Why should religious order wield more power in hospitals than Minister for Health?
The battle between St Vincent’s Healthcare Group (SVHG) and the National Maternity Hospital (NMH) boils down to one thing: should a religious order have ultimate control over the State’s maternity services?
The State funds St Vincent’s Hospital to the tune of more than €200m a year, yet despite this mammoth sum an order of nuns wields more power at the hospital than the Minister for Health.
Contrary to the recommendations of the National Maternity Strategy and the express wishes of acting Minister for Health Leo Varadkar, the Masters of all three maternity hospitals in Dublin and the Chairman of the Institute of Obstetricians and Gynaecologists of Ireland, SVHG is refusing to allow the construction of a new €150m maternity hospital on its Elm Park campus unless it controls corporate governance at the facility.
Why might this be problematic? The sole shareholders of SVHG, with fixed assets of €531m, are the Religious Sisters of Charity, while its primary mission statement is “to bring the healing love of Christ to all we serve”.
Now, this is a perfectly fine sentiment for a religious institution to espouse, but what place does it have in a State maternity hospital where medical decisions must be based on clinical need and not religious ethos?
With wide support for a broadening of access to abortion services in the future, and legislation regulating IVF and surrogacy coming down the tracks, the prospect of a religious order being responsible for maternity services should ring loud alarm bells.
Dr Peter Boylan, the chairman of the Institute of Obstetricians and Gynaecologists of Ireland, has explicitly said his professional organisation has deep concerns about the Sisters of Charity exerting any control over maternity services.
“Catholic-controlled hospitals around the world forbid the provision of modern contraceptive services, IVF, sterilisation operations, and gender-reassignment surgery. We also have concerns in this respect about the implementation of the Protection of Life in Pregnancy Act,” he said.
In response, SVHG has derided these claims as “sensationalist” and insisted its proposal would ensure the NMH had full “clinical autonomy” and independent control over human resources and finance.
However, if this is the case, why is it so determined that the NMH must dissolve its own board and agree to cede control for corporate governance to SVHG before the project can proceed? Its demand is unprecedented, given St James’s Hospital made no such stipulation when a new National Children’s Hospital was proposed for its site.
For its part, the NMH is clear the demands of SVHG amount to “no less than a complete takeover of NMH by the Religious Sisters of Charity”, who, it should be noted, have no track record of providing maternity services.
The request is also audacious given the director general of the HSE, Tony O’Brien, last year told the Public Accounts Committee there were “serious outstanding issues concerning overall governance arrangements” in SVHG which necessitated an audit by forensic accountants.
Meanwhile, as the battle between SVHG and the NMH continues to rage with no end in sight, the only assured losers will be pregnant women and babies in Ireland.
Speaking recently, the Master of the NMH, Rhona Mahony, said the nation’s maternity hospitals were “falling down” and “not fit for purpose”. She wasn’t exaggerating.
A Hiqa report in October 2015 was scathing about the Dickensian conditions endured by women giving birth in the Holles Street hospital, which first opened its doors in 1894 and the architecture hasn’t changed much since.
Despite the fact that nearly 10,000 babies are born in the hospital every year, there are just 10 delivery rooms, with five of these linked so that access to one delivery room is via the two delivery rooms on either side. This transforms delivery rooms “into a thoroughfare for staff, visitors and waste and cleaning supply transportation”.
Inspectors also documented serious overcrowding in the neonatal intensive care unit, where 46 babies were being cared for in a unit designed to accommodate just 36 infants.
The report raised concerns about the “risk of cross-infection spread” to vulnerable newborns in the overcrowded unit while inspectors also observed a baby cot partially obstructing a fire exit.
Elsewhere, inspectors found a patient bed located in a lobby used to store cleaning supplies, operating theatre trolleys stored on ward corridors, large waste containers stored in stairwells and insufficient space and inadequate facilities everywhere they looked.
“This infrastructure does not facilitate patients’ dignity, confidentiality or privacy and does not facilitate effective infection prevention and control,” it concluded. Amazingly, despite these shameful conditions, clinical outcomes at the hospital are good, but the construction of a new national maternity hospital is clearly essential to safeguard the health and welfare of women and babies. According to SVHG, a core value, which “permeates every aspect of the life and work of [its] service”, is “concern for others”.
Perhaps a representative can explain how its obsession with wresting control of corporate governance from the NMH exemplifies concern for women and babies who urgently need a safe and modern new hospital.
As the war of words between the two hospital groups becomes increasingly bitter, the inability of the Minister for Health to do more than merely wring his hands and appeal for a compromise is a further indictment of the health system.
Evolution of the country’s health services, in line with international best practice, should not be stymied by the unreasonable demands of a private company that is utterly dependent on the State for its continued existence.
Religious orders did the State some service in setting up hospitals in centuries gone by, but in 21st century Ireland it is the State that should control healthcare services, not religious institutions.
Given the State awards these groups hundreds of millions in current and capital funding, the Minister for Health, at the very least, should have some say in the organisation of services and their provision into the future.
Ultimately, the provision of safe maternity and neonatal services is the responsibility of the State and not voluntary hospital groups.
Consequently, it’s time for the Minister to act as more than a concerned bystander and intervene in this row to represent the interests of women and babies.