Tuesday 28 January 2020

Don't throw baby out with the bathwater

Private faith should never dictate public healthcare, writes Group Business Editor Dearbhail McDonald

(Stock photo)
(Stock photo)

Dearbhail McDonald

Had we burned the Religious Sisters of Charity (the owners of the St Vincent's Hospital Group) at the metaphorical stake last week, it still wouldn't have been enough for some.

Last week, the anti-Catholic Twitterati were blindsided when a group of elderly nuns announced they were withdrawing from any involvement in the new National Maternity Hospital - and getting out of healthcare. In one deft move, this group of sisters stole the thunder from another group of sisters - a social media mob - by removing the bogeyman of Catholic ethos from the table.

The truth is, this maternity dispute has always been more about mammon than God.

Catholic ethos may hover like an unwelcome Holy Ghost. But ethos was never truly on the table in the lengthy and torturous negotiations to co-locate - as per the Government's national maternity strategy - the unfit-for-purpose NMH on to the site of the St Vincent's Elm Park campus. This much was clear in the nuns' comprehensive statement as well as the memorandum and articles of association of the new company that will operate the maternity hospital.

The national maternity strategy is critical for the future health and well-being of women, infants and Irish society as a whole. The NMH is one of three maternity hospitals in the capital, the others being the Rotunda and the Coombe, that are due to be co-located alongside major tertiary (i.e. specialised, consultative healthcare) hospitals. The strategy is needed to save the lives of women and babies and to ensure that expectant mothers - as well as women requiring gynaecology services - are cared for with expertise and dignity.

The NMH, led by its current Master Dr Rhona Mahony, should have moved lock, stock and barrel on to the St Vincent's campus as a stand-alone clinical legal entity.

But it was a bit more complicated than that. There was an epic battle as two of the country's 23 voluntary hospitals - which are primarily State funded but not State owned - went to war over the ownership and control of the new maternity hospital, a 44,000 sq metre behemoth to be built in the middle of the St Vincent's campus. The proposed hospital will be physically linked to St Vincent's ICU and operating theatres - an extraordinary benefit for women.

It was a struggle that required three sets of mediations to determine how the NMH - whose 114-year-old charter allows its assets to be used only for the provision of maternity care - would fit into the complex and opaque legal and financial matrix operated by St Vincent's, which is nursing a €150m debt headache due to the construction of its private hospital. As a result of those borrowings, several banks have charges over some of the lands.

Despite the new maternity hospital comprising, along with the construction of the National Children's ­Hospital, the largest investment in public healthcare in modern history, the State left it to two voluntary hospitals to slug it out, acting as if it were some indifferent third party with little interest in the outcome of the dispute. The State is the paymaster. Yet the Government, through the Department of Health and the HSE - which has a vituperative relationship with the SVHG - couldn't tell "the nuns" what to do with land or buildings the State doesn't own.

It is a toxic relationship tarnished by an unforgivable decision by the SVHG to use the public hospital as collateral for its private one. And it's a relationship that has never recovered from accusations by the HSE in late 2013 that St Vincent's broke public pay rules or the depiction in April 2015 by Tony O'Brien - then director-general of the HSE - of St Vincent's Private as having a "parasitic dependence" on the adjacent State-funded public hospital.

I hear you, ladies. It is infuriating that women have been repeatedly sacrificed at the altar of disputes between the HSE and the SVHG. And it is inconceivable that, in 2017, we still have not uncoupled religion from the provision of vital public services. But that's what we are dealing with as a result of the accidental manner in which the State's health and education services were devised over time. The ownership and control of most of our schools and up to a third of our hospitals is much maligned and a two-finger salute to the concept of the separation of Church and State.

But, let's be honest, it's a conceit with which we collude every day of the week when we marry in their churches and bury our dead in their graveyards.

The conceit of that much- fabled Middle Ireland is worse - you don't hear the well-to -do giving out about ethos when they're trying to get little Johnny or Mary into their private Catholic schools, do you?

Despite much of the malevolence that emerged from the Catholic Church, it's all too easy to forget that our social care system sprang from acts of benevolence by religious orders.

Such is our ignorance of the gargantuan task ahead to decouple Church and State, we can't find it in our hearts to give credit to the Sisters of Charity for making a significant decision that will benefit Irish women for generations to come. The NMH/Vincent's debacle is the first real test of the separation of the Church from State-funded services. It won't be the last.

And, believe it or not, it could have been a lot worse.

Had the Sisters of Charity been hell-bent on locking Catholic ethos down in perpetuity, they could have transferred their freehold interest in the lands to the Vatican. That truly terrifying option, the wholesale transfer of freehold interest in religious- owned lands and buildings to Rome to protect ethos has, I understand, been considered by a number of orders.

The NMH row raises fundamental questions about how we fund and operate our health system. In the fury, there have been calls for public ownership of all hospitals and the abolition of voluntary hospitals which- unlike State owned and operated ones - are legally required to comply with company law and governance standards.

Should all hospitals be owned by the HSE with its, at times, deplorable record? Could we afford it? Are we really saying all public investment in healthcare should be ceased if it is Catholic owned or maintained - in which case, the Mater's new trauma centre could not proceed?

Private faith should never ever dictate public healthcare. But do we really need to throw the voluntary baby out with the religious bathwater?

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