Transcript generated automatically by AI and may contain errors.
Chapter 1: What is the main topic discussed in this episode?
Good morning. You're very welcome to the show. Before we meet our panel, let's have a look at the front pages. So look, if dysfunction in the health service and hospitals is your thing, then you love the papers today. I think the technical and medical term would be they are, the papers are riddled with it. The Sunday Times is leading with St. Vincent's liver transplant service in crisis.
A leaked audit of the state's liver transplant service has found evidence of unequal access high complication rates and inadequate monitoring at St Vincent's University Hospital, where transplant numbers have fallen sharply in recent years.
Chapter 2: What are the major health service issues highlighted in the newspapers?
Interestingly, I think the transplant was one of the areas that were also looking for kind of derogations and exceptions from the public only consultant contracts. The Sunday Independent As another health service story, I blew the whistle on Harvey case at CHI. Insider calls for health minister to fast track statutory inquiry and says I 100% will be willing to testify.
This is a former manager at Children's Health Ireland who is now identifying herself as the whistleblower herself. who flagged concerns around the case of Harvey Morrison Sherratt. The Irish Mail on Sunday is leading. The headline is Garda abuser quotes protected by colleagues and the force.
A woman who was physically, sexually and emotionally abused by her former partner and serving Garda while she was pregnant has accused the force of failing to properly investigate their colleague. And that is not a unique case. The Business Post has an exclusive Guinness owner plans for radical operational overhaul.
I think you always know if your new boss is called Drastic Dave and he's warning of difficult changes in the need to streamline the company, then you probably should be nervous. So that's Diageo. which has seen a lot of kind of trouble and change over the last few years. The Sunday World is leading with Kinahan, I'll never get a fair trial.
And that was in a conversation between their man, Ken Foy and Daniel Kinahan, who said,
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Chapter 3: How is the liver transplant service in crisis affecting patient care?
claimed that he's a victim of a witch hunt and a corrupt Irish government. That conversation happened in 2021. And the Murr is leading with the chief suspect in the Sophie Toscan du Plante murder case, gave Gardaí a sample of his DNA before his death in 2024. And that is Ian Bailey's sister saying that about her brother.
because he wanted to ensure, she says, that no one could say there was a problem with his DNA after he was dead and gone. OK, our panel this morning. Dr. Suzanne Crowe is a consultant in paediatric intensive care at CHI Crumlin. David Quinn is a commentator and head of the Iona Institute. Pete Lunn is the head of behavioural research at the ESRI.
And Ellen Coyne is political correspondent at the Irish Times. And good morning, everybody. Ellen, you've been following the maternity services rotunda story very carefully, and there have been a lot of developments over the weekend as well that aren't necessarily reflected in all the papers today. So bring us up to speed. Nobody's backing down here.
Nobody is backing down. This seems like an absolutely intractable dispute between the Rotunda and the state.
People might have seen that the Rotunda decided to have an extraordinary general meeting of its board on Friday, where it considered some of the, I suppose, would you call them threats to its funding, its insurance status, even the Minister for Health suggesting that women who had received private care from public-only consultants might be in line for a refund. But at that meeting, the board...
You've been reporting that there are only two such cases in the first quarter of the year. Is that correct?
Only two known cases. So people might have some anxieties and think that this is like a widespread issue. As far as I'm aware, there is only one consultant obstetrician at the Rotunda who is on a public only contract who is continuing to do private care. The figure of 14 that people see of these 14 consultants who signed that contract, I understand, might relate to people who do gynecology only.
So there was only two babies delivered under that model. And in both of those cases, the insurer, which happened to be VHI in both cases, refused to process the claim because the consultant was on a public owning contract.
And just because I think people are a bit confused around a lot of this. Am I right in saying you reported the other day there are 18 children consultants who are on the old contract still free to do private work. Is that correct?
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Chapter 4: What whistleblower revelations are impacting Children's Health Ireland?
This will become a bigger issue as those people retire because anybody post, I think, 2023 is automatically on the new contract. So that's why the Rotunda is picking this battle.
It's trying to fight this on principle, not for what's actually happening in the hospital at the moment, which is very minimal in terms of the impact of this, but because in the future, the Rotunda is fighting tooth and nail and has a lot of support privately in the other maternity hospitals to stop private care being removed from public maternity hospitals completely.
Okay. So, Suzanne Crowe, I know this is not your specific speciality, but I presume you know more about this than the rest of us do. In your opinion, what is Sean Daly at here? I know that from the beginning he's been fighting this battle, hasn't he? And I know that he talked early on, he gave a discussion document to the board at the time when the public owning contracts were coming in.
He talked about major issues, challenges, adverse outcomes, unintended consequences, financial losses, impact to ancillary fund for the Rotunda as well. And he stuck with this. What's he at?
Well, I mean, just to be clear, I've never worked in the Rotunda Hospital, so I don't have any connection there. Professor Daly is a seasoned operator and manager of hospitals. This is the second hospital he's been managing. I don't imagine that that piece of information came out at the Oireachtas hearing by accident.
To me, there's something to be asked around why this has come out in the public domain like this. I think it was deliberate and I think it reflects the fact that there hasn't been resolution on the issues that have been raised going back several years. And the deadline for implementation is passed now. I think it's passed over a year. And there seems to be a stalemate.
And so there's a stalemate in the last week or two since that Oireachtas hearing. But that reflects the fact that there's been a stalemate for the last couple of years.
Yeah. And this was going on. This row was going on between him and the minister long before it suddenly happened. came up at that Oireachtas committee.
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Chapter 5: How are Gardaí handling allegations of abuse by their own officers?
