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HEALTH MINISTER JENNIFER Carroll MacNeill is facing some disquiet among some within her own party regarding the approach taken with the Rotunda Maternity Hospital and private care.
Over the last week, there has been a stand-off between the hospital, the minister and the HSE over consultants, who have signed up to the public-only contract, continuing to see private patients.
The HSE threatened to trigger a process that could result in a funding cut to the maternity hospital unless it complied with its legal obligations under the service level agreement.
As a result, the hospital board met on Monday and agreed to end the practice of public-only consultants treating private patients on the hospital site.
Senior government figures such as the Taoiseach, Tánaiste and the minister for public expenditure all publically backed the health minister’s stance this week.
Micheál Martin and Simon Harris both said those that signed up to the public-only consultant contract must fulfil the terms of their contract of employment.
However, it is understood that a number of Fine Gael TDs are unhappy with the position taken by Carroll MacNeill, telling The Journal that a number of constituents and party supporters have been in touch to convey their concern over private care being phased out for women.
The Sunday Times reported over the weekend that one cabinet minister said the health minister “seems hell-bent on demonising women who want and need the support and certainty of access to the same consultant from early stages through to birth”.
The minister reportedly added: “A politically charged campaign of threats and intimidation that might appear laudable but in practice will result in significant damage to her own political career and will win her no fans from the 48% of people in Ireland who pay for private healthcare and have little faith in her socialist approach.
“If the public system was so brilliant already, wouldn’t women already be exclusively using it?”
This point was echoed by some within Fine Gael who told The Journal that concerns were going to be raised with the minister at the parliamentary party meeting this week.
They said women who had experienced difficult pregnancies in the past still wanted the option of paying for continuity of care in the private system, stating that they wanted to avail of earlier scans and more appointments with a consultant of their choice, something which is not automatically available through the public system.
One TD said the “at the heart of this, I think, is an issue choice. If you want to pay for something to get a different service, you should be allowed to do that”.
They said that the maternity sector is an exceptional area of the health system as there currently is no private maternity hospital in the country.
Looking at how this has played out politically, this TD said many of the people Fine Gael represent have the means to pay for private maternity care and want to exercise that choice.
“I don’t really know why we would be going out of our way to deny them that choice,” they said.
They went on to state that from a broader policy perspective, they understand the HSE and the Department of Health’s perspective on public-only contractors undermining the system they signed up to.
However, they added that the one-size-fits-all argument put forward by the government is not a reality right now in the public system, stating alongside this debate about contracts there has been no discussion or mention of how the public maternity system is going to level up to resemble more of what is on offer in private care once the private system is scrapped.
Another Fine Gael TD told The Journal that they are also not comfortable with the position that minister has taken, stating that many women have been in touch to say they are worried about the choice of care they want being removed.
Again, this TD said it will be a matter that they believe will spark robust debate in the Fine Gael parliamentary party meeting on Wednesday.
While some TDs in the party appear to be at odds with health minister on the matter, others wholeheartedly support Carroll MacNeill, with one TD stating that the minister has the “solid backing on this in Fine Gael”.
“She’s taking on vested interests who have already signed up to contracts and service level agreements for public only activity. This is about fairness and holding people to account,” said this TD.
Speaking on radio today the master of the hospital, Professor Sean Daly said the board of the hospital on Friday requested to meet with Carroll MacNeill to explain why they had taken the decision they did, but she said no meeting would take place unless the hospital agreed to align with the agreement.
Daly said he felt the meeting “should have happened” because the issue of choice for women “is not going to go away”.
He said the benefit of private care comes down to continuity, adding that he would love a situation where every woman would see the same midwife throughout their pregnancy, but he does not believe it will happen in the next 10 years because there is not enough money to support that.
Speaking on her way into cabinet today, the health minister said she has been a “little frustrated with the narrative that the only safe care is private care”.
“I just don’t believe that that is true and it is an argument that is being advanced by people who have a monetary interest in perpetuating private care,” she said.
She said as a woman who has been through the maternity system, she firmly believes “that every woman should have the expectation of the best possible care – consultant-led, if that’s what they want – and not just because they can pay for it”.
“I can’t countenance a situation in which a woman giving birth in a maternity hospital, who’s in the public system, who’s giving birth to twins, or has a risky pregnancy, doesn’t have a consultant there simply because she’s in the public system.
“That’s not right. It’s not right. And I believe in equality for all women,” she added.
She said that another significant issue will be the full implementation of the public-only consultant contract and said she was “disappointed” with the work practices on Saturday or extended hours.
Speaking to Virgin Media’s Gavan Reilly, Tánaiste Simon Harris said on Monday that ultimately, over time, the plan is to make sure that more doctors are working in public maternity care, “and a woman, regardless of their ability to pay, being able to access the very best possible medical treatment in maternity care”.
Reacting to the stand down by the Rotunda Hospital, Labour’s health spokesperson Marie Sherlock said serious conversation on better resourcing of maternity care must now begin.
“The stand-off over the past week will only constitute real progress if we now see a real and meaningful political push from Government towards offering better maternity services,” she said.
A statement from the HSE and the Department of Health to The Journal regarding what is offered to women in the public system stated that continuity of care is a key objective of the National Maternity Strategy.
However, the HSE said “in practice, there is no guarantee that a woman in the public system will see the same consultant obstetrician or the same individual midwife at every appointment”.
It said in most instances, women are cared for appropriately by a multidisciplinary team and may see different members of that team over the course of their pregnancy, labour, and postnatal care.
“For women receiving care through midwifery-led services, continuity is typically provided by a team of midwives rather than by a single named midwife. Similarly, women may request to be under the care of a particular consultant, and maternity services will seek to accommodate such requests where possible, particularly where there has been an established clinical relationship in a previous pregnancy.
“However, this cannot always be guaranteed and is subject to service availability and clinical requirements,” said the HSE.
In relation to additional scans and appointments that women might request, the HSE said public maternity services provide care, investigations and ultrasound scans in accordance with national clinical guidelines and individual clinical need.
“Additional scans or appointments are generally arranged where there is a clinical indication. Public maternity services do not routinely provide additional scans when no clinical need is identified,” said the statement.
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