Master of Rotunda says issues raised after public contracts row 'need to be explored further'

THE MASTER OF the Rotunda Hospital has said that he does not want to draw a line under the controversy surrounding public-only consultants treating private patients because it raises issues that “need to be explored further”. 

The board of the maternity hospital announced that it would no longer permit the practice on Monday evening following a two-week row with Health Minister Jennifer Carroll MacNeill. 

Professor Sean Daly said it was a source of regret that the row had led to a threat of funding to the hospital being cut, but emphasised that while he agreed with the board’s decision, the issue “is not going to go away”.

He also said that he believes the board of the maternity hospital still maintains confidence in him.

Opposition parties had called on the health minister to meet with the board to discuss the matter further, with Labour highlighting an “issue” in the public-only contract itself. 

Speaking on RTÉ’s Today with David McCullagh, Daly said a clause was inserted into the service level agreement “late in the negotiation process” which allows for a consultant who is on a public-only contract to request to offer a private service. 

“The hospital has to deal with that request appropriately,” he said, adding that the Rotunda received “very strong legal advice from Arthur Cox” on the matter. 

“The fact that there was going to be, potentially, people requesting to offer service, the board had to take a view on that, and the board took a view that women’s choice was very important, and that because of women’s choice and the necessity to ensure that women continue to have choice, the board took a view that if we get a request, we will have to review it, and we may have to allow it.”

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Daly said that when the agreement was being negotiated in 2023, the masters of Dublin’s three maternity hospitals met with then-health minister Stephen Donnelly and requested that obstetrics be “looked at differently” to other specialities in the contracts. 

“We had a very, very difficult meeting and got absolutely nowhere,” he said.

‘Could never do anything that would affect funding’

He affirmed that the Rotunda has a contractual obligation to look at requests independent, adding that it is “very clear” in the contract that in special circumstances, management can permit private practice on the grounds at the hospital.

“I can guarantee you that every consultant in the Rotunda does their public hours, and then some do extra hours for their private patients. Nobody just does private practice in the Rotunda.”

He said legally, the board felt that it had made a reasonable decision.

“The practicality of that has now turned out to be that we could lose our funding. We deliver more than 6,000 public patients every year. We deliver the most complex patients in the country. We could never do anything that might affect that.”

Daly confirmed that since the new contracts took effect in January, there have been five babies born to mothers who were under the private care of public-only consultants.

Asked if the women would be refunded, he said: “We only took the decision by the board last night. We will ensure that the right thing is done by those women. Don’t worry about that.”

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”. 

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Issue of choice and continuity of care

When it was put to him that choice was only available to women who can afford private care, he said: “If we have sufficient midwives to ensure continuity of care, we would love to be able to offer that service.

“We have unbelievably good midwives in the Rotunda, but we don’t have enough of them. We don’t have enough of them for the 8,600 babies that we delivered last year. We need many, many more midwives.

If the minister wants to give us more midwives, we would absolutely take her hand off.

On the issue of choice, Daly explained that women can choose to employ a private midwife or a doula -  a non-medical maternity worker who provide support to women in labour – to assist them during their labour, but they can’t choose a consultant under the Sláintecare model.

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 ten years because there is not enough money to support that. 

He also pointed out that while 40% of babies are born in the Rotunda between 10pm and 8am, he can’t roster a consultant for any hours after 10pm under the new contract.

“I would love to have enough consultants to roster people through the night to ensure that consultants were on the labour ward. We just don’t have that number.”

Asked if he believes the board of the hospital have confidence in him, Daly said he did. 

Asked if he now wanted to draw a line under the matter, he said: “I don’t really want to draw a line under it. I think there have been many issues raised during the last two weeks that need to be explored further.”

He said the decision by the board was taken unanimously. “I believe it was taken for the right reasons, and that was, we were not going to do anything to jeopardise patient safety.”

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