The committee will consider the issues around the public-only consultant contract, POCC, in the Rotunda Hospital and Cork University Maternity Hospital and related issues around it.

I will set a bit of context for the meeting. This is now the fourth session that we have had regarding maternity services since last December. We had sessions focused on Portiuncula University Hospital, miscarriage and infant loss and the national maternity strategy. Throughout those sessions over the past number of months, we have discussed many issues from the domino scheme, homebirths, midwife-led care and miscarriage and infant loss. The purpose of our sessions over the past period of time has been to feed into the national maternity strategy which is in formulation. We, as a committee, are quite keen to have an input into that strategy and ensure that we get the most robust strategy possible. Our previous session caused significant debate. It was discussed quite widely in the media regarding the issues that were exposed in terms of the public-only consultant contract and public-only consultants doing private work that was in the breach of the contracts and the wider issue around public-only consultants receiving additional payments for those works.

I wish to remind members of the significance of the work that we do and the impact we can have as a result of that session and the debate it has caused. There has been a nationwide Department circular issued and changes to governance arrangements in relation to the public-only consultant contract. There has also been quite significant debate on the airwaves regarding Sláintecare. It has put a renewed focus on Sláintecare. However, there are many other issues that have come up time and again that need ongoing consideration, particularly issues around how we provide continuity of care within the public system and choice within the public system and what it means to have real choices that are not based on means in terms of the care that is delivered to a patient. I am looking forward to continuing that discussion and engaging on some of those issues and follow-up questions we have in relation to the public-only consultant contract but also the broader issues on its implementation and the impact that it has on care and the issues for the national maternity strategy and other maternity services.

To assist the committee on this matter, I welcome from the HSE, the chief clinical officer, Dr. Colm Henry, accompanied by colleagues, from the Rotunda Hospital, Professor Sean Daly and his colleagues, and from the Department of Health, Mr. Michael O'Leary.

Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that may be regarded as damaging to the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction.

Members are reminded of the long-standing parliamentary practice to the effect that they should not criticise, comment on or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

To commence today's proceedings, I invite Dr. Colm Henry to make the opening remarks on behalf of the HSE.

I thank the committee for the invitation to meet with it to discuss the POCC23. I am joined by my colleagues, Ms Anne Marie Hoey, chief people officer with the HSE; Dr. Eamon Dolan, regional clinical director of HSE Dublin and North East; Dr. Catherine Peters, regional clinical director in the HSE Mid West; Ms Mellany McLoone, integrated healthcare area, IHA, manager in HSE Dublin north city and north west; and Dr. Mairead O'Riordan, clinical director of the Cork University Maternity Hospital, CUMH. We are joined by colleagues from the Rotunda Hospital. Dr. O'Riordan from CUMH will respond to any questions or communications that the committee has in relation to this hearing.

The public-only consultant contract represents one of the most significant reforms in the history of the Irish health service. It was designed to deliver the Sláintecare vision to move towards a universal, single-tier health service where access is based on clinical need rather than ability to pay. Ultimately, the POCC aims to fully transition hospital consultants to public-only practice on public hospital sites, ensuring that all public hospital resources are dedicated to serving public patients and advancing the core objectives of Sláintecare. The terms of the contract also comply with the recommendations outlined in the de Buitléir report, including a public-only consultant model was consistent with Sláintecare objectives, consultant recruitment and retention requiring competitive remuneration, greater consultant presence outside traditional weekday hours as necessary and new contracts should support extended service delivery and improved patient flow. The contract recognised the vital role played by consultants in our health service and the benefits of a consultant delivered public health service. To date, the implementation of the public-only consultant contract has driven a fundamental shift in our senior clinical workforce.

As of June 2026, out of a total national headcount of 4,986 consultants - a definitive majority of 69% - are now on the POCC23 contract terms. Crucially, this includes 1,266 entirely new consultant appointees who have entered our health service directly under this contract framework. This improved access to senior decision-makers is delivering tangible, front-line benefits across our services. The strategic expansion in emergency medicine, for example, will improve care to our patients. Our emergency departments and injury units now collectively provide over 1.8 million episodes of urgent care annually. The impact of the contract on our emergency departments extends far beyond headline headcount. It has fundamentally altered the model of care by enabling a visible shop-floor consultant presence beyond the traditionally nine to five framework. This shift delivers immediate clinical decision-making, resuscitation leadership, and specialised competency for increasingly complex, frail, or older adult presentations. The contract introduced several significant changes including senior decision-making availability, extended hours during which consultants can be rostered, enhanced provision for continuing medical education and innovation and prohibition on private work in public facilities.

According to clause 24.10, consultants employed under the contract may not “engage in any private medical practice at any location operated by the employer or another part of the public health service”. In doing so, the contract established the framework for a phased elimination of private care from public acute hospitals. As those consultants who moved from an older contract to POCC and whose transitional period to wind down private practice on the public site has come to end, the compliance to POCC must be adhered to. To reinforce this policy, the HSE issued formal notice to all public hospitals in December 2025 clarifying this position and ensuring consistent application nationwide, which was further mandated to all regional clinical directors via direct correspondence from myself on 24 June 2026. The communication requires that compliance is closely tracked at both a regional and national level and all clinical sites have been required to confirm compliance and this verification is under way.

Regarding extended consultant presence, the contract recognises the need for change in existing work patterns, including an extension of the number of core hours and working week to six days from Monday to Saturday over which a consultant may be rostered within their 37-hour working week. The contract is a key enabler for the delivery of services outside the traditional work patterns of nine to five Monday to Friday and its ultimate aim is to enable us to transition to fully operational services over a six-day week. The extension of core working hours to include Saturdays also requires other categories of staff, such as administration, nursing, diagnostics and facilities and this will be a developing model.

Regarding improved recruitment and retention, the HSE is operating in a fiercely competitive global healthcare recruitment market across all professions, including consultants. The contract is attractive and competitive as well as providing enhanced supports for innovation and research and continuing medical education. It also commits employers to providing flexible working arrangements. These measures were intended to address consultant recruitment challenges and make public service posts more attractive internationally.

