If Jennifer Carroll MacNeill means what she says about women’s choice, she needs to fund it

T he past fortnight has been a difficult one for maternity care in Ireland, and for public confidence in the consultants who provide it. The dispute between the Department of Health and the board of the Rotunda Hospital has now come to a resolution of sorts, with the hospital agreeing to bring its arrangements into line with Government policy. I want to use this moment to set out where the Irish Hospital Consultants Association (IHCA) believes we should go from here, and to correct some of the impressions left by a debate that became heated and unfair.

I write not only as president of the IHCA and member of the association’s negotiating team for the public-only consultant contract, but also as a consultant who works in a maternity hospital, a woman, mother and patient. I hold the public-only contract and no longer do on-site private practice since December 2025.

During the contract negotiations in 2022-23, the association argued that a small number of specialties are different because they have no off-site private setting – these are neurosurgery, transplant surgery and obstetrics. When section 24.10 was included in the contract, allowing an employer to permit private practice in defined circumstances, many of us understood this to be practical recognition of that difficulty – a view also reached by the Rotunda’s legal advice.

Contracts must be honoured and applied consistently – that is not in question. But what is in question is whether we have the right policy for maternity care and whether the present arrangements truly meet the needs of women.

Over the past two weeks, obstetric consultants have seen their integrity and motives called into question in a way that was unfair and, in places, simply wrong. At no point did the obstetric members of our negotiating team look for pay parity with the public-only contract salary for colleagues wishing to continue private obstetric work. They sought a process that recognised the particular nature of their specialty and kept an option open for patients.

Consultants take on private work for a range of reasons. Yes, it is well remunerated and the recent media coverage tends to settle on that – but that isn’t the whole story. Many consultants speak of valuing that part of their working lives and some keep a private caseload precisely so that they retain a number of deliveries of their own. In hospitals that train the next generation of doctors, consultants spend much of their time teaching and supervising trainees through instrumental deliveries and Caesarean sections. To criticise consultants for keeping their own skills sharp is unfair.

Some of the commentary seemed to assume that women who choose private maternity care do so out of fear or that anyone who argues for choice is implying that public care is less safe. Both assumptions are wrong. Our maternity hospitals have excellent outcomes and strong safety records, and women who attend them, publicly or privately, are in very good hands. Women choose private care for reasons that are entirely their own. They do not have to justify those reasons to anyone, and least of all to the Department of Health. I opted for private care on three occasions, in two of Dublin’s maternity hospitals. Not out of fear, but because I wanted continuity of care and some control over the timing of my appointments so that I could keep my own clinics running. I recognise the privilege in being able to make that choice – but the choice itself should not be caricatured.

[  ‘I felt nobody had my back’: What the Rotunda row says about public v private maternity care Opens in new window  ]

If the Government is serious about offering every woman continuity of care, the consultant of her choice and some say over her appointments within the public system, then that needs investment. Ireland has a lower number of consultant obstetricians and gynaecologists per capita than any comparable jurisdiction, at just 3.85 public consultants per 100,000 population. This compares with 4.97 per 100,000 people in Wales, 5.37 in England, 5.74 in Scotland, 5.72 in Canada, 5.91 in Australia and 6.6 in New Zealand – up to a 71 per cent differential.

Ireland also has a disproportionate reliance on non-consultant hospital doctors who are not on a training scheme, which is indicative of recruitment to service gaps and unmet demand, often in smaller Model 3 hospitals.

The HSE estimates that Ireland needs a 60 per cent increase in the consultant workforce by 2040. If Minister for Health Jennifer Carroll MacNeill means what she says about women’s choice, she needs to measure it in funded consultant posts, not in announcements, or refusals to meet. That is the conversation the IHCA wants to have.

Not every woman needs or wants consultant-led care, and many who could afford to go privately choose not to. For very many women, midwifery-led and Domino (domiciliary in and out) schemes are an excellent model of care, and they should be resourced to match the demand for them.…