Rotunda Hospital Defies Government on Private Maternity Care, Faces Funding Threat

Sinead Murphy Collins, 34 weeks pregnant with a high-risk first pregnancy, travels from Mullingar to Dublin for private antenatal appointments. She chose private care for control over her consultant, acknowledging it's expensive but a calculated financial choice. She feels frustrated by pressure to justify her decision, unlike those using private insurance for other care.

A national debate on private maternity care erupted after Dublin's Rotunda Hospital publicly defied the HSE and Government. The Rotunda, the world's oldest maternity hospital, claims a right to allow doctors on public-only contracts to offer private care on-site, contradicting Sláintecare, the government's strategy for a single-tier health system. This defiance has led to threats from the HSE and Minister for Health Jennifer Carroll MacNeill to withdraw State funding.

This dispute has brewed for over three years. In 2023, the Rotunda, along with the National Maternity Hospital, Coombe, and Cork University Maternity Hospital, sought a Sláintecare exemption to continue private maternity care in publicly funded hospitals, a request denied. Despite warnings, the Rotunda planned to flout policy, with its master, Prof. Sean Daly, informing Carroll MacNeill in June 2025 that consultants would continue private care. Carroll MacNeill reiterated there would be no exemptions.

In February, after a planning refusal, Carroll MacNeill again pressed Daly to end private care by public-only consultants. The following month, private insurers confirmed the Rotunda's continued private offerings. Daly dismissed this, stating it was an issue for insurers. Relations deteriorated, culminating in a Monday deadline for the Rotunda to audit consultants acting outside contracts. The Rotunda cites legal advice from Arthur Cox, prompting questions about public funding for it.

The Rotunda's battle is more academic than obstetric, as only one consultant delivered two babies privately (0.5% of 373 private deliveries) between January and March this year. Most obstetricians did not sign new Sláintecare contracts, but future replacements will be public-only. The Rotunda seeks to set a precedent before private maternity services vanish. VHI has already refused claims for two private patients delivered by a public-only consultant at the Rotunda, citing the consultant's Sláintecare contract. The Rotunda has informed patients it has an «exception» under Sláintecare.

Many other hospitals quietly support the Rotunda, hoping for a precedent. Some within the Rotunda accuse critics of hypocrisy. However, other obstetricians feel the profession appears «tone deaf.» Arguments that private services promote «safe care» are abrasive to midwives and can create anxiety for high-risk women who cannot afford it. Minister Carroll MacNeill stated that having private consultants on call for overall safety «missed the point entirely,» emphasizing that staff should not be there solely for private patients.