joint Committee on the Eighth Amendment of the Constitution and the urgent need for a modern national maternity service in Ireland, capable of standing up internationally, was brought home to us in a very forceful manner. Can we come to a decision whereby the project can proceed to the satisfaction of all concerned? In other words, the State has to be assured, which I understand the Mulvey agreement provided for, that the hospital will be fully independent, that any State investment going into it will be fully independent and that procedures carried out in it will be at the behest of the State and nobody else. However, since then, the “what if” has started. I am concerned that we may find that in two or three years down the road, we will have a different location. Medical politics will take over and we will then have a third or fourth location. I will cut to the chase by asking do we abandon this site or proceed with it? That is the issue.

Deputy Stephen Donnelly: I thank the Deputy. The Mulvey agreement set out the principles but it did not include, for example, the legal documentation. After the Mulvey agreement set out the principles, there were years of detailed work to enshrine it in legal work. It is not that we are going back to pull apart the Mulvey agreement. The cornerstone of what we all want to achieve is to build as quickly as possible a wonderful new maternity hospital with full clinical and operational independence. That is enshrined in the Mulvey agreement. We are now ensuring that the details in the final agreements on governance and so forth fully reflect that and give us all the guarantees we want.

I share the Deputy’s concerns about considering moving to another site. It is not that anyone is expressly taking any options off the table but moving to another site would add several years to the project. The only question would be how many years it would add. It would potentially also add significant cost to the project, money that should be spent on providing maternity services. I would be concerned about such a move and would agree with the Deputy in that regard.

Deputy Bernard J. Durkan: The obvious thing is to determine the status of independence of the maternity services and the State’s right to govern in respect of policy and procedures at the maternity hospital and, at the same time, to meet the urgent need to provide those facilities. That is important.

Deputy Stephen Donnelly: I fully agree with the Deputy. The Mulvey agreement was a

4 14 JULY 2021 framework agreement. A vast amount of work has been done since then to find a legal agreement that works. Very reasonable questions have been posed recently. People want to be assured of the clinical and operational independence of the new hospital. We need to listen carefully to those concerns and address them. We must listen to the board of the HSE and the Department’s analysis of where matters stand. If there are additional things we need to do to be fully satisfied, we will pursue them. We are looking at those options now. We are not looking to unpick the framework agreement that was set out and potentially delay the project. We owe it to the women, babies and healthcare staff to move them out of Holles Street as quickly as possible and into a new and modern maternity hospital.

Deputy Bernard J. Durkan: I and others posed questions about the independence of the hospital and the difference in circumstances between now and the time of the Mulvey report. There is an urgent need to proceed because the project is going to take some time anyway. We must get out of the way but we need to know the extent to which the independence of the hospital is going to be guaranteed. We also need to know about the independence of the State and we must acknowledgement the State’s need to provide the services as already laid out and identified. What progress has been made to get those assurances? Have questions been raised and, if so, by whom? What has been the outcome?

Deputy Stephen Donnelly: The questions are being raised in part by members of the committee, Members of the Oireachtas and members of civil society. Those are people who have a legitimate desire to see full clinical and operational independence.

Deputy Bernard J. Durkan: Is that not guaranteed?

Deputy Stephen Donnelly: Concerns were raised by the Tánaiste in the Dáil quite recently.

Deputy Bernard J. Durkan: I am raising concerns here and now.

Deputy Stephen Donnelly: We are still engaging with the stakeholders on all of these issues. I reiterate that there is no formal proposal yet that the Department has brought to me or that I have brought to Cabinet. This is an ongoing process which we want to bring to a satisfac- tory conclusion very quickly.

Deputy Bernard J. Durkan: When does the Minister expect to bring proposals to Cabi- net? Is it deemed to be important to bring them to Cabinet and to eliminate delay as quickly as possible?

Deputy Stephen Donnelly: I wish I could give the Deputy an accurate answer as to when that will happen. Engagement is ongoing. There are legitimate outstanding concerns which need to be resolved. As soon as they are resolved, I would like to discuss the final agreement with my colleagues at Cabinet and in the Oireachtas.

Deputy David Cullinane: I welcome the Minister and wish him good morning. Most of my questions will relate to the national maternity hospital. To date, what has been the overall State spend on the national maternity hospital in totality, including any spend on the site itself? Does the Minister have up-to-date figures?

Deputy Stephen Donnelly: I thank the Deputy for his question. I have those figures. A project board is in place to oversee the development of the capital project. The board is chaired by HSE estates and includes representatives from the national maternity hospital, St. Vincent’s Healthcare Group, the HSE and the relevant national clinical programme in the Department

5 JH of Health. The first phase of the capital aspect of the project includes the construction of a replacement pharmacy and an extension to the multistorey car park at St. Vincent’s University Hospital. I am pleased to say that the replacement pharmacy is now fully operational and the HSE-----

Deputy David Cullinane: With respect, my time is short and I asked about the cost.

Deputy Stephen Donnelly: The cost is €51 million, including VAT. I was trying to share what we are getting for that money.

Deputy David Cullinane: I appreciate that. We have spent €51 million on a hospital in respect of which there is no agreement regarding a lease or the governance structure. How is that the case?

Deputy Stephen Donnelly: These are enabling works. There has been broad agreement for some time that this would be the location. The State has been criticised in the past for being too slow in its major capital projects. It was a decision for the previous Government. My understanding is that the decision made, which seemed sensible, was that where we could do things in parallel to speed up how quickly we could open this hospital, those things would be done.

Deputy David Cullinane: Let us test that for a moment. The Minister is saying that the €51 million was for enabling works. There was agreement within this Government and that which preceded it that this is the best site and we should go ahead with the build. We then spend the money because that is where the hospital is going to be built. How is it then the case that when Deputy Bríd Smith and I put questions to the Tánaiste a number of weeks ago, his response was that he agreed with our concerns and, in fact, said there were real concerns over the ownership of the site. He talked about alternative options, including the State purchasing the land. If the Government was of the view that all of this was settled and that we were going to continue with the project and spend this money, how is it then that the Tánaiste made those statements? Since then, the Taoiseach and former Ministers, including a former Minister for Health, have raised serious concerns over this project and its location.

Deputy Stephen Donnelly: It would be fair to say that those people the Deputy mentioned have not raised serious concerns about the location. I have never heard anything to that effect, although I am open to correction if the Deputy has references to things they have said. Cer- tainly, in my discussions at Cabinet, there have not been any questions as to whether co-location at St. Vincent’s is the right choice. I have always seen broad public and Government support and support in the Oireachtas for that. The concerns I heard the Tánaiste and Taoiseach raise related to the details of the project at Elm Park, including governance and site ownership or leasing details.

Deputy David Cullinane: I will get to at least one former Minister who did raise the pros- pect of an alternative site, but we will stick with the Tánaiste and the Taoiseach for a moment. The Minister is right in saying that they raised concerns about details, but they were talking about the ownership of the site. How is it the case that the St. Vincent’s Healthcare Group issued a statement a couple of days after those interventions by the Tánaiste to say that, from its perspective, that it had what it felt there was an agreement with the Department that the lease option was the way forward. It also indicated that there was no discussion between the St. Vincent’s Healthcare Group and the Department with regard to the purchasing of the site and yet we had the Tánaiste in the Dáil saying that should be one of the options. What is going on?

6 14 JULY 2021 People are asking the question and I am putting it to the Minister. Were there discussions on the ownership of the site with the St. Vincent’s Healthcare Group prior to the Tánaiste saying in the Dáil that should be one of the options?

Deputy Stephen Donnelly: The short answer is “Yes”. The then Minister for Health, Deputy Harris, in a meeting with St. Vincent’s Healthcare Group, raised the point that the State wanted ownership of the site. My understanding is that the then Secretary General, either at the same meeting or subsequently, raised the same issue. That is in the minutes of the meeting. We can-----

Deputy David Cullinane: In more recent times since he came to office, did the current Minister put on the table with the St. Vincent’s Healthcare Group the possibility of the State purchasing the land?

Deputy Stephen Donnelly: I have put that on the table, both publicly and privately.

Deputy David Cullinane: Privately. Was that before or after the Tánaiste’s remarks?

Deputy Stephen Donnelly: It was after the Tánaiste’s remarks.

Deputy David Cullinane: Before the Tánaiste’s remarks, the Minister did not have that discussion with the St. Vincent’s Healthcare Group. It was a response to the pressure that was coming on the Government with regard to dealing with this issue, which is part of the problem. We are now dealing with it at the eleventh hour. I want to get to the remarks made by the previous Minister, Deputy Harris. Dr. Peter Boylan said on RTÉ:

I think the Government are considering a plan B, and let me tell you why ... Last Satur- day, I was out returning from the shops when I bumped into Simon Harris. We discussed the issue of the hospital. He suggested that possibly Tallaght might be an option. That makes me think the Government is considering a plan B.

If the previous Minister for Health was having a discussion with an individual, even though it was private, about the possibility of an alternative site, was that ever given serious consideration by the Government? Is it a serious consideration for the Government?

Deputy Stephen Donnelly: With regard to the second point, all I can say is that the account of the Minister, Deputy Harris, of that conversation is markedly different to the account conveyed on the radio. We are not actively looking at other sites. I do not believe that the Minister, Deputy Harris, told Dr. Boylan that we were, based on the conversations I have had with him. That is a conversation between them and it is what it is. It was a private conversation.