In March 2023, the HSE had a 12% vacancy rate for the total number of consultant posts and as of May 2026, it is 8%. The reliance on temporary and locum consultants has also reduced, with 83% of posts now filled by permanent consultants, compared with 78% in 2023. Retention of graduates from our postgraduate training programmes is strong and has improved since the introduction of POCC, when we consider that only 75% of our postgraduate training graduates from 2018 are now working in Ireland but this figure increases to 87% for the 2021 graduates.

This recruitment momentum is vital because it is building our capacity to meet a rising demand in healthcare. Comparing our 2019 baseline to our mature 2025 output, annual outpatient attendances scaled from 3.35 million to 4.12 million, while inpatient and day case volumes grew to over 1.97 million. This upward trajectory has continued directly into 2026, with year-to-date outpatient activity up over 4% and inpatient and day case activity up by over 3% compared with the same period last year. Furthermore, the flexibilities within the new contract support a crucial, safer model of care delivery. Between 2019 and 2025, elective inpatient discharges reduced by 8.3% while more efficient day case discharges grew by 24.9%. The overarching trend from 2019 to 2026 proves that our expanded consultant workforce is successfully turning contract reform into measurable patient activity.

In the context of governance and accountability, the introduction of POCC has led to extensive consultant work plan reviews for both new consultants and existing consultants moving onto POCC. The introduction of a national digital platform, DIME, to record the consultant work practice plans allows, for the first time, the ability to report at a national level on the work plans for our consultant staff. This will provide transparency, ensuring consultant commitments to the public health services are clear, clinical work planning is more transparent and teaching, management and research responsibilities are clearly defined.

While significant progress has been made in implementing POCC, there are challenges relating to the consistency of implementation, variation across regions and the quality, clarity and comparability of POCC reporting. In response, the HSE has established a national performance action group, focused on standardising and strengthening reporting on POCC implementation; the achievement of enhanced Saturday and weekday evening rostering; accelerating and supporting the effective implementation of POCC across regions and services; and the elimination of private practice in public settings.

In tandem with these compliance checks, the HSE is optimising public resource utilisation. Following a recent directive from the CEO on third-party insourcing, we are ensuring stricter alignment of external capacity with public needs. The HSE currently has established governance for POCC under the regional clinical directors and the clinical directors to provide oversight and assurance of compliance through the development and management of individual consultant work plans. Regional clinical directors, as the designated leaders of clinical services, hold a central responsibility in delivering the required changes in consultant work patterns and regional executive officers for enabling and driving the regional operational changes required to ultimate assurance. All regional clinical directors and regional executive officers are focused and committed to the delivery of the POCC task ahead. Full transparency and compliance, providing accurate and standard data to build trust in our reporting on the implementation of extended working patterns and ultimately measuring, in a meaningful way, the productivity and impact of POCC is a top priority of the HSE.

The ambition of POCC is significant and requires a system-wide shift to provide the delivery of additional capacity. Consultant work plans provide an enabling mechanism to introduce this additionality by providing extended clinics, theatre lists and diagnostic sessions outside of the traditional 9 a.m. to 5 p.m., Monday to Friday, window. The attendance of consultants outside these hours is not the end-point. Reconfiguring services to support the extended working day and week requires a system change which will include redesigning staffing across all disciplines and grades to ensure maximum efficiency and maximum benefit to our patients. The appointment of a consultant under POCC represents a commitment to ensure that clinical activities are exclusively dedicated to public service provision. A critical requirement under POCC is the assurance that consultants do not engage in any form of private practice within the premises or under the auspices of public hospitals.

As we move forward, the focus of the POCC benefit realisation will now move into consistent and measurable site-level outputs, prioritising the introduction of this additionality supported by the site-based key performance indicators rather than just per-consultant metrics. Ultimately, the success of this contract reform will be measured by the tangible improvements our patients experience every day: improved access to care, shorter waiting times and a safer, more sustainable and innovatively structured public health system for the future. I welcome questions from committee members.

I thank the Cathaoirleach and members of the committee for the invitation. I am joined by Dr. Vicky O'Dwyer, clinical director, and Mr. James Hussey, our secretary and general manager. We are here to assist the committee fully and to answer committee members' questions openly.

The Rotunda Hospital has cared for the women and families of this country since 1745. We are the oldest continuously operating maternity hospital in the world. In 2025, the Rotunda Hospital cared for 10,000 pregnant women and delivered more than 8,600 babies, roughly one in six of all births in the State. We look after many of the most complex pregnancies and some of the most deprived communities in our society. The Rotunda is unique as an institution, in that it has continued to provide an unbroken record of service to women and infants since its foundation and in 2027, we expect to deliver our one millionth baby.

I begin there not out of pride, although we are proud, but because that history carries an obligation. An institution that asks women to trust it with the most important moments of their lives is rightly held to the highest standard. I want to be clear on one point, because it matters more than any other. The safety and standard of care given to every woman in the Rotunda, public or private, are identical. In the most recent national outcomes for 2025, our results for safe care in labour are significantly better than most units in the country and we achieve this while caring for a higher risk population, with midwifery and physician numbers below international norms. Nothing about a woman's safe care has ever been predicated on whether she was public or private.

There are two larger questions I would put briefly to the committee, not as an excuse but because they are real and unresolved. The first is choice. There is no private maternity hospital in this State and as the new contract takes full effect, women who choose private maternity care will, over time, have nowhere in the system in which to do so. Choice is a fundamental right and is embedded in the current maternity strategy, which I know is Government policy. Sláintecare is also Government policy and I reassure the committee and the Cathaoirleach that the Rotunda Hospital is absolutely committed to Sláintecare, as evidenced by its inclusion in framing the strategic principles for our five-year strategy from 2022 to 2026.

