I now move to our second leader, Deputy Holly Cairns.

There have been a lot of questions raised about our-----

Sorry, could we have decorum, so the Deputy can be heard?

A lot of questions have been raised about our maternity services in recent weeks and there appears to be confusion about a hugely important issue. Which category of patient deserves continuity of care in our maternity services? Can I be absolutely clear about what I thought was obvious? Every woman accessing maternity services should be entitled to the highest quality care. It should not be an optional extra reserved for those who can pay for it. Public maternity services should not feel less safe than going private.

However, that is very much the feeling people have been left with because that is exactly what the master of the Rotunda said. He said the reason the hospital was breaching the public-only consultant contract by allowing consultants on that contract to treat private patients was "safety for women". He has not withdrawn that statement but in an interview with David McCullagh earlier, he attempted to clarify it. He said "nobody is saying it is about safety" even though that is literally what he said.

He went on to say that having consultants treating private patients at the Rotunda improved safety for public patients because if they happened to be around when a public patient needed consultant care, they could potentially pitch in. I cannot have been the only person listening to that interview in complete disbelief. Are we really saying that safety for public patients in maternity hospitals now depends on blind luck, in that if they happen to be giving birth when a consultant is on site with a private patient, then they will be taken care of? This is the type of two-tier care that the head of the busiest maternity hospital in the country is fighting for.

The Social Democrats fully supported the approach the Minister for Health took in relation to the Rotunda but this controversy has exposed deep flaws in our maternity services and the so-called choices that are available to women. The choice that is only available to women who can afford to pay for it is not a choice at all. What woman is choosing not to have continuity of care? Every woman should have that. It is the bare minimum we should expect in our public system and that is what the Government's national maternity strategy is supposed to deliver. The focus now needs to be on delivering this for all women in maternity services.

With regard to the particular consultant, will their previous patients be refunded? Are the eight current patients aware of the situation they are in? Does the Rotunda's statement draw a line under this for the Taoiseach, or is he aware of further concerns about the operation of public-only contracts in our hospitals?

I thank the Deputy for raising what is a very important issue. I appreciate her party's support for the Government's and the Minister of Health's position on thisbecause a lot was at stake here, not just for maternity services but for the entire edifice that should govern public health and the provision of public health into the future in our acute tertiary system.

The Government took a decision following negotiations in respect of the public-only consultant contract, which is a cornerstone of the Sláintecare framework and policy. Our very clear reading of this was that it was an attempted breach of the fundamental position regarding the public-only consultant. We were very clear from the beginning. The Minister was very clear from the beginning and I was 100% behind her in respect of her position, having been in the last Government with the previous Minister, the former Deputy Donnelly, in negotiating this contract, which was signed off by the representative organisation of the consultants, the Irish Hospital Consultants Association, IHCA. People cannot sign contracts and then casually deviate from those contracts.

On the question of safety, in my view, the private model of care in obstetrics and maternity is not sustainable. It has not been sustainable for a long time. The State had to intervene a long time ago - well over 20 years ago - in terms of indemnifying obstetricians and gynaecologists in respect of maternity care, given that the insurance costs and so on were just not sustainable for any individual consultant.

I recall when we built the maternity hospital in Cork, which is actually a very good example. In fact, in Cork, you had a ridiculous situation where if you went to the Bon Secours Hospital, when it was private, and there was a complication, you were sent straight away to the Erinville Hospital, the public hospital, because it was the only hospital that had a neonatal. That was a fairly rudimentary neonatal at the time because I recall having to make decisions around all of that subsequently. When we decided to build a maternity hospital in Cork, the Bon Secours Hospital acknowledged that it would not be able to sustain as a private maternity hospital.

Can the Taoiseach answer the questions?

I will make my point generally. There is an issue here. We are very clear; we support what the Deputy is saying and, as far as we are concerned, a private model is not sustainable in maternity and, therefore, we want to build and develop hospitals where there is universal access and where, eventually, we will move to public-only consultants. Some have opted out of that, and that is their entitlement under the agreement. The patient should be refunded because this should not have happened in the first instance. These contracts were transparently signed up to by all concerned, including the hospital with regard to its service level agreement with the HSE.

Like I said, I am glad that the Minister and Government held the line. The reason many people were surprised to see the Government coming out to bat so strongly for public health is that we do not see that with regard to all aspects of Sláintecare. I hope that we see more of that now. For example, 80% of home care is private now. That is just going up and up. There is no money behind the 2025 plans for Sláintecare. There are so many things that need to be addressed.

I asked the Taoiseach two questions and he did not answer either of them, so I will put them to him again. With regard to the particular consultant, will their previous patients be refunded and are their eight current patients aware of the situation that they are in, that their consultant who is providing this care has a public-only contract? Does the Rotunda's statement draw a line under this for the Taoiseach or is he concerned about other governance issues with regard to the public-only contract in hospitals around the country?

I did answer the question. I said the money should be refunded. I made that clear in my original reply. The Minister is concerned about the operation of the public-only consultant contract throughout the entirety of the health service and in all hospitals. There is no going back from the position that we negotiated fully, transparently and comprehensively. Over the last five years, there has been an extraordinary level of investment in our health service at a scale that has dwarfed anything the previous-----

Are the eight current patients aware?

We do not allow a second contribution.

I made it clear that they should be refunded. The Minister has also sought assurances on that front.

I am asking about a different answer.

Deputy Cairns may have to write to the Taoiseach if she did not get the answer the first time.

The investment has been substantial in the last five years. In terms of the Deputy's question about Sláintecare, I do not think what she said about the lack of investment was fair. We could continue to invest more and more in health, but anybody looking at the last five years will see an extraordinary uptick and scaling-up of investment in the public health service.