Opinion Sarah Carey

Monday 21 October 2019

Maternity hospital row should be over money - not the politics of fertility

The petty squabbles and vengeance against nuns are just distractions, argues Sarah Carey. The real issue is about hospital ownership

Independence: Master of Holles Street Rhona Mahony Photo: Anthony Woods
Independence: Master of Holles Street Rhona Mahony Photo: Anthony Woods

One mention of nuns and everyone loses the head. The idea of a maternity hospital built by the State but owned by a religious order, threw many into apoplexy this week.

Most objectors didn't seem to know that the National Maternity Hospital (aka Holles Street) has never been owned by the State either. It's another "voluntary hospital" owned by a private trust whose chair is the Archbishop of Dublin.

Despite this, its "Master" - the clinical head - functions completely independently and all manner of procedures, from legal abortions to sterilisations, are carried out without any interference from anyone.

In fact the Archbishop long ago said it was inappropriate for him to attend meetings. He leaves his official duties to the Deputy-Chair. In other words, the on-the-ground reality today is that despite the legacy of church involvement in this peculiar system of Voluntary Hospital ownership, there is no evidence that priests or nuns have any interest in telling doctors how to practice medicine.

In fact, when you talk to women about their poor experience of childbirth in the last 30 years, you won't hear a word about nuns. The bad boys in the politics of childbirth in recent decades have been "The Boys": the men who formed the elite of obstetric practice. They never liked anyone telling them what to do; least of all women. The Labour Ward Management system - while revolutionary in its day - medicalised childbirth robbing women of their agency and leaving them mentally traumatised and in their view, unnecessarily physically injured.

The worst case of all was the famous Dr Michael Neary in our Lady of Lourdes Hospital in Drogheda. When midwives complained about his unusually high rate of emergency hysterectomies, he was able to rely on his male obstetric colleagues to back him up. He was eventually found out, but his buddies weren't much help to a lot of young women who lost their wombs to a man who told them he'd saved their lives.

In fact, when people complained to the nuns who ran the hospital about his practice they refused to hear a word against him. In Drogheda, Neary was God.

So I'm not as willing as others to defer to smooth-talking patronising men who seem convinced it is they, and not us, who create life. If I was sick, I'd want those doctors. But I wasn't; so I stuck with midwives and was extraordinarily happy with them.

I'm relieved to see that in the past 10 years a generation of women obstetricians has emerged - women who've had babies themselves. I'd trust them a lot more than the men, many of whom got rich "controlling women's bodies"; the crime for which a few old nuns currently stand accused.

I did note Peter Boylan's claim that vasectomies and sterilisations aren't carried out in St Vincent's now. I asked the hospital about this and they said no particular procedures are prohibited. That might be "official" talk but I pressed further.

The lads have plenty of places to go for an elective snip, and a maternity hospital isn't one of them so I don't need to worry about them. For women, I was told the gynaecology department works in cooperation with Holles Street already with the same surgeons operating out of both. It might well be the case that the sterilisations are in practice just done in Holles Street.

Even if that is how it works, we need to remember that this new maternity hospital isn't St Vincent's. It's an independent entity and the current Master of Holles Street Rhona Mahony has insisted on national radio that she is happy she has full clinical independence.

Having looked at the new governance structure, I believe her and note that in many respects it's actually a vast improvement on the old Holles Street charter that had the Archbishop in charge; even if he made himself informally redundant. Therefore I haven't the slightest fear that the new structure presents any risk as to how women will be treated.

The other objection to the governance of the new maternity hospital is that, leaving aside the politics of fertility, the Sisters of Charity haven't honoured their legal or moral obligation to pay redress to the residents of the various homes they ran in our dark and damaging past.

Defending nuns is a dangerous business, but I've always had a problem with the stereotype of the sadistic nun. It serves a convenient purpose. I've read some of the reports into these awful places like Magdalene Laundries and Mother and Baby Homes.

What always strikes me is that the story of institutional neglect is not one that the government discovered to its shock 10 or 15 years ago.

The State knew what was going on all the time. They knew because they sent out inspectors who faithfully sent in their reports. Bessborough Mother and Baby Home had to have been one of the worst. In 1939 the inspector reported a 47pc infant death rate. The babies were in a dreadful condition: sores and green diarrhoea. Caring for babies is easy. Keep them warm and clean and fed. It's beyond my comprehension how any woman could allow children to suffer like that. But it was in the report.

In the same year - 1939 - Ms Alice Litster, the inspector for boarded-out children in the Department of Local Government and Public Health, said: "The chance of survival of an illegitimate infant born in the slums and placed with a foster-mother in the slums a few days after birth is greater than that of an infant born in one of our special homes for unmarried mothers."

