There are a number of issues about the now ‘settled’ row over consultants with public-only contracts engaging in private practice at the Rotunda Maternity Hospital which aren’t being addressed honestly. These include trust in the health service, equality of care and the need to improve maternity services.
Let’s look at the controversy from the point of view of patients in general. In an ideal world, it would be wonderful if everyone in need of hospital treatment could avail of equal care.
So why do 2.5 million of the population invest considerable sums in paying for health insurance? They do so by choice, even if they can ill afford it, because, for one thing, they don’t want to wait months and months, or probably years, for treatment they may desperately need. For another, they may want to choose their consultant and they may prefer to have the peace of a private room as they recover. Most of their expenses will be met by their insurance cover and funds paid out for beds, tests and services go to the hospitals.
Critically too, people may not trust the health service to provide the best possible care and, given the shocking headlines about problems in the health service, you can hardly blame them. Among them: the scoliosis and paediatric surgery scandals at Children’s Hospital Ireland (CHI), where unauthorised springs were used in surgery and patients’ names were taken off waiting lists; the toxic culture at St Vincent’s Hospital, revealed in a recent report, which affected cancer patients’ care. Then there are waiting lists and long trolley waits, at their worst in University Hospital Limerick (UHL).
The Sláintecare 2025 programme aims to provide healthcare on the basis of need rather than ability to pay. Reducing waiting times and ending the two-tier system are among the targets of the programme, which runs until 2027. But it seems to me that equal care is still a long way off being realised and that more time is needed for the health service to get its act together before it can deliver on Sláintecare’s promises.
About 60% of consultants have signed up to the public-only consultant contracts, which have been obligatory for new entrants since 2023. Meanwhile, the numbers with health insurance and attending private hospitals like the Beacon Hospital and the Blackrock Clinic in Dublin are going up, with even the HSE outsourcing to the private sector to lessen the waiting backlog.
In the future, when private practice in public hospitals is phased out under Sláintecare, at least people needing hospital treatment for, say, a hip replacement, can opt to go to a private hospital. But since the closure of Mount Carmel post-pandemic, there are no private maternity hospitals. There simply aren’t the numbers of births to support one. Women are having fewer children, the birth rate has now dropped to 1.5, well below the replacement rate of 2.1.
With two precious lives at stake, women may opt for private care and, according to the ESRI, 14% do so, with 11% going semi-private. Among other things, they do so in order to have continuity of care or from Here to Maternity – to misquote the 1953 film title From Here to Eternity, starring Frank Sinatra. This means seeing the same person through antenatal care to the birth, rather than being seen by someone different for each appointment.
They go private to have consultant-led care, TLC in privacy while recovering and getting to know the new arrival, and to have a full choice of birth options, whether it be having a say in their pain control or a choice about how they give birth. Options might include choosing the Domino scheme for a home birth in low-risk cases or the need for an epidural or a Caesarean. Continuity of care is not always possible at present in the public system.
One upside of the Rotunda row has been to focus on the urgent need to continue upgrading public maternity care and ensure that it offers full and equal care. As the Master of the Rotunda, Professor Sean Daly, commented on RTÉ Radio: “Women should have a choice.” They deserve one. When they do go private, they certainly don’t deserve snide comments about being ‘too posh to push’.
We need to put mothers and babies first.
