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Chapter 1: What is the main topic discussed in this episode?
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Good afternoon. You are very welcome to LiveLine. 51551 is the text number. You can email LiveLine at rte.ie or give me a call on 0818 715 815. We are going to kick things off today with this ongoing row between the Department of Health and the Minister for Health and the HSE and the Rotunda Hospital, because lots of people...
have been getting in touch with us over the last few days about different aspects of this row. People who take issue with sláinte care and public-only contracts, people who take issue with some of the language used in the reporting on this, posh pushers. as one columnist described, people who opt for private maternity care. And a few different aspects of this, like I say, coming up.
You're going to have to bear with me. I have to explain very briefly what's happened here for people who haven't been following it. Essentially, consultants who sign the new sláinte care contract, the public-only contract, are only allowed to treat public patients in public hospitals. They can't treat their private patients
in a public hospital anymore, as used to happen across the health system. They can still work privately and do bits on the side in their own time in a private hospital. They can only work in a private hospital if that's what they want. But if you sign the sláinte care contract when you're in the public hospital, you treat public patients, except in the rotunda.
Because Professor Sean Daly is the master there, confirmed last week that they allow people who signed up to the public only contract, which comes with a quarter of a million euro plus salary. They allow them to keep treating private patients in the public hospital.
Now, I don't want to get lost in the weeds in that there's a bit of a legal dispute happening because there's exceptions in the contract and the Rotunda say they got legal advice and what they're doing is fine. The Minister for Health is having none of that, Jennifer Carroll-McNeill. She's talking about withholding funding from the hospital. if they don't reverse course.
But like I say, people have gotten in touch with us about all different aspects of it. And we're going to get into it with some of them. I want to read a text, though, before any of it, because this texter takes issue with what they say will ultimately mean the withdrawal of private maternity services. They think that's the direction of travel.
You know, once everybody's on the public-only contract, you won't be able to opt for private maternity care. So let me read this. Typical. Remove choice from women again. The Minister for Health should be ashamed.
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Chapter 2: What sparked the discussion about private maternity care?
I've had my babies there myself and I have no affiliation with the hospital or any political party. Midwife and nurse-led appointments are brilliant and absolutely have their place. But if I choose to have a consultant perform all my scans... and oversee my care, I can currently access that privately.
Publicly, consultant involvement is determined only by what the hospital classifies as high risk. That system does not take into account what a woman herself may consider a risk, nor her right to choose the model of care that gives her confidence and reassurance during pregnancy. Women deserve options, not fewer choices.
So that's just one of the texts that we've got in on this issue, and it's why we're going to talk about it. Now, 51551 is the text number, as I say, like that person, if you want to get in touch that way. If you want to give me a call, 0818 715 815. Jessica Ryan is on the line. Jessica, I know you read a piece that Fintan O'Toole wrote, the columnist in the Irish Times.
Rotunda's defiance of public policy shows us how some are born more equal. What issue did you take with that piece?
Hi, Ciarán. I had a baby seven months ago under private care, and I felt Vincente O'Toole's piece on the rotunda came across deeply misogynistic and dismissive of women's experiences. And it also lacked any real appreciation, I suppose, of the complexity of maternity care and the realities of women currently navigating the system. And I suppose I
took particular umbrage to the framing of women who choose private care as seeking a posh push um because i would just love to know what the definition of that is is it seeking um pain care is it epidurals is it abdominal birth um or is it consultant-led care and i just can't really believe that this is 2026 and this is the discourse
We contacted Fintan for comment. He said he'd be happy to debate the core issue with the rotunda, the issue of consultants providing private care in a public hospital. But he wouldn't be interested in participating in a discussion about the semantics of the phrase posh push.
OK, that's convenient for him. I just think it reduces a deeply personal health care decision to a caricature. You know, it ignores the many reasons women make choices to go private, to go public, to go semi public. private and it's just very nuanced and I suppose for me why I chose to go private and continuity of care was the deciding factor for me.
