THE HSE HAS warned the Rotunda Hospital that funding could be withheld if it continues to allow consultants who signed public-only contracts to continue to practice privately at the hospital. 

It comes after Professor Sean Daly, the master of the Rotunda, told the Oireachtas health committee last week that the practice was being allowed to happen as there is no private maternity option for women to avail of in Ireland.

“The only private care that is being allowed in the Rotunda for public-only contract holders is for pregnancy-related care, and that is because the Rotunda has long believed that women should have choice,” he said.

Daly told the committee that he explained what was happening to Minister for Health Jennifer Carroll MacNeill when she came to the Rotunda last year, adding: “Suffice to say, she wasn’t happy.”

In a letter to Daly, seen by The Journal, the HSE said his comments to the committee “give rise to the most serious apprehension on the part of the HSE that the Rotunda may be failing to comply with several exceptionally important provisions” of its service level agreement. 

The health service said there is ”not a shred of doubt that the Rotunda is aware that it does not have discretion” to grant permission to public-only consultants to carry out private healthcare in the hospital, saying that granting or continuing to give this permission would be a “manifest breach” of the agreement. 

The health service said it is now considering “all its options in that respect”, including commencing the ‘Performance Issues’ process set out in clause 14 the agreement.

The clause states that if the hospital has not addressed a non-compliance issue, the HSE may “withhold a proportionate percentage” of the funding allocated to the Rotunda, or “preclude any consideration of any request” from the hospital for funding for services. 

The letter goes on to ask the Rotunda for a list of the names of each public consultant who was practicing privately in the hospital, as well as who granted permission for this and why. 

The HSE is also seeking the number of babies delivered by each consultant since 1 January, the number of expecting mothers currently under the private care of these consultants and the amount of money billed for and received by the Rotunda for these services so far this year.

These must be provided before 8 June, the letter states, adding: “The HSE will consider the Rotunda’s response to these questions in determining the steps that it will take in respect of this matter.”

‘Serious breach of contract’

Speaking on RTÉ’s Today with David McCullagh programme, Social Democrats TD and Oireachtas health committee chair Pádraig Rice said it is a clear violation of policy. 

“We have an agreed policy, Sláintecare, which is about moving towards universal healthcare, and a key aspect of that is public-only work in public hospitals for those who sign up to the new contract,” Rice said. 

Consultants are being very well paid to give up private work and to do public-only work in our public hospitals, and I think they should adhere to that contract.

He said the Rotunda “took it upon themselves” to unpick “what is a landmark contract about changing how we deliver healthcare in this country and delivering universal healthcare based on clinical need and not ability to pay”.

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“It’s not for any individual hospital to decide themselves to do that, as I say, in clear violation of instructions from both the HSE, the Department of Health and what is cross-party policy within the Oireachtas.”

He welcomed the fact that Carroll MacNeill was taking action on the matter “because it is a very serious issue”. 

“This is a serious breach of the contract of the landmark reforms to deliver universal healthcare under Sláintecare.” 

He said around half of the obstetricians have signed up to do public-only work, so the other half “will continue to do their private work, and people, if they so wish to have private care, can pay for that”.

He added that the issue is those who signed the public-only contract and are now “trying to get around that and have the best of both worlds”.

“They want the public-only contract, the good salary that comes with it, and they also want to continue their private work, and I don’t think that’s acceptable.”