The second issue is resourcing, and this was highlighted by members of this committee when we were here in May. Ireland has just 3.85 obstetrics and gynaecology consultants for every 100,000 women. This compares with five to 6.5 across Wales, England, Scotland, Canada, Australia and New Zealand, which is a gap of up to 70%. As we highlighted in our previous submission, our midwifery numbers are also well below international standards.

The issue of continuity of care has been raised over recent weeks and it is more challenging in the public system due to the ratio of doctors and midwives to pregnant women. This is something that needs to be addressed in the next maternity strategy. It is an opportunity to look at what was not achieved in the last strategy and to implement new opportunities for improving maternity care for all women. The Rotunda believes it is a major stakeholder in the provision of maternity care and can contribute to this discussion in a meaningful way.

The past six weeks have been a particularly challenging time for the Rotunda Hospital, its staff and the women and families we serve. The decision, taken in September 2024, was heavily considered over a period of 18 months by the board of the Rotunda Hospital and was not taken lightly. The implementation and support for Sláintecare was, and continues to be, a priority for the board of governors of the Rotunda Hospital. On Monday, 8 June, the board of governors reversed the decision to allow private practice by public-only contract holders for pregnancy-related care. The Minister, in correspondence to the hospital, highlighted that any decision about the contract required the support of the Minister and the HSE. The board was unaware of this stipulation as it is not detailed in the contract and all employees of the Rotunda Hospital have Rotunda Hospital contracts. What occurred over the past few weeks, where women were made to feel guilty or privileged for having made certain decisions about their care, was unconscionable. There have also been many misconceptions propagated over the past number of weeks and I assure the committee that there is no consultant working in the Rotunda Hospital who does not fulfil their commitments to the provision of public care before undertaking any care for private patients.

The Rotunda Hospital works in partnership under a service level agreement with the HSE to deliver care to approximately 10,000 pregnant women and over 8,600 babies. In addition, the Rotunda Hospital currently receives more than 1,300 referrals every month for women with benign gynaecological disease. We pride ourselves on this partnership and strive to deliver the best quality of care to every woman who wishes to attend our hospital.

Private practice cover arrangements have existed in the Rotunda Hospital for more than 20 years across multiple different specialties, as they have in many other units. As of the board’s decision on 8 June 2026, these arrangements no longer include consultants on the POCC contract.

The Rotunda Hospital has stood for the women and babies of this country for almost 300 years and we intend to stand for them for the next 300. To do that, we must hold ourselves to the standards our history sets. We want to work with this committee, the Minister, Deputy Carroll MacNeill, the Department and the HSE in the same constructive spirit to help develop a new maternity strategy for the years ahead.

I express my sincere apology for all that has occurred over the past few weeks. When we were before the committee in May, I had prepared for a discussion on the maternity strategy and was not adequately prepared for questions on the public-only contract. I apologise for that. My colleagues and I are happy to take questions.

I thank Professor Daly. We will now move to questions from members. In line with our standing practice, we will move on an agreed rota by party size. We aim to take a break in about an hour’s time. Each member will have nine minutes, and I ask members to stick to that so that everyone gets the same amount of time.

I might be a bit quicker. I have a question for Professor Daly. Over the last few weeks, how women have been made to feel because of their privilege and so on has been “unconscionable”, in the Professor’s words. What does he mean by “unconscionable”? Who is unconscionable? Is it the committee, or does he mean the Minister? Was it unconscionable to continue to permit private practice in breach of public obligations? Was it unconscionable to suggest women were getting less safe care when private practitioners were not on site and that all women were safer because some women were getting private care and, as a result of that, the women in public care were safer?

In the last few weeks, there have been plenty of comments that Professor Daly and the board were sure of their legal position. Today, he said that the board did not know the private work was not allowed, despite considering it for 18 months. What did Arthur Cox do for the Rotunda Hospital? What was the legal advice for exactly? Who paid for that legal advice? Was it through the public purse or fundraising money? Did the hospital get legal advice in the month up to September 2024 when it made its first decision and who paid for that advice?

I will try to answer the questions, if I remember them all.

I can remind Professor Daly along the way.

Great. The board has its own funds, which paid for the legal advice. The Rotunda Hospital has existed, as I said, since 1745. It generates its own funds by virtue of the fact that it owns the Ambassador Theatre and the Gate Theatre Dublin. It generates its own funds and it used those funds to pay for the legal advice.

The Senator asked when legal advice was sought. Clause 24.10 is reasonably clear in that it states that private practice should not be allowed, except as expressly granted by the employer. The employer of everyone who works in the Rotunda Hospital is the Rotunda Hospital. The Rotunda board, over an extended period of time, considered all the aspects of Sláintecare. The Rotunda board and the hospital prides itself on being a hospital of choice. Therefore, in order to ensure that choice was preserved, the board took the decision to allow private care under the public-only contract. On 8 June, the board reversed that decision. There is now no private care given to any women by public-only contract holders.

What did Professor Daly mean by using the word "unconscionable"? I asked whether it was the committee or the Minister who was unconscionable.

Absolutely not. There were a number of articles in the media that raised that issue. It is included in this statement - written not by me but by a group of people - that it is unconscionable that women would be called out in the media for having made those decisions. It was never a criticism of this committee or the Minister.

Was it unconscionable to suggest that women were getting less safe care when private practitioners were not on site?

As I said, when I was before the committee at the end of May, I had prepared for questions around the maternity strategy. The Rotunda Hospital is a significant stakeholder in the provision of maternity services. I was not aware of questions related to the public-only contract. If I misled anyone by suggesting that there were safety issues, I apologise unreservedly for that.

Was it unconscionable to continue to permit private practice in breach of public obligations?

We were not permitting private practice in breach of public obligations.

I keep using the word “unconscionable” because that was the word used by the Rotunda Hospital.

I understand that. There was no private practice in breach of public obligations. Anyone doing private practice in the Rotunda Hospital fulfils their public commitments first. The Senator is absolutely right that it was portrayed in the media that there were consultants who solely did private practice in the Rotunda Hospital. I assure the Senator and the committee that never happened.