If that is not an option, realistically, the only two options

Deputy David Cullinane:

left are that the State uses a compulsory purchase order, CPO, in respect of the land or that there is an agreement with St. Vincent’s Healthcare Group to transfer the land to the State. It has stated that it is not going to do that, which leaves only one option, namely, a CPO, and that would take time. We are not really getting any clarity. It seems we will go ahead with some sort of lease arrangement, notwithstanding the concerns that people have. That is what concerns me. That is the crunch here. Either we will proceed with a lease arrangement under which the State will not own the land and it will be transferred to a private charitable company or the State will own the land. It is one or the other. It strikes me that where the Department and the Minister are - I will leave the Minister speak for himself - is that is the

7 JH way it will go. I am looking for absolute clarity regarding the Minister’s position on that.

Deputy Stephen Donnelly: I would describe Deputy Cullinane’s characterisation differ- ently. No options have been taken off the table. Let me state that clearly. If, however, we were to pursue a CPO option, there would be significant risks. First, you may not get the CPO. Second, you are adding significant time to the project regardless. Third, this is meant to be a partnership. As such, it needs to be entered into in good faith. Starting off what could be a 50- or 100-year partnership in the courts would not bode well. However, no option has been taken off the table. Similarly, choosing a different site, moving to one of the other locations that we could have has not been taken off the table. Deputy Cullinane referenced one and there are others. In consideration of that, we would all have to accept that we would be adding many years to the project, delaying essential care for many years and adding significant cost.

Deputy David Cullinane: I hear that and I have one question on the easing of restrictions. To be fair, what the Minister is saying is that it is not off the table. However, the caveats he puts on it by saying that it will delay the project by years suggest it really is off the table in practical terms. That is what people will read from what he said. That is my opinion and the Minister has given his.

With regard to the restrictions, it was disconcerting to hear a Minister and a Minister of State yesterday have different opinions on the issuing of certificates for those who are recovering from Covid-19. There is still uncertainty. Can the Minister clarify that? Were there any discussions at all or were there consultations with the Irish Medical Organisation, IMO, on any of this? Where will people get those certificates? The HSE was saying it was not for it. The GPs are saying it is not them. There is still confusion. Can the Minister take the opportunity to offer clarity? It is really frustrating for people. Aside from what I feel is an unfairness in what is being proposed and in rushing the legislation, this is problematic. Can I give the Minister the opportunity to clarify that?

Deputy Stephen Donnelly: My understanding of how it will operate is that people can contact a call centre that is being set up and then a digital Covid-19 certificate can be arranged for them. It will be based on their testing and tracing history. It can then be issued. I heard the commentary yesterday. I appreciate that people want absolute clarity but I remind the Deputy and colleagues that what the Government said was it would have a plan ready by 19 July. The Minister, Deputy Catherine Martin, and others were being asked for details that are still being worked through. Normally, if were not dealing with a pandemic or react quickly to the Delta variant, these kinds of things would take many months. The committee would carry out pre- legislative scrutiny-----

(Interruptions)

Deputy David Cullinane: I accept all that. My time is up. I asked if the Minister consulted with the IMO because GPs were getting calls left, right and centre. In the context of this, was the IMO consulted?

Deputy Stephen Donnelly: My understanding is it was not consulted. The details of this are still being worked out between the line Departments and the stakeholder groups.

Chairman: The next question is from Deputy Lahart.

Deputy John Lahart: Is it ten minutes? 8 14 JULY 2021 Chairman: Yes.

Deputy John Lahart: I welcome the Minister. He has my support during a tricky time in terms of the new regulations. If you can tease out the different details, there is broad acceptance among the public of the need for them, especially when on considers the international context relating to the variant. A number of weeks ago, the Taoiseach, in the context of delaying the relaxations, mentioned that the Delta variant was working its way through Scotland and that we would be informed by what happened there to see if there was a correlation between case increases and increases hospitalisations, which there does not seem to have been. Scotland is now beginning to relax. I do not have a question. We are a few weeks behind Scotland in terms of that, and I hope we can look forward to positive news on this.

With regard to the national maternity hospital, as I said at the briefing we had with him, the Minister inherited this. I do not envy him. He may be able to clarify the position with regard to November 2019, when the then Taoiseach, Deputy Varadkar, told the Dáil that the new national maternity hospital would involve State-owned buildings on State land and that he anticipated the details of the legal transfer would be sorted out in the weeks that followed. What went wrong? Briefly.

Deputy Stephen Donnelly: The Deputy is asking me for details relating to a time when he and I were in opposition. In regard to what exactly happened with the previous Government in respect of statements, that is something I can ask the Department for a note on, but it is not something I was aware of. Deputy Lahart and I were in opposition at the time. However, we can certainly ask to get a note from the Department.

Deputy John Lahart: I am particularly concerned about what led the Tánaiste to come to that conclusion. I refer to it being important that this new hospital would be State-owned and on State land. I have another question regarding the board of the St. Vincent’s Healthcare Group and its stated values being the stated values of the Religious Sisters of Charity. We have gone backwards and forwards on this issue. In regard to one detail in this respect, though, who appoints senior consultants now and who will appoint senior consultants to the new national maternity hospital?

Deputy Stephen Donnelly: Senior consultants, or any consultants, would be hired according to the normal recruitment process. The HSE has a national recruitment process in place. I can get the Deputy a detailed note on whether there may be any idiosyncrasies or specific details in respect of the new national maternity hospital.

Deputy John Lahart: I do not want to be dramatic about this issue, but it could be significant if the board has an input into such appointments, especially given the nature of the medical procedures that are legally entitled to be carried out in the new national maternity hospital. Would the Minister have any concerns if the board of the St Vincent’s Healthcare Group had a say in the appointments to senior consultant posts?

Deputy Stephen Donnelly: Based on the proposal and the constitution of the board, the reserved powers of the National Maternity Hospital mean that the board cannot act other than in accordance with full clinical and operational independence. The Deputy might be referring to a potential situation where senior clinicians, mainly obstetricians, appointed might refuse to carry out operations or influence operations in the hospital in such a way that would result in not all clinical procedures being available. That would certainly be a situation which would warrant an intervention from the Government. However, it is absolutely not something that we

9 JH see happening. Again, the reserved powers of the National Maternity Hospital fully protect its clinical and operational independence.

Deputy John Lahart: Yes, but my question concerns whether that will make the choice of consultants to fill positions fully autonomous. I understand if the Minister is not in a position to answer this question, but it is something we and the public would like information on.

Deputy Stephen Donnelly: The answer to that query really, though, is what the National Maternity Hospital does currently. Does it currently provide all services? The answer is that it does. It is on the record that many of the-----

Deputy John Lahart: However, it is not subject to-----

Deputy Stephen Donnelly: -----obstetricians involved campaigned publicly for the repeal of the eighth amendment of the Constitution.

Deputy John Lahart: I appreciate that, but it concerns the present situation. Things may change in the future. This is the point I have been making regarding the long-term lease and structure of the board of management. In other words, what the Minister has said applies today but I refer to what might happen in future. Several clinicians around the country have refused to carry out the procedures concerned since the repeal of the eighth amendment. This is an area of anxiety.

My next question concerns the fact that representatives of the St. Vincent’s Healthcare Group will constitute the bulk of the board of the new national maternity hospital, or the new national maternity hospital will to some degree be subject to it. Are any legally available clinical procedures not available now in St. Vincent’s University Hospital?

Deputy Stephen Donnelly: To answer the Deputy’s second question, I am informed that the answer is “No”, that there are not. If one or two procedures are unavailable, it is for clinical reasons and not because of any ethos. Returning to the Deputy’s opening point-----

Deputy John Lahart: To clarify, it would be due to a lack of professional expertise in a particular faculty on that site and the hospital just not dealing with such aspects.

Deputy Stephen Donnelly: It may be a clinical specialty or facilities.

Deputy John Lahart: That is fine.

Deputy Stephen Donnelly: Different hospitals obviously offer different services across Ireland, whether that is in obstetrics and gynaecology or other services. I looked into this, because this point was raised at a previous committee meeting. I asked if all services were being provided in the National Maternity Hospital and in St. Vincent’s Hospital. I was told that they were. I also took a look at the charter for St. Vincent’s Holdings CLG, because there were sug- gestions that it and the St. Vincent’s Healthcare Group referred to a religious ethos, but that is not the case.

Deputy Lahart also said that St. Vincent’s Healthcare Group will have a majority of the members of the board of the National Maternity Hospital. That is not the case. The Mulvey agreement sets up a board composed of four members appointed by St. Vincent’s, four members appointed by the National Maternity Hospital and one member appointed by the Minister for Health. That conversation is under review.

10 14 JULY 2021 Deputy John Lahart: That is fine. I presume that conversation is being undertaken to change the number of board members in the State’s favour.

Deputy Stephen Donnelly: Yes.

Deputy John Lahart: How much has the State invested in St. Vincent’s University Hos- pital? Does the Minister happen to know offhand? How much has that been annually in recent years?

Deputy Stephen Donnelly: I think it is about €300 million a year. However, I will ask the officials for the details.

Deputy John Lahart: In essence, therefore, this is a State hospital. It is like our schools and things like that. I suspect it is completely State funded, except for private practice and such aspects.

