Photographs of the statue of the Virgin Mary guarding the entrance to St Vincent’s campus in Dublin 4 were in demand this week following the shock announcement by the Sisters of Charity that they are pulling out from ownership of St Vincent’s Hospital Group (SVHG).
What might have surprised visiting media, had they ventured further, were the references in a display in the hospital to Friedrich Engels, co-author of The Communist Manifesto with Karl Marx. It was Engels's writing about the abject poverty of Irish people in the 19th century that helped inspire the sisters to set up the hospital at Dublin's St Stephen's Green centre in 1834.
Little has been heard about the order's tradition of service to the poor in the past month's tumult over the planned transfer of the National Maternity Hospital (NMH) to the St Vincent's campus at Elm Park. Perhaps this will change now that the order has relinquished ownership of the hospital.
But then this story has never followed a set narrative. It started with all the ingredients of a lively novel: religion, money, politics. Throw in some strong leading characters, family rivalries, and a number of plot twists – and the controversy became a page-turner.
Accidental crisis
This was an accidental crisis into which two institutions – the existing NMH at Holles Street, and SVHG – stumbled, quickly followed by Minister for Health Simon Harris. Not for the first time, public distrust of institutions and the speed of social media combined to electrify opposition to what was perceived as a secret decision designed to shore up the status quo.
The pullout by the nuns addressed many of the concerns raised over the past month about church and State issues, but there are other elements to this story.
The Sisters of Charity moved slowly and deliberately, the way their organisation has always moved, but the hospitals and the Minister have little excuse for being ill prepared to deal with the firestorm that arose after the public learned the NMH would be owned by the sisters after it moved to Elm Park.
But even the best-laid defences might not have been enough to withstand the sustained assault on the relocation plan from former NMH master Peter Boylan. The retired obstetrician took aim at what he regarded as the threat of Catholic Church influence being exerted through religious ownership of the new hospital. He continued firing until that threat was removed.
That Boylan's stance set him against his former employer, where he had delivered 6,000 babies over three decades, and where his sister-in-law Rhona Mahony is now master, added piquancy to the controversy.
The question now is whether last Monday’s announcement by the order that they are withdrawing from involvement in SVHG and so will have no involvement in the ownership of the NMH is the final chapter in this saga. Or is it only the latest plot twist in a story that has some way to run?
Tensions
The pullout by the nuns addressed many of the concerns raised over the past month about church and State issues, but there are other elements to this story.
It started as a turf war between two institutions with long-established structures and traditions, and those tensions haven’t gone away.
Private medicine is something of a taboo subject in the Irish medical world, yet a project that will unite private obstetric and gynaecological services in St Vincent’s, located in the heart of affluent south Dublin, is a potential money-spinner.
St Vincent’s itself is a microcosm of the confluence of private and public medicine that politicians are currently promising to disentangle. The Elm Park campus is home to both a public and a private hospital, and it isn’t very long ago since the head of the Health Service Executive claimed its private operations had a “parasitic dependence” on the public hospital.
Both St Vincent’s and the NMH are currently the subject of HSE investigations following controversy over issues such as top-up payments and the level of private work in their hospitals.
Politics, too, has played a role in this crisis, in particular, the eagerness of politicians to kick-start projects they can claim credit for, before the details have been hammered out and areas of disagreement put to rest.
Unnamed staff in St Vincent's said patients were often referred to other hospitals to avoid conflict with the hospital's ethical guidelines
In May 2013 the then minister for health, James Reilly, announced the move of the NMH to St Vincent’s. “There was a lot of surprise that Holles Street was being moved ahead of the other Dublin maternity hospitals,” according to one doctor in another maternity hospital. “Rhona [Mahony] had played a big role in the Oireachtas hearings on abortion, and so this was seen as a thank-you for her help in getting the legislation through,” according to one doctor in another maternity hospital.
It is easy now to see some of the mistakes made. Reilly allocated an “indicative sum” of €150 million; it will cost at least twice that to build the hospital. No indication was given how Holles Street, with its own board, would join with St Vincent’s, also with its own board, or how either hospital was supposed to merge with the hospital group structure then being created by the Government, which is also supposed to have its own board.
Tough negotiator
Meanwhile, over at St Vincent's, changes were afoot. The Sisters of Charity replaced the existing board of the hospital group, some of whom had been in place for decades. The new chairman, ex-KPMG partner James Menton, quickly delivered on his reputation as a tough negotiator.
He first went to war with the HSE, threatening a “legal battle” over threatened restrictions on consultants doing private work. Menton accused HSE boss Tony O’Brien of taking a “personal approach” based on “aggression, threats and unsupported allegations”.
Menton’s approach seems to have worked: little has been heard of the HSE’s concerns since then.
The SVHG chairman then switched his attentions to the maternity hospital talks. Governance of Holles Street should be subsumed into that of his own hospital, he insisted, and there should be one chief executive to whom clinical directors for both hospitals would report.
The existing post of master of the maternity hospital would be “evolved” into a clinical director role. “It is simply not practical for a practising clinician to also fulfil the role of CEO,” Menton declared.
The maternity hospital would get a few seats on the St Vincent’s board and some other concessions, but would have to play second fiddle to the adult hospital, which is eight times its size.
These suggestions were anathema to Holles Street, and the project stalled. Two mediators came and went without agreement, until Harris drafted in Kieran Mulvey in May 2016, the country's best-known industrial relations "fixer".
