Around two thousand demonstrators, including a high proportion of women, held a rally on Saturday afternoon outside Leinster House, the building housing the Irish Parliament. They were protesting the lack of clarity around whether the new maternity hospital will carry out pregnancy terminations on demand — with the suspicion that it will not.
But speaker after speaker went further still and demanded the secularisation of the Irish health service and of society in general.
The issue arises in the first place due to the necessity to relocate the Dublin maternity services currently based at Holles Street due to the inability of the latter to meet the demand. However, the Government decided to relocate the facility to land near St. Vincent’s Hospital, owned by a Catholic Church organisation, which in turn formed a company to buy the land and lease it to the State at a nominal annual rate. It is the perceived Church veto on some procedures that has raised so much concern.
A SECULAR SOCIETY – A REPUBLICAN DEMAND
A secular society is a fundamentally republican demand, up there with opposition to monarchy. English Republicanism failed to achieve1 it even after the execution by Parliament of Charles I in 1649 but the French revolution did not, which was one of the reasons why the Irish Catholic Church hierarchy was against La Republique and against the United Irishmen too.
Irish Republicans after the United Irishmen have had at best an ambivalent attitude to the Catholic Church – although the Young Irelanders and even more so the Fenians were decidedly anti-clerical, the Republicans in the first two decades of the last century were not so in general and many actually courted the support of the Church. The fact that the Irish Republican movement during the rest of the century failed to lead social struggles is adequate testimony to its leadership at the very least not wishing to earn the hostility of the Catholic hierarchy. That in turn was one of the factors ensuring that the Republican movement failed to broaden its struggle to encompass the majority of the nation … a factor sufficient on its own to ensure its defeat.
On the whole it has been left to writers, revolutionary socialists, social democrats and liberals to fight the secularisation battles – but above all, left to women. Control of fertility, access to contraceptives, personal sexual freedom, gender equality in law, equal pay, and termination of pregnancy were all hard battles won over decades by women. And often at huge personal cost. Most of those battles confronted the authority of the Church Hierarchy and even when some did not so directly, they did so by implication, undermining its basic judgement that the role of a woman is as wife to husband and mother to children.
The position of the Church hierarchy in Irish society was one of moral judge, jury and practical punisher and when punishment failed to correct, the State took over. In fact, we can view the Irish State in social and political terms as a partnership of native capitalist class – the Gombeens – and the Church hierarchy. In return for its role in social control, the State permitted the education, health and social care systems to be run by the Church either wholly or in part. Which in turn increased the power and authority of the Church hierarchy further. And it was that unquestioned (and unquestionable) authority that fostered the decades of physical, mental and sexual abuse carried out by so many clergy, in particular on women and children.
Women are still to the forefront of the struggle for the secularisation of the State and they are too in this struggle over an important branch of the health service. The people need a well-resourced national health service, with free access – but it needs to be secular also. Irish Republicans who do not actively support this struggle are failing not only the society they hope one day to lead but, in secularisation, failing also a fundamental principle of republicanism. That one of the issues with regard to Church influence on the maternity hospital is a suspicion that it will not carry out elective pregnancy termination should not prevent even those Irish Republicans opposed to elective termination from supporting its secularisation.
Quite simply, one is either a Republican and therefore in favour of a secular health service — or one is not a Republican.
Since 1524, not only is the UK a monarchy but the monarch, the Head of State, is also the head of the (Anglican) Church of England.
In Henry Street on Saturday I stopped to contribute to a fund-raising event for a child to have an operation in the United States. I was partly motivated by remembering when a granddaughter of mine, Caitlin Rose, needed to go to the US also for a special operation. I remembered too how generous people had been to my fund-raising for that objective. I had no idea when I stopped in Henry Street that the girl, Sienna, was heading for the same surgeon who had operated on my granddaughter Caitlin Rose some years ago.
Men from Dublin Fire Brigade were doing the fund-raising, their fire truck carrying big posters advertising the campaign. One of them told me that he does a number of charity fund-raisers a year, always in Henry Street, where he finds the response of the people supportive. They don’t get time off from work for this activity and he would be heading into his Blanchardstown Fire Station that evening for a 12-hour shift.
As I stopped to take some photos, I noticed a woman wearing a fire-fighter jacket and went to talk to her, asking how many women were now in the Dublin Fire Brigade. But she wasn’t a firefighter — she was the girl’s mother and only wearing the jacket on loan for the occasion. Chatting to her I discovered that her daughter Sienna is heading to Louisville, USA, to be operated on by Dr. Park, just as was my granddaughter some years ago. When Dr. Park first pioneered it, the operation was a startling new one and, though it is now available through the NHS (Caitlin Rose lives in London) and the HSE, for some reason the recovery time is much slower than under Dr. Park’s treatment.
In the most crude and simplified explanation, in SDR operation the surgeon opens the patient’s back to test which of the sensory nerves are pulling limbs taught and — cuts them! It sounds scary and crazy even but when one sees the results ….!
Dr. Park, a US-based surgeon from Korea, perfected this operation which he carries out in Louisville, Kentucky. Of course, lots of other work is required, including physiotherapy, exercising and often, orthopaedic surgery to correct bone deformity, etc. On 15th November 2018, Dr. Park performed his 4,000th SDR operation.
The cost of the operation, for the flights and the accommodation for the parents while the child is in treatment, time off work – all this is piles up frighteningly high. My daughter, my son-in-law and my son all organised fund-raising events and I was lucky that singers and musicians here supported two fund-raising events I organised, with support from Club na Múinteoirí here in Dublin — and that so many bought tickets. Before the operation, Caitlin Rose could barely walk; now she can even run and dance a bit, ride a bike, etc, and go to school on her own.
I hope at least as much for Sienna.
And that the same operation at the same level of effectiveness be available to all people in Ireland without having to fundraise or leave the country to access it.
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.