She went on.

"I have grave doubts of the wisdom of continuing to urge Boards of Health and Public Assistance to send patients to the special homes so long as no attempt is made to explore the causes of the abnormally high death rate. We cannot prevent the birth of these infants. We should be able to prevent their death."

To repeat: that was in 1939. Not 2017. The State knew. So as far as I'm concerned, there is a very strong case that it is right and proper that the greatest obligation to make redress to the people who suffered in them, should be the State. Furthermore, as Enda Kenny pointed out, it is absolutely clear that the chief clients of these premises were the families who hopped their daughters into them with the express intention that the child would disappear, never to be mentioned again.

And let's remember too that the Mother and Baby Homes were only the half of it. Prod an elderly person and wait for the stories to tumble out of the babies that were privately swapped between families, or stealthily disappeared.

Sure remember the Kerry Babies? Two babies disposed of: in relatively recent times.

Without doubt, we can attribute the shame and stigma of unwanted babies on the Church. But the people were active and willing participants in the system. It involved doctors, social workers, nurses in hospitals and the families. The religious orders can take their part in the blame, but ask your parents what they knew and what they did when all this was going on. Said nothing? Never spoke of her or that baby again?

What happened will take generations to heal, but I'm not pawning it off on a comic strip villain in the form of a wizened old nun. It's too easy. Way too easy.

Having said all that, nothing changes the fact that - developments over the weekend notwithstanding - the State is about to spend €300m on a hospital it won't own. This for me is the real issue and one that's been largely lost in the shrill paranoia over fertility politics and vengeance seeking.

It's becoming a cliche but this really is a legacy issue. Since the foundation of the State, governments willingly outsourced health and education to religious orders. To be fair, much of the work done by them was outstanding for its time, particularly given the poverty of the country.

But it meant that we paid teachers but never owned the schools. We built the hospitals and paid the nurses, but never owned them. This policy was driven principally by parsimony but also respect for the management expertise of the Orders.

Don't people keep telling us how clean the hospitals were when the nuns were in charge?

In the case of schools we fully understand now the problems that solution created. Even though the National School system has great advantages, the religious problem grows with our diversity. But we can't show up and kick out the priests because they own the schools. Buying them is unaffordable. No one - apart from a few zealots - has the appetite for a row. So we're stuck.

So it is with the many hospitals owned by religious orders via this "Voluntary" system. The State continually digs deeper by investing in buildings they won't own. For example, the government spent €266m at the Mater in the last 10 years, owned by the Sisters of Mercy. They spent €29m on the Nutley Wing at St Vincent's and the National Rehabilitation Hospital is currently getting huge investment.

None of those projects raised an eyebrow because regular medicine lacks the emotive power of fertility and religion. But the bottom line is just the same.

I think it's mad that the government would spend money on buildings they won't own. At what point should they change the system and demand ownership? Was the construction of this new maternity hospital an opportunity to draw a proverbial line in the sand?

It could have been, but I understand the problem Health Minister Simon Harris had.

Both the NMH and St Vincent's are not owned by the State. The single biggest problem was the turf war they had with each other over governance.

The new hospital isn't on a stand-alone site in a corner of the St Vincent's campus. It's actually a massive extension of an existing building and they'll be joined by a corridor for easy transfer of patients. With all the rows over governance, inserting a conveyancing issue into it would delay everything.

They were getting the site for free, and Harris insisted on a golden share. This means the hospital cannot be used for any other purpose other than maternity and he actually has significant power. It was pragmatism.

Boring, dull, practical, compromises to try and get the bloody thing built. I get it.

Nevertheless it's frustrating that technically, the Sisters of Charity, who are paid a rental fee by St. Vincent's HealthCare Group for their land, receive an income out of all this. Right now they get €1.2m a year which they say they invest in their charitable activities. It doesn't sit right with people.

That aspect is a problem which time will solve. The nuns are literally dying off. Both the Sisters of Charity, and say the Bons Secours orders (who get a cool €3m rent for their land) consist principally of a few dozen elderly ladies in nursing homes. What happens when they die?

They'll probably sell to a bunch of businessmen, or an investment house, or perhaps a trust will continue to run the hospital groups making money for more (men) like lawyers, investment managers and property managers.

It's all wrong. Perhaps a good result from this row is a realisation that this hybrid system of voluntary ownership must be wound down.

But how is that to be done? How long will it take? Are we willing to buy them out or force some kind of nationalisation? That's a conversation we need to have, but in the meantime we need a maternity hospital. So build it and then talk without anyone losing the head.

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