Of two national obsessions, the political agitation concerning the new site of the National Maternity Hospital continues to focus on the one that is no longer relevant. The project’s legal framework documents published by the HSE this week show that the last stretch of negotiations has been about property interests – not the social influence of clerics.

The previous time any tangible information about the transfer of the National Maternity Hospital to a new building on the campus of St Vincent’s Hospital came to light was last July. At that point, the Religious Sisters of Charity had already committed to transferring ownership of St Vincent’s Healthcare Group to a new, independent charity, St Vincent’s Holdings, after which all ties with their order and references to the Catholic ethos would be removed.

This has now happened. Last week, the Religious Sisters of Charity announced that they had handed over St Vincent’s Healthcare Group to St Vincent’s Holdings and “will have no role in the future of the new independent Charity, the St Vincent’s Healthcare Group, St Vincent’s Holding CLG or the new National Maternity Hospital”.

This was confirmed in the new constitution adopted by St Vincent’s Healthcare Group on April 22 and largely absent from public discussion since, despite the core changes it has made to the hospital’s ethos. This entire section has been removed: “The Mission of St Vincent’s University Hospital, St Michael’s Hospital and St Vincent’s Private Hospital is that of the Religious Sisters of Charity, that is to bring the healing love of Christ to the sick and poor in the spirit of their Foundress Mary Aikenhead and in keeping with the mission of the Catholic Church.” St Vincent’s Healthcare Group is also no longer bound by the “Health Care Philosophy and Ethical Code of the Religious Sisters of Charity”.

St Vincent’s new constitution acknowledges its religious heritage in two places. Its preamble introduces “St Vincent’s Hospital, the first hospital of the St Vincent’s Healthcare Group, founded by Mary Aikenhead as part of her mission to provide Service to the Poor. It was funded by a fellow Sister’s dowry, was established in a house on St Stephen’s Green in 1834.” In addition, the provision of “pastoral care services” is included in its main objects, which are centred on delivering healthcare “in compliance with national and international best practice guidelines on medical ethics, and the laws of Ireland”.

There are no other religious references in the St Vincent Group’s constitution, nor in that of its parent, the non-profit St Vincent’s Holdings established in 2020. This new, charitable ultimate owner for the group has an objective phrased in the same medical-centred terms and its board may elect new members only among candidates nominated by at least two of the following bodies:

  • Chartered Accountants Ireland;
  • The Royal College of Physicians in Ireland;
  • The Royal College of Surgeons in Ireland;
  • St Vincent’s Healthcare Group;
  • University College Dublin.

The current member-directors of St Vincent’s Holdings are medical doctors and former St Vincent’s Healthcare Group directors Michael Keane and David Brophy, and pharmacist Sharon McCabe. The company’s secretary is St Vincent’s group finance director Neil Parkinson.

For all the fears of Vatican and Canon Law influence, there are no apparent provisions making this possible in the legal documents establishing the new ownership structure for St Vincent’s Healthcare Group. 

Then there is the constitution of the future company to be established as a subsidiary of St Vincent’s Healthcare Group to operate the new maternity hospital. It is to be called the National Maternity Hospital at Elm Park DAC and its draft constitution published this week states: 

“3.1 The principal object for which the Company is established is the promotion of health, in particular by the provision of all clinically appropriate and legally permissible healthcare services, including research, by a maternity, gynaecology, obstetrics and neonatal hospital, and a range of related health services in the community.

“3.2 The services referred to in clause 3.1 shall be carried out in accordance with the clinical and other governance arrangements set out in or adopted pursuant to this Memorandum and Articles of Association, without religious ethos or ethnic or other distinction.”

The requirement to operate “without religious ethos” is mentioned six times in the document, including twice in the list of “reserved powers” governing the “independent operation” of the new maternity hospital. The minister for health’s consent is required specifically to amend any of these reserved powers, and the constitution of the company in general, thanks to a golden share.

Under a separate lease for the site of the new maternity hospital, St Vincent’s Healthcare Group is to permit its use “as a public hospital primarily for the provision of all clinically appropriate and legally permissible healthcare services, including research, by a maternity, gynaecology, obstetrics and neonatal hospital, and a range of related health services in the community and any other public healthcare service or services”.

Asked about the “clinically appropriate” restriction, Taoiseach Micheál Martin told the Dáil those words “were imposed by the HSE in the legal document to make sure it would not be a cardiology hospital, a neurology hospital or whatever else. That is all that means”. Unless the Taoiseach bare-facedly lied to the Oireachtas, this only restriction is not a back door for mercenary medics planted by the Vatican to prevent abortions.

Finally, under the operating licence granted by the HSE for the use of the state-owned New Maternity Hospital (NMH) building on St Vincent-owned land, all parties agree “to preserve the clinical and operational independence of the NMH in the provision of NMH Health Services in the NMH Areas, including strategic planning in relation to the development of such services in the future in accordance with developing best practice, free from interference from any party”.

All these provisions boil down to a set of connected documents from which the risk of religious influence on the services available from the new maternity hospital has been consistently removed, in line with the commitments made public last July.

