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Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance. Now, the board of the Rotunda Hospital decided overnight to bring the hospital in line with the government's policy on the terms of the public-only consultant contracts. You will have heard about this controversy over the last couple of days. There was a threat from the health minister to withdraw funding.
This means that consultants on public-only contracts will now not be allowed to treat private patients. Professor Sean Daly is master of the Rotunda and he joins me now. Good morning to you.
Chapter 2: What recent decision did the Rotunda Hospital board make regarding consultant contracts?
Good morning.
It's been a rough few days. We'll go through it all. Um... That decision last night by the board to come in line with what the health minister and the government and the Taoiseach was out on this yesterday, was that contrary to your view on what should happen when it came to the public-only contracts?
So I suppose, first of all, I'm not a member of the board. I did contribute to the discussion. I contributed to most discussions in the board because I have been around a long time and I have, I think, got a range of experience of women's health care that some people don't have, you know. So I absolutely contributed to the conversation. I contributed to it last night.
And the board made a unanimous decision. I think the possibility of funding being withheld from the Rotunda Hospital just made it a situation where the board, who would always put the health of women and children first,
Chapter 3: What implications does the health minister's funding threat have for private patient treatment?
could not continue to hold its position. Now, I actually think they were right to take the position they did. You know, it is about women's health care. And there's been a lot of misinformation, Clare. You know, if you work in the rotunda, you have a rotunda contract. Therefore, the rotunda is your employer. The new POCC contract was not negotiated by the rotunda.
It was negotiated by the Department of Health.
This is the public-only contract.
Sorry, the public-only contract. So we were implementing that contract. And, you know, the option or the, I suppose, principle that women should be allowed to choose is a very important one, I think.
But was it allowed under that contract? Because it's the Minister's firm view that you should not be doing seeing private patients if you're on a public-only contract.
Right.
So Clause 2410, which interestingly was inserted by the department in the late stages of the negotiations. Now, I wasn't part of the negotiations, but I understand it was inserted by the department, said that the management, the senior management of a hospital can decide to allow private practice in certain circumstances. And it's as plain and as simple as that.
So you felt that you had license to allow those consultants on the new contract to see private patients?
So there was a discretionary aspect to the contract and consultants asked, can we see private patients? And the hospital had gone out. I had gone out, as I said, with the two other masters and Dr. O'Riordan representing Cork to go into the department at 2023 to try and explain that pregnancy is different. And we didn't get anywhere. But the hospital had always said pregnancy is different.
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Chapter 4: How did Professor Sean Daly contribute to the board's discussions?
I don't think she or her, the department, have actually questioned the contract. They've said that the hospital signs a contract, which we do on an annual basis with the HSE to provide service. And that's where we get 90% of our funding. And they had taken a legal opinion to say that they could enforce aspects of the contract through the SLA. Now, you know, I'm not a lawyer.
It's not down to me to discuss the nuances of the legal interpretation of things. But it got to a point, Clare, that... that potentially the health of women and children was going to be compromised by the board's decision. If funding was cut. Yeah.
Was there a question mark over you continuing as master of the Rotunda, given that the board ultimately didn't support you on this?
Oh no, the board did support me on this.
But they didn't. I mean, last night they didn't, essentially. I mean, you believe that you should keep pushing.
Oh, no, no, I didn't. I didn't believe that we should keep pushing.
But you, Rosiles, you went out on a limb with this position. When the threat was made about the funding, you and the board then decided, no, we're going to pull back from this position. So what does that say about your leadership? Did anyone question you on that last night?
No. And like this was a decision for the board. Did I inform that decision? Yes, I would hope I did. I believed it was the right thing not to continue with the decision that they had taken. But it wasn't my decision. So I was informing the board, as indeed there were many board members. And the board in the Rotunda is a group of voluntary individuals who give their time
free of charge, and they have expertise across a broad range of professions and different skill sets. And they took the decision. Now, they informed themselves by various means, and I would hope that I contributed to that.
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Chapter 5: What are the main points of contention regarding the public-only contract?
In fact, there's evidence to the contrary. Every woman in the Rotunda is as safe as every other woman. Every baby is as safe as any other baby.
So what was the point of the whole thing from your perspective? Because there is a suspicion that what you're trying to do is protect an income stream, both for the consultants and for the hospital.
So that was absolutely not the motivation. And I think the other, I suppose, salient fact here is that this isn't really an issue now for the Rotunda. So there was five women delivered, five babies, up till the end of May. there was over 600 private deliveries. So there's plenty of private practice in the Rotunda because people haven't changed.
They're on the old contract.
Yeah. Now, that isn't the case throughout Ireland. There are many units that are now not able to offer the option of private care. And so so this was never about, you know, the redundant safety. This is about my children, your children having choice in 10 years time or 15 years time when all the consultants who are currently on the old contract have retired.
But the sláinte care ambition is that we would all have access to excellent care without having to pay for it.
So I think public patients in the Rotunda, and we have more than 6,000 public patients, we have more complex public patients than anybody in the country, have access to excellent care. They have it already. There's no two-tiered system in the Rotunda.
Then we shouldn't have any need for private care. It shouldn't be an issue.
But that is a woman's choice. So if a woman has had recurrent early pregnancy losses... or has a medical disorder like high blood pressure or Crohn's disease or something like that. And she feels, I'm very anxious about this pregnancy. I actually want to know who's going to take care of me, who's going to be there for the delivery. What all the rotunda is saying is that she's entitled to that.
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Chapter 6: What is the significance of the discretionary aspect of the new contract?
So the battle is lost but the war is not over yet. Would that be the right way to frame this? So
So the provision of pregnancy care, and it's only about pregnancy care, is not simple. You know, pregnancies or deliveries can occur at any time of the day or night. You absolutely want to have appropriate professionals in there dealing with women. Women want continuity of care. Some women want continuity of care and they should be entitled to it.
And we would really like to engage with the minister about how we can move forward around the provision of perfect pregnancy care.
OK. And in the middle of all of this, you had a bereavement at the weekend and your father died. So... There may have been questions asked about why we didn't hear as much from you over the weekend. And I think it's important to say that just to explain to people why you're speaking today. Obviously, you're still in the middle of all of this. And my sympathies to you on that loss.
Sean, thank you very much for coming in. That is Sean Daly, who is master of the Rotunda.
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