Prof Sean Daly, master of the Rotunda, stands on the balcony of Hampson House, the new outpatient facility for the world’s oldest maternity hospital.
Located in the newly revamped Clerys Quarter, behind him is the Spire, the Dublin landmark. Over his shoulder, the top of the original hospital is visible.
He is in the heart of north inner city Dublin, allowing the hospital to serve what he says is a uniquely disadvantaged community. There are very specific health needs for these women, he adds.
“I remember when I worked in the Coombe, I kind of thought the Coombe and Rotunda were the same, and cared for the same kind of women. But that’s not true,” he says.
“The Rotunda cares for women who recently migrated into this country, who live in very socially deprived areas in north Dublin.”
Around 60 per cent of women who are homeless and having babies are cared for by the Rotunda. On average, about 500 Romanian women deliver babies in the hospital every year.
These women, he says, often “get married very young, have a lot of children, they don’t speak English, they don’t engage with healthcare”. But this should be viewed as an opportunity, he adds, as healthcare staff can “gain their trust” and encourage them to come for cervical smears.
“If you are brought up traumatised because you have lived with your family in very poor social circumstances, or you have recently migrated from another country and you don’t have all your family here ... we need to understand that and it needs to inform the care we give.”
The hospital is undergoing a significant transformation. On January 6th, the new outpatients facility will open to patients providing a range of services including maternity outpatients, paediatric outpatients, colposcopy, perinatal mental health and allied health and social work/dietetics.
The Health Service Executive (HSE) recently purchased space on Dominick Street, a street away from the hospital, for the Rotunda to develop gynaecology services, while the planning for a new critical care wing was lodged in recent weeks. Prof Daly says he is “fairly confident” the hospital will be in that building in four to five years’ time.
All three of these new developments equate to an investment of some €200 million, all of which seeks to enable care to be delivered in a modern, 21st-century environment.
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Currently, in the oldest part of the hospital, built in 1757, there are two wards in which between 10 and 12 women who have babies are cared for.
“And their babies aren’t really even kind of counted as beds. You could have 25 people in one space, sharing one or two toilets. It’s utterly unacceptable,” he says.
“Having more postnatal accommodation will allow us to repurpose those spaces.”
Unlike around the rest of Europe, the birth rate in the Rotunda is increasing. In 2023, the hospital delivered 8,442 babies and cared for almost 10,000 pregnant women. This year, he says births will be up about 2 per cent.
The number of babies it delivers, he says, is higher than the other two Dublin maternity hospitals – Holles Street and the Coombe. But this rising activity can be difficult to maintain in the current space.
“If we deliver more than a baby an hour, so 160 babies a week, the hospital is full. We have no beds. So women who are coming in for routine gynaecology surgery are frequently cancelled,” he says.
There was one week in which the hospital delivered 182 babies – more than the number of beds in the healthcare facility. In a bid to cater to this, the hospital tries to “discharge anybody we feel we safely can”.
Safety is paramount to those working in the hospital. There were no maternal mortalities in the Rotunda last year, Prof Daly says, while the number of babies who died is “historically low”.
Twenty years ago, when he was master of the Coombe hospital, the mortality rate for babies who weighed more than 500g who were normally formed was five per 1,000. In 2023, the figure in the Rotunda was two per 1,000.
“There has been a decrease of 60 per cent over those 20 years, and back then I didn’t think that was possible,” he adds.
Overall, Prof Daly’s message around delivering the best care to patients relates to being kind. Women have traditionally stated they feel their healthcare needs are often ignored or dismissed by the health service.
“I think it is better but it is by no means perfect,” Prof Daly says.
“I would really believe that kindness is the essence of care. If you’re caring for somebody, you need to understand that they have worries. Coming into a hospital, even a beautiful place like this, people are anxious. You have to understand that,” he adds.
The needs for kindness is particularly true when it comes to termination of pregnancy, he says – a form of care in which this can sometimes “be in short supply”.
He would be in favour of the removal of the mandatory three-day waiting period to access abortion, which was recommended to the Government as part of a review into termination of pregnancy services by barrister Marie O’Shea.
“I think nobody goes down this route lightly. Women don’t arrive into a doctor having not spent a lot of time agonising about what they’re doing. Forcing them to wait another three days, I think that should be looked at,” he adds.
There has also been much focus on the interconnection between abortion and Down syndrome. The current legislation does not allow for termination for this reason. Prof Daly says he is a believer in women being able to make their own choices about their own healthcare.
“If you discover your baby is having Down syndrome and you want to interrupt the pregnancy, then you inevitably have to travel abroad,” he says.
“You could argue about the rights and wrongs about that. We all want our children to grow up, be loving and contribute to society. Lots of people with Down syndrome are loving and contribute to society.”
He adds: “Therefore, I feel there has been too much of a focus on that area. We need to understand that people make choices and respect those choices even though they might make choices we wouldn’t make ourselves.”
Though generally very complimentary towards the HSE, Prof Daly is critical of the funding allocation the Rotunda received. The facility will have a €6 million deficit this year, he says
What’s going to happen as a result of that deficit?
“I don’t know,” he says.
In previous years, the HSE has plugged financial holes in hospitals, however Prof Daly said the hospital has been told any plugs or bailouts will “come off next year’s allocation”, which he believes will further exacerbate the issue.
“Will we start turning women away? I really hope not. Should women who come from Kildare deliver in the Coombe? Yes, of course they should. But lots of them come to the Rotunda,” he adds.
Adding to this, the hospital has exceeded the headcount for staff allocated by the HSE; 85 per cent of the hospital’s budget is pay.
“We’re constantly getting ticked off or told off for being over our headcount. And while we don’t really like getting ticked off, I’ll take that.”
In a bid to reduce the cost overruns, the hospital looked at curtailing gynaecology services for the last two months of the year.
“We would have saved €200,000 had we done no gynaecology. We have a €100 million budget. What’s €200,000? So we decided not to. Because most of it is fixed costs, it’s hard to justify changing activity.”
Though he admits staff count is higher than limits imposed on it, the cost of working and living in Dublin can be a barrier for recruitment. This is something the hospital intends to tackle.
The board of the hospital recently purchased 1, 2 and 5 Cavendish Row, opposite the eastern side of the hospital, with non-front-facing services due to be moved here. Many of these services will be relocated from the hospital’s old nurses’ home. Once vacant, the board intends to renovate it for 25 to 30 staff housing spaces.
“One of the difficulties with the nurses’ home is it was built in the 1930s, there’s no en suite rooms. So it would be shared bathrooms, shared kitchens, but we can make them nice,” he says.
“I think we will be in a position to offer short- to medium-term accommodation for people.”
It is an exciting time for the master, with so many developments ongoing, as well as growing demand for its service. Prof Daly appears proud of all the Rotunda has accomplished so far, and is ready to tackle the challenges ahead.
“Am I saying we do everything perfectly? No,” he says.
“Do we wish we had more space, more time, more opportunities to care for people? Yes.”
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