Cian O'Callaghan: Questions €1,500 gifts at Rotunda

Taoiseach, the Board of the Rotunda has now said it will abide by national health care policy and ensure that consultants on public-only contracts are not breaching them by treating private patients. But Taoiseach, how confident are you that you can rely on what the Board says? Because at the weekend, the Irish Independent revealed more concerning details of practices at the hospital. Consultants on public-only contracts who deliver babies for private patients at the weekend are routinely gifted with sums of up to €1,500 by consultants contracted to do that private work. Taoiseach, the hospital is aware of this and described it as a long-standing practice. The hospital also says the payment of these gifts is, and I quote, personal to the consultants and the hospital is not involved. Now, given women are given birth in the Rotunda and are treated by consultants employed by the Rotunda, this is clearly nonsense. The hospital is very much involved. It just doesn't want to act. Taoiseach, whistleblowers have informed my colleague, Deputy Padraig Rice, that the payment of these gifts is not confined to the Rotunda. It's happening at Cork University Maternity Hospital too. It takes place at weekends because of the way the Rotunda and CUMH are operating their rosters. They have just one roster, while other hospitals are operating two, one for public patients and one for private patients. Taoiseach, whistleblowers have also come forward to Deputy Rice about issues at University Hospital Galway. The hospital has a deal in place to do lab work for a private hospital, and consultants on public-only contracts are being asked by management at the hospital to do lab work for private patients. Now, while many consultants on public-only contracts are refusing to do this, it is nonetheless leading to big delays in the processing of samples for public patients. This includes public patients with cancer. Taoiseach, as you know, an early cancer diagnosis can save a life. Delayed diagnosis can be fatal. Delays are so bad at the hospital, it is outsourcing some lab work for both public and private patients to commercially run labs. This is at enormous expense to the public purse. Taoiseach, my questions are, were you aware that some consultants in the Rotunda were receiving gifts of up to €1,500 to deliver a baby? Did you know this was also happening in the Cork University Maternity Hospital? Has revenue started an investigation into these gifts, given that no tax has been paid? Are you concerned that this could give rise to the level of fraud if insurers are being billed for work consultants have not done? Were you aware of the issues at University Hospital Galway? Are you concerned that public patients are receiving delayed diagnosis for life-threatening conditions? Taoiseach, what action are you going to take to address this? First of all, Deputy, may I say that the last government moved very quickly, well not quickly, we moved in terms of negotiating a public-only consultant contract. We spent a lot of time and a lot of work on it. We negotiated with the IHCA. Government not only expects that to be fulfilled, but will work relentlessly to ensure its enforcement and fulfilment. People can't be signing contracts and then arbitrarily varying those contracts or deciding to ignore them. Neither can hospitals that are funded predominantly by the state do that either. It is an imperative that the public-only consultant contract is implemented and that it works as it is supposed to across the entire health service. Strong progress has been made in contract uptake and in increasing consultant capacity, but the clear focus now on the Minister's behalf and the department and the HSE is on delivery and practice, particularly extended hours and weekend services for patients. More consultants are now rostered for evening and Saturday work, but the current levels remain too low and need to improve further. We are fully committed from a government side to the implementation and enforcement of the public-only consultant contract. There has, as I said, strong national uptake. About 3,416 consultants signed up as of 29 May of this year, including 1,220 new entrants and 2,196 consultants who have switched from the older contracts. This means that about 69% of all consultants working in our hospitals are now on the public-only consultant contract. And consultant numbers themselves have also increased significantly. 51% more consultants now working in our hospitals than in 2020, strengthening overall capacity. But the fundamental issue and the rationale for the contract is delivering stronger consultant presence on site, including, of course, at evening time and at weekends, so that the patients see the benefits of this contract. And as you know, the contract allows for rostering from 8 a.m. to 10 p.m. Monday to Friday, 8 a.m. to 6 p.m. at week and Saturdays. And at the moment, current figures show that only 37% of consultants are rostered for evening working and only 11% for Saturday. That is far too low and simply has to improve. And the HSE has a governance and program structures to strengthen its oversight, reporting and accountability. And the Minister is very clear about engaging with all of the hospitals to ensure compliance and implementation. Now, in terms of your two questions, the answer is no and no. I was not aware of what was contained in that report at the weekend in respect of gifts to consultants who turned up. And again, revenue, as you know, is independent. But I'm sure revenue read the article as you read it and as I read it. And it's a matter of revenue, so any issues that arise from that. Yeah, Taoiseach, clearly this is an issue beyond the rotunda. There's instances in Cork and Galway. There's an emerging pattern around the country of breaches of the public only contract. Now, you and the government have a responsibility to patients and to the taxpayer to ensure that that contract is being implemented. You're clearly not aware of the different breaches around the country. You and the government and the Minister of Health need to get a grip on this, need to get ahead on this. You need to take actions to ensure that the public only contract is actually being implemented and enforced. So Taoiseach, what are you, the Minister for Health, what is the government doing to ensure that the public only contract has been adhered to? Are you going to get a grip on this? Are you going to get a handle on this? And when are we going to see results in terms of ensuring that the public only contracts are actually implemented? You mentioned whistleblowers. I hadn't had access to those whistleblowers. I don't know whether they have formally given their information to the HSE or to the department. So are the whistleblowers as per the Act or is it people who've just gone to you directly? You might clarify that at a later stage. You don't have the opportunity. No, I appreciate that. But I think that's an important point. And I think that needs to be clarified and you need to be very transparent about that because I don't have access to that information. But what I can say to you is the Minister is extremely strong on this. The government brought in this contract, which in itself was a radical change from what had historically been the case. We are determined that it has impact and has an effect. And as far as the government is concerned, and I've been very clear last weekend in my statements on this and the Minister likewise, we will not tolerate any variation from the contracts that people have signed up to. And that has to be implemented.