I lost a baby and I experienced significant challenges while navigating that loss within the public system and that's just my experience. I know people who have had incredible experiences with the public system and And in my case, I wanted that reassurance of seeing the same face if I had a subsequent pregnancy, which I did seven months ago. And for me, that was the best decision.
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Chapter 3: What are the implications of the 'sláinte care' contract?
When I lost my baby, it was a struggle to get in contact with my GP. And I mean, this is not necessarily reflective of one clinician. It's the system. I understand that. I struggled to get in contact with my GP and then kind of describe my symptoms, what was happening to me. And a day later, I got a web text on my phone saying, sounds like you're having a miscarriage.
And I can write you a note for work if you need it. And that was it. And then over the next 10 days, I had, you know, quite significant pain. And I was ringing Hollis Street and I was getting advice from the midwives. But it was kind of like, this is normal, this is normal. And kind of varying responses. And then I actually checked the text this morning.
And then I actually scheduled another appointment, a virtual appointment with my GP. 10 days later, because I was still having the pain. And when I got on the phone with her,
and i had set this up she said um oh um did you not go for a procedure and i just i couldn't even speak i i was like i i didn't know i had to send myself for a procedure so i found that very traumatizing and um so when i decided to go private i did a lot of research um into who who might be best in caring for me.
And I went with Professor Shane Higgins in Hollis Street and I was so anxious going in and he said, oh, would you like to come in for an early scan? And I just remember the feeling walking into his office and having just this sense of safety and warmth when I walked into the door. And then not everyone will have that experience as a consultant.
Some people might have midwives, GPs, but I just felt so looked after, especially through my antenatal care. And I absolutely got what I paid for. And I know that sounds a bit crude, but I wanted that consistency. I had a pretty tough second half of my pregnancy. And Professor Higgins was absolutely amazing and supported me through that.
And I mean, everything has worked out, has it?
It has. Yeah, everything worked out and I just haven't slept in seven months so just trying to put a few heaps of thought together. But yeah, everything worked out and I have a lovely baby boy who's seven months and I did get great care in the end and it's such a complex and nuanced and personal decision but I think ultimately
The system is far from perfect and consultant-led care has limitations and there's questions around equity and access and staffing and outcomes that do deserve scrutiny but those discussions should be grounded in evidence and focused on improving care for the people who need it which are people giving birth and their babies.
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Chapter 4: How do personal experiences influence maternity care choices?
Or are we arguing trying to make sure that everybody, no matter how much money they have, no matter what place they find themselves in economically, That those people are guaranteed to be able to have health care that they feel confident and safe with, no matter if they choose a home birth or whatever. And, you know, the lack of choice now isn't the point. You know what I mean?
Because in the sense that like a functioning system should take it like take all of these things into account. to make sure that women have access to the care they need.
But that lack of choice, you say it isn't the point. I mean, it is the point for some people. They think it's the point. Jessica says it's the point. Is she wrong?
It's the point for people with money. Yeah, she is wrong. And nothing against Jessica. I mean, she thinks I'm wrong, right? I mean, Jessica thinks I'm wrong and I think she's wrong. And that's okay.
I think you make some valid points. I think you make some valid points. Like I said, I worked in a public health care system for years. It's wild to me, though, that a man is telling me that I am wrong about it. And I do think it's down to choice. You are in the most vulnerable position you have ever been in. Every circumstance is different.
I would absolutely wholeheartedly agree that we need a public system that is efficient, that includes everyone and that everyone has access to the best care they need. Unfortunately, that isn't the situation. And I'm saying people who have money, I don't know if you've listened to my situation and I'm incredibly privileged. I understand that.
But maybe my decision was fear-based given on my horrendous experience when I lost my baby. Okay, but just for a man to tell me I'm wrong about a choice, and it is a choice, and it was a really well-thought-out choice and a hard choice about the care that I deserved and I needed.
Jessica, if you didn't have that money, would you have been able to make that choice?
Of course I wouldn't be able to, but the other choice was probably the health care.
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Chapter 5: What criticisms were raised regarding the term 'posh push'?
