Masters of maternity hospitals criticise move to end private care of pregnant women

Introduction of new public-only contract could have ‘serious implications’

Masters of two Dublin maternity hospitals have strongly criticised Government plans to phase out private care for pregnant women.

The heads of the Rotunda Hospital and the National Maternity Hospital say an exception should be made to allow their patients retain the choice of private maternity care in public institutions.

Under the new consultant contract agreed by Cabinet this month, private care is being phased out of public and voluntary hospitals.

Consultants opting for the new Sláintecare contract can earn almost €300,000 including allowances but they will not be able to see private patients on-site. They may see private patients off-site in their own time but in obstetric care no private facilities exist. Private patients pay up to €5,000 to see the consultant of their choice.


Master of the Rotunda Hospital Prof Fergal Malone described the proposed change as “chilling” and said it would have “serious implications” for maternity care.

“This is the death knell of the national maternity strategy, in one fell swoop. This is one of the best things they’ve done this decade, but its essence is about choice for women and if there’s no choice in your care that completely undermines the strategy.”

“This is about the right of women to choose their healthcare,” said Prof Shane Higgins, master of the NMH. “We have listened for a long time about how women’s health rights have been placed behind those of others in society. If you’re a man you are able to get continuity of care, but as a woman, with these changes, you won’t.

“For any other procedure – a stent, a new hip, the removal of the prostate – you can go to any one of a number of private hospitals. But there are no private maternity hospitals.”

“Maternity services are unique; there is no non-public option to deliver a baby in Ireland,” Prof Malone said. “But if the Department of Health insists that you cannot see private patients in public hospitals, that will mean women who are being cared for by obstetricians won’t be able to choose who looks after them.”

Among the one-third of the population with private health insurance are many younger people and families who pay premiums specifically for maternity care, he pointed out.

Prof Higgins said the change will remove choice from the 35 per cent of the women attending the NMH who opt for private or semi-private care. It will also impact on neonates.

Twelve per cent of women attending the hospital are over 40, he said, and because many have complex medical needs, they are more likely to opt for continuity of care provided privately.

A new private maternity hospital is unlikely to be set up due to the cost of providing professional indemnity, he said, and even if one were established in Dublin it would cover only 40 per cent of births.

Prof Higgins said the solution is to make an exception for maternal medicine by allowing hospitals to continue to facilitate private practice.

The last private maternity unit, Mount Carmel hospital, closed in 2014 after running into financial difficulties. Prof Malone said he doesn’t foresee a new free-standing private maternity unit due to the “stratospheric” costs of litigation around obstetric claims.

The Rotunda’s €100 million budget includes about €15 million from private insurance income. Prof Malone said he had “no doubt” the Government will have to make up this income.

He predicted the measure will impact negatively on the efforts of maternity hospitals to lure back Irish staff working abroad. “You want the next generation of the best and brightest to go abroad to learn skills and then come home, but if I have to tell them they can’t do private practice it makes recruitment more challenging.”

The Department of Health said the new consultant contract will ensure public healthcare facilities are used for public patients only.

“The transition applies to all private care, including maternity, in all public hospitals [HSE and voluntary],” a spokesman said.

The transition will be implemented on a phased basis so the immediate impact on private maternity care will be limited, he said. Most serving consultants have contracts that allow them on-site private practice.

“While maternity care is not currently available in private hospitals, like the NHS, all consultants who hold the contract, including those who specialise in obstetrics and gynaecology, will be entitled to treat private patients off-site in their own time, subject to the primacy of their public contract and meeting their commitments under it.”

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times