So can you, maybe you can explain a bit the model for people who mightn't understand. So the doctors in public hospitals who are doing private care also, they are doing it, are they doing it with the facilities, support services, et cetera, under the indemnity of the public hospital system?
That's correct. And that's been happening all around the country for decades. And it's gradually phasing out because of this new contract. But there are still people on the old contract who deliver private care within public hospitals.
And do they pay the public hospital a portion of what they're earning privately for the use of the, you know, the use of the hall kind of thing, as you might say?
No, they don't. And they do a lot of that care in the hours above they're contracted, 40 hours a week. But they use the facilities.
OK, so they do have for free, effectively, the ecosystem of the public hospital there.
That's true.
Okay. And Camille, are you aware of, there seems to be mutterings that this is not a unique situation. Are there other pockets within specialisms in the system that you're aware of where similar is still happening to that there are people on public-only contracts still doing this? There seems to be a suggestion that this might not be the only situation.
I'm not aware of any and I think it's been quite easy to actually introduce a new contract in the majority of other hospitals because there's very often a co-located private hospital where those on the new contract can deliver private services above their contracted hours in the private site. The difficulty in obstetrics is that there is no private site.
Okay. And there is no private site because it clearly is not economically viable to deliver maternity services in a completely private setting. Is that correct?
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Chapter 6: What are the implications of Diageo's operational overhaul?
Yeah, largely because of indemnity. Mount Carmel Hospital closed over 10 years ago and it was due to the rising cost of indemnifying obstetrics. If you were to pay for private indemnity, it would cost somewhere close to a quarter of a million euros.
And as far as you understand it now, the ones who are doing the private work in the public hospitals, they're operating under the indemnity of that hospital, yes?
Yes, yes.
Okay, so they're being heavily subsidised to do the private work, correct?
Yeah, and the state picks up the indemnity costs for obstetrics, but also for a couple of other quite high risk specialities, such as high risk spinal surgery, neurosurgery and eye surgery. So the state steps in because it would just will be economically impossible for an individual doctor to cover the indemnity costs.
Okay. And you may or may not know the answer to this. I know that people who go into paediatrics don't go in it to make massive money. Am I right in saying that obstetricians and gynaecologists, it would be one of the more lucrative specialisms?
I suppose the specialities where there's interventions that are billed individually, that's where you see people making large sums of money. So things like obstetrics, surgical specialities, radiology, where they're billing per procedure, they tend to be the higher earning specialities.
People tell me that a good obstetrician working privately as well is making between half and three quarters of a million a year. I wouldn't comment on that. Yeah, but that doesn't sound outlandish to you either.
No, it doesn't sound outlandish, no.
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Chapter 7: What recent developments are there in the maternity services dispute?
However, there's a lot of women who would like continuity of care with a midwife. But I think the nub of the issue that emerged this week, which I do not think has been addressed by the Rotunda or any of the consultants that have been advocating against this, is we will never have continuity of care for every woman, every pregnant woman in this country...
while private maternity care exists, because it is not in the interests of doctors to interrupt their own business model. Continuity of care has to be an exclusive premium service for you to get people to pay €5,000 for it.
And from my discussions with consultants this week, many of whom do have private practices, I do not believe that it is impossible for the health service to offer continuity of care through a consultant or a midwife for everybody in the public system. But it is impossible for that to happen while private care exists.
because they're not going to undermine their own business model by making it available to everybody.
Okay. By the way, you mentioned that a lot of the other doctors on the public-only contract are doing purely gynaecology. And that can be done in private clinics, can't it? So basically they have a mechanism for doing their private work.
Well, that's the whole point of these contracts, that you can do private care off-site.
Yeah, and the gynaecologists can, can't they?
I believe so, yes. But the obvious issue is that you can't do obstetrics off-site because there's no off-site private maternity hospitals.
OK, just before we leave this, Claire Scott has an interesting piece in the Sunday Times that you picked. Minister faces cabinet backlash over rotunda consultants row.
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Chapter 8: What is the impact of immigration on the health service and public perception?
And that relies on you being a participant, ideally in the dream world as a minister for agriculture. So Michael wanted to go in. Danny was ambivalent, shall we say the least, about Enda Kenny. And it was kind of understood that there was a disagreement there.
So have you all in the political bubble have known for years that these two lads aren't really talking or getting on or whatever and no one ever told us?
Which I was always a bit baffled by because often you would talk about cabinet ministers who don't get on with each other or who are known to despise each other. But with the Healy Rays, they kind of had like this almost royal aura around them, where the Healy Ray dynasty was like a firm and no one would dare.
I mean, in fairness... It's like the royal family, people kind of left it alone. They were active participants. I don't know if it's the royal family I reported all the time on. But for a long time, let's face it, for a long time, David, we weren't told.
We're being told now. They would put on a show in the Dáil Chamber as well, where if Danny was in a row with someone, Michael would come storming in in his little hat and they would kind of be, you know, yelling indecipherable words at people across the chamber.
But obviously it came to a head when Michael felt, and we know this from the Radio Kerry interview, that he was forced to give up what had been his dream job.
He loved being a Minister of State at the Department of Agriculture because he got the very clear impression from the Department of Taoiseach that he had only gotten that job on the condition that the government could rely on two Healy Ray votes, Michael and Danny. And Danny was very opposed to the position Micheál Martin had taken during the fuel protests.
So Michael felt that, and this is the understanding I had from the Department of Agriculture, the worst of all worlds for Michael Healy-Ray would have been to vote confidence in the government over the fuel protests and then be fired as a minister. That would have been inconceivable to him and the way that he does politics and his political reputation.
Okay, he would have lost everything.
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