National Maternity Hospital: Inside the Cabinet room as ministers approve controversial move

Last Friday, the Arts Minister revealed she would back the NMH’s controversial move from Holles Street to the St Vincent’s Hospital campus in south Dublin having been, until that point, the only remaining Cabinet minister not to back the deal.

Yet some of the reports from Cabinet today were to the effect that the Green Party deputy leader, appearing via video link, had only agreed to back the move after Attorney General Paul Gallagher gave the structures underpinning the deal his robust backing at that morning’s meeting.

What’s more, it was said that Ms Martin pushed for the new NMH to be a centre of excellence for maternity care. The reality was somewhat different, according to one Cabinet source, who acerbically observed: “She didn't mention it in her comments live from California.”

In fact, the memo brought before ministers by Stephen Donnelly makes clear the vision for “a co-located centre of excellence” and that the Health Minister was committed to “ensuring that the new NMH at Elm Park is supported as a centre of excellence for maternity care”.

The difference between what Ms Martin actually says at Cabinet – or does not say in some instances – and what is being briefed to the media about what she says at Cabinet is beginning to irk some of her ministerial colleagues. The Green Party minister’s spokesman said he “can’t comment on Cabinet confidential matters”.

After two weeks of intense debate across the airwaves, hours of Oireachtas committee hearings and the publication of complex legal framework documents a fortnight ago, the Cabinet memo approving the deal runs to just four pages, the last of which is mostly empty.

It was signed-off by ministers despite concerns expressed by opponents of the plan that the failure to build a public hospital on public land will leave open the possibility that religious influence could mean terminations of pregnancy, gender-affirming care or fertility treatments would not be permitted at the new hospital when it opens sometime later this decade, or more likely, in the early 2030s.

The inclusion of the term "clinically appropriate and legally permissible" in the legal documents has sparked concerns, which the memo itself acknowledges, that some procedures may not be carried out when a woman requests them.

But ministers were told that this term is in line with a definition proposed by the HSE board, agreed by the hospitals, and used across all documents in the framework and reflects that the hospital would not carry out cardiac or orthopaedic surgery, for example.

This term, the memo argues, is also broad enough to include future improvements and innovations in healthcare. The protections in the new hospital’s constitution and related legal documents are “extensive and explicit and oblige” the hospital to provide the “full range of legally permissible healthcare services and to do so without religious ethos or ethnic or other distinction”. These services include abortions. The minister also has the power to direct the board to ensure all such services are provided “in the unlikely event it is ever required”.

Such assurances, outlined in detail to ministers today, have not been enough to convince two Green Party TDs, Neasa Hourigan and Patrick Costello, to back the deal, with the latter saying the Cabinet decision was “the wrong one”.

But the Cabinet moved to see off a potential backbench revolt by also agreeing not to oppose a Sinn Féin motion calling for a public hospital to be built on public land. The private members’ motion is non-binding, legally meaningless, and “designed to divide”, says a minister. Sinn Féin has criticised the cynicism of the Government move.

The Cabinet meeting itself was “straightforward”, according to one of those present, with Mr Gallagher, the AG, clear on the robust nature of the legal agreement and the “unprecedented” level of protection the deal affords in terms of the provision of all legally available services.

Social Protection Minister Heather Humphreys said the decision was being made in an informed and transparent way and told colleagues the feedback she was getting is that people want the Government to get on and build the hospital.

In that spirit, Public Expenditure Minister Michael McGrath told the meeting that a tendering process – which took almost two years for the National Children’s Hospital (NCH) – can be done in parallel with an “external assurance process”, where an independent expert reviews the business case for the new NMH to identify project risks, delivery feasibility, and the robustness of costings, governance and procurement. The Department of Public Expenditure’s Major Projects Advisory Group (MPAG) will then review this report.

Mr McGrath reminded the Cabinet of the lessons to be learned from a PWC report into the debacle that has become the NCH project – the cost of which is soaring toward €2bn.

Tánaiste Leo Varadkar told the meeting he wanted a shovel in the ground next year and is believed to be frustrated at the delays that have held up delivery of the hospital so far. “Delays increase cost and women and infants are waiting long enough,” said a senior Government source.

The ultimate judgment on whether or not the Government was right to push ahead with this plan will only be made when the hospital is built and in operation, something which is still several years and many millions of euro away.