Tuesday 27 September 2016

Irish women cannot be sacrificed as maternity hospital plans collapse

Published 26/04/2016 | 02:30

Dr Rhona Mahoney is currently Master of Holles St, but under the St Vincent’s plan, Holles St would devolve not just clinical control, but also control of resources, including staff and funding. Photo: Gareth Chaney, Collins
Dr Rhona Mahoney is currently Master of Holles St, but under the St Vincent’s plan, Holles St would devolve not just clinical control, but also control of resources, including staff and funding. Photo: Gareth Chaney, Collins

Inside the beautifully maintained, Georgian-era Provost's House at Trinity College Dublin, a bunch of mostly middle-aged men are fighting over plans to form a Government.

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The tiresome theatrics unfolding at No 1 Grafton Street is the political equivalent of watching two bald men fighting over a comb, such is the dearth of difference - despite all the tribalism and testosterone-induced struts - between the former civil war rivals.

Meanwhile, in Holles Street, home to the National Maternity Hospital (NMH), the busiest maternity hospital in Ireland - and one of Europe's busiest - women are giving birth to babies in cramped, inadequate buildings, parts of which date back to the 1700s and all of which lack the palladian glamour of No 1 Grafton Street.

As our Cabinet-in-waiting huffs and puffs over the bungled delivery of Irish Water, the proverbial house is blowing down on the future health, safety, autonomy and dignity of women in Ireland.

The collapse in all but name of plans to co-locate Holles Street on the grounds of St Vincent's Campus in South Dublin is not just staggering.

It is sickening.

First mooted as far back as 1998 and formally announced by the Government three years ago, the re-location of Holles Street to St Vincent's marked one of the most positive developments for the healthcare of women, expectant mothers and their newborns.

Under the plan, a new state-of-the-art, custom-built maternity hospital, with features including a single room for every woman - regardless of whether she is a public or private patient - would be co-located beside St Vincent's, one of the capital's major acute adult hospitals.

The project will be entirely exchequer funded, with some €150m already approved in the HSE's Capital Plan to allow the project to proceed.

The ailing infrastructure at Holles St, which last year handled almost 9,500 births and sees the transfer of some 80 women a year to St Vincent's, is not fit for purpose.

It would take a least €25m in short-term capital funding to keep the NMH in situ on Holles Street.

This runs contrary to the Government's recently published National Maternity Strategy, which wants all of Dublin's maternity hospitals - Holles Street, the Coombe and the Rotunda - co-located with acute adult hospitals to enhance the safety of women and children as they will be treated in close proximity to specialist services which they may need to access.

Co-location also allows for cost reductions as services ranging from catering and cleaning, to laboratory, pathology and diagnostic facilities - as well as consultants and other clinical staff who already work seamlessly across both campuses - are shared.

So, what has gone so catastrophically wrong with the birth of a new era for women's healthcare? The Holles Street/St Vincent's merger has stalled, ostensibly, over a row over corporate and clinical governance.

But is it really a question of governance or control?

Why can't two legal entities, sharing resources and world-class expertise, exist on the same site?

The board of the St Vincent's Hospital Group (SVHG), whose main shareholders are the Roman Catholic Sisters of Charity, says that the NMH cannot transfer over to its Elm Park campus unless it dissolves as a legal and clinical entity and come under its governance structures, ie, under its control.

This was never on the cards when the plan was first mooted in 1998 and only surfaced as a key issue around 18 months ago.

For its part, St Vincent's says that it cannot operate a large healthcare campus with "competing systems" of clinical and corporate governance.

However, Holles Street, which operates under the 250-year-old mastership system, says that it was never envisaged that complete control would be surrendered to a limited company (owned by nuns).

Neither did the Government.

As part of the recent National Maternity Strategy, the State endorses the 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 obstetrician - to deliver the best clinical outcomes for women and babies.

Holles Street says it cannot devolve control of clinical decision making. It's hard to disagree: if the many maternity scandals of recent decades have proved anything, it is that robust, independent governance is the best protection for birthing women.

Under the St Vincent's plan, Holles Street would devolve not just clinical control, but also control of resources, including staff and funding, to the St Vincent's Group, which has been at odds with the Government after the head of the HSE claimed last year before the Public Accounts Committee that St Vincent's Private Hospital facility had "a parasitic dependence" on the adjacent State-funded public hospital.

I suspect that it may be commercial control and pressures that is driving this drama to deadlock. But the underlying ethos of St Vincent's main shareholders complicates matters.

It is salient to note that the two main prospects for co-location of maternity hospitals with acute adult ones in the capital - St Vincent's and the Mater - are located on lands owned by religious orders. St Vincent's and other Catholic-maintained hospitals, insist they provide medical services in accordance with law, which they no doubt do.

But a woman can't receive a tubal ligation (sterilisation by sealing of her fallopian tubes) at St Vincent's.

And if 2013's difficult birth of the Protection of Life During Pregnancy Act is anything to go by, the Catholic Church is unlikely to support the development of IVF technologies and fertility treatments, including surrogacy and egg freezing - not to mention stem cell research or transgender reassignment - on their sites.

Such is the complex relationship between Church and State in matters of health and education, matters such as money and ethos will be difficult to resolve.

But our women and their sisters and daughters who will give birth to subsequent generations cannot be sacrificed at the altar of corporate governance or Catholic ethos when the State maintains the public health services on their lands.

If the Holles Street/St Vincent's merger collapses, it will condemn Irish women to another century of unacceptable conditions in childbirth, a barbaric insult to those who gave birth to this Republic.

Irish Independent

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