Catholic ethos
Concerns over the Catholic ethos of St Vincent's had emerged in the media, but had not been the subject of much public debate. There was no prohibition on any medical procedure, whether elective or emergency, that was "clinically indicated", including vasectomy or tubal ligation, a spokesman told The Irish Times in April 2016.
However, unnamed staff in St Vincent’s contradicted this in other articles at the time, saying patients were often referred to other hospitals to avoid conflict with the hospital’s ethical guidelines.
The Tuam mother-and-baby home controversy served to inflame opinions about the legacy of Catholic religious orders
Oncologist Prof John Crown spoke on radio last month of his experience of sitting across the table from members of the ethics committee who objected to a cancer trial that stipulated contraception.
“It’s sort of subtle – I don’t want people to think it’s some sort of Taliban-like theocracy – it’s not like that. On a day-to-day basis people would have no awareness of it.”
At the Mulvey talks, car-parking figured more than ethos as an issue. Holles Street sources maintain they understood the Sisters of Charity were moving out of healthcare: “We accepted what they told us; that the nuns would be gone from St Vincent’s by the time we arrived.”
Finally, last November, Mulvey succeeded in hammering out an agreement between the two sides. The Minister was, in his own words, “thrilled”. Harris finally had some good news, six months after taking over the health brief, with its relentless diet of rising waiting lists and staff shortages. He had made this project one of his “key priorities” on coming to office and now it was about to become a reality.
Taoiseach Enda Kenny even popped down from his office last November to see his young Cabinet colleague announce the deal. The turf war between the NMH and SVHG seemed to be finally over. The development could finally go ahead.
The Minister was still smiling the following day, when he called in to Holles Street, held a few babies and was pictured with Mahony.
New company
The next day’s newspapers reported the details of the deal between the two hospitals. A new company would be set up to own the new hospital when it moved to St Vincent’s and various checks and controls were to be put in place to protect the interests of the two institutions. There was, it seemed, nothing more to see.
Or was there? The agreement brokered by Mulvey stated that the new company set up to run the maternity hospital would be owned by SVHG. What it didn’t explicitly say, but was obvious to anyone who read the document carefully, was that this group was owned by the Sisters of Charity.
The order, which was providing the site free, would therefore become the owners of the relocated NMH.
It took six months for the penny to drop. A lot happened in that time, notably the revelations about buried infants at a mother-and-baby home in Tuam and an ensuing row over how much religious congregations still have to pay to abuse victims under the redress scheme. These controversies served to inflame opinions about the legacy of Catholic religious orders.
We were presented as a power-grabbing congregation, a group of old ladies who didn't know what they were doing. It was very distasteful"
Yet the world remained indifferent, even after the website of the London Times reported in March that the new hospital would ultimately be "given" to the nuns. Hidden behind a paywall, the article went unnoticed.
But in the quiet days after Easter, the story was resurrected, when Irish Times religious affairs correspondent Patsy McGarry reported confirmation by the Department of Health that the order would be the "sole owner of the new hospital". In the newspaper, the article didn't even make the front page but online it went viral.
The speed and vehemence of the reaction was astonishing. Within days, more than 100,000 people had signed an online petition against the “gifting” of the maternity hospital to the order of nuns. Hundreds demonstrated outside the Department of Health, and TDs lined up to condemn the deal.
Boylan made his case by taking to the airwaves to call for the separation of church and State. Holles Street, under pressure from St Vincent’s, demanded his resignation from its board, and he resigned a few days later?.
The NMH maintained that clinical and financial independence, not ownership, had been the key issues during mediation. "This wasn't The Field, it was about getting on with a badly-needed new hospital. The Earl of Pembroke owns Holles Street, technically, but what does that matter," one source familiar with the Mulvey process points out.
Period of calm
Caught off guard, Harris suggested a reopening of the Mulvey agreement, and St Vincent’s threatened to review its involvement in the project. Eventually, an appeal by the Minister for a month’s “period of calm” succeeded in quietening things down.
In time, it may well be confirmed that the order was considering withdrawing all along
Sources say little happened in this period. There were a few brief meetings, some involving the Minister, but St Vincent’s insisted the Mulvey agreement had to be implemented as it stood.
The month was nearly up when the order made its shock announcement, taking even Holles Street by surprise. The nuns say they have been considering withdrawal for some time; Menton says they would have announced this in September but brought forward the decision to “facilitate” the NMH project.
“It was under discussion for a number of years,” says Sr Stanislaus Kennedy, probably the best-known member of the order. Though she was not involved in the process of deciding to withdraw, she says this was the plan all along, rather than being a response to public criticism or media attention.
“It shook me,” she says of the harsher criticisms directed at the order at the height of the controversy. “We were presented as a power-grabbing congregation, a group of old ladies who didn’t know what they were doing. It was very distasteful.”
In time, it may well be confirmed that the order was considering withdrawing all along. It has already been confirmed that the Sisters of Charity did not owe any money under the redress scheme for institutional abuse victims, having been allowed to offset their legal fees against the €3 million that was due under that scheme.
Whether there was ever a real threat of Catholic interference in the maternity hospital, or whether these worries were unfounded, the course of history has been changed by a curious collection of events and individuals.
The stage is set for further divestment of Catholic organisations from health and education, with the path taken by the Sisters of Charity seen by Government as a template for others.