Will women who were charged be refunded for that mix of private and public care? What is happening in that regard?

I will ask Mr. Hussey to address that issue.

I thank the Senator for the question. First, I will provide the Senator with some assurances around her earlier questions. The board of governors of the Rotunda Hospital is the guardian of the hospital. Its members give their time voluntarily to that commitment. They give extensive time and commitment voluntarily to the hospital. To go back to the Senator’s earlier question, we have a wide skill mix on that board, which includes legal and HR board members. We utilised that up to the decision in December 2024. The POCC, its opportunities and the implications and challenges of its introduction were discussed extensively by the Rotunda board. It was not a decision arrived at lightly. It was discussed at in excess of 16 meetings. It received extensive papers and contributions from various skills and skill mixes since its introduction in March 2023.

We utilised external, professional legal advice through Arthur Cox in 2026. That was around two particular aspects of the contract, which were the employment relationship in the contract and clause 24. We must bear in mind that the POCC is a national contract. It is not a Rotunda construct. Therefore, we sought advice on the employment relationship and the employer-employee relationship in the contract.

I am running out of time. I have a quick question for Dr. Henry. Does he agree with that contract interpretation?

The contract applies to all consultants working in public sites, be they HSE-run or voluntary hospitals with a service level agreement, SLA, and funded by the HSE.

To answer the Senator’s question about redress, the Rotunda Hospital will reimburse any private medical insurance, PMI, or patient who seeks a withdrawal of charges raised by the hospital.

I welcome all of our witnesses. I will start with Professor Daly. I will pick up on that part of his speech where he said, “What occurred over the past few weeks, where women were made feel guilty or privileged for having made certain choices was unconscionable.”. Does Professor Daly accept that, from the perspective of the committee, the Minister, the Department and the HSE, the core issue was not about choices women made but the choices the board of the Rotunda Hospital made?

I would accept that, yes.

I will start with that. It was the board that made a decision to allow consultants on public-only consultant contracts to carry out private work for a time period within the Rotunda Hospital. Is that right?

Yes, but only in pregnancy-related care.

I understand that.

Not in gynaecology and obstetrics.

It was in that area. It was a board decision.

That is correct.

Professor Daly said that it was not taken lightly and was considered over a period of 18 months. I assume that was based on legal advice as well. I know Arthur Cox was mentioned. The board obviously received legal advice on the basis of the contract, or its interpretation of the contract. Is that right?

As Mr. Hussey has said, there are a wide variety of skills available to the board by virtue of the fact that there are-----

I appreciate that there are probably other advices as well but there was legal advice.

There was not formal legal advice until this calendar year.

Okay, but there was legal advice given in this calendar year.

Absolutely.

How much did that cost?

To be honest, we are not absolutely sure because we have not received the bill. As I explained to Senator Costello, that money will be paid by the board and not by the hospital.

There will be no public money used to pay for those legal fees.

Absolutely not.

Professor Daly went on to state that the Minister, in correspondence with the hospital, highlighted that any decision about the contract required the support of the Minister and the HSE. He said the board was unaware of this stipulation as it is not detailed in the contract. Surely it is a matter for the Minister and the HSE to stipulate what their interpretation of the contract is and what should or should not be happening. Does Professor Daly now accept that is the case?

I do.

Why was there some confusion?

It was because the wording of the contract does not suggest that the board, who are the employers, need to get any additional permissions to exercise the contract.

Does Dr. Henry accept that?

As I stated during the opening statement, and again to answer Senator Costello's question, our position is that the contract applies to all publicly employed consultants, regardless of where they work.

There is a deviation between the HSE's understanding and what was the board's understanding, and certainly there was from the Minister as well. Does Professor Daly accept that?

I do and the board has now accepted the Minister's interpretation.

How many consultants are there in the Rotunda?

I will ask Dr. O'Dwyer to come in.

I just want the data. I just want to know how many there are.

There are 61 consultants.

There are 61 consultants. How many of them are on type B contracts?

Just under half of them. There are 37 on POCCs.

The terms of those on type B contracts is that there is a percentage of private work allowed. What is that percentage?

The percentage for type B contract holders pre-POCC is 80:20.

That is 80% public and 20% private.

That is correct.

Are there instances in the Rotunda, or have there been over the past number of years, where consultants on type B contracts have done more than 20%?

Not that I am aware of. We have agreed work plans for all of our consultants of 37 public hours.

Has Professor Daly examined that?

Yes we have. The issue with pregnancy-related care is that it is not the same as other care.

I accept that. My question is very clear because there has been a lot of public commentary about this and lots of concerns about the public-only contracts. I did not get into the whole issue of that as I accept women were caught up in all of this and I think that was deeply unfair. The issue here is that we have signed up to Sláintecare and public-only contracts are what they are. There were breaches of those contracts but there were also these type B contracts, and it is very clear that you cannot do more than 20% private work. Was any analysis done by the board in relation to whether any consultants did more than 20% private work?

The consultant public-private mix is monitored continually.

I did not ask that. I asked if there is any analysis done or is Mr. Hussey aware of any circumstance where more than 20% of private work was carried out by consultants on type B contracts?

That would be included in reports that went to the board over the past number of years.

I am asking a straight question so is the answer, "Yes", that there are instances of consultants n type B contracts doing more than 20% private work?

I do not believe there are. I need to frame this.

When Professor Daly says he does not believe there are, is that because it is a factual position or is it that he is not aware?

No. You can have a consultant who does no antenatal care, for example, because they are foetal medicine specialists and all-----

I accept that and I do not want to go off on tangents. Who is here from the Department? It is Mr. O'Leary. Is the Department aware? Did the Department get any information from the Rotunda in relation to consultants on type B contracts and activity? Are there any concerns within the Department that consultants on type B contracts may well have been doing more than 20% private work?

The Department has not received any data from the Rotunda.

Has the Department asked?

