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Chapter 1: What ongoing controversy is discussed regarding the Rotunda Hospital?
Next, though, I want to return to the ongoing controversy over the Rotunda Hospital, where some consultants who signed public only contracts continue to practice privately at the hospital. I'm joined in studio by Professor Jennifer Walsh, Master of the National Maternity Hospital. Good morning. Thanks a million for coming in.
Morning. Thanks for inviting me, David.
Now, we did speak to Jennifer Carol McNeill, the Minister for Health, earlier in the programme. I think you were listening to that.
Yes.
Yeah. What did you make of what you had to say?
You know, I think this is, it's really important. And I said a couple of months ago when I came on the show, it was really important that this conversation started again around maternal choice. And I do believe it is around maternal choice. I'm really keen that this is a conversation, that it isn't a battle. And obviously, there are a lot of issues at play at the moment.
But ultimately, what we are hearing on the ground, the people working in the maternity hospitals, I've I've been delivering babies for over 20 years, so my day job is listening to women, listening to their partners, listening to what they want and what they don't want.
And the reality is that there's a continued demand for private obstetric care, and it's one that we can't shy away from, and we need to have a conversation as to what we are going to do as this new contract starts to evolve. And it is at its earliest stages in terms of its effect on the packages of care, but it is the time to have the conversation.
Why do you think that demand is there? Because the minister seemed to suggest that there is a narrative in support of private care and it's been led by people who have a financial interest in private care continuing.
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Chapter 2: What are the implications of maternal choice in maternity care?
I can speculate as to the reasons. But in reality, they are choosing it. And in no other facet of health care, if people are getting their hips or their knees or their cardiac care or their prostate done privately. Nobody is subjecting that decision to any scrutiny. But our women are being scrutinised as to why they are choosing this pathway of care.
And in some areas of the media, they're being judged for that decision. I think that's unfair.
OK. But the minister was making the point that the difference between maternity care and any other procedure or discipline within medicine, there isn't a private maternity hospital.
She's absolutely right.
And the reason for that is because the insurance company
Absolutely. So there is, as far as I'm aware, there is no insurance company that will indemnify obstetrics in this state. For a very long time, the state claims agency has covered all of the hospitals in Ireland, it has to be said, and including our schools, many healthcare facilities, many community facilities, we are indemnified by the state. That's absolutely correct.
So there won't be a private maternity hospital in Ireland. It's also something, as the master of a maternity hospital, that I would not like to see. I would see that as a hugely backward step toward...
If it was a private hospital?
To move toward a standalone maternity. We are moving towards co-location of our maternity services for safety. So to move backwards towards a standalone private centre, I think, for safety for our patients would be a backward step.
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Chapter 3: Why is there a demand for private obstetric care?
There's been some conversation around safety. The word superior was used in one article in the newspapers over the weekend. And I think that is really dangerous rhetoric. The reality is that our public maternity services, our maternity services full stop in this country by any international standards or benchmarks are excellent and they are safe. But there are many packages of care.
You can choose community midwifery care, which we have led out on for over 25 years at NMH. You can have consultant led care. You can have specialised care if you have particular needs and you can choose private care. And it is just another package of care.
And part of it is you get a private room and so on.
You might get a private room in reality in our hospitals at the moment. And that's another important point. As we move to Elm Park, everybody will have a private en suite room. That's absolutely the most basic standard that everyone deserves. It would be interesting to see how that played out in terms of demand for private care.
I don't personally believe it is the accommodation alone that people are attracted towards. I think it's just a choice that people like to make.
OK. I mean, you mentioned that there was a narrative about safety. In fairness, your counterpart from the Rotunda, Sean Daly, did make the point at the Oireachtas Health Committee last week that safety was one of the factors. He actually raised it.
I don't know if that's how I interpret it, but irrespective, there's no objective evidence of that. We genuinely have a very safe maternity service at every level.
Absolutely. But private patients get more scans. There's more continuity of care. So many women might feel that that is better. And you could see why they would think that.
The number of scans is the same. You know, as someone who's scanning is my day job, I'm a foetal medicine consultant. So there's a scan and there's a scan. There's a bedside scan to look at a heartbeat and fluid. And then there are formal scans, which are an early dating scan and an anatomy scan. And everybody across the board in our 19 maternity hospitals gets that. And it's continuity of care.
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Chapter 4: How does the public maternity care system compare to private care?
I'm a clinician. This isn't a clinical problem. It is a policy issue. But I do think we need to hear what the women are saying.
OK, but I mean, the minister was making the point that, you know, the state pays for pays the salaries, the state pays for the electricity, the state pays for, you know, the upkeep of the premises and everything. And as you said yourself, it's not a realistic prospect to expect a private standalone maternity hospital to open because the indemnity issues apart from anything else.
So the point of sláinte care is that you get public facilities working for everybody equally, that you level the playing field. Now, the question, I suppose, is whether the level for everybody goes up or the level for everybody goes down.
Absolutely. But this is an unintended, I think, consequence of sláinte care is that we have a cohort of people who can't access care. We're in every other facet and branch of medicine now. they have that choice. You know, if they have the means and if they are lucky enough to be able to afford private health insurance and every other facet of health care, then that choice remains.
And so we have an outlier here in maternity and in obstetric care. And it's one that is particularly emotive because most women going through pregnancy, they're not unwell. They don't have any issue with access to care, which is an issue in our public medical and surgical specialties.
The big problems are getting in, getting your appointment with a consultant, getting a theatre slot that isn't cancelled because of a trolley crisis. There's no access to care issues in maternity. Your baby's coming, your baby's coming. No one asks what health insurance you have. So we don't have access to care issues, but we have we have choice issues.
OK, the minister said that when this eventually feeds through and everybody is on the public only consultant contract, that women will have a choice of consultants. They'll be able to choose their consultant. I mean, is that a realistic prospect, do you think?
I listen to that. It's interesting. We have consultant led clinics, we've midwifery led clinics, we've high risk specialised clinics. I think the suggestion that, you know, everybody will have a consultant for every single visit and at every single birth is A, not necessary. And B, I would imagine would bankrupt the country in reality, you know, because you can't have that many consultants.
So in any public, well-functioning, safe public health system, which we have, then the seniority of the presence at your delivery is based on risk and based on clinical need. That hasn't changed. That continues. Our public health service, you see a consultant at every visit in a high risk clinic if you're high risk. You see a midwife if you choose to do so in a low risk clinic if you're low risk.
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