Deputy Stephen Donnelly: Was the Deputy asking that as a question?

Deputy John Lahart: No. I have about a minute and a half left and I will move to another point. I do not understand the structure of St. Vincent’s University Hospital. Should terminations be available at St. Vincent’s University Hospital as it is now? Is that a service which should be available there or is it a service that just cannot be available there, as a matter of interest?

Deputy Stephen Donnelly: My understanding is that obviously this is something that would normally be within the maternity hospital and maternity units. It is not something that is precluded.

Deputy John Lahart: Right now.

Deputy Stephen Donnelly: That is correct.

Deputy John Lahart: Have any terminations taken place in St. Vincent’s University Hos- pital then, given that it is not a service that is precluded?

Deputy Stephen Donnelly: I would prefer to get a detailed note on that aspect, if I could. I do not have that information in front of me right now.

Deputy John Lahart: That is fine.

Returning to €300 million of State money provided to the hospital annually, and this may be a frivolous thought on my part, but could the State just nationalise the hospital? Whatever about a compulsory purchase order, CPO, process, could the State just nationalise the hospital, since it funds it entirely?

Deputy Stephen Donnelly: Could we try to buy out the entire site of the hospital at Elm Park? Maybe we could. However, we would be talking about a vast amount of money.

Deputy John Lahart: Sure. We are already putting a vast amount of money into the hospital annually. I refer to the €300 million.

Deputy Stephen Donnelly: We are and-----

Deputy John Lahart: This is not a point I am making to get at the Minister. He is a very

11 JH good colleague of mine. It is a bigger question, I suppose, in respect of his position as Minister. What goes to the heart of any concerns I have is that the State, in essence, runs this hospital. It has done so since the numbers of religious have diminished over the years. The State invests a colossal amount of money in this hospital and will do so for the next 100 years. It will be €300 million indexed annually as the years go on. I refer to the cost of that to the taxpayers. To build a proper republic, there must be a turning point in what the State does at some stage and in the way it treats the whole issue of health. That is the whole point that I am making but it is one that is very dear to me.

I have probably run out of time. We look forward to receiving those detailed notes. The Minister has given us a great deal of information and I appreciate it. I wish him well in his oner- ous task which is often not appreciated by his colleagues. He has enough on his plate between Covid-19, the new national maternity hospital and the cyberattack. I ask him to pass on our best wishes to the HSE as well in respect of its ongoing work. It is much appreciated.

Deputy Stephen Donnelly: I thank Deputy Lahart. Chair, I cannot see the clock so I do not know the time. Can I respond briefly to Deputy Lahart?

Chairman: We are way over time but go on.

Deputy Stephen Donnelly: On St. Vincent’s, I have had confirmation in recent weeks that all medical procedures in accordance with the law of the land are available at St. Vincent’s, including pregnancy termination, tubal ligation and gender reassignment procedures. The information I, as Minister for Health, get as to the number of terminations does not specify the locations, but I can confirm that.

Buying out a campus at God’s knows how much money would not be that useful in terms of the serious things we need to be able to do to address waiting lists, promote women’s healthcare and much more. That is where we would spend the money.

However, the Deputy raises an important point around the State involvement on the boards of the voluntary hospitals, because we fully fund them. At present, we have a peculiar situation where the State has very little oversight and involvement. Where we have had good progress recently is with the children’s hospital, where three voluntary hospitals have come together. In fairness to all three and the great work by the Department, there are now a significant number of public interest directors on the board of CHI. That is a model for the future.

Deputy John Lahart: I thank the Minister.

Chairman: I am moving on to Deputy Shortall.

Deputy Róisín Shortall: I thank the Minister. I will start off on the question of ownership. It is more than two and a half years since the Mulvey agreement was signed off on and every time the Minister or his predecessor has been asked a question since then about what was happening the reply has been that finalisation of the legal agreement is imminent. That has been the reply for the past two and a half years and yet it has not happened. What is the difficulty in finalising that agreement?

Related to that, the Minister said in his opening statement that it is “my preference ... to own the land ...”. Why is it the Minister’s preference to own the land? What difference does he think that would make?

12 14 JULY 2021 Deputy Stephen Donnelly: My understanding is that the negotiations between the stakeholders were complex, that there were multiple legal firms involved in looking at a way to flesh out the Mulvey agreement and that it was not an easy process. Significant process has been made this year. I wanted to see significant progress last year but we were, obviously, very focused on Covid and many other issues. This year, much progress has been made and I would be confident that we are close to a final agreement. I take Deputy Shortall’s point that my predecessor said the same, and no doubt he believed it at that point. The indications I have are that we are close to an agreement.

With regard to site ownership, for me, it is mainly symbolic. The governance issues can be dealt with largely through the legal agreement, the reserve powers, the public interest directors, etc. I do not believe who owns the site has an impact on the clinical and operational independence of the hospital. That is an issue that we have to take extremely seriously, and we are. As I stated previously, I will only bring a recommendation to Government when I am convinced that it is absolutely watertight in terms of the operational and legal independence.

The ownership of the site versus what is on the table now, for example, a 150 year lease, does not make a difference in operational terms or in terms of independence, but it is clearly the case that many people in Ireland would like it. As people said, if you were building your house, you would prefer to build it on land that you owned rather than on land that you were leasing.

Deputy Róisín Shortall: I find that hard to accept. It goes way beyond being symbolic.

Deputy Stephen Donnelly: Why does Deputy Shortall find it hard to accept?

Deputy Róisín Shortall: It is because of the fact that there is no example anywhere in the world that I am aware of where there is a hospital operating under the auspices of a Catholic organisation which performs the full range of women’s healthcare services. If the Minister knows of any-----

Deputy Stephen Donnelly: That is not true.

Deputy Róisín Shortall: If the Minister knows of any such hospital anywhere in the world, can he tell us where it is because I am not aware of one?

Deputy Stephen Donnelly: With respect, I have heard Deputy Shortall make this statement on many occasions. I checked to be absolutely sure that we were not setting up a national maternity hospital under the auspices of a Catholic organisation and I can tell the Deputy categori- cally that we are not. I refer to the comparison Deputy Shortall is making. What the Deputy is saying is happening in Ireland, based on everything I have seen. I fully accept the Deputy is saying it in good faith and she is genuinely deeply concerned about it. She said it to me on several occasions, so I checked and double-checked. The charters of the hospitals do not contain any reference to religious ethos.

Deputy Róisín Shortall: It is the case that the entire St. Vincent’s operation, the entire campus and St. Michael’s Hospital remain fully owned by the Religious Sisters of Charity. They have said at some point in the future they will transfer their shareholding into their own holding company. As of now, they still fully own the entire operation. Will the Minister be negotiating with that body? The Minister is saying that he hopes to reach agreement shortly. Whom will that agreement be with? That is the first question.

The new holding company has the same ethical code as the Religious Sisters of Charity.

13 JH The ethical code is based on the founder of the order. The plan may be that it will be a lay organisation but it will be a lay Catholic organisation. Is the Minister aware of any hospital in the world that is built on land that is owned or was previously owned by a religious organisation that has got approval from the Vatican to transfer ownership of that site to a hospital that will provide the full range of women’s healthcare services, including abortions which are outlawed by the Catholic Church?

Deputy Stephen Donnelly: The position on the share is that in May 2017 the Religious Sisters of Charity announced their decision to end their involvement and relinquish their shareholding.

Deputy Róisín Shortall: Sorry, I am short of time. I know what was said in the past. It is still the case that the Religious Sisters of Charity are the full owners of St. Vincent’s University Hospital. They have said they will relinquish that ownership at some point in the future but it has not happened yet.

Deputy Stephen Donnelly: What I am saying to Deputy Shortall is it is far more advanced than some vague promise that they will relinquish ownership in the future.

Deputy Róisín Shortall: The point is they still own it.

Deputy Stephen Donnelly: The point is that there is a very advanced process in place and we will not be signing up to any national maternity hospital until that share transfer has been completed.

Deputy Róisín Shortall: That share transfer will take place to a successor organisation to the Religious Sisters of Charity-----

Deputy Stephen Donnelly: No.

Deputy Róisín Shortall: -----which will be operating to the same-----

Deputy Stephen Donnelly: Deputy Shortall keeps making these statements-----

Deputy Róisín Shortall: It will be operating-----

Deputy Stephen Donnelly: ------and they are simply not true. Deputy Shortall has made statements. The Deputy has done it at the committee previously. She keeps suggesting that this new group is some sort of clandestine Catholic organisation. I am telling the Deputy that I have gone through the charters and it is simply not the case. I will read out the charter, if the Deputy wants.

Deputy Róisín Shortall: Will the Minister tell us who is appointing the holding company that is promised?

Deputy Stephen Donnelly: The holding company is being appointed at present by St. Vincent’s Healthcare Group.

Deputy Róisín Shortall: Which is wholly owned by the Religious Sisters of Charity.

Deputy Stephen Donnelly: I will not be wholly owned when the system is adopted.

Deputy Róisín Shortall: I will repeat my question. Does the Minister know of an example anywhere in the world of a hospital which is owned by a religious organisation or a Catholic 14 14 JULY 2021 organisation, or had been previously on a site owned by a religious organisation, where the full range of women’s healthcare services are available? Is he aware of any example of that anywhere because that transfer requires Vatican approval and the Vatican is opposed to termination?