We have asked. The Minister has asked the HSE to look at the compliance of all consultants across all hospitals so that work will be in progress very shortly and led by Dr. Colm Henry.

That information is important. I will go back to Professor Daly. This issue of €1,500 being paid to consultants on the POCC was really alarming for people. I do not know whether this was happening in other hospitals. How in God's name was that happening in the Rotunda? How was that allowed to happen?

First of all, it was a private arrangement between consultants which the hospital was not involved in, whereby if you did a delivery for-----

We know what the issue is. We have all read about it. What I am asking is, where is the oversight here? Does Professor Daly accept those payments were wrong?

To POCC holders, yes.

I want to come to Dr. Henry. We had a situation in the Rotunda Hospitals where consultants on POCC were receiving up to €1,500. It may not have been that amount in all circumstances, it may have been less - but they were receiving money. Is that outside the terms of their contracts?

As stated before, the policy applies.

I know Dr. Henry said that, but yes or no, is it outside the terms of their contracts?

The policy applies to all consultants on all sites that there is no receipt of payments either directly or indirectly.

I am asking, is it outside the terms of their contracts?

My understanding is that it is.

It is. Again, we had a situation where consultants were operating outside the terms of their contracts. Were they getting paid cash? How were they getting paid for this?

Can I try answer that question? The provision of emergency care was reimbursed to individual consultants who, in emergency situations, delivered somebody's private patient.

I understand that.

There is no money that transfers for regular care. If, for example-----

I understand that as well. I am asking about the money that was transferred. We have established money was transferred. What I am asking is, how was that money transferred? Was it from consultant to consultant?

I do not know if Dr. O'Dwyer wants to take this but essentially what happened was that, during the weekends, which is the only time this happened, in emergencies consultants would deliver-----

I know that and I am not being difficult. My question is really straightforward. This is where transparency is important. We deserve a straight answer.

Absolutely.

We now know that payments were made. I am trying to establish how those payments were made. Was it from consultant to consultant? Was it in cash, by Revolut or by bank transfer? How was it happening?

It is a pooled arrangement for cover at the weekends. The transfers are all declared and there was no cash that I am aware of. The payments were made by cheques and bank transfers. There has been an insinuation that it was not declared to Revenue. As far as I am aware every payment was declared.

It is now stopped.

There is no POCC consultant-----

Through the Chair, I think the committee needs to see a very detailed breakdown from the Rotunda about that awareness of those payments, how often they were happening and so on.

Yes, I thank the Deputy.

I think that would be useful for the committee.

For the record we are very happy to do that.

Sorry, we are over time.

The witnesses are all most welcome. It is important we have this engagement in order to understand fully the background to this. I am a little surprised that the Rotunda made the decision to go against the wishes of the HSE and the Minister. I am conscious that in one of the contributions made thus far that what really is paramount here is the clinical need rather than ability to pay. I will go to Professor Daly first.

On 27 May, Professor Daly was in this room and he said the Rotunda had made the decision to go against the public only consultants contract as it was "primarily about safety for women and women's choice". Today he said:

I want to be clear on one point, because it matters more than any other. The safety and standard of care given to every woman in the Rotunda, public or private, is identical.

I am trying to understand why Professor Daly would tell women that the service was only safe, or primarily safer, if there was an element of private care involved.

As I have said at the end of my statement, I apologise for any ambiguity that arose from my statements here at the end of May. I was not expecting to be asked about the public only contract. Was that naïve? Perhaps it was but I was not expecting to be asked about it. What I was referring to is that we have a system now in Ireland that is very safe. The Irish Maternity Indicator System, IMIS report across maternity services in Ireland for last year looked at the major key performance indicator of perinatal mortality, which is the number of babies who weigh more than 400 grammes who die either during pregnancy or within a week of delivery. That has consistently fallen over the past ten years. What I was referring to was if we changed the system, we go from a system that we know is safe to a system that we cannot be sure is as safe. I was never suggesting, or at least if what I said was interpreted as suggesting, that women were safer in the private system than in the public system. I absolutely apologise for that. I never meant to say that because it is not true. That is why we put it in this statement. Women in the Rotunda are very safe. Our results for last year are phenomenally good. We do not differentiate between public and private. The reason this system is safe here is the HSE, Dr. Henry, and the surveillance that is in place. The IMIS report details all 19 units in Ireland, and shows what their perinatal mortality rates are, their caesarean section rates, etc., so we have a very safe system at the moment. Is it perfect? Absolutely not. Could it be improved in certain areas? It could. Is it under resourced? Absolutely. However, we believe that in terms of safety, it is safe.

I get what Professor Daly has just said in terms of his clarity around what he said in May, but he can get a sense also that it was documented and it is on public record so we have only that to go on. That is the reason I asked the question.

I have a second question. I hate to describe this as "divvying out" but in terms of the allocation of births to consultants, is there an equal distribution of deliveries right across the consultants?

Does the Deputy mean private deliveries or public deliveries?

Both, but take the private one first.

I might answer that. Our consultants have specialist interests or skills. Some of them are primarily obstetrics, some of them are gynaecology and some of them are a mix. Within their work plans, they will have certain sessions. Some will provide antenatal care, some will cover the labour ward and some will be operating on gynaecology patients. It is difficult to say the percentage of each but we have a team system, so every consultant is part of a team. For example, I am part of team D so I do a ward round and I cover the late ward. Everybody is seeing public patients in some capacity but some of it may be gynaecology rather than obstetrics.

To add to that, not everybody does an antenatal clinic. We have foetal medicine consultants who specifically look after high-risk pregnancies, be they maternal or foetal. Some of those consultants do no public antenatal clinics but absolutely contribute to the care of huge numbers of women. Getting back to what Deputy Cullinane said, we will very happily give all that information to the committee. We have no issues with that.

If somebody has the specialist knowledge and there was a greater need for that individual consultant to deal with more cases than normal, or which may be different from others, which contract would they be on? Would they be on private or public?