And I recognise my privilege in being able to pay for that private care. It wasn't easy, but 100% it is a privilege. But it was on the politicians, the HSE, the Department of Health, to create a better system for us all. Absolutely. So this transition to slaughter care. Yeah, I absolutely agree with you on those points. I just... It's a very emotional issue and it's very raw.
I'm seven months postpartum and it's been extremely challenging. Side point, I have been engaging in the public system with my son for the past seven months as an outpatient in Crumlin Hospital. So I am well aware of the public system and the challenges and the benefits there. It's just, yeah, it's really complex and nuanced. So I don't think there's a yes and a no.
There are so many intricacies involved.
Well, I want to get into Jessica. Go on. Sorry, Chris. Go on. Sorry.
Just sorry. Sorry. But Jessica, you said that that choice is only a choice if you have money. So that's that's not a real choice for average people. So this can't be about a choice. It's about a choice if you have money. And so that's a very different that's a very different calculation, because if you didn't have that money and you didn't have that privilege and you didn't have those options,
And you heard people saying the most important thing about maternity leave or maternity care, sorry, is that people with privilege get to have more freedom. You would be going, well, it seems to me that the most important thing is that everybody has a standard of care and that we're losing sight of this because privileged people are saying, I want more options.
And I'm sorry about the tragedy that's happened to you. I have two kids. I've struggled with public health care. I've struggled with all kinds of things. I lived in America for years. I understand exactly what you're saying, okay? I'm not trying to be dismissive of you at all. But the reality of the situation is what we're talking about is wealthy people and their options, not average people.
And the vast majority of people are average people. and the vast majority of health care is for average people.
I don't know why you think I'm a wealthy person. I have a very average salary, and this is actually getting too personal, but I would not consider myself. I rent in Dublin, and at a huge rate, I am about to start paying huge childcare costs in the next coming months. I am currently on unpaid mat leave, and I say privileged because I do have so much privilege.
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Chapter 6: How do women perceive their choices in maternity care?
My sister, my niece, whatever, might be pregnant and her priority is she would like to see the same person at every visit. If she goes, certainly in my experience, and I promise any expectant mother out there, in the unit that I worked, hand on my heart, there was no difference in the care that woman received by the midwife in the labour and birthing room. None.
The vast majority are going, and I hate to say this, and my colleagues will probably shoot me for saying this, but the other option was the option of, of getting a room. And that really doesn't exist in the public system. And even within the public system at the moment, you have, you know, the Rotunda, Hollis Street, the Coombe, they have a limited number of rooms.
But if that continuity of care is the ideal, should we not then be focusing on making sure that every patient gets that?
We should. Yes, you're right. You're right. But it doesn't exist. You would want many, many more health professionals to provide that care. Many more. And it doesn't happen. And even, you know, people out there think that a consultant in obstetrics, we'll say, sees every single solitary pregnant woman. Now, that's ridiculous. The Rotunda has 9,000 births.
Well, there's no way Sean Daly sees 9,000 women. So they're split up into teams. But within that team, you have senior registrars, junior registrars. They all change in July and January of each year. So the only person in that team that doesn't move around every six months is actually the consultant. So that's where the women are falling through the cracks. of not seeing the same person.
I think everybody would realise, well, one consultant can't see 9,000 women. It has to be divided up. And that's the way it happens. There is a consultant with a team, but the team under him are all trainees and they're all moving around every six months. So you're not going to see the same person every visit.
Laura is back with us. Laura... What do you say to people who, getting in touch, who would argue, yeah, by all means then, you know, improve the public system or extol the virtues of it. But if people have the money or like Jessica, if they can scrape the money together and it provides them comfort, emotional or mental comfort to go private, that we shouldn't be stopping them.
We shouldn't be putting barriers in their way. That it's not one or the other.
Yeah, well, I would say... That's different than a private hospital. Publicly funded hospitals that we're all paying. I think universal healthcare would say we believe that everyone should have access to excellent care where they need it no matter who they are. continuity of care is something that we should be and are working on in the public system, you know?
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