Public consultants doing private work

I think some of the media are mis-framing this situation as preventing choice.

It's not. Its about the fact that we have well paid public servants earning over 250k a year; who are paid to spend their full working week in the public health service; being allowed to do private work on taxpayers time.

There is no ban on private maternity care or hospitals - there are other consultants who dont have public only contracts and consultants are perfectly free to take a full time job with a private hospital if they dont want to work in the public service.

The difference for obstetrics compared to other medical specialties is that there are no private maternity hospitals. The last private maternity hospital was Mount Carmel and it closed in 2014, primarily for financial reasons.

The issue of private practice in obstetrics was a particular bone of contention when the public-only contract was being implemented, as the medium-term will see no private maternity care at all in Ireland. This will not be the situation in other specialties, as the private hospital sector will increasingly absorb that demand.

The Rotunda's own 2026 information sheet for patients says, inter alia:

"Maternity hospitals in the Republic of Ireland provide inpatient care to both public and insured (private patients). There is no maternity service in the Republic of Ireland that provides care to insured patients only. As such, there is no alternative outside public maternity hospitals. The Rotunda Hospital permits private practice under a contractual exception for Sláintecare (Public only) consultants providing maternity care. This approach supports women’s choice, continuity of care and the safe delivery of specialist maternity services within a tertiary maternity hospital."

Clearly, this hospital (and maybe others) is challenging the Minister and the HSE in this regard. A subsidiary issue is that, once there are no patients who are the private patients of a consultant, the hospital cannot categorise them as private for accommodation and hence charging purposes. That represents some income loss, which they would look to the funders to compensate them for.

The problem is you cannot get indemnity insurance to provide maternity care in Ireland.
imagine the situation in the Routunda will land before the courts

You are incorrect in stating that consultants are billed for use of the facilities. They are not - and it has always been thus.

There was a discussion on this topic on Brendan O’Connor’s RTÉ Radio Show this morning, one of the guests was a hospital consultant who confirmed this.

The client/patient will be billed, but in most cases that money will be paid exclusively to the consultant. There may be theatre fees or room charges etc., but these will be billed separately to the consultant’s fees.

The hub of it all is Hospital consultants are getting 250K of a salary for seeing public patients but they are a GREEDY bunch and want to make obscene money packing in private patients in public facilities as well . It’s why people are so long on waiting lists.

Doesn’t happen in Belgium or Holland where consultants are more interested in reducing the public waiting lists time than making obscene money .

I dont think anyone is suggesting private maternity care shouldnt exist, but rather that public only contracted consultants should not be doing private work on the taxpayers time.

How is the public "subsidising" private care when all of the private aspects are done off site and on the consultants own time which they are paid well for. The delivery is the only part that actually happens in the hospital and what difference does it make to the tax payer that it is your own chosen consultatn that attends rather than the random one on duty? The costs are the same to the tax payer.

Exactly.

What is happening here is that the private sector cannot get indemnity insurance to provide private maternity care, because of the huge settlements awarded by the courts.

As a result, these consultants want to stick any bill for insurance on the State, while collecting huge fees from private patients. The taxpayer is left holding the baby when something goes wrong.

Our first child our consultant was on rota, patients were being seen on a needs first basis - he did make sure to be the one to deliver our child but he was also seeing public patients at on the same day. For our second he came in especially which was a massive deal for us to be fair, I couldn't really care about anything except this gave the best care to my wife and child.

I'm not seeing the issue? You are giving birth in a public hospital why wouldn't the state cover the insurance? The private aspect is mostly in the lead up to the birth done on the consultants own time and the fact they attend the birth which is a massive deal for women but most men don't care about this of course….

The cost of private mat care is no where near a level that would cover the cost outside of the scans and consultant visits etc. It would be unaffordable for most in a fully private system and who suffers then - the women and children.

You are giving birth in a public hospital on a private-paid basis and you expect the taxpayer to pick up the bill if something goes wrong. That is a problem.

The system that the Rotunda is defending is one that gives a taxpayer-funded advantage to wealthy people.