The Rotunda Hospital faces mounting pressure to provide the Health Service Executive (HSE) with a detailed audit of private work undertaken by consultants employed under public-only contracts, following a deadline set by Minister for Health Jennifer Carroll MacNeill.
The controversy centres on consultants who signed up to the Public-Only Consultant Contract (POCC), introduced in 2023 as part of the Government’s Sláintecare reforms. Under the contract, consultants are prohibited from carrying out private practice within public hospitals.
Minister for Public Expenditure Jack Chambers has strongly backed the Health Minister’s position, warning that failure by the Rotunda to comply with Government policy could trigger escalation measures under the hospital’s service level agreement with the HSE.
Speaking on RTÉ’s Today with David McCullagh, Mr Chambers rejected suggestions that contractual provisions permit consultants on public-only contracts to continue private work.
“The Rotunda cannot have an a la carte approach when it comes to contracts or seek to circumvent what is clearly a public-only contract,” he said.
Mr Chambers argued that the dispute reflects an attempt by the hospital’s board and management to challenge established public health policy.
“This is an attempt by the Board and management of the Rotunda to challenge what is a very clear direction of public health policy and a clear direction of the service level agreement,” he said.
The minister stressed that public funding is tied to compliance with agreed healthcare policies and contractual obligations.
“Service level agreements are in return for public funding. There is compliance around the set of directions and the principles under which maternity care and healthcare are delivered within the hospital,” he said.
He also noted that hospitals had been given a transition period from 2023 until the end of 2025 to adapt to the new contractual framework.
“We’ve had strong uptake by doctors, and we can’t have cherry-picking of public contracts. This is a critical part of Sláintecare and delivering a universal health system,” he added.
The disagreement intensified following an appearance by Rotunda Master Professor Sean Daly before the Oireachtas Health Committee last week, during which he confirmed that private maternity care continued to be provided by some consultants despite instructions for the practice to cease.
Under the POCC arrangements, consultants who transferred from previous contracts were granted until the end of 2025 to complete the transition away from private practice. Nationally, around 70% of consultants have signed the new contracts.
Mr Chambers said the reforms were designed to improve access to maternity services and strengthen public healthcare delivery.
“This contract has been signed up to by consultants in the Rotunda and many other hospitals to deliver better public healthcare and more accessible maternity care for women and babies,” he said.
“The Rotunda cannot have an a la carte approach when it comes to contracts that have been signed by doctors in their hospital. They should not be seeking to circumvent what they know is very clearly a public-only contract.”
The issue is particularly significant in maternity care, where no private maternity hospitals operate in Ireland. As a result, private obstetric services are delivered within public hospital settings. Of the 32 consultants providing maternity services at the Rotunda, 14 are employed under public-only contracts.
Last week, Minister Carroll MacNeill called on the hospital to confirm that the practice had ended and suggested that women who had paid for private services from consultants on public-only contracts should be reimbursed.
She also warned that the hospital did not have permission to continue facilitating such arrangements.
Meanwhile, opposition parties have urged both sides to resolve the dispute.
Sinn Féin health spokesperson David Cullinane expressed confidence in Professor Daly and criticised the public nature of the disagreement.
“Any row or standoff on contracts is unseemly. It’s in nobody’s interest. It’s not in the interest of the hospital and it’s certainly not in the interests of women, whether they are public or private patients availing of services,” he said.
Mr Cullinane praised the quality of care at the hospital while reiterating support for public-only contracts.
“The standard of care in the Rotunda is absolutely outstanding,” he said.
“These are well-paid consultants and well-paid contracts to do public work, and they must be held to that.”
Social Democrats health spokesperson Pádraig Rice welcomed the minister’s intervention, describing the reforms as essential to the future of the healthcare system.
“I welcome the line the minister has taken on this. This is a crucially important reform and we can’t allow it to be unpicked,” he said.
“It’s not a role for the state to provide private healthcare. We need to focus on providing the best quality public care. Most European countries have universal, single-tier healthcare systems and we need to do the same here.”
Labour health spokesperson Marie Sherlock also called for a resolution to the dispute, arguing that responsibility ultimately rests with the Government and the HSE.
“If we are serious about public hospital facilities being used for publicly provided care, then it is on Government and on the HSE to resolve this difficulty,” she said.
Ms Sherlock acknowledged that patients have differing preferences but stressed the importance of maintaining choice within a publicly funded healthcare system.
“Different women will want different things, and we have to acknowledge and respect that. But when we have a publicly funded healthcare system, we have to make sure that there’s a range of choice within the public system,” she added.
The HSE is expected to review the Rotunda’s audit submission before determining any further action.