Hospitals are corporations in their own right

The Currency’s coverage at the time framed the ongoing negotiations as a typical mergers-and-acquisitions scenario and highlighted the various corporate interests at play. While many politicians insist on painting the situation as an arm-wrestling match between the Religious Sisters of Charity and the State, they ignore the reality that St Vincent’s Healthcare Group and the existing National Maternity Hospital are sizable corporations in their own right, with their own turf to defend (although the National Maternity Hospital was never formally incorporated). 

The quid-pro-quo agreed with the National Maternity Hospital’s existing charitable trust was that its maternity operation would be acquired by a new subsidiary of St Vincent’s Healthcare Group and its Holles St property sold by the HSE to pay for the new building. In exchange, the new hospital will retain three major symbols of its proud history:

  • Its name;
  • The continuation of the trust, with equal powers to appoint directors to the new maternity hospital’s board; and
  • The mastership model, under which it appoints a recognised clinician as the top executive running the hospital.

This doesn’t mean there haven’t been vocal advocates of the existing National Maternity Hospital and its interests, such as its former master Peter Boylan.

As reported last year, beyond the broad outline agreed through the mediation of Kieran Mulvey in 2016, the parties to the negotiation were still looking to advance certain additional points before the final deal was sealed. Tánaiste Leo Varadkar expressed those sought by the Government at the time: He wanted to appoint directors to the board of the new maternity hospital, and to secure its site for longer than the 99-year lease proposed at that point.

The State has won on both counts. The term of the draft lease has been extended to 299 years (with annual rent set at just €10 for as long as the property is run as a public maternity hospital) and the minister for health now has the right to appoint directors through the Public Appointments Service. 

While the proposal one year ago was that National Maternity Hospital at Elm Park DAC would have four directors appointed by each of the existing National Maternity Hospital trust and St Vincent’s Healthcare Group, this has now changed to three appointments by each and three by the minister.

The quid-pro-quo to extract this double concession from St Vincent’s Healthcare Group has been the protection of its property asset.

The quid-pro-quo to extract this double concession from St Vincent’s Healthcare Group has been the protection of its property asset. The integrity of its south Dublin campus has been a major red line for St Vincent’s through years of negotiations, acknowledged in public documents through the phrase “that future campus development would not be disadvantaged”.

Property has been at the core of St Vincent’s success as a voluntary hospital through the generations. As noted above, all religious references to its foundation by the Sisters of Charity have been removed from the group’s constitution, but the crucial dowry that funded the purchase of the hospital’s first premises on St Stephen’s Green remains acknowledged.

It was also a hard-nosed property play that allowed St Vincent’s to secure its current campus a century later, and patiently build its current hospital in what has since become a densely populated suburb, while selling out of a highly valuable St Stephen’s Green.

As previously reported, land was again the resource that allowed St Vincent’s Private Hospital to conduct a full-scale redevelopment in the middle of a financial crisis in 2010. Not only did the Elm Park campus provide space to erect and demolish buildings in sequence – the group also mortgaged the entire underlying property to borrow from banks and tax-incentivised investors until 2024, causing frictions with the HSE over publicly-funding buildings on the site.

As a nearly 200-year-old organisation, the time horizon applicable to St Vincent’s extends beyond the life of any building. Whether it leases the site of the new maternity hospital to the HSE for 99 years or 299 years, it doesn’t make much difference – either way, the building will be obsolete before the lease is up. In the meantime, keeping the property in one block, including this central chunk, is essential to its owner for two reasons.

NMH site map

Firstly, St Vincent’s Healthcare Group has reserved the right to mortgage the property. This cannot happen for 30 years, or 20 years from the construction of the new maternity hospital building, whichever comes first. Under the draft lease, however, after that period elapses (or even before construction starts), St Vincent’s is fully entitled to borrow against its property, including the land under the new maternity hospital. 

The lease recognises the fact that this is already the case for the debt raised in 2010 on the occasion of the redevelopment of the private hospital: “The Tenant acknowledges that the Landlord has created security over its interest in the Premises and on the date of this Lease has furnished consent of its lender to the creation of this Lease.”

St Vincent’s property portfolio, which is mostly made up of the Elm Park campus, was valued at €220 million by Cushman and Wakefield at the end of 2017. It is probably worth a lot more now, but would be a lot less with a state-owned hole right in the middle. That’s a lot of borrowing power the hospital was never going to relinquish by transferring outright ownership of the new maternity hospital site.

This makes any discussion of a compulsory purchase order on this site irrelevant. The co-location of the new maternity is intended as a tight-knit collaboration with St Vincent’s. A CPO would mean war – the HSE would have a site, but no existing hospital to collaborate with at this location, which was the whole point of choosing it in the first place.

The only circumstances under which the HSE could acquire the site according to the current draft documents would be St Vincent’s insolvency, or its failure to resolve a major breach of the land lease or the operating licence for the new building.

Secondly, when – not if – the hospitals co-located on the Elm Park campus by St Vincent’s and by the new public maternity become too old to be fit for purpose, St Vincent’s Healthcare Group will depend on the sale of the property to finance the acquisition of a new home. At that point in the future, both the State and the group will be happy to terminate the lease and move on.

Anyone reading this today will be dead, but so are those who decided to acquire the Elm Park site almost a century ago. This is simply the timescale to be considered when planning hospitals. As an organisation twice as old as the State, St Vincent’s understands it very well.