We have about 1,000 women each year who need to see a foetal medicine specialist and another 1,000 who will see a maternal medicine specialist as part of their clinical pathway, which includes their antenatal care, delivery and postnatal care. That is shared among consultants on all contracts.

In the context of the conversation we are having, has Dr. Henry ever done any private work himself?

I work full time for the HSE now. I am seconded from a position as consultant geriatrician in the Mercy Hospital where I worked exclusively-----

As the chief clinical officer of the HSE what has Dr. Henry done to make sure that private care has been taken out of the public system?

Our position has been entirely consistent. The contract must be adhered to in letter and in spirit. To that end, and following on from directives that have issued from national HR by Ms Anne Marie Hoey, who is by my side here, I have written to all clinical directors in recent weeks reminding them that there can be no payment or payment in kind for POCCs and of the purpose of the contract, and in delivering the De Buitléír report and its vision that we ensure equitable delivery of services to all patients in hospital.

It is important to build on Professor Daly's remarks and to assure people who might be listening that our maternity services are safe. Professor Daly has emphasised that. We compare very well. We have seen falling birth rates but increased complexity and we have 19 units that work at greatly different volumes. They are under a huge degree of scrutiny. We will be publishing the metrics related to all these 19 units later in the year, which will be open for all people to see. As he said, the perinatal mortality rate, which is a standardised common indicator comparing maternity services, has been falling year on year. It is important to reinforce the point he made on how safe our maternity services can be. That is important for anybody listening or for any report from this committee.

The clock is catching me so I will pass on.

I thank the Deputy. The next slot is mine. The national debate over the past number of weeks has been quite useful in putting a spotlight on maternity services. It shows how much people generally, women and the Oireachtas and members of committee care about these services, how they should be resourced and invested in, and the priority that should be placed on the national maternity strategy. I really hope that this message has landed with the Department, the Minister and the HSE.

I have a number of questions I want to focus on. I want to pick up on the safety point with Professor Daly. When the question was put to you at the committee the last time, it was around why the Rotunda had made that decision to allow public only contract consultants to do private work. He said:

That is why the board of the Rotunda made that decision. It is primarily about safety...

I know you apologised for that but would you like to withdraw that statement?

What I was referring to is that we have a safe system at the moment and if we change that system, we cannot be absolutely sure it is as safe. If I misled the committee by that statement, I absolutely apologise for that.

The question was: do you want to withdraw the statement you made?

No, I do not want to withdraw it.

I want to tease out another point made by the Rotunda since, which was around the numbers of babies delivered POCC holders. We we were told that it was just five deliveries done. Is that correct?

Five deliveries. Yes, five deliveries in 2023 were done emergently.

The numbers just do not add up. If we are saying there are 8,600 deliveries per year, there were 4,300 between January and May. They happen every day of the week. They are not just happening Monday to Friday; they are happening at weekends. We now know that the public only consultants were doing deliveries at the weekend and getting those payments. Surely it is more than five. Does Professor Daly accept that?

No. It may not have been clarified sufficiently but there are emergency teams on call in the Rotunda for obstetrics, gynecology, anesthetics, and pediatrics. The public-only contract holders are part of those teams on a rostered basis. In 2023, the number of emergency deliveries for private patients which were performed by public-only contract holders was five. We can absolutely stand over that.

Professor Daly is saying that between January and May of this year, the total number of deliveries done by public-only consultant contract holders was five.

No. Between March 2023-----

The statement was that between January and May of this year one consultant, who had signed a contract to provide public only care in a public hospital, provided care to five patients. I ask somebody else from the Rotunda to answer the question. Was the number five or higher?

There is one consultant, who is providing private antenatal care, who delivered five.

If we take in the weekend deliveries and those cash payments, cheque payments or whichever the payments made, what is the total number?

If we look at the total number of payments over the three-year period, it was 49.

The question was: between January and May of this year, how many deliveries were done by public-only consultant contract holders? It is not a very difficult question. We were told five. What is the correct answer?

We do not have the 2026 figures but I can give the figures for 2023, 2024, and 2025.

The figure we were given for this year was five. I would like to know the total, including weekends. The witnesses do not have the answer. I would like a written answer on that because it does not stack up.

We will absolutely supply that. We have it, we just did not-----

The witnesses did not give it to the media or the committee.

That individual consultant who was delivering private care delivered five women. However, on the emergency deliveries, we will clarify.

We have learned since that it is beyond just one person, it goes much wider, and there were these payments. We want to know how many in total. That was the question, and the witnesses can write to us and give us an answer.

Okay.

The information provided to date has not been accurate.

In relation to public clinics, how often are there consultant-led public clinics which do not have a consultant present?

It is very rare. Everybody is entitled to take annual leave, so there may be situations where there is no consultant present or there is a cross-cover arrangement. We have a fantastic building off O'Connell Street for public antenatal care, and there are a number of clinics which run concurrently.

How is the Rotunda ensuring that consultants on older contracts are not missing their public clinics to do private work?

We have agreed work plans, and they are there. We sometimes check that people are doing the sessions they are supposed to, and I can confirm that they are there doing their public work.

What happens if a private patient needs to be seen while a consultant is at a public clinic? What happens in those situations?

The public clinic is not in the main building; it is in Hampson House. There are cross-cover arrangements within the building, where a type B consultant will cover-----

There is a different consultant so that the consultant is not missing from their clinics. Is Dr. O'Dwyer satisfied that the consultants are at public clinics almost all of the time?

Absolutely.

Yes.

In relation to the piece around pick up on the weekend cover, Professor Daly said that on 8 June, the board decided to reverse its decision to allow POCC holders to do private work. However, on 13 June, a spokesperson for the Rotunda told the Irish Independent, "This arrangement is personal to the consultants, and the hospital is not involved.” If the decision to stop public-only consultants covering private practice was taken by the board on 8 June, why did the spokesperson for the Rotunda attempt to wash their hands of any involvement of it just a number of days later?

