Martin Daly: Why private maternity hospitals don't exist
Martin Daly questions why there are no private stand-alone maternity hospitals and whether private obstetrics is insurable outside public hospitals. He challenges officials over whether access to private care is embedded in the state maternity strategy and raises concerns about safety, underwriting and fairness.
Key exchange and question
Martin Daly presses Professor Daly and officials on whether the maternity strategy explicitly includes access to private maternity care. He highlights that the strategy mentions choice, but contains no explicit provision for private obstetric facilities.
Historical context
The discussion recalls past private facilities such as Mount Carmel and Bon Secours and explains the Mount Carmel split into a PropCo and an OpCo. Martin Daly uses that example to separate historical property issues from the central insurance question.
Insurance and safety concerns
The central point raised is whether private obstetrics can be insured outside public hospitals. Speakers note very high obstetric claims exposure and argue that private maternity care, if it exists, must be safety netted by public hospitals like the Rotunda to protect women.
Implications for policy and taxpayers
Martin Daly frames the issue as a question of what taxpayers are asked to underwrite. He warns against creating a system where some citizens receive privileged access to care underwritten by the state while others do not, and concludes that providing private obstetric care outside the public system will be challenging given current indemnity arrangements.
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First I want to again reiterate that we recognise that maternity services in this country are safe and they are of a very, very high quality. And I suppose what I want to come to is really, and again it's Professor Daly, it's in your statement here that you've stated that choice is an issue for women and that there's no private maternity hospital in the state and I accept that. But you said it's embedded in the maternity strategy. Is access to private care specifically, you know, I just want to, maybe I'm mistaken, actually embedded in the maternity strategy. I don't think I see that anywhere. I think the issue of choice is embedded in the maternity strategy. No, no, no, no, no. But no, you're absolutely right, Deputy. There's no mention of private care within the maternity strategy. No, I just, it needs to be straight because people are watching and listening here and that is a state-documented strategy and hopefully there'll be a new one. One of the reasons, and you can enlighten us, why there isn't a private stand-alone facility in obstetrics in your view? So there was two private facilities. There was Mount Carmel Hospital in Dublin and there was the Bon Secours in Cork. Now, I can't really talk much about the Bon Secours but I know that for Mount Carmel there was a property developer bought the site of Mount Carmel, I think back in 2005, and to a great extent I believe or I understand that it was a property play. He wasn't looking for a hospital. So that's the historical thing. But there are reasons we know why there aren't private obstetrics. Is private obstetrics outside of a public hospital insurable in this country? If I could have finished. Well, no, in fairness, we know about Mount Carmel, the property play, and I'm asking a specific question here, which is to remain. And I ask you to answer it now, yeah, please. So Mount Carmel functioned as a maternity hospital. The patients were insured. The private consultants paid for that insurance. So it wasn't that they were uninsurable. And what happened was that the Mount Carmel entity divided into a PropCo and an OpCo. This is relevant. No, no, no, what's really relevant really is not so much about Mount Carmel. If someone went outside the public system today, outside the Rotunda Hospital, went down the road and set up a private hospital, I know how much it costs to insure an orthopedic surgeon, for example, in private practice. I can't get that figure for obstetrics because it's my information that indemnity bodies will not cover private obstetrics in this country. That's the question, not about Mount Carmel, not about property plays. That's the question. So as I understand it, Deputy, there are limits that are in place for various specialties and that if you wish to practice privately, for example, in obstetrics or in orthopedics, you pay insurance up to that limit. And those limits, if applied to obstetrics, could result in private maternity care. However, private maternity care has to be safe and private maternity care cannot exist where women might not be safe. And if private maternity care ever exists, it has to be safety netted by hospitals like the Rotunda. We do not want women who are accessing private maternity care to not be getting private safe care. We're in absolute agreement on that. If you're going to have obstetrics, it has to be safe. There's no question about that. That's why it's in the Rotunda. But if we were to extrapolate from that, so what we're asking the taxpayer and the citizen to do, because it's not insurable outside of that, we're asking the taxpayer and the citizen, and I'm talking in terms of contract here, this is not ideological, but we're asking the taxpayer and the citizen to underwrite private obstetrics in a public setting where one set of citizens get privileged access and another don't. That's what the public are saying. So that's the point I'm trying to make. So if I understand you, Deputy, you're asking why does private practice occur in public hospitals? No, no, that is not the point I'm making. That if private obstetrics was insurable outside of the public setting underwritten by the state indemnity scheme, and you went to the Beacon Hospital, for example, and made arrangements with the Beacon Hospital, or Matter Private, or any other private hospital, it would be simply uninsurable. We know what the exposure to the state is to claims, mainly obstetric claims, are massive. I think the underwriting is somewhere around five billion. So the question is very simple. There's a reason why there isn't a private obstetric hospital outside, because there has to be a reason. It's uninsurable. Is that the reason? That's the question I'm asking. I might just contribute to that question if I might, Deputy. I agree with you, actually. I think that is one of the challenges about providing obstetric care outside of the public hospitals currently. I totally agree with you. But that's not unique to the result. It's across the whole system in Ireland. It's not a unique return. No, I agree. The state claims agency have absorbed obstetric care within their systems over the 20 plus years, possibly. I think it's a very fair question to ask, but I think it's a broader question to ask. Absolutely, and I agree. I just wanted to tease it out. I think, to answer your question straight and honestly, and this is my opinion, possibly, not just necessarily a returned opinion, I think it will be a challenge for anyone to provide private obstetric care outside the public system.
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