ieExplains: What has caused the standoff between the Rotunda hospital and health minister?

But what is the row about, and what does it mean for the women of Ireland?

What is Sláintecare?

The crux of this argument focuses on consultant obstetricians in the Rotunda who have signed 'Sláintecare' contracts.

Sláintecare is a plan to reform the health service, aimed at moving Ireland away from its public and private healthcare system and replacing it with a universal public health service that provides care related to need rather than ability to pay.

The 10-year plan was developed and agreed by an all-party Oireachtas committee in May 2017. The first action plan was published in 2019.

What did it mean for consultants?

Under Sláintecare, new contracts were introduced for consultants. They were introduced in March 2023 and named the “Public-Only Consultant Contract”.

In return for basic pay between €217,325 and €261,051, consultants had to agree they would no longer do private work in public hospitals. They were free to do private work outside of the public hospitals.

The higher pay also meant consultants were signing up for a 37-hour week from 8am to 10pm, between Monday and Friday, and 8am to 6pm on Saturdays.

Some 69% of consultants working in Ireland (3,389) have signed up for Sláintecare contracts, while more than 1,600 have remained on older contracts.

What is going on in the Rotunda?

In the Rotunda Maternity Hospital, based in the heart of Dublin City, 14 of its 32 consultants have signed up to the public-only contract.

However, during a meeting of the Oireachtas health committee last month, the Rotunda’s master, Professor Seán Daly, confirmed the Rotunda was allowing consultants on the public-only contracts to conduct private work.

“The only private care that is being allowed in the Rotunda for public-only contract holders is in pregnancy-related care,” he said.

“That is because the Rotunda has long believed that women should have choice.” 

He said he had told Ms Carroll MacNeill about the Rotunda’s plans, and she was “not happy”. No agreement was provided to the Rotunda by the HSE or the Department of Health.

Mr Daly also argued it was “primarily about safety for women and women's choice”.

It has been argued clause 24.10 of the Sláintecare contract allows public consultants to conduct private work when it is “expressly permitted by the employer”.

What has the Government said?

Mr Daly was putting it mildly when he said Ms Carroll MacNeill was not happy about the situation.

She said there was “no provision for private work being carried out by consultants on the public-only consultant contract” and she first raised this issue with Mr Daly in June 2025.

Ms Carroll MacNeill said there was no liability cover in the Rotunda for private maternity care, and there was an “open question” about whether there was an insurance issue for people providing private care on public contracts.

She argued the Rotunda was not the employer under clause 24.10, saying the minister and the HSE must give permission.

The minister said while rescinding funding would be the “last thing” she would want to do, she did not rule it out.

What have women said?

The airwaves and letter pages of newspapers have been inundated with women expressing concern about the row and the removal of choice between public and private maternity care.

Many have said they chose to go private as it guaranteed they would see the same consultant each time they have an appointment.

In the public system, care is generally midwife-led, but expectant parents are likely to see different midwives or doctors each time.

Many women who opt for private care also argue the continuity of private care means they do not have to explain previous pregnancy complications or traumas each time they have an appointment.

What happens next?

The big question is whether the Rotunda or the Government backs down first.

Ms Carroll MacNeill has asked the Rotunda to confirm by Monday evening it has rescinded the process, and has sought details of the derogation provided to consultants who provided permission, details about the women who paid the Rotunda for private services from publicly-contracted doctors, and how many doctors on public contracts have been carrying out public work.

Whether that information will be enough to put this row to bed is another question.