There was no attempt to wash their hands. I think-----

It was stated that this arrangement was personal and the hospital was not involved.

If I could finish, Cathaoirleach. There are two different types of contracts operating in the Rotunda at the moment. There are those people who have the public-only contract, and those people who have the older type B contract. People who have the type B contract are still allowed to do private practice. Those arrangements continue at the moment. What has now happened is that no public-only contract holder will do emergency private deliveries as of 8 June.

Yes, but a number of days later, the hospital said it had no involvement in it, even though these are Rotunda employees rostered by the Rotunda and scheduled. If the public-only consultants who are being rostered in this way did not want to do the private work, did they raise those concerns with the hospital? Were they able to opt out of this? What were the arrangements?

We have some consultants who only provide gynecology cover on call at the weekends, and they did not participate.

What about the others?

The others did participate.

Did any of them raise concerns about it?

Everybody opted into the rota when it was done.

I understand that the rota has now changed and there are two separate rotas. When the old rota was in place, is it true that the consultant on call, who was sometimes the public-only consultant, had to attend every private delivery?

Yes, that is true but they were all emergencies.

I ask Professor Daly to let me finish my question. They attended every private delivery but not every public delivery. Is that correct?

This is an on-call team. The on-call team deals with emergencies. If a given woman came in in labour at the weekend and required care, the public-only contract holder would provide that care in an emergency. The team, and this involves a huge number of midwives who deliver a huge amount of care to both public and private patients, is involved in their care also.

Yes but attending every private delivery and not every public delivery.

I only have a moment left, and I want to put a similar question to CUMH. In relation to the piece around the payments - because this was not happening only in the Rotunda; it was also happening in CUMH and potentially elsewhere - what is the witnesses’ interpretation of the tax situation? Is there tax liability for the hospital?

Not for the hospital. This was again a private arrangement between consultants, so it was separate from the hospital. From a-----

These are public-only consultants

This has been a long-standing arrangement in the service so it is more than 20 years. Since before the hospital even opened, there has been a long-standing arrangement. There are any number of contracts within the service, and quite a lot of our consultants do not actually provide private practice.

Is Dr. O’Riordan satisfied that all the tax has been paid?

I do not know anyone's particular tax issues but from discussion, this was always done formally. I did private practice before, and was billed for it. I declared what I received. That is my understanding.

I thank Dr. O’Riordan.

I thank everyone for coming in today. I want to say from the outset, I have no ideological difficulty with private practice. I will declare my own interest. I have a general practice and I have private practice but I have a real attachment to contractual obligations to service and to the State. I want to make absolutely clear that none of this is personal but it is critically important in terms of the provision of publicly-funded services to the citizens of this country. That is what we are talking about. We are not talking about the rights of anyone else, we are talking about the right of citizens and taxpayers to get value for their money, and that contracts which are freely entered into are fulfilled.

I am going to come back to the safety issue. Professor Daly was the one who raised the issue of safety at the last committee meeting. He then talked about it being unconscionable, about the fears that were raised around women making certain choices to go for private care. That is what he raised. It was not the media, the committee or the Minister for Health who raised this, he raised it and the Cathaoirleach asked him again whether he would consider withdrawing that remark around safety, where there was a definite inference. Everyone else cannot be wrong on this because everyone got the same inference. The inference was that women who get private care are receiving safer care than women who get public care. That was the inference. He has apologised for that but I ask him again if he will withdraw it.

I will absolutely withdraw it because it has created a false impression.

Professor Daly either withdraws it wholly because it is not true, or it is true.

Then I agree to withdraw it because it is not true.

The Cathaoirleach was very correct in asking Professor Daly to withdraw it. It is what he said, not the media, the committee or the Minister said.

Professor Daly said that the fear of the board was that if there was a change in the way services operated heretofore that the service would be less safe in the future. He has said that again this morning on two occasions. Does he withdraw that comment?

I think the Deputy misinterpreted what I said.

No. Whatever Professor Daly does I ask him to please not accuse me of misinterpreting. I have been listening very carefully to him. I have read his statement very carefully. I have listened to the Cathaoirleach and other members of the committee. Professor Daly has said on a number of occasions this morning that the fear of the board was that the change in the way the hospital operated heretofore to operating the POCC would create a less safe service. The professor has said that. Will he withdraw that comment? That leads to engendering fear in women and to people doubting the service. As has been pointed out by Dr. Colm Henry here and Professor Daly himself, we have one of the safest maternity services in the world. We might not have the nicest facilities at times and there may at times be deficiencies in the services but overall, in a public health setting, we have a very safe service. Is Professor Daly suggesting that the board, when it was making its deliberations - I want to come back to that - to unpick what essentially was a pretty clear contract to most people, was doing it on the basis that a system going forward would be less safe because it would be in the hands of public-only contract holders?

That was never the-----

Will Professor Daly withdraw that comment? He has said it twice or three times today.

I cannot remember the exact words I used.

I remember because I have been listening carefully to what Professor Daly has been saying.

Okay, so-----

Is Professor Daly saying it is not the case? Is he saying that the service will maintain its quality and be safe going into the future, no matter what contract, provided it is a good one, which many consultants have signed into?

I would like to think it would be but if the Deputy is asking me-----

That is entering a caveat.

If I could answer the question.

Yes, okay.

If the Deputy is asking me am I absolutely sure that a new system of care is as safe as the old system, I honestly do not know because the new system has not occurred. I am absolutely sure that if we resource healthcare and maternity care the way we would all like to see it resourced that it will be safer.

That is a fair answer and I understand that now completely. Professor Daly says that he and the board of the Rotunda Hospital committed to Sláintecare but it appears to me that they went to extraordinary lengths to unpick the public-only contract. It was almost Jesuitical. One of the biggest firms in the country was retained in order to back up that. Now the interpretation has proven to be incorrect. If Professor Daly was committed to Sláintecare, and to the public-only contract and its roll-out, why did he and the board go to such extraordinary lengths to try to unpick that contract?

