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Politicians were last week briefed by the Irish Department of Health to the effect that the construction costs of the projected National Maternity Hospital are expected to reach €800 million — and it appears that neither the land nor the management of the hospital will be under the control of the State. The project has been controversial from the outset, with issues of its location, cost and religious institutional management and now conflicting narratives on discussions of ownership of the land have appeared between the Government and the religious bodies involved.
It is precisely concerns over governance arrangements at the hospital, linked to ownership of the site, which have stalled progress on construction over the years, while projections of costs have grown from the original €150 million. The most recent estimate was around €350 million but on Friday, a spokesperson for Minister of Health Stephen Donnely said: “The building infrastructure cost has been priced at €500 million. Further commissioning costs, including fit-out and transferring an entire hospital to a new site, will be a further €300 million.”
The Religious Sisters of Charity, which order owns the land, is transferring it to the newly-created private charity St Vincent’s Holding CLG, which will then lease it to the State for 99 years. The directors and members of this new private charity are the shareholders of St Vincent’s Healthcare Group, of which in turn the Sisters of Charity are the sole shareholders.
According to a report in the Irish Times, politicians were told on Thursday that several attempts had been made to purchase the site but this was contradicted by the religious institutions.
The Religious Sisters of Charity said it had “never at any point been contacted by Government or the State to discuss purchasing the site”, while SVHG – on whose campus the new hospital is to be located – said in a statement: “At no stage was any proposal or approach to sell the land, meaningful or otherwise, received or considered by the board of SVHG.”
While the text of a letter in 2017 from the St. Vincent’s Group may appear at one reading to contradict their later statement, another reading may see it as purely forestalling any attempt to purchase the site from them. The text, shown to the Irish Times presumably by Government sources reads: “This is why SVHG cannot countenance any sale or lease of part of the land on site, or any separate ownership of a hospital on site”.
The versions of the Government and of the religious institutions contradict one another and which is correct remains to be ascertained. What is certain however is that the religious institutions wish to control the site and at least influence governance, while at the same time it is the taxpayer who will fund the construction and the running costs of the hospital.
Asked on Saturday if the site might have to be abandoned for the hospital, the Tánaiste Leo Varadkar said: “Of course there is that risk, that’s the reality of the situation.” He added: “This hospital has to be publicly owned and it has to be the case that any obstetric or gynaecological service that’s legal in the State has to be available in that hospital.”
Earlier, the Taoiseach (Prime Minister of Irish government) Mícheál Martin told RTÉ, the national TV network: “But there’s a very basic point in terms of the taxpayer, and I think into the future we’re in a new era, when the State is building new hospitals and paying the full total of the costs, the State should own the facility.”
UNHEALTHY SERVICE IN THE IRISH STATE
The Irish State has never had a comprehensive public health service, unlike the rest of Europe. When the State was created in 1921, there were a number of health care institutions run by the Catholic Church and the State integrated them into the state-funded service, leaving them under religious institutional management but providing them funding through the state’s health care budget. And so it continued to this day.
This means not only that the public taxes of residents of the Irish state are funding private health care but that those institutions are not answerable to the public in terms of policy on what they consider moral issues – in other words Catholic Church ideology. Hence it is not known at the moment whether the new proposed National Maternity Hospital will provide a service within the terms of what is legally permitted in the Irish state such as voluntary sterilisation, gender adjustment or IV fertilisation. Or pregnancy termination along the lines of what is agreed and desired by the majority of the citizens in the State, as shown in public opinion polls and the 2018 Referendum on Abortion.
In addition, private health centres compete with public services for funding and for staff.
The controversy around the governance and construction costs of the National Maternity Hospital is not alone since there is also another with regard to the projected National Children’s Hospital siting and construction costs, with BAM company claims against the National Paediatric Hospital Development Board (NPHDB) totalling €300 million. The original construction cost estimate was €1.74 but some projections now are estimating an excess of €2 billion — and completion not until 2024.
Since construction companies in the Irish state are all private capitalist companies, these problems of course end up in the profits of the companies and a loss to the common taxpayers.