Deputy Stephen Donnelly: The transfer has Vatican approval and the new organisation will have no share ownership by any religious organisation, Catholic or otherwise. This deal will not be authorised until the share transfer is done. The legal documentation is in place for that share transfer. I have checked the charter of St. Vincent’s Holding Group and it does not contain any reference to the Religious Sisters of Charity.

Deputy Róisín Shortall: It has the same ethical code as the Religious Sisters of Charity which is based on the foundress of that religious organisation.

Deputy Stephen Donnelly: With the Deputy’s permission, let me tell her exactly what it states. This is the constitution of St. Vincent’s-----

Deputy Róisín Shortall: I know what the constitution states.

Deputy Stephen Donnelly: The Deputy stated St. Vincent’s University Hospital has a religious ethos. I have got its constitution in front of me and there is no religious ethos mentioned in it.

Deputy Róisín Shortall: I know what it states. Recently-----

Deputy Stephen Donnelly: If the Deputy knows what it states, why does she keep stating there is a religious ethos when clearly-----

Deputy Róisín Shortall: That is my understanding of it and because the Minister has not been able to point to any example anywhere in the world, where a Vatican-----

Deputy Stephen Donnelly: I will read out the constitution for the Deputy if that is what she wants.

Deputy Róisín Shortall: -----approved transfer allows for the provision of termination services in a hospital. If the Minister can find an example of that, please let the committee know but there is none, as far as I know.

The Religious Sisters of Charity issued a statement stating that the full range of healthcare services are available. I have not been able to find anybody who believes that statement. There were many weasel words in it and much talk about consultants who are currently employed by St. Vincent’s providing these services. The point is they do not provide them in St. Vincent’s University Hospital but in Holles Street, which is not a Catholic hospital. How many terminations and direct terminations, if any, have been performed within St. Vincent’s University Hos- pital on its grounds at Elm Park?

Deputy Stephen Donnelly: As per Deputy Lahart’s question, I get a report on the total numbers of terminations. I do not get any information on where they are performed.

Deputy Róisín Shortall: How has the Minister assured himself that what is being claimed is actually the case?

Chairman: I have asked Deputy Shortall to end her questions. She has had her fair share

15 JH and I need to move on.

Deputy Neasa Hourigan: I will stay on that issue for the moment. It is important that we receive this aggregated data on whether the full complement of services has been provided on the land we are discussing. I note the phrases the Minister used today include “have been told” and “they are available” but none of those gives assurance that things like gender-affirming sur- gery or specific reproductive rights services will be provided. One of the issues we talked about today was wanting to start this partnership on the right foot but the most important partnership is the one between the State and the women of Ireland. There is a piece of work to be done in rebuilding trust between the State and the women of Ireland. For that trust to be rebuilt, we need to see those numbers. Can the Minister provide them?

Deputy Stephen Donnelly: I do not have those numbers. There is a requirement under the Act that the Minister is provided with the total numbers but I do not have-----

Deputy Neasa Hourigan: I will ask the question in another way. Will St. Vincent’s Uni- versity Hospital give us those numbers?

Deputy Stephen Donnelly: The Deputy will have to ask St. Vincent’s University Hospital about that. I commit to engaging with the Department and directly with St. Vincent’s to get as much detail as possible for the committee.

Deputy Neasa Hourigan: I thank the Minister. I reiterate, and I am sure St. Vincent’s University Hospital staff are listening to this, that we need those numbers. We must have them to move forward with this. I call on St. Vincent’s University Hospital to release that kind of information. It is very important.

I will move on to the issue of the lease. When will the proposed lease begin?

Deputy Stephen Donnelly: There is no final deal in place so the detail-----

Deputy Neasa Hourigan: I will expand a little on this issue because the Minister has members of staff who have worked on these projects before. We already have a project on site and excavation works taking place. Will the lease be in place from, let us say, the preparatory works or substantial completion stage or is it predicated on the establishment of the holding company?

Deputy Stephen Donnelly: I will get the Deputy a detailed note on that but the lease will commence either from the beginning of the works or, potentially, from the commissioning stage.

Deputy Neasa Hourigan: I suspect the Minister is right. We are talking about a 99-year or 150-year lease. A lease commencing from the commissioning stage could be a ten-year process, while one commencing from the preparatory works stage will probably be a five-year process if everything goes to plan, which we know does not always happen in Ireland, and will actually be a 140-year or, perhaps, an 89-year lease. We have to include the construction work in consideration of the lease. Has the State done any work in terms of the end of that lease, which in the context of the lifetime of a hospital is quite short, and recovering the asset that, I presume, will be worth billions of euro at that stage?

Deputy Stephen Donnelly: By “the asset”, is the Deputy talking about the building?

Deputy Neasa Hourigan: Yes.

16 14 JULY 2021 Deputy Stephen Donnelly: The estimate is that the life cycle of a building like this would be 40 years to 50 years. I cannot remember exactly how old Holles Street is but it is less than 149 years. Certainly, the economic value of something built today would be pretty small in 150 years.

Deputy Neasa Hourigan: I have had this conversation about how we look at cost-benefit analysis and the time horizons contained therein. Estimating a hospital’s lifespan, even the building itself, at 40 years or 50 years is not a starter. Certainly, architects and project managers on the project would not be doing their job and would definitely be failing in their role if they expected to significantly replace that building within 50 years of its construction. Most hospitals last for centuries, not decades, even with the maintenance required. Is it fair to say that there has been no review of how that might work at the end of the process and after 99 years?

Deputy Stephen Donnelly: I apologise to the Deputy. I ask her to help me understand the question. Is she asking if we are planning now for what we will do in 150 years’ time-----

Deputy Neasa Hourigan: Is the project being worked on the basis of a 40 year to 50 year lifespan for the building?

Deputy Stephen Donnelly: No, not at all. We could discuss this for some time but the advice to the Department is that modern hospitals can sometimes have a lifespan of 40 years to 50 years, at which point you will want to replace them.

Deputy Neasa Hourigan: To be clear, if we have a lease of 99 years, and we might take ten years or five years to commission and build it, we are talking in the region of 80 years. At the end of 80 years, has the Department done a piece of work on what happens next? How do we recover the State’s asset? Can we renegotiate? What happens?

Deputy Stephen Donnelly: First, the lease would be for 150 years. If you want to take off the years for building, then let us say 145 years. At the end of 145 years, we would still own the building. The agreement is we would own the building. There are so many variables at play for what options might be chosen to exercise or agree, say a decade ahead of time, or in 130 years’ time, that I do not know if you could accurately plan for what would be done with the building in 150 years’ time. We would own the building and there could be any number of outcomes. It would depend, given the timeframes involved, on many different factors at that time.

Deputy Neasa Hourigan: In the context of things like hospitals and universities, long-term trusts that last not just for decades but centuries would not be that unusual. To have absolutely no plan other than to negotiate the lease a decade before it ends, is not really much of a plan for a massive piece of State infrastructure that will provide such a core service to people.

I realise I may be nearly out of-----

Deputy Stephen Donnelly: The Deputy may be right but, for example, let us say in 140 years’ time we have a much better location for a maternity hospital, or multiple better locations for maternity hospitals, or healthcare has advanced to the point where there is a blended model of acute care provided in very different ways and we might no longer want this or that hospital. I am saying it is very difficult, in fairness, to know what we will want to do with a building in 150 years’ time, especially in the world of healthcare where things move, and medical science is advancing, so quickly.

Deputy Neasa Hourigan: All of those variables are true. Unfortunately, we know we will

17 JH not own the land.

Deputy Stephen Donnelly: We do not know that yet because no agreement has been reached. If we were to lease the land for 150 years, in about 140 years or perhaps a bit earlier or whatever it might be, we would look at options. What those options would be would depend on our healthcare requirements at that time which would be very difficult to predict.

If you were to go back 140 years to whenever that is, it would be very difficult to predict what we would want to do with-----

Deputy Neasa Hourigan: Many of the hospitals that provide services to us now were in place 150 years ago.

Deputy Stephen Donnelly: Okay-----

Deputy Neasa Hourigan: I think I am out of time.

Chairman: We need to move on.

Deputy Bríd Smith: I thank the Chairman for letting me in on the meeting to replace Dep- uty Kenny. A number of matters arise from the conversation and are not necessarily the original questions I was going to ask. This is not a criticism of the Minister but is an effort to find out what exactly he knows, does not know, and is being told about this because he was asked earlier how Deputy Varadkar was able to say to the public in 2019 that the hospital would be fully owned by the State. The Minister was not able to answer that question; he did not know. He was also asked if he could confirm if any terminations had taken place in the hospital and he was not able to answer that question.

I want to differ with the Minister on where he is getting his facts because the National Women’s Council of Ireland recently conducted a survey on the delivery of abortion services post repeal in the hope that very soon we would be having a review of the legislation, which is meant to happen before the end of this year. One of the things the survey was able to show quite clearly was that approximately half of the maternity hospitals in the country do not deliver abortion services at all since the legislation was passed. If the National Women’s Council of Ireland can find that piece of information, it seems extraordinary the Minister cannot establish whether terminations, which are just one service of women’s reproductive health which women are legally entitled to, as indeed men are to vasectomies, can be performed currently in St. Vin- cent’s University Hospital. I find it extraordinary that the information the Minister is giving the joint committee is not adequate.

