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Chapter 1: What recent developments have occurred in the private care debate?
The Clare Byrne Show on Newstalk. With Aviva Insurance. that the Sláinte Care Plan is finally moving at some sort of a pace. Roisin Sheen-Shortall is here, former Social Democrats TD, who was chair of the All-Party Committee on the Future of Healthcare, which you'll remember produced Sláinte Care. And Roisin, you're very welcome. Thank you, Clare.
We wanted to get your take on what's happened over the last week and in general terms, whether Sláinte Care is moving now at a pace that you would be happy with. But firstly, on that maternity care row, what did you make of it all?
I suppose it was a case of things coming to a head and it was inevitable that there was going to be a bit of a showdown at some stage because for many decades in this country, there's been a kind of lack of clarity about the role of consultants and the kind of mix that they could engage in between public work and private work.
And I mean, there was a row around 2008 with Mary Harney as minister and there was a new contract introduced and still that contract wasn't fully implemented. So it's always been a grey area and there's always been question marks over who actually supervises consultants.
And finally, then, as part of the Sláinte Care proposals, the new contract, the public only consultant contract was introduced in 2023. It was signed off by the representative organisations and the government. Stephen Dunley did a huge amount of work and deserves credit for that. And it was introduced, approved in 23 and then came into force in January this year.
And it's a very generous contract. And I think that's very important because the work that obviously public consultants and all consultants do is really important. But this was requiring a commitment from consultants that they would only engage in public work in public hospitals. And that's what they signed up to. And they did that voluntarily. Now, it was very popular, as it turned out.
The representative organisations weren't in favour of it for a long time, but consultants themselves were, and particularly consultants who had gone abroad and wanted to come home and didn't really want to be part of that whole public-private mix thing. And they signed up to it. So now 70% of consultants are on that contract.
But was there a provision, as Sean Daly told us when he was in here last week, that management of individual hospitals could decide if they wanted to allow certain consultants on that contract do private work?
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Chapter 2: How is the Sláinte Care plan progressing?
Well, I mean, that's the argument that there's under putting forward, that that's their legal interpretation. But it certainly wasn't the intention of the contract. And as I say, that was all signed up to public only work in public hospitals. There was a concession made that some of those consultants could do private work in other hospitals, in private hospitals.
But if you're signed up for public work in a public hospital, well, then that's what you do. And they're very well remunerated for that.
I suppose that the argument for maternity care was that there is no alternative, like there is no private maternity hospital since Mount Carmel closed in 2014. So for women who wanted to go down that route, it was closed off for them as a result of this contract.
Well, it wasn't closed off. It still remains an option. And that's the very important thing. With people who are on the old contract. Yes, people who are on the old But in time, it'll be closed off. But over a long period of time, and that was the whole approach with Sláinte Care. This wasn't a big bang thing.
There was a recognition that, you know, there are different models within the health, Irish Health Service, very different to most other European countries. But we recognised that they were there and we took the approach of phasing things out rather than, you know, changing things overnight.
So what we've seen in the Rotunda, for example, and I think the same applies in other maternity hospitals, is that the majority of consultants didn't sign up to the public-only contract. So they can continue to do their mix of public and private work. And, you know, I know the master of the Rotunda made some comment about this would be phased out in a couple of years. That's not the case.
If you look at the consultants who are there on the old contract contract, in the Rotunda.
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Chapter 3: What are the implications of the new public-only consultant contract?
They're, you know, people in their 30s and 40s and they'll be there for as long as they choose to be there. And, I mean, there was also an argument made by some women that, you know, they had had consultants be for their previous births and they wanted to continue with that person and they couldn't now because that person had gone on to the public-only contract.
But that was a choice that that consultant made. Do you know, it wasn't that that consultant was forced to go into the public arena. It was a choice that they made. But there are many other consultants available. There are 18 consultants available in the Rotunda who can continue to do.
private work. You're not buying that argument this removes choice for women who want a continuity of care who have decided they want that person and because that person is on the new contract they can't have them and they can't get them privately now.
They can't get that particular consultant if that consultant has signed up to the new contract but that's something that the consultant has decided to do and that's the choice that the consultant made but there are many other consultants available to do private work.
But, you know, things you have to bear in mind, the Irish Health Service has been extremely dysfunctional, really unequal for many, many people who are depending on the public service. OK, more than half the population who are. And the scale of the waiting lists and the lack of access is It's just not acceptable in a modern country. I mean, we're completely out of line with the rest of Europe.
But people you say with private health insurance can jump the queue. Well, I'm not couching it in those terms. I'm saying that people who are dependent on the public health system are not getting a good enough service. That's the start and end of the thing. You know, the waiting lists are too long. There's a lack of access. Cost is a serious barrier to people.
Accessing, very often, life-saving care. And that's just not acceptable in a modern country. And it wouldn't be tolerated in other countries in Europe.
I'm sure you read the piece by Gabrielle Colleran, President of the Irish Hospital Consultants Association. She was writing about this debacle in the Irish Times. And she referred particularly to how the minister, Jennifer Carol McNeill, dealt with this.
She says it would have been better for her to have met the consultants, sought common ground with them, rather than to make that threat to withdraw funding. What did you think of how the minister dealt with it?
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Chapter 4: How does the maternity care row affect women's options?
Now, the whole sludge care thing was put on hold and shouldn't have been during that. And then Stephen Donnelly, you know, realised what it entailed. He hadn't been involved in the production of the report at all. And he introduced a number of important measures, start at important measures. And, you know, the challenge now is for the current minister, Carol McNeill, to carry on that.
And I think what we've seen over the last couple of weeks where that important principle of public only work in public hospitals has been upheld. And I think that's a really important milestone in health care reform. And I hope that the minister will kind of take courage from that and will plough ahead with a quicker introduction of the various elements or acceleration of the various elements.
Most of them have been started and some of them very well. Some of them are behind the scenes, so people aren't necessarily seeing the impact of that in their day to day lives. But there is important work that has been done, but it certainly needs to be accelerated.
All right. Well, Roisin, we may catch up with you again in time to see where you think things are at at that point. Thank you very much for coming in. That is Roisin Shortall.
Still to come.
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