I can take that, Deputy. I do not think the board ever tried to unpick the contract.

There was a very definite attempt to reinterpret the terms of the public-only contract and to find a way around it. That is a reality. Do not take me for a fool. That is the reality. One of the most expensive firms of lawyers in the country was retained to back up that claim. Mr. Hussey rolled up his tent after he was challenged on that because in fact that was not the true position contractually. I will put this to Dr. Henry again. Is it the position that individual institutions could reinterpret the terms of the public-only contract?

As was communicated by Ms Hoey, and I might ask her to come in on this, the policy stated clearly that it applied to all consultants in HSE-run and HSE-funded facilities.

To restate, the Sláintecare policy is really clear. The contract is also clear. There is no private practice on site in public healthcare facilities. It is one of the key differences in the public-only contract compared to the previous contract. The correspondence that Dr. Henry and I issued restates the provisions of the contract very clearly in that regard.

Has there been an examination by the HSE of other maternity facilities in terms of how the new public-only contract has been initiated and is operating?

We have made it very clear in a series of communications the requirement is that there is no payment or payment in kind for private work on public sites.

We have been told this morning that this type B contract and the new contract are being closely monitored, yet we cannot get figures. The Rotunda does not have figures. Does Ms Hoey have figures?

On a wider-----

Saying it is closely monitored is an oxymoron. If it is being closely monitored, there should be an audit and there should be figures.

It might be helpful for Deputy Daly to know that we have a verification or assurance exercise under way at the moment in relation to the cessation of private practice in public hospitals. Those who have transitioned from the old contract had to cease. Those who are new starters obviously would not have that within their provision anyway. That exercise is well-advanced at this stage. Based on the returns we have to date, no other non-compliance in maternity hospitals has been reported as yet. I would hope the verification exercise will be closed out this month.

I only have a few seconds. Again, it is in the statement from the Rotunda Hospital that it has been a very difficult time. I pay tribute to all levels of staff of the hospital for running a superb service. I know it has been a difficult time for the board but it has not been a difficult time for the rest of the staff. They have got on with their work and done it as they normally do, I would imagine.

I thank our guests. I will start with Dr. Henry. In his opening statement he said that all clinical sites are required to confirm compliance and that verification of the public-only contract is under way. How many sites have completed that confirmation of compliance?

We are seeking compliance on a number of fronts. One is that no private work is being done by POCC consultants.

My question is how many sites have come back and have completed that piece of work?

A total of 75% of returns are in regarding consultants. I do not have the actual number of sites.

When did that piece of work start? When was confirmation of compliance first sought?

We started seeking it around March or April of this year.

Was that on the back of what was going on in the Rotunda Hospital?

No. It is part of the wider assurance that the HSE-----

What happened in March specifically of this year that compliance started to be sought?

The provision came to an end. There was an incremental drop in private for those who transitioned from the pre-POCC to the POCC, which ended in December 2025, to 0%. Therefore, it was appropriate that the assurance against that would begin at the beginning of this year rather than last year, when there was still an allowance for some of those who transitioned-----

To taper off, effectively.

Yes, exactly.

Formal guidance was issued in December 2025. Further communication was issued in June 2026. The compliance work started halfway through that six-month period in March. If what was communicated in December 2025 was clear and unequivocal in what it was asking of public-only contract holders, why was there a need to issue further guidance in June 2026? Was it because of what was coming out of the compliance review?

It was clear that some people may have interpreted it that it was not just about seeing patients but also receiving payment in kind or payment from other people. Our interpretation is very clear that payment or payment in kind for review of private patients on public sites is not-----

It is not acceptable.

No.

Did that come out of the compliance review?

No, not to date.

When did Dr. Henry first become aware that there could potentially have been private payments being made on public-only contracts?

We became aware because of the story emerging about the Rotunda Hospital.

Was there never any indication before that date that these payments were being made?

We were asking questions on compliance with the contract, and when it became clear there was an interpretation that there were third-party payments, it was then that we needed to ensure there was no ambiguity-----

I want to be crystal clear on this. The HSE was never made aware or never became aware of third-party payments for any hospital or any site before the Rotunda.

Not to my knowledge, no.

Okay. I want to move on to Professor Daly. I welcome his clarifications around safety. I say that as somebody who has given birth three times in the public system in the Rotunda and who had to attend for non-pregnancy-related emergency care. I can speak from personal experience that in the public system in the hospital Professor Daly represents, the care I received was second to none. As I found it very alarming when safety was being mentioned in such a way that could have caused distress to women who were there, I welcome that clarification.

In response to the Chair's questions to Dr. O'Dwyer around how many consultants were providing private care, if she does not have the figures for 2026 to hand, does she have them for 2025? How many consultants did some element of private care in 2025?

Only one consultant was providing private antenatal care. In regard to the unscheduled emergency care at the weekend, there were eight.

Eight in total, across the 52 weeks of the year 2025.

Yes.

How does that compare to 2024?

It was similar. I have figures for the three years from 2023 to 2025. There were, in total, 49 deliveries, which represents 0.9%.

I thank Dr. O'Dwyer. I want to go back to the €1,500 payments. I was following the committee meeting before I had the opportunity to come down. My understanding of what the Rotunda has said is that these payments were made directly, consultant to consultant. Am I correct in that statement?

The Deputy is.

Regardless of the method of how they were paid, there was no involvement with the Rotunda. Would I then be correct - or do the witnesses want to clarify this statement - in saying that in no way, shape or form was the payroll system of the Rotunda involved in any of those third-party payments?

Correct.

I might take that because as general manager of the hospital, I can assure the committee that none of these payments went through the hospital. That is why, in the statements previously, the hospital was not aware of this.

When did the Rotunda first become aware that these payments were being made? I do not expect an exact date but was it 2026, 2025 or 2024?

When I joined the staff of the Rotunda from the Coombe hospital in 2021, I became aware of the emergency private practice cover arrangements. To be clear, there is emergency and there is routine.

Yes, we have established that.

With the routine