I will return to the key question, which is the one of ownership. The Minister in his statement conveniently goes back to the letter published in The Irish Times where 42 senior clinicians expressed concern that misinformation and misunderstanding could delay what they describe as a vital project. I accept the Minister’s bona fides that we all have to have this, and sooner rather than later. Is it not a fact, and it was more or less admitted by a civil servant in the previous meeting we had, that for the past eight years this project has been held up because of, as the Minister has quoted, the many legal entities that have been involved in discussing it? Is the core issue not the ownership of the land? If the State had owned the land, would this legal and tortuous process and this complex method of how companies and charities deal with this issue have been an obstacle?

The Minister has said to us and in the Dáil that his preference is for the State to own the land.

18 14 JULY 2021 Will he now publicly call on the Religious Sisters of Charity to hand or gift over that land to the State? The Minister has the high moral ground here. We have been pumping €300 million of taxpayers’ money a year into St. Vincent’s Healthcare Group. Why, therefore, does he not publicly call on the religious order to hand over the land to the people?

Deputy Stephen Donnelly: I thank the Deputy very much for the questions. On the issue of termination, the situation is, as we will all appreciate, that terminations, by and large, will happen in the maternity units themselves. I take the Deputy’s point and that she was raising it by way of background, that there is a very uneven spread of terminations throughout the country. This is one of the things we will be looking very closely at in the review of the Act which we will be getting under way very shortly. This will be for another day.

The point I was trying to make, and my apologies if I was making it badly earlier, is that all procedures are permitted at St Vincent’s University Hospital and the hospital has confirmed that. In the case of a termination, a woman may have one performed at St. Vincent’s if, for example, she were severely ill. In the normal course of events these procedures are provided at maternity hospitals. What I was saying that the information provided under the legislation does not specify the locations but I will endeavour to provide for the joint committee the information that has been requested.

On the question that the Deputy has asked on the ownership of the land, it is my stated preference that the State would own the land and I have raised this directly with the stakeholders. It is important to say, however, that regardless of whether the State owns the land, what we have to focus on to ensure clinical and operational independence, which I believe we all want, is not who owns the land but the governance structures and independence through the hospital itself. The ownership of the land matters to people. I said it is my preference and indeed that of the Government that the people would own the land, but it is not the solution to clinical and operational independence which is around governance, board members, reserved powers and things like that.

Deputy Bríd Smith: Surely, if the State owns the land and the hospital in its entirety then, as the Tánaiste stated, the State would have more influence on the governance and on the board of directors because the hospital would be entirely in the ownership the State. It is the question of the ownership of the land that has held up the reality of this hospital for years, so this is a very significant issue.

Returning to why it is such a very significant issue, this is because we do not trust the church. This is a fair enough statement to make given the legacy we have had in this country and given statements made by the head of the Religious Sisters of Charity herself, Sister Patricia Lenihan, who said last year that the hospital will maintain the ethos of Mother Mary Aikenhead. The Minister has to square that circle for the women of Ireland because it is a very important issue given the legacy of this State in its treatment of women and it cannot just be parked because everybody is just paranoid. Another way of describing paranoia is a heightened sense of awareness and that there is a collective heightened sense of awareness here among the women of this country that we do not want the church having any say whatsoever in our maternity care. There is a principle that flies in the face of Sláintecare, which Deputy Shortall and others worked very hard on, which is that we need to move to a fully State-owned and controlled healthcare service. If we are spending millions of euro on this, why do we not pursue the ownership of this hospital? That is why I am asking the Minister publicly to call on the sisters to hand over ownership of the land. I understand legal niceties but these have gone on for too long.

19 JH Deputy Stephen Donnelly: I again thank the Deputy very much. I agree with a great deal of what she has just said. Let me be very clear: no one is dismissing the concerns being raised around clinical and operational independence. I, the Deputy and all of the members of the joint committee understand that and we are taking it very seriously.

On the second point raised by the Deputy around a Catholic or religious organisation having an involvement, these issues have been raised at the joint committee and in the media, and on the back of those I took another look, and asked the Department to do likewise, to be absolutely sure there would be no influence, be it Catholic or otherwise, other than a secular influence through the laws of the land and being governed by good clinical practice. I will not be bringing any recommendation to the Oireachtas or to the Government unless that is absolutely guaranteed.

We went back, for example, and looked at the charter for St Vincent’s Healthcare Group because it had been alleged the group was carrying on through its charter and mission a specific reference to Catholic ethos. I am glad to inform the Deputy that is not the case. The ethos and core values referred to by the group, and there are a few, are human dignity, compassion, justice, quality and advocacy. It talks about its mission being to advance medical education, promote medical research and patient care in all areas of medicine and to be known for the highest standards of patient care, clinical excellence, medical research, staff education, and so forth. These are things I believe we would all say sound very reasonable. I assure the Deputy that all such concerns are taken very seriously and everything is being done to ensure it is watertight, is free from religious influence and is secular.

Deputy Bríd Smith: I have one final question which gets to the core of this. If the Minster believes all that, is reassured by what he is being told or what the sisters have written down, namely, that all services will be available and there will be no influence of any religious ethos on the delivery of services in this hospital, then why do the sisters not give up the land? There must be an answer to that question. I believe the answer to that question is corporate interest. The Catholic Church is the biggest owner of land in this country and very seldom yields it to State interests. I believe that is the reason. Why does the Minister think the church will not relinquish the land to the State?

Deputy Stephen Donnelly: The Religious Sisters of Charity are transferring to St. Vin- cent’s Healthcare Group.

Deputy Bríd Smith: I understand that but why do they not give it to the State?

Deputy Stephen Donnelly: That is the position they have taken. It is the position they took a long time ago. It is the framework agreed under the Mulvey agreement and all the subsequent work that has been done. It is not for me to speculate as to why transfers are made. What I can say is they stepped back from St. Vincent’s Healthcare Group, I think in 2017. They are fully transferring all ownership to the healthcare group. That healthcare group does not contain any reference to the Catholic Church, to the Vatican or to anything like that. As another safeguard, it is important we go back to the National Maternity Hospital, NMH, at Holles Street. It does a very good job. We all know it provides the full range of services. I do not think any of us have ever suggested the clinical leads in the NMH would allow themselves be constrained by, let us say, a religious ethos. Let us remember the NMH itself has looked at the governance arrangements and said this gives it the clinical independence it needs. We as the Oireachtas are adding in an extra element to that, namely, the public interest. I do not mean to speak for the Deputy or anyone else on the committee but I think we all have a very high regard for the NMH at Holles 20 14 JULY 2021 Street. There is no way it would be signing up to an agreement whereby its clinical leads were being told what they could and could not do based on any religious ethos. What we all need to do is ensure that is enshrined in the legal protections and powers of the maternity hospital when it moves to Elm Park.

Deputy Bríd Smith: Can the Minister guarantee we, as a State funding this project, will have the majority influence on the board of directors?

Deputy Stephen Donnelly: Not at this point. I would very much like to be able to say that. Those conversations are ongoing.

Deputy Bríd Smith: If he cannot, will he then purchase the land by means of a compulsory purchase order, CPO?

Chairman: I need to move on. There are others looking to come in here.

Deputy Bríd Smith: I know, Chairman. I just want to ask the Minister if he would purchase the land by CPO.

Chairman: The Deputy is way over her time.

Senator Martin Conway: I find myself very much in agreement with much of what Depu- ty Smith and other speakers have said. It is incumbent on the Minister to establish the number of terminations that have taken place in St. Vincent’s. He needs to get that information and St. Vincent’s must provide it to him. If the hospital does not do so, then we have a problem. It is one thing to say the service is available but another to state whether it has been provided and whether it has happened. I would just moot that.

Deputy Stephen Donnelly: I will revert to the committee with that. I will make an ob- servation, if I may. The conversation we have been having to date is around the clinical and operational independence of the NMH. It has not been around what happens in St. Vincent’s hospital. I appreciate some are saying they are linked but let us-----

Senator Martin Conway: They are inextricably linked. The Religious Sisters of Charity are talking about transferring the land to the St. Vincent’s Healthcare Group. There needs to be a building of trust here, on their part as well. It is not too much to expect that the women of Ireland would get this information. It is only right and proper, to be quite honest. Since the Tánaiste raised his concerns in the Dáil in response to Deputies and since St. Vincent’s made its statement following on from that, has the Minister met either the Religious Sisters of Charity or St. Vincent’s?

Deputy Stephen Donnelly: I have, yes.

Senator Martin Conway: Okay. Will he brief us on how those conversations went?

Deputy Stephen Donnelly: They went fine. They were productive. I put forward the position of the State and the position of the Government. Out of respect for what were private conversations as part of an ongoing process, I am sure the Senator will understand if I do not get into too much detail. I can say there has been productive engagement and that engagement continues.

Senator Martin Conway: The Minister is not in a position to say the State would have a majority on the board today. What kind of timeline are we looking at? As Deputy Shortall has

21 JH pointed out, the same answers have been made available for the past two and a half years. Are we talking about concluding this arrangement in a matter of weeks, months or will it be years?

Deputy Stephen Donnelly: I would hope we would have an agreement in place in a matter of weeks. Then the lawyers have to turn that into the final contracts. I caveat that by saying the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, made similar statements when he held this portfolio and I have no doubt he fully believed them. This has been a long and complex process but I very much hope we are close to completion of this deal because, ultimately, we must start getting this hospital built.

