The dispute over whether hospital consultants on public-only contracts at the Rotunda Hospital should be permitted to provide private services onsite has generated significant controversy. The hospital argues that the issue is fundamentally one of patient choice and that it should be allowed to facilitate private maternity care through these consultants. The HSE and Department of Health maintain that public-only contracts preclude such arrangements and that public resources should not continue to subsidise private healthcare provision.
The fact remains that a core element of the State’s cross-party healthcare policy, Sláintecare, is the removal of private practice from public hospitals and the expansion of consultant-delivered care across a longer working week, as facilitated under the 2023 public-only consultant contract.
More than half of the Rotunda’s obstetric consultants remain on older contracts that allow them to provide private care onsite. Therefore, the “choice” of private maternity care remains available there, and across other maternity units, and will continue until those consultants retire or move to the new contract.
The hospital’s attempt to face down the Minister for Health, Jennifer Carroll MacNeill is unwise and looks unsustainable. Consultants need to abide by the terms of the contracts they signed.
The dispute highlights a complex issue. Maternity care is one of the few areas of Irish healthcare without a full private-sector alternative. Ireland’s last standalone private maternity hospital, Mount Carmel, closed in 2014.
Many women want the option of private maternity care, raising difficult questions about how that demand should continue to be met under Sláintecare. Whether the private sector can or will fill that gap remains unclear. Against this uncertain backdrop, uptake of the new consultant contract remains lower among obstetricians than in many other specialities.
The Rotunda stand-off has again exposed the more limited and uneven range of maternity choices available in Ireland compared to many countries. Concerns continue to be raised about the availability of a variety of important supports.
The controversy also comes as planned investment in new maternity hospitals has stalled. Like Holles Street, the Rotunda and the Coombe were due to relocate to new purpose-built facilities, but these projects have been shelved, leaving both hospitals to expand on their existing constrained sites. While there have been welcome investments and improvements in Irish maternity services over the past decade, key gaps remain. The forthcoming new HSE national maternity strategy is an opportunity to address these shortcomings and develop services that better reflect women’s needs. Real choice for women should not hinge on purchasing power.
