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A complicated delivery

10 May 2017

Dara Gantly

Dara Gantly on the continued complications behind the delivery of our new National Maternity Hospital

The delivery of the new National Maternity Hospital at the St Vincent’s Hospital campus would certainly seem to qualify as a post-term pregnancy, with the due date for a ‘revised’ deal now extended to the end of the month. But as we all know, such extended gestations can bring their own risks, and even end up with an NICU admission!

After weeks of controversy — fuelled by the principled stands taken by a number of high-profile clinicians, the Dáil recess and perhaps an otherwise slow news fortnight (how the story ‘got legs’ would be a great topic for a journalism PhD), Minister for Health Simon Harris last Sunday week (April 30) tried to draw a line under the issue.

While he believed the agreement between the NMH and St Vincent’s brokered by Kieran Mulvey last November had “robust measures” to protect the State’s investment, via a new role for the Health Minister of the day in terms of a “golden share”, in effect a ministerial veto, he nonetheless outlined breathing space was still required to allow his officials to work with both hospitals and report back by the end of May.

“I want to be very clear that I want this time to pursue solutions that address the issue of the ownership of the facility,” stated Minister Harris, who believed there was potential to devise “creative and acceptable solutions” that would provide further reassurance. Talk is now of a possible long-term lease (999 years anyone?) at a nominal or ‘peppercorn rent’.

It’s a curious development, given that the terms of agreement between the Holles Street and the St Vincent’s Hospital Group (SVHG) clearly stated that both hospitals realised this mediation process represented “the final opportunity to reach agreement on the project”, and that the Minister previously didn’t want to renegotiate it. Is that what is meant by a ‘lien’?

Okay, we should not confused an agreement between two voluntary hospitals with the detailed legal and contractual arrangement that the State will have to enter into with the new National Maternity Hospital at Elm Park Designated Activity Company (DAC) — a 100 per cent subsidiary of SVHG owned by the Sisters of Charity. We should give the Minister and the Government’s legal team the space to get those reassurances in order to ensure our investment is 100 per cent protected.

But there are many circles needing squaring, given that while on the one hand clinical and operational independence (“without religious, ethnic or other distinction”) is to be maintained alongside the retention of the Mastership model, on the other hand the agreement recognised it was “not unreasonable” that SVHG retained some “corporate oversight, or integration” of operations on the entire campus.

The problem with political fudges — and I haven’t decided if this falls into that bracket — is that while they often given opposing sides a sense of victory, they often don’t turn out to be good deals.

Take the make-up of the new hospital Board: nine Directors, four of which will be nominated by SVHG, with another four nominated by the NMH Chartered Trust, two of whom shall sit on the SVHG Board. The final Director shall be an independent international expert in obstetrics and gynaecology chosen from a list of candidates drawn up by SVHG and the NMH Trust, but assessed by a Selection Committee, chaired by the SVHG Clinical Director, with the SVHG CEO and a representative from the NMH Trust. Would that tilt things one way or the other?

In terms of governance, what struck me was that the Board will not exactly comply with the recommendations of the seminal 2012 HIQA report into Tallaght Hospital, which stipulated that Boards should be selected and appointed through an “independent process established by the State” as well as on the basis of having the necessary skills, experience and competencies required to fulfil the role effectively.

HIQA recommended: “The board should comprise non-executive directors and a chairperson and, in keeping with good governance, individuals with conflicts of interest, including employees of the hospital and those with other relevant conflicts of interest, should not be appointed to the board.”

And in advance of such an independent process being established, the members of boards with the necessary knowledge, skills, competencies and experience “should be appointed by the Minister for Health”, the HIQA report added. So, will the new National Maternity Hospitals be drawing up its own rules on corporate governance?

Of course, HIQA also advised the business of boards in receipt of State funds should all be conducted openly and transparently. “All boards should hold the maximum amount of their board meetings in public by June 2013 including conducting an Annual General Meeting in public from 2013.” Now that would be interesting.

What is of further interest now is that the Minister wants to begin a “broader conversation” about the structure of our health service, including the role of voluntary hospitals and the interest religious congregations have in them. This has been happening in education (slowly mind), so we should not be too surprised to see it start in Health.

“That is a good thing and I want to separately put in place a process to facilitate that broader conversation which is long overdue and which will, rightfully, take some time,” Minister Harris has noted.

This one has legs yet.

The post A complicated delivery appeared first on Irish Medical Times.

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