Senator Martin Conway: Okay. The Minister has also said this morning that he and his Department are not actively looking at alternatives. I suspect one of the alternatives is Tallaght hospital. We accept he is not actively looking at this but does he have officials in his Depart- ment putting contingency plans in place in case this does not work out? Are the Minister and his Department working on a plan B?

Deputy Stephen Donnelly: The plan is we build at Elm Park and that we secure the State’s investment and we secure clinical and operational independence for the national maternity hospital. That is the plan and needs to remain our focus. This project has gone on far too long for us to be looking to do something fundamentally different right now. However, all options remain on the table. I want the Department focused on what is needed now to get this hospital built as quickly as possible.

Senator Martin Conway: Okay. Has the Minister a timeline in mind? He has said he hopes to be in a position to bring a memo to Cabinet in a few weeks. Is there a period after which he will just have to say we have done our best but it is not working out and we will have to move to a plan B?

Deputy Stephen Donnelly: I do not think it would be helpful at this point in the talks for me to speculate in public on that. It is a very fair question but it would not be helpful for me to speculate at this point.

Senator Martin Conway: I will put it to the Minister another way then. Two and a half years ago everyone would have been of the view this needed to be dealt with in a matter of months, not years. We are now two and a half years down that line. I respectfully suggest if this is not concluded by the end of this year, the Minister will have to look at a plan B and it will have to be actively considered.

Deputy Stephen Donnelly: The Senator may well be right.

Senator Martin Conway: Okay. If I may have a quick word on vaccinations, is the Min- ister satisfied the supply line of vaccines coming into the country now is acceptable? Are there going to be any difficulties? Does the Minister foresee any challenges over the next few weeks? Clearly, the more people who are vaccinated, the fewer difficulties there will be with indoor dining.

Deputy Stephen Donnelly: It is moving well. By the end of this week we aim to have administered more than 5 million vaccine doses. We have very high uptake rates among the populations to whom it is available. We are now using the full range of vaccines across all age groups. That has helped because it means we can use all the vaccines coming in. We have good line of sight on many of the deliveries we are expecting in the coming weeks. There have been and there remain challenges with some of the volumes that were contracted and did not arrive. 22 14 JULY 2021 There is no question about that. Not everything that was contracted arrived. There are ongoing conversations between me, the Department, the task force, the HSE and the pharmaceuti- cal companies to that end, but I can say there is a lot of very positive progress. This week, for example, the portal opens for the alternative pathway for the cohort of people for whom mRNA vaccines are preferred by NIAC but who, if they want to be vaccinated earlier, can now opt for AstraZeneca through a vaccination centre. We have very strong demand through the pharma- cies for Janssen and more Janssen will be distributed soon. Some 40,000 doses were distributed and another 85,000 or so are to go out soon. Things are moving apace.

Senator Martin Conway: Are there any further developments in terms of buying unused vaccines from other countries? I know some have already been bought. Will the Minister confirm whether he is in a position to purchase more or if deals are almost concluded?

Deputy Stephen Donnelly: At this point, I am not. There have been some very useful talks and the talks continue in that regard, but there is nothing concrete I can share at the moment with the Senator.

Senator Martin Conway: I thank the Minister.

Senator Annie Hoey: It is very interesting that Senator Conway asked about the next plan, the contingency plan. I feel it is a good bit further on and that we are on plan D or E. The Min- ister said he wants to ensure clinical and operational independence for the national maternity hospital but does he still envision a situation where the hospital will remain within the ownership of the St. Vincent’s group and that he may not be able to negotiate the full handover of the site?

Deputy Stephen Donnelly: I am confident the State will own the hospital we build. I am also confident we will agree final governance structures that give watertight guarantees in terms of the clinical and operational independence of the hospital. Further, I am confident we will have a long lease and that options can be put into a legal contract as to what happens at the end of the lease, for example. As to the ownership of the land, my understanding is that St. Vincent’s Healthcare Group has stated repeatedly for many years that it will not sell the land. I do not believe its position has changed. The position of the Government and of the committee is that our preference is for ownership of the land, but the most important thing is clinical and operational independence.

Senator Annie Hoey: This is not a reflection on the Minister’s negotiating skills but is he absolutely confident the guarantees are watertight to the point that abortion services, for example, would be available on the site? Currently, nearly half of maternity hospitals still do not provide abortion services and they are supposed to be under State ownership. I am sure the Minister can understand why there is so much deep concern that, despite the best will in the world, we are still going to continue to have a situation whereby, if the land remains in the ownership of the group, there will somehow be a way to curtail or prevent certain procedures from happening on what will be an extraordinarily expensive but very worthwhile investment. I am sure the Minister can understand how concerned people are, given that half the maternity hospitals currently do not provide services.

Deputy Stephen Donnelly: Yes, I do. We must make sure we address all of these concerns comprehensively. We will have multiple safeguards in place. One safeguard will be the final agreements on the governance structure for the national maternity hospital, including the reserved powers. What the reserved powers essentially do is prohibit the board, if you like, from

23 JH acting against the clinical and operational independence. They are very strong. We are taking a look at the public interest representatives on the board as well. That is one of the safeguards. I will only bring a recommendation to the committee, the Government and the Oireachtas if we have watertight guarantees around that.

Another safeguard is the National Maternity Hospital, NMH. We sometimes forget that we are not setting this hospital up from scratch. This hospital exists in Holles Street. It is highly regarded and it provides the full range of services. The people who work in Holles Street will move down the road and work in Elm Park. It will be the same people treating the same patients with clinical and operational independence.

I campaigned for repeal shoulder to shoulder with some of the people who work in the Na- tional Maternity Hospital. They would not tolerate a situation where simply moving from one building to another, albeit from an old building to a new building, would somehow stop them providing the services they provide today. They would never do it. We sometimes forget that. They raised their voice a few weeks ago when quite a large number of very senior clinicians wrote and said some of this debate perhaps misunderstands their clinical governance and that some of it is “misinforming the debate”. Those are their words, not mine. Senator Hoey can be absolutely sure they would not sign up to an agreement that stopped them doing what they do today. She can also be sure the Government will not sign off on an agreement that would in any way stop that. It is full clinical and operational independence.

Senator Annie Hoey: Yes. Is the Minister very happy therefore, as the current Minister for Health and as someone who has worked on this, to stand over the expenditure of €800 million of the State’s money on something where, ultimately, the land will not be owned by the State? I know we are getting into technicalities, but if the Minister was outside of this remit, would he say this is a good idea?

Will the Minister comment on the current situation whereby some women and pregnant people are not able to avail of their partners being with them in a number of hospitals? Only yesterday, we heard of one more person whose partner was refused permission to accompany them. Will the Minister comment on why that is still going on?

Deputy Stephen Donnelly: This is a source of frustration for women and their partners, for me and for the HSE as well. I asked for an update for the committee today in case any member wanted to raise it. The situation right now is that there is very clear guidance on daily visits for a minimum of 30 minutes, for the anomaly scan, neonatal intensive care and birth right from the start, including when induced, and right through. It has not always been possible to facilitate visits in the multi-occupancy antenatal wards before labour. This is for infection prevention and control reasons. Often, pre-Covid it would have been the case that visiting arrangements on antenatal wards would have had to be mindful of the women there.

In addition, building on the guidelines for planned attendances, the HSE has advised that updated guidance was issued on 24 June relating to unplanned attendances or emergency presentations because that has been a real issue. It is arguably the most important time, so work was done on that. The HSE has advised me that the acute operations office and the national women and infants programme have engaged across the six hospital groups to confirm compliance across the 19 maternity services. The responses we have received this week are as fol- lows: 18 of the 19 units are fully compliant, with partners being allowed in the early assessment units; 12 of the 19 are fully compliant with high-risk pregnancy visits; and 15 of the 19 are fully compliant with emergency presentation visits. I am engaging with the HSE to get that up to full 24 14 JULY 2021 compliance across all 19 units. Compliance is a lot higher than it was. We pushed for compliance on the four original criteria and then we moved on to early attendance and emergency. That is moving at pace but there is not full compliance yet. Like Senator Hoey, I am aware of very difficult individual cases requiring emergency presentations where there is still not access for the partner. That is causing huge grief and huge problems for the women and their partners as well. We have to keep working with the HSE to get full compliance across all 19 units.

Deputy Cathal Crowe: I confirm I am in Leinster House 2000. I thank the Minister for being present, for his opening statement and for all the work he, his Department and front-line staff are doing.

I wish to make a few points. The Minister stated, “my preference is for the State to own the land on which the new national maternity hospital will be built”. The trustees of the Religious Sisters of Charity claim that they are under a legal obligation to enforce the values of Mother Mary Aikenhead, who passed away 163 years ago this month. I am not quite sure what she would have made of the angling taking place this morning or of the overall debate on this matter. Mother Mary Aikenhead has been described as “one of nursing’s greatest leaders”. With the greatest respect, I do not imagine that she wants to enforce any of her values in respect of this matter from the grave. She would very much want to see a hospital built as quickly as possible. The Minister has stated many times this morning that there will be clinical and operational independence. However, despite how good Mother Mary Aikenhead may have been in the context of leading charity and nursing, I do not believe that she should still dictate from her grave what happens with health policy in 2021.

