In the Rotunda, there are consultants on public-only contracts receiving payments for delivering babies while covering for their private colleagues. On Tuesday, I told the Taoiseach that this was happening at Cork University Maternity Hospital, CUMH, too. The Taoiseach admitted that he did not know anything about this. Today, it has been reported in the Irish Independent that a long-standing professional fee arrangement had been in place among consultants in CUMH. The spokeswoman for the HSE said, "This a private professional arrangement between some consultants in which Cork University Maternity Hospital plays no part". While it is no doubt true that hospital management plays no part in administering the payments, it organises the rosters that facilitate this practice. It appears from reports today that rosters are being changed and this practice has been stopped in Cork this week. However, no such confirmation has been forthcoming from the Rotunda.

We also know that there are major issues at University Hospital Galway where public consultants are being asked by management to do lab work for a private hospital. While some are refusing to do this, this is nonetheless leading to huge delays, including in tests for life-threatening conditions such as cancer. As a result, lab work is being outsourced for both public and private patients to commercially run labs. This is at enormous expense to the public purse.

This is not just about consultants and public-only contracts getting extra payments for private work or billing insurers for work for private patients. It is also having a real and negative impact on the care of public patients. These are patients whose lab work is being delayed while private work is done. These are patients whose health and lives are being put at risk.

The whole point of the public-only contract is to improve our health system and level up care for public patients so that they are receiving the same continuity and quality of care as private patients. Instead, at the Rotunda and the CUMH, rostering gaps were being filled for private consultants. This appears to be stopping at CUMH, but what about the Rotunda? Has the Rotunda been instructed to stop this practice? Has University Hospital Galway been told to stop asking public consultants to do lab work for private hospitals? What is the Tánaiste doing to ensure that the public-only contract is being enforced around the country?

I thank the Deputy for raising the issue. At the outset, I agree with him on the importance of the public-only consultant contract. It is something that arose from one of the better days or better periods of time in this House where the Government and Opposition worked together on a vision for the future of the health service called Sláintecare. I was the Minister at the time. The Deputy's former party leader, Róisín Shortall, chaired that committee. It has produced a good blueprint that we are all working our way through. It has taken some of the day-to-day politics in terms of policy direction out of health. That is a good thing. I want everybody who works in our health service, no matter what role they play, to understand that this Oireachtas speaks with one very clear voice when it comes to public health policy and we all expect it to be followed.

I also agree with the Deputy that there has been progress. We see the benefits of the public-only consultant contract. I will not go through them all, but as an example, St. Vincent's University Hospital has brought about a Saturday hub with participation by 40 consultants. In Wexford General Hospital, we now have weekend consultant cover in emergency medicine, surgery, paediatrics and gynae services. In University Hospital Waterford, we have seen a minimum of 26 consultants rostered at the weekend with outpatient diagnostics running until 8 p.m. during the week and on certain weekends. I use these as examples of where when this is applied correctly, we can see the real benefit in terms of public healthcare.

In relation to some of what has emerged, I acknowledge the Deputy and Deputy Rice's work on this. The idea of anybody being given a gift or paid to do a nixer effectively is not in line with the contract. It is not an improved HSE arrangement. It is not something that the Department of Health, the Minister for Health, the HSE or the Government would condone. Measures are now being taken to ensure that this practice ceases with immediate effect. My understanding is that the HSE chief executive is currently engaging with all the regional health areas and the regional clinical directors in relation to this practice.

I wish to make a couple of other points because people - certainly not the Deputy; quite the opposite to him - sometimes try to muddy the waters in relation to this. As would be the case in all specialties, the maternity consultant on duty in any hospital is responsible for the care of all patients requiring attention regardless of whether they are private or public. This idea that if a consultant is on call, they have to be given some sort of gift or payment is not how it works. Doctors know that, too. Cross-cover between consultants is routine. It is an expected part of how our public health services are delivered, ensuring continuity of care. Any suggestion of private financial arrangements in this context is inconsistent with contractual obligations, raises concerns and risks diverting time and resources away from treating public patients. We have seen no tolerance from the Minister for people who sign on the dotted of a contract and do not adhere by it. The Deputy can be sure that the Minister, Deputy Carroll MacNeill, is working intensely on ensuring the full implementation.

Speaking as the Minister of Finance, and lest anyone be of any other view, I wish to say that any income, be it direct or indirect, gained from employment is taxable. Revenue has standard audit compliance procedures that it operates across all sectors. Whether it is payment in the traditional way, a gift or a nixer, please be aware of the taxable obligations on any income derived through that.

There are patients waiting on test results who want answers in relation to lab work at University Hospital Galway. They want to know what is being done in terms of their test results, which they need a quick turnaround on. Their health and lives depend on a quick turnaround. They want answers as to what the Government is doing on that. The Tánaiste has not addressed that at all. He may say what the Government is doing about that.

It is welcome that the HSE is following up on this, but when are people going to know that these additional payments that are in breach of the public-only contract have stopped? We are seeing more and more things emerging about breaches of the public-only contract. What is the Government doing to ensure that the public-only contract is being enforced? Is it waiting for a drip feed of things to emerge around the country? Is it being proactive in ensuring that the taxpayer and public are getting the service that they are paying for and deserve?

I assure the Deputy that there are few more proactive Ministers than Deputy Carroll MacNeill. She is fully committed to the implementation and enforcement of the public-only consultant contact. We have already seen strong national uptake of the contract, with 3,416 consultants signed up as of the end of May, including 1,220 new entrants. There are over 2,000 consultants who switched from the older contract as well. We now have a health service where 69% of all consultants working in our hospitals are now on the public-only consultant contract. This represents a lot of progress in the time between now and 2023 when it was introduced.

I asked about breaches.

I know. I will get those. Consultant numbers have also increased significantly.

Regarding any breaches, the Minister for Health and the wider Government have shown that they simply will not be tolerated. There is a process under way - I have briefed on this at the Cabinet subcommittee on health - within the HSE and led by the chief executive, regional health area by regional health area and hospital by hospital, to make sure there is full compliance. The Minister is very eager to keep engaging with the Deputy's colleague, Deputy Rice, as Chair of the Oireachtas health committee on this. That committee is a useful place to continue monitoring progress. This can be a game-changer for the delivery of public health. When someone signs on the dotted line and takes the larger salary, they are expected to deliver on those terms just like anybody working in the public service.