Holly Cairns: Every woman deserves continuity of maternity care

Taoiseach, a lot of questions have been raised about our maternity services in recent weeks and there appears to be confusion about a hugely important issue. Which category of patient deserves continuity of care in our maternity services? Can I be absolutely clear about what I thought was obvious? Every woman accessing maternity services should be entitled to the highest quality care. It should not be an optional extra reserved for those who can pay for it. Public maternity services should not feel less safe than going private. However, that is very much the feeling people have been left with because that is exactly what the master of the rotunda said. He said the reason the hospital was breaching the public-only consultant contract by allowing consultants on that contract to treat private patients was quote safety for women. He hasn't withdrawn that statement but in an interview with David McCullough earlier he attempted to clarify it. He said quote nobody is saying it's about safety even though that is literally what he said himself and went on to say that having consultants treating private patients at the rotunda improved safety for public patients because if they happen to be around when a public patient needed consultant care they could potentially pitch in. I can't have been the only person listening to that interview in complete disbelief. Are we really saying that safety for public patients in maternity hospitals now depends on blind luck? That if they happen to be giving birth when a consultant is on site with a private patient then they'll be taken care of and this is the type of two-tier care that the head of our busiest maternity hospital in the country is fighting for. Taoiseach, the social democrats fully supported the approach the health minister took in relation to the rotunda but this controversy has exposed deep flaws in our maternity services and the so-called choices that are available to women because the choice that is only available to women who can afford to pay for it isn't a choice at all. What woman is choosing not to have continuity of care? Every woman should have that. That is the bare minimum we should expect in our public system and that is what the government's national maternity strategy is supposed to deliver. The focus now needs to be on delivering this for all women in maternity services. Taoiseach, my questions are with regards to the particular consultant will their previous patients be refunded and are their eight current patients aware of the situation that they're in and does the rotunda statement draw a line under this view or are you aware of further concerns about the operation of public... Thank you deputy Taoiseach please. First of all deputy thank you for raising what is a very very important issue and I appreciate the your party's support for the government's position on this and the minister for health's position on this because a lot was at stake here not just for maternity services but for the entire edifice that should govern public health and the provision of public health into the future in our acute tertiary system. The government took a decision following negotiations in respect of the public only consultant contract which is a cornerstone of the slanted care framework and policy and in our view or reading very clear reading of this was this it was an attempted breach of that fundamental decision to sign you know of the fundamental position read the public only consultant and the we were very clear from the beginning this was very very clear from the beginning and I was 100 behind the minister in respect of her position having been in the last government the previous minister Donnelly in negotiating this contract which was signed off by the representative organization IHCA of the consultants. We cannot people cannot be signing contracts and then casually deviating from those contracts. On the question of safety in my view the private model of care in obstetrics and maternity is not sustainable and hasn't been sustainable for a long long time. The state has had to intervene a long time ago well over 20 years in terms of indemnifying obstetricians and gynecologists in respect of maternity care given the insurance costs and so on were just not sustainable for any individual consultant and also I recall when we built a maternity hospital in Cork. It's a pretty good example actually in fact in Cork you had a ridiculous situation where if you went to the bonds when it was private but there was a complication you were sent down straight away to the Erneville which was the public hospital because it was the only hospital that had a neonatal and that was a fairly rudimentary neonatal at the time because I recall having to make decisions around all of that subsequently and when we decided to build a maternity hospital in Cork the bonds themselves acknowledged we will not be able to say in a private maternity hospital. I make my point just generally there's an issue here that we're very clear we support what you're saying and as far as we're concerned a private model doesn't isn't sustainable in maternity and therefore we want to build and develop hospitals where there's universal access where eventually we will move to public only consult consultants some have opted out of that that's their entitlement under the agreement but the patients should be refunded they should be refunded because this should not have happened in the first instance these contracts were transparently signed up to by all concerned including the hospital in terms of a service level agreement with with the HSE. Taoiseach like I said I'm glad that the minister held the line and glad that the government held the line and I think the reason a lot of people were surprised to see coming out to bat so strongly for public health is that we don't see that with regard to all aspects of slaughter care and I really do hope that we see more of that now for example home care 80% of that is private now and that's just going up and up and up and the new plans for slaughter care no money behind those 2025 plans there's so many things that need to be addressed but Taoiseach I asked you two questions and you didn't answer either of them so I'm just going to put them to you again with regard to the particular consultant will their previous patients be refunded and are there eight current patients aware of the situation that they're in that their consultant has a public-only contract and is providing this care and does the rotunda statement draw a line under this for you or are you concerned about other governance issues with regard to the public-only contract in hospitals around the country? Yeah could I just say I did answer the question I said the money should be refunded I made that very clear my original reply just to be clear about that the minister is concerned about the operation of the public-only consultant contract right throughout the entirety of the health service and in all hospitals because there is no going back from the position that we have negotiated fully and transparently and comprehensively and just to say over the last five years there's been an extraordinary level of investment in our health service at a scale that has dwarfed anything in the previous sorry now I've made it clear that it should be refunded I mean the minister has also sought assurances in that front to write to the Taoiseach if you didn't get it in the first time Taoiseach yeah but I just want to make the point that the investment has been substantial in the last five years in terms of your question around slanting care and I don't think it's fair in terms of what you said in terms of the lack of investment of course you can continue to invest more and more in health but anybody objectively looking at the last five years will see an extraordinary uptick and scaling up. Thank you Taoiseach time is up and now we move to