A CPO process must still form part of the discourse. It has been estimated that it could cost in the region of €50 million. I do not imagine that the Minister will be able to answer my next question, but it would be brilliant if he could. Much of what happens with this issue will come down to pounds, shillings and pence. If a CPO process were to cost the State €50 million, we must then juxtapose that amount with the reality of the cost of leasing this land for 150 years. Therefore, a leasehold fee greater than €330,000 annually would, on a simple calculation, make it sensible to just go out and buy this land. CPO processes are complicated, but if we consider the relative bang per buck for the State and the taxpayers, then paying an annual leasehold greater than €330,000 would, I think, necessitate buying the land outright for the State. That would also secure independence and everything else in this regard. I ask the Minister to comment on that aspect. Does he know the cost of the annual leasehold fee, or is that sensitive information and off the cards here?

Deputy Stephen Donnelly: I thank the Deputy for his questions. Regarding his original comment about Mary Aikenhead, I confirm that in the charter of the St. Vincent’s Healthcare Group there is no reference to Mary Aikenhead, that I am aware of, or to a religious ethos. The core values in the charter are “human dignity, compassion, justice, quality and advocacy”. The charter also then refers to clinical excellence, excellence in patient care and so forth. Turning to the subject of clinical and operational independence, it is important that we are clear that the ownership of the site and clinical and operational independence are separate issues. In other words, clinical and operational independence can and must be achieved through legal agreements and governance structures.

For example, we could ask Jimmy Sheehan, who builds hospitals around the country very well, to go out and build us a new maternity hospital. The chances are that he would do it much faster than the State. We could then tell Mr. Sheehan that he fully owned the building and the land but that the State would be the occupier and would rent the building back off him 25 JH lock, stock and barrel for the next 150 to 200 years. In that hypothetical case, the legal contract signed would state that Mr. Sheehan would have absolutely no say, obviously, in what happens inside the building. I do not think that anyone would ever suggest that Mr. Sheehan could influence what services would be provided to women in the hospital in such a scenario. What would guard clinical and operational independence would be how such a hospital would be set up, the board of directors, the articles of association and the legal powers and protections. To me, the most important issue is full clinical and operational independence.

A second issue relates to circumstances in which people have said, very reasonably, that they would prefer to own the land. We want to own the land. We will own the hospital and people want to own the land. I fully understand that desire, and that is our preference. That view has been conveyed to all stakeholders by me directly and by the Department. The Govern- ment’s public position on this issue is well known. Now, the position of St. Vincent’s Health- care Group is also well known, namely, that the land is not for sale. As a result, a conversation is ongoing between the various stakeholders in that regard. However, I think we must keep the focus on clinical and operational independence.

Deputy Cathal Crowe: I am sorry to cut across the Minister, but is it possible for him to tell us what the annual lease fee will be?

Deputy Stephen Donnelly: No. We cannot provide details such as those relating to the lease fee.

Deputy Cathal Crowe: I will move on because my time is limited. I was a primary school teacher 16 months ago and I taught in a school with a Catholic ethos. I had no problem with that. That was my job and I did it gladly every day. In one of the lessons we used to teach what the word “church” meant. It means people. When, therefore, the Religious Sisters of Char- ity, or any other church group, refers to church ownership, it is actually people ownership. I am sorry to digress slightly, but I love my history. Some of the most beautiful cathedrals and convents in Ireland were built when the Famine was at its height and when people did not have a crust to put on the table. They were still able, because of a deep religious faith, to cough up some money to build these beautiful buildings. The very sites these buildings are sitting on were developed, owned and built by people over many generations. That point needs to be re- flected on as well. The best thing that the order could do would be to gift this land to the State or charge a very small transaction fee for it. That would be following the true spirit of Mother Mary Aikenhead.

In my last-----

Chairman: I am sorry, but Deputy Cathal Crowe is over time.

Deputy Cathal Crowe: I have a minute left.

Chairman: The Deputy does not have a minute left.

Deputy Cathal Crowe: By my clock, I have. I will conclude with this remark. It is welcome to hear that vaccination is being considered for younger age cohorts, such as those from 16 to 18 years of age. I ask that people younger than that who suffer from cystic fibrosis also be considered. I ask the Minister to comment briefly on that point in the last few seconds I have left.

Deputy Stephen Donnelly: I fully agree, and I have asked for prioritisation to be given to

26 14 JULY 2021 children aged 12 to 15 years of age who have underlying conditions. We are waiting on some detailed advice from NIAC. In the meantime, however, ahead of receiving that information, I have asked the HSE to prepare and ensure that we can reach out to the parents and guardians of these children and get them vaccinated.

Returning to the Deputy’s earlier question, I have a note here which states that there is a notional annual fee in respect of the lease. We could certainly do an awful lot with money that might be used for a CPO process. I have no idea what the cost of such a process would be or whether we would win in the end. To contextualise the situation, €12 million has been enough to fully fund the national maternity strategy for the first time this year and it is already making a big difference.

Deputy Cathal Crowe: I thank the Minister.

Deputy Stephen Donnelly: Therefore, very targeted amounts of money can make a big difference in women’s healthcare and in maternity care.

Deputy Cathal Crowe: I again thank the Minister. I know of a golf club which has a 999- year lease. I respect everything the Minister has said, and he is doing a good job, but I ask him to please represent, as he is-----

Chairman: We have other colleagues trying to get in.

Deputy Cathal Crowe: I thank the Chair and the Minister.

Chairman: I call Senator Higgins. She is very welcome to the meeting. I apologise for the cutback on time.

Senator Alice-Mary Higgins: I thank the Chair. I am happy to substitute for Senator Black, who would have liked to be here.

The Minister talked about the antiquated building in Holles Street. The concern is that we are continuing with an antiquated approach to healthcare in that a private voluntary body would be delivering healthcare to women rather than there being national delivery of such healthcare. That is the wider frame of concern as to why it would be a private voluntary body rather than a national hospital delivering State public healthcare.

We turn then to the nature of the body concerned and the nature of the holding company. It is important to state that this is not a continuation of the national maternity hospital. The latter had 100 independent governors and it was not owned by one holding company in the same way. The Minister indicated that this new building will be owned by the State, but a new governance structure is also being put in place. In that context, there are real concerns, as people have said. We must move past the detail concerning whether services will be available.

I am going to ask two sets of questions. One set will be on those services and the other will focus on the land. Regarding the services, it is not just a question of whether services will be available. Abortion was available in Ireland prior to the repeal of the eighth amendment but you had to be dying. How will those services be delivered? In what circumstances will they be delivered? Will it be in the rarest of circumstances? Will it be on demand? We have not had answers to these questions. No hospital in the St. Vincent’s Healthcare Group is listed as an abortion provider by the HSE. That is on the record. It is a fact. In the past, hospitals in the St. Vincent’s Healthcare Group were given guidance to only make sterilisation available to

27 JH patients if the procedure were not to limit fertility, but as a by-product of another health issue. These are the nuances and details. Those concerns are extremely valid because in 2017 it said it would not gift or sell the land because it wanted to have integrated services and common protocols. Just a few weeks ago, yet again, it said the reason it will not sell the land is that it wants integrated patient care.

If this hospital operates under the same laws and delivers the same services set out by the State, what, then, are the differences in patient care that requires them to have control and input in the governance of the hospital? Is it around the protocols of when services are provided? Is it around how they are provided? Why is it telling us that it would not be able to work with the public maternity hospital? If it says it will not be able to work with the public maternity hospital, then why not? That is a core question on the delivery of services that needs to be an- swered. I would like to hear the Minister’s thoughts on that. I also have a follow-up question on ownership.

Deputy Stephen Donnelly: I thank the Senator. Her first question was on a private voluntary hospital versus a State hospital. The alternative would be to disband the National Mater- nity Hospital. I do not think that anyone has suggested that. The National Maternity Hospital is a private voluntary hospital. I am not sure if the Senator is proposing to disband the National Maternity Hospital and set up a HSE-----

Senator Alice-Mary Higgins: The Minister is disbanding the National Maternity Hospital and replacing it with a new entity.

Deputy Stephen Donnelly: We are moving it down the road. It will be the national maternity hospital at Elm Park. It will have the same commissions, the same staff and it will treat the same patients-----

Senator Alice-Mary Higgins: It is not. It is a new governance structure in which the Na- tional Maternity Hospital will play a part.

Deputy Stephen Donnelly: It is the National Maternity Hospital. Is the Senator proposing that we would set up the new hospital without any reference to the National Maternity Hospital and just have it as a HSE-run hospital?

Senator Alice-Mary Higgins: No. I am proposing that the new national maternity hospital would be a national maternity hospital and that it would, as it already does, pay the same commissions, deliver the same services and so forth but that the ownership and the governance would be public and nationally delivered.

I have limited time so I would like the Minister to address my questions on whether services will be available, what services will be available, how they will be made available and when they will be advised? Why is there a difference in the way these services would be provided by St. Vincent’s Healthcare Group? Why, from its perspective, is there a difference between how it can work with this hospital and how it could work with a publicly owned hospital? What are the differences in how the services are provided, because that is the reason it has given for not selling?

