Revealed: Nuns obstruct major maternity hospital plans
Holles Street move to St Vincent's is under threat
Major implications for maternity services as proposed co-location is hit by merger dispute
Plans to co-locate the National Maternity Hospital on the site of St Vincent's University Hospital in Dublin have all but collapsed over a merger dispute, with major implications for maternity and neonatal services in Ireland.
The design for the co-located National Maternity Hospital on the St Vincent's Hospital Group Campus at Elm Park, first mooted in 1998 - and formally announced in May 2013 - is ready for submission to An Bord Pleanala.
However, St Vincent's is insisting that the Holles Street National Maternity Hospital - the largest maternity hospital in Ireland, which last year delivered almost 9,500 babies - must dissolve as a legal and clinical entity and come under its governance structures.
The National Maternity Hospital, which describes its current hospital as "antiquated, undersized and unsuitable for modern obstetric and neonatal practice", says that proposed governance requirements set down by the St Vincent's Hospital Group (SVHG) will place all services, including tertiary maternity and neonatal services at National Maternity Hospital, under the complete control of the St Vincent's board and shareholders, the Religious Sisters of Charity.
"SVHG demands that the governors of the National Maternity Hospital dispose of the board in exchange for being allowed to operate as a branch of SVHG, transferring the operation of National Maternity Hospital to SVHG, the elimination of the National Maternity Hospital as an independent entity and the elimination of decision-making capacity at senior clinical and corporate level, creating unacceptable clinical risk," said the National Maternity Hospital in a statement last night.
SVHG, whose mission of care is built around the philosophy and code of ethics of the Sisters of Charity, said that the agreement to accommodate the maternity hospital was always predicated on the recommendations of the Independent Review of Maternity and Gynaecology Services in the Greater Dublin Area (GDA), which was undertaken by KPMG for the HSE and was published in August 2008.
"Key amongst these was a recommendation that the co-located hospitals would operate under a single system of clinical and corporate governance for the campus," said a spokesperson for the group.
However, the National Maternity Hospital said that all parties, including the hospital, SVHG, the HSE and the Department of Health - which have been engaged in extensive mediation to resolve the dispute - explicitly agreed that the 2008 KPMG report was superseded by other reports and by the recent National Maternity Strategy.
The strategy and government policy state that the three stand-alone Dublin maternity hospitals - the National Maternity Hospital, the Rotunda and the Coombe, should be co-located with tertiary acute adult hospitals.
Critically, the strategy endorses the current Mastership system, which consists of an executive team, including a Chief Financial Officer, Clinical Director, Director of Nursing and Midwifery, as well as a lead obstretician.
Under the St Vincent's Hospital Group proposal, the role of Master (currently occupied by Dr Rhona Mahony) would be replaced by a single clinical director reporting to a CEO appointed by it.
SVHG says that the question of campus governance is the "only disagreement of significance" between it and the NMH.
However, it insists that it cannot operate a large healthcare campus with "competing systems" of clinical and corporate governance.
It says this is a stance that reflects the consistent views of directors, management and consultants at St Vincent's, adding that the medical services it provides are in accordance with the law and "not affected by the views of our shareholders".
The NMH says it remains hopeful that the proposal can proceed.