Any agency that gets even €1 of State funds is accountable to the Irish people. Holles Street is no exception

THE National Maternity Hospital is not a Statefunded entity. The hospital is neither accountable to the Health Service Executive for its governance, nor for its day-to-day-running.

Yes, yes, I know – I had to read that twice too, just to make sure I had it right. The claim was part of a submission by the hospital to a HSE audit of its payment practices and its relationship to a semi-private clinic next door – a very incomplete submission, it must be said, since the HSE did not receive answers to many of the questions it asked. The review nonetheless was able to conclude that a €40,000 salary top-up for the hospital’s Master, Rhona Mahony (supplementary to a not ungenerous €235,000 a year), and additional emoluments for three other senior executives, violated public pay policy.

Holles Street pointed out that over 30% of its funding came from non-HSE sources, namely the fees generated by its private patients, and it appears to believe this somehow places it beyond the oversight of the HSE. By any reasonable yardstick, this claim is sheer nonsense, given that the HSE funds the National Maternity Hospital to the tune of €49million a year, or 70% of its funding.

In any walk of life, that level of financial input would buy a pretty huge chunk of accountability. If a producer raised 70% of his funding from a single source to make a movie, you could be fairly certain the investors would like a say in the script and the casting. If a pension fund invested 70% of the funding into oil exploration, it would demand detailed geological reports on the CEO’s desk every morning.

So, when the HSE hands over €49million – and, in case we forget, since it always comes back to this, that is your money and mine – surely it too has a right to question ‘governance and day-to-day running’ in the hospital. It seems not, and not only in Holles Street but in many other areas of Irish life.

We have seen it in the university sector, which also receives incomes from registration fees, philanthropy and investment by corporations in the likes of the pharmaceutical and tech industries, on top of the direct subvention from the State.

We particularly have seen it in the charity sector, where State subsidy is boosted by donations, individual and corporate, and by other fundraising drives. My late mother stood outside Killiney Shopping Centre every year, well into her seventies, collecting for the Irish Cancer Society’s Daffodil Day (as a breast cancer survivor of more than 30 years, she was hugely supportive of its work), and for Rehab.

When news of the financial mismanagement of the latter charity broke, it was devastating for her after all the years she not only shook the boxes but spent more hours meticulously counting and bagging the cash and accounting for every cent.

It just makes you feel like a bit of a mug when, having donated money or time to any cause, you then hear stories of ludicrous salaries for management or, as was the case in St John of God and Console, of expenses claims for travel and entertainment, and company credit cards being used for private expenses.

The even greater outrage is that these charities and, as it now seems, the National Maternity Hospital, explicitly view themselves as no more accountable to the State than they are to an elderly woman standing in the cold outside a shopping centre.

Controversies

We have long had a problem in Ireland with accountability. We have seen the lack of it for years in politics, and we currently see it in the Garda Síochána, where Commissioner Nóirín O’Sullivan hangs on to her job despite a series of controversies that would have led someone in her position, in just about any other country in the developed world, to the nearest door.

We saw it after the bank collapse, where rapacious boardroom greed went largely unpunished. We saw it in the National Asset Management Agency where, for the first four years of its operation, it was not subject to Freedom of Information legislation. Indeed, Nama went to the Supreme Court to try to protect its right to exist off the radar and continue to operate in the shade as it sold off completed buildings and landbanks to international vulture funds as if they were prizes in a cheap tombola.

We have seen it after tragedies too. Who ever went to prison for the Stardust disaster, despite clear breaches of fire regulations? Nobody. Who compensated the tradespeople and other creditors of developers who fled to the UK and lived there for a few months to get quickie bankruptcies and kiss goodbye to their debts? No one.

There have been some improvements. The case of FÁS was a landmark moment in instilling fear into State agencies over wasted and mismanaged funding, and a warning shot that using public money for lavish travel and private dinners was a thing of the past. For all that it sometimes can be like hitting a brick wall, Freedom of Information has shone light on many of the darker connections between the State and private investors. One legacy of the Troika’s intervention during our darkest hour is that it still keeps an eye on budgetary matters, no harm in a country used to expensive election promises we cannot afford. And, while tribunals may be without consequences for most found to have been corrupt, at least we know they were.

These were good starts, so now we are at an important juncture. The State is about to build a new National Maternity Hospital but, as constituted since the decision by the Sisters of Charity to hand over the site and relinquish any right to impose their ethos on the new facility, the board has representatives of the National Maternity Hospital, St Vincent’s Hospital Trust and one external board member, an international expert in obstetrics. Where will the taxpayer be represented? Who will keep an eye on salaries, governance and the day-to-day running of the hospital for us, the people who will pay for it and, in hundreds of thousands of cases, the women who will use it?

Who would be there to guard against the ‘potential conflicts of interest’ identified in the audit of Holles Street? Who will ensure, on taxpayers’ behalf, that the interests of the state hospital will not be outweighed by the interests of private entities connected to some of the people in charge – as the auditors suggested had occurred at Holles Street? After all, Holles Street argues that its private work is vital because they say it subsidises the public hospital: will this same attitude prevail at the new NMH? (As it happens, the example of Mount Carmel suggests that a standalone private maternity hospital is not financially viable in this country – and that was without having to build or staff operating theatres.)

So, no, the game is up. Any agency in receipt of even one euro of State funding must be made to understand it is accountable. If it refuses to accept accountability, it must be de-funded. If it then threatens to withdraw its services in a game of macho brinkmanship, it must be made aware that the State will allow it to do so, but also will mercilessly identify the individuals behind that decision and their exact reasons for making it.

It is time everyone knew that €49million of funding buys €49million of accountability. If slow learners refuse to sign up to this, they must be made aware they are not too big to fail. The Console charity is a perfect example, because services can and will be provided somewhere else.

Defiance of authority, aloof dismissal of official audits and misplaced braggadocio must, in future, lead only to either an enforced change of the personnel at the top, or closure. It really is that simple.