INCREASED HEALTH FUNDING – FOR WHOM?
The Tánaiste (Ireland’s Deputy Prime Minister) Leo Varadkar has stated that the funding of the State for the Health Service which was increased to deal with the Covid19 pandemic is not to be cut when the pandemic is over but will be kept at €22 billion. If the projected costs of the maternity hospital construction works of €800 million are going to come out of that (without any estimate on site purchase cost), it would leave only €21.2 billion to run the whole health service which is actually less than the 2018 budget of €22.5 billion. And if the €300 million of BAM’s claims were granted, this to be deducted from the budget, only €20.9 billion would remain.
If we assume that the projected construction costs of the National Maternity Hospital are to come from a different budget then it still leaves us the question of who is to benefit from the health budget, the public health service or the private services (Church and other).
In 2019, €1.311 Billion of public funding went to just five private health services1
- Sisters of Mercy (including Mater Hospital, Mercy University Hospital — €432 million
- Sisters of Charity (including St. Vincent’s University Hospital — €373 million
- Brothers of Charity — €218 million
- St. John of Gods – 166 million
- Daughters of Charity €122 million
A TWO-TIER HEALTH SERVICE
The existence of private alongside public health care facilities creates a two-tier system, one with fast access to treatment alongside another with long, sometimes fatal delays (especially in the case of cancer diagnosis and treatment). Yet both are funded, as we have seen above, by the taxpayer.
With the disparity in waiting time and, to some extent quality of treatment, people who can do so of course tend to opt for the private service. And in order to afford that access, they take out private health insurance.
“According to the Health Insurance Authority, the average health insurance premium has increased from €423 per person in 2002 to €1,200 today”, “which has led to tripling of premium income for the insurance industry, from €822 million in 2002 to €2.5 Billion in 2016, as the numbers taking out insurance have also increased substantially.”2
It is not tolerable that our taxes are going to fund health care facilities that may not, because of religious ideology, provide a full service within what is legally permitted. Nor is it tolerable that our taxes are funding private healthcare facilities at all, never mind funding them to compete with public ones.It is not acceptable that our two-tier system discriminates against the less wealthy and promotes the huge growth in the private health insurance sector. Nor that people are being driven to take out private health insurance which has that sector’s companies raking in profits.
People resident in Ireland need and are entitled to a public health service that is well-funded and staffed to undertake timely illness prevention and health care at all levels in all areas of medicine. And a service that has the spare capacity to deal with emergencies without straining its facilities and harming its staff.
That is what we need and the vast majority of the population would support that, in this state and even in a united Ireland3. But which political party would give us that in government? Not FG, FF, Lab, Greens or SF, on any rational prediction. Although it would be just a reform, will it take a revolution to achieve it?
Let the religious fund their religious-ethos health services and let the rich fund their own private services but ALL PUBLIC FUNDING FOR ALL-PUBLIC SERVICES ONLY.
1From “A brief history of Ireland’s two-tier system”, (Rupture Issue 2, p.22).
2Ibid, p.23, quoting the HIA 2004 / 2005 report and Irish Times article.
3People in the Six Counties have a part of the UK’s NHS there and use and by all indications approve of a public health service.
Maternity Hospital news report: https://www.breakingnews.ie/ireland/fresh-controversy-emerges-over-maternity-hospital-as-state-offered-to-buy-land-1144144.html
Background to decision to build new hospital: https://www.irishtimes.com/news/politics/q-a-why-is-the-national-maternity-hospital-moving-and-why-are-people-concerned-1.4579356
Government plan to expand Irish health service: https://www.breakingnews.ie/ireland/tanaiste-calls-for-e22-billion-health-budget-to-be-retained-permanently-1144208.html
Construction company suing over Children’s Hospital: https://www.irishtimes.com/news/ireland/irish-news/contractor-bam-suing-national-children-s-hospital-board-in-20m-costs-dispute-1.4532352
Moratorium on BAM’s litigation: https://www.irishexaminer.com/news/arid-40297367.html
National Children’s Hospital costs overrun: https://www.rte.ie/news/2021/0209/1196082-childrens-hospital-pac/