Private maternity care to end under health service reforms

A new contract for hospital consultants will see private care  being phased out of public and voluntary hospitals as part of the Sláintecare reform programme for the health service.

A new contract for hospital consultants will see private care  being phased out of public and voluntary hospitals as part of the Sláintecare reform programme for the health service.

A new contract for hospital consultants will bring many changes to the public hospital system — among them, an end to private maternity care.

Under a new deal for salary and working conditions, private care is being phased out of public and voluntary hospitals as part of the Sláintecare reform programme for the health service.

This is a significant change for maternity services — 24.8% of pregnant women opt for private or semi-private maternity care, according to the most recent research.

The rate of private care in larger hospitals is estimated to be as high as one in three patients.

This is quite different from the National Health Service (NHS) in the UK, where just 5% of women opt to give birth in a private hospital or a private wing of a public hospital.

At the moment, women in Ireland can pay for a private pathway in public or voluntary hospitals. There is no standalone private maternity hospital since Mount Carmel closed in 2014 following financial difficulties.

The new consultants' contract, announced last week, is to be phased in between now and 2025 as part of an overall change to the health service.

“In line with the principles of Sláintecare, and like the NHS, consultants will be entitled to treat private patients off-site, as we move to a system where all patients of public hospitals are treated in accordance to need rather than ability to pay,”

a spokesman for the Department of Health said.

“This applies to all private care in all public hospitals, irrespective of voluntary or HSE status.” 

All 19 maternity units in Ireland offer private options, including Cork University Maternity Hospital and the National Maternity Hospital (NMH).

The new consultants' contract, approved by Cabinet, is now under discussion by the Irish Medical Organisation and the Irish Hospital Consultants Association (IHCA).

Professor Declan Keane, former master of the National Maternity Hospital, was involved in negotiations on the deal as a member of the IHCA.

“I don’t think the Department of Health has really thought this out,” he said, pointing out that the option for off-site operations would not apply to birth.

“The option for maternity patients going privately is going to go,” he said. 

“I don’t really feel that message has got out there.” 

Prof Keane, who oversaw the establishment of a homebirth pathway at the National Maternity Hospital, said there are a number of concerns.

Choice

“Let’s forget the headline issues around the salary, what this is about, I believe, is women’s choice,” he said. 

“We are currently at a time in obstetrics where we offer women so many choices, whether they want to go for homebirth, whether they want to go public, private, combined care or want to do Domino care where they have their baby in the hospital and are looked after by midwives when they go home.” 

In his experience, women go private because they want the same doctor by their side throughout pregnancy and giving birth.

“At one stage during the Celtic Tiger I’d say 40% of our (NMH) patients were private or semi-private, now it’s down to about 32%,” he said. 

“That would be pretty much the same in all of the Dublin maternity hospitals, it is fairly similar in Cork and Limerick, some of the smaller units would be less than that.” 

Others involved in maternity care have urged greater focus on midwifery-led care instead.

Interventions

Typically, in Ireland and internationally, the C-section rate among private maternity patients is higher than among public patients. 

Advocacy group AIMS Ireland has particularly queried the high rate of interventions among first-time mothers across public and private care.

An Irish study on C-section rates among private maternity patients identified a “complex” association between private health insurance and this higher rate.

These findings, published in the journal BMC Pregnancy and Childbirth (2020), found women opting for private care were more likely to have a history of infertility, a history of miscarriage, a multiple pregnancy, and to be older than 35.

Despite these needs, interest in private maternity care has been dropping since 2008. 

A separate study on maternity trends, by UCD Centre for Human Reproduction and the Coombe maternity hospital, found bookings never rebounded after the recession.

This is perhaps not surprising, with VHI estimating the average cost for private maternity patients ranges from €2,500 to €5,000.

“We are, in Holles Street, expected to generate a percentage of our budget from private patients,” Prof Keane said. 

“That obviously will go, the Government will say they will fill that from the Exchequer but I think the greatest effect will be on women’s choice.” 

Minister Donnelly has already confirmed the State will make good these costs for all hospitals, with the gap for this year estimated at €450m to €460m in private income.

Many women will no doubt be watching the consultants’ discussions with interest and waiting to see how their care options could change over time.