LAST UPDATE | 22 hrs ago

THE ROTUNDA HOSPITAL has requested a meeting with the minister of health to “explain the rationale” behind it allowing consultants on public-only contracts to see private patients.

It follows strong comments by minister Jennifer Carroll MacNeill this morning in which she said such consultants are paid “richly” to work in the public system, and are therefore expected “to be there”.

The controversy started when Professor Sean Daly, the master of the Rotunda, last week told the Oireachtas health committee that deviation from the contracts was being allowed as there is no private maternity option for women to avail of in Ireland. 

The controversy spurred the HSE to threaten a funding cut, unless the hospital began complying with its legal obligations.

Speaking to RTÉ’s Today with David McCullagh on RTÉ Radio One, MacNeill said the state “has paid considerably to educate the consultants”, in addition to their salaries.

“They are being paid very good salaries to work in the public system, and we expect them to be there,” she said.

“It would not be correct for any health minister to not push this in the way that is necessary,” she said. “They have signed a contract.”

Asked whether she has confidence in the hospital’s master, MacNeill said: “I expect that he will make sure that the Rotunda is operating in compliance with government policy, and the contract that he personally has signed with the HSE.”

However, the Rotunda has this afternoon sought a meeting with the minister to explain “the rationale and impact” of continuing to allow consultants on public-only contracts see private patients.

It follows a meeting of the Rotunda’s board, at which it discussed “the merits, risks and consequences” of the practice.

“In all of its deliberations, the board’s overriding priority is to ensure that every patient receives the best possible care, regardless of whether they are a public or private service user,” the board said in a statement.

It says it now wants to talk to the minister, so they may “seek a way forward to resolve this issue for the common good of all patients”.

MacNeill said earlier that she had asked the hospital multiple times to comply with the public-only contracts.

Funding cut? 

MacNeill said she has “no interest in defunding anybody”.

That is despite the HSE telling the Rotunda in a letter that it is considering all its options up to and including withholding funding, if the hospital continues to breach its contract with the state.

When speaking earlier today, MacNeill said she anticipated that the Rotunda would soon comply. The hospital’s latest statement suggests otherwise.

Meanwhile, the hospital has until Monday to provide information including the names of consultants operating privately and the amount of money billed for and received by the Rotunda for their services so far this year.

Asked what measures she’ll take if the hospital doesn’t comply, MacNeill said: “Nothing that will interrupt [patients'] care.”

Entrance to the Rotunda maternity hospital on Parnell Square in Dublin Alamy Stock Photo Alamy Stock Photo

Insurance

MacNeill explained that insurance for maternity care is so expensive only the state can afford it. Hence, even private maternity care is provided in public hospitals.

“The scale of payouts in birth injuries, because of the nature of the damage done to somebody, is so great,” she said.

“There’s private orthopaedic work happening everywhere because, with every respect to an injury to a knee, it is not the same as a birth injury to a brain, and the cost of those different things are very different.”

MacNeill said that if the private network were to set up its own maternity hospitals and cover the insurance themselves, she would have no problem with that.

“The point of differentiation on this is if something goes wrong in maternity, at the moment it is only the state that can underpin the liability,” she said.

“That is not something that you’re hearing forthcoming from the (hospital) masters, when they have this conversation about choice.”

Public versus private 

MacNeill doesn’t accept that private maternity care is necessarily better than public. She said public maternity care should be perceived to be of the same standard as cancer or neurology care.

She said consultant-led maternity care should be available for any woman who wants it.

“Not just women who can afford it, but all women have risky pregnancies, all women are capable of having twins, all women can have gestational diabetes,” she said.

“There are risks with all pregnancies, and all women deserve and need the support that expert-led care can provide.”

MacNeill also said there is a narrative that private maternity care is “safer”, which is being pedalled by those who “benefit” from women choosing it.

There are currently 14 public-only consultants in the Rotunda. MacNeill says, in the future, every obstetrics consultant will be on a public-only contract, “as others retire and move out of the system”.

She said that the implementation of Sláintecare, which seeks to provide universal healthcare, requires public-only consultant contracts in public hospitals.