Deputy Stephen Donnelly: I thank the Senator. With regard to services provided at the National Maternity Hospital, the St. Vincent’s Healthcare Group charter works according to the laws of the land. The Senator is asking when they and how they will be provided-----

28 14 JULY 2021 Senator Alice-Mary Higgins: No, I am asking what the difference is. What is the difference from its perspective? It is not just about whether the services will be available. How will they be available? The Minister mentioned that a person can potentially get an emergency abortion, for example. However, it is not listed on the HSE list of providers for voluntary terminations, for example.

Chairman: Can the Minister please reply?

Deputy Stephen Donnelly: I am genuinely trying to be as helpful as possible to the Sena- tor. In terms of when and how services will be provided, they are clinical and operational matters for the new national maternity hospital, just like they are in National Maternity Hospital today. However, the full range of services will be provided in the interests of patients.

Senator Alice-Mary Higgins: Just a couple of weeks ago St. Vincent’s Healthcare Group said it could not provide integrated patient care unless it retained ownership of the site. Why is that? Why can it not provide integrated patient care with a publicly owned hospital on a publicly owned site?

Deputy Stephen Donnelly: I believe it can. I think it was an unhelpful statement. I cannot speculate as to what it meant by that statement. What I can say is that it is Government policy that we have co-location. It is important as is integrated patient care. As for the operational matters as to when and how services are provided, these are clinical and operational matters for the new national maternity hospital.

Senator Alice-Mary Higgins: These are clearly overarching issues. That is why we need a lot of detail on exactly what it means by those matters. It is a concern if it feels that a publicly owned hospital on public land would operate in a different way in its approach to these services-----

Chairman: I need the Minister to-----

Senator Alice-Mary Higgins: I have a final question-----

Chairman: I do not have the time.

Senator Alice-Mary Higgins: It is very important.

Chairman: I do not have the time, Senator Higgins.

Senator Alice-Mary Higgins: I know but I will ask this question as it is crucial. In 2018, St. Vincent’s Healthcare Group was valued at €661 million. The Minister told us that we pay €300 million to St. Vincent’s Healthcare Group every year. Surely, we could have a compulsory purchase order, CPO, for this site. That issue of the CPO and why we are not doing it is crucial. I mention alienating the land and alienating the land being a long process. Is the reason we cannot have a CPO that there is a mortgage on the grounds? If so, that problem becomes worse in that St. Vincent’s Holdings CLG can, under its constitution, issue new mortgages on that site. That problem deepens if we allow a body to create mortgages on that site - further future mortgages. Can the Minister clarify if the reason we cannot compulsorily purchase the site that there is a mortgage on this site from Bank of Ireland or is it that we are worried St. Vincent’s Healthcare Group will fight us in the courts? Can we estimate the comparable costs of those two actions? Is it because we would have to buy the full St. Vincent’s Healthcare Group which, as I said, was valued in 2018 at €661 million. This is just twice what we pay it every year.

29 JH Deputy Stephen Donnelly: The amount for the land-----

Chairman: Could the Minister for Health please provide Senator Higgins with a written reply? I do not have the time. Other members are looking to get in. They have been here since the start. I will now have to cut their time. I was going to ask questions but I cannot do that now. Three members want to come in.

Senator Colm Burke: Chair, I do not accept that I am only entitled to four minutes. I have been here since the start so I am entitled to the same number of minutes as everyone else. I ask the Minister about the title currently held by St. Vincent’s University Hospital. Do we know what title it has? I sit on a hospital board and know it has a lease, which is granted under certain terms. Does it hold a lease or a freehold interest?

Deputy Stephen Donnelly: I will write a note to the Deputy about that.

Deputy Colm Burke: We do not even know. In other words, it may be restricted on what it can grant, because of the title it already holds. Could that be the position?

Deputy Stephen Donnelly: The Deputy is asking me to speculate about the motivations behind St. Vincent’s Healthcare Group. Can I suggest that he invite it to the committee to ask it directly? I cannot speculate on its motivations-----

Deputy Colm Burke: Surely, if the Department is dealing with negotiations and the issue of getting a lease, it should know what the prior title is? What title does it currently hold?

Deputy Stephen Donnelly: My understanding is that it is freehold.

Deputy Colm Burke: Can that be clarified?

Deputy Stephen Donnelly: Like I said, I will provide the Deputy with a more detailed note.

Deputy Colm Burke: The second issue is that 42 consultants wrote in. They were concerned about the debate that should occur on how this structure is set up. Has there been a direct meeting with the representatives of those consultants, so that their concerns can also be taken on board?

Deputy Stephen Donnelly: There has been an ongoing and in-depth engagement between the Department and people right across the National Maternity Hospital, as well as all other stakeholder groups. The views of the clinical community within the National Maternity Hospi- tal are very welcome and will be accorded-----

Deputy Colm Burke: Has the Department contacted the consultants directly since they issued their statement?

Deputy Stephen Donnelly: This was a group of 42 senior clinicians. They wrote about misinformation and misunderstanding. There has not been direct contact with them but the issues they raised are understood. They were expressing a concern that statements were being made regarding religious ethos which were not backed up by the facts. They were very concerned that some of this misinformation had the potential to put at risk this project which they, along with all of us, believe is absolutely essential for women and babies in Ireland.

Deputy Colm Burke: With regard to the structure of the board, the board of the National

30 14 JULY 2021 Maternity Hospital is independent. When the hospital is established on the St. Vincent’s site, will the board be under the jurisdiction of the St. Vincent’s structure or will it be independent of it?

Deputy Stephen Donnelly: The corporate structure is such that there is a holding company, then the St. Vincent’s Healthcare Group and then the national maternity hospital. The critical point is that the national maternity hospital’s board is to have reserved powers granting it full clinical and operational independence.

Deputy Colm Burke: Why can it not be set up so that it is independent of the St. Vincent’s Healthcare Group?

Chairman: The Deputy is over time.

Deputy Colm Burke: I am asking a very clear question. Why can it not be independent of the St. Vincent’s Healthcare Group?

Chairman: The Deputy is over time.

Deputy Colm Burke: It is a simple question.

Chairman: It is a simple question but the Deputy will have to accept a written reply.

Deputy Stephen Donnelly: I am happy to revert to the Deputy in writing if that would be helpful.

Chairman: Is that okay?

Deputy Colm Burke: The Minister could answer it here. Why can the board not be independent?

Deputy Stephen Donnelly: I believe I am not being allowed to answer the question but I am more than happy to come back to the Deputy on it.

Deputy Colm Burke: I am asking the Minister to deal with the question. Why can the board not be independent of the St. Vincent’s Healthcare Group?

Chairman: We will get a written reply to that question. Senator Clifford-Lee is next.

Deputy Colm Burke: In fairness, it is a crucial question.

Chairman: In fairness, I have been very lenient with everyone. I should really be stopping the meeting at this stage but I will let in our last colleague, Senator Clifford-Lee, who has been here since the start.

Senator Lorraine Clifford-Lee: I had not indicated because I realised we had run over time. I am happy to let the Minister answer Deputy Colm Burke’s question if that is what he wants to do.

Chairman: I thank the Senator. Will the Minister reply to that last question?

Deputy Stephen Donnelly: The structure was put together in 2016 and 2017 as part of the Mulvey agreement. That is what was agreed with the national maternity hospital and the St. Vincent’s Healthcare Group. The representatives of the national maternity hospital were satisfied that this structure would work for them and provide them with the safeguards and guaran- 31 JH tees they needed.

Deputy Colm Burke: That is not the question I have asked. Concerns have been raised that the Department and the St. Vincent’s Healthcare Group will have a say and will be able to overrule the people who are working on the front line. Can this issue be looked at so that the board that is set up to run the national maternity hospital cannot be overruled by the St. Vin- cent’s Healthcare Group?

Deputy Stephen Donnelly: Under the current proposal, the board of the national maternity hospital cannot be overruled by the St. Vincent’s Healthcare Group. It is an independent board. Not only is it an independent board, but its reserved powers require it to adhere to clinical and operational standards.

Deputy Colm Burke: It will still be part of the St. Vincent’s Healthcare Group however. Can we not draw a clear line, which can be done in company law, ensuring the board’s independence and that it is not answerable to any body other than the HSE and the Department of Health? That is what I am suggesting. In other words, we now have a board that is answerable to the HSE-----

Chairman: Will the Deputy please let the Minister reply so that we can end the meeting?

Deputy Stephen Donnelly: I thank the Deputy for his question. It is very reasonable. I asked the exact same question when I was shown the corporate structure. That is the agreement that was in place in 2016 and 2017. It provided safeguards for the national maternity hospital ensuring that it would have full clinical and operational independence. This is contained with the reserved powers of the board. Behind the Deputy’s question are the questions of whether this guarantees full clinical and operational independence and whether the board has a direct relationship with the HSE. The answer to both is “Yes”. It should be remembered that the final agreement has not been reached. We will be making sure that any and all safeguards, director- ships, reserved powers and so forth that need to be in place will be in place.

Deputy Róisín Shortall: May I raise a point of order?

Chairman: We are over time.

Deputy Róisín Shortall: It is a very brief point.

Chairman: I am not allowing anyone to make a point. I am finishing the meeting. I am concerned that we are way over time. We are the health committee. I am working to guidelines from the Oireachtas. I want to end the meeting. I thank the Minister for attending here today. He said during the meeting that he was close to an agreement. We wish him well in the negotiations and we hope the issue is resolved but I need to end the meeting.

The joint committee adjourned at 11.36 a.m. until 9.30 a.m. on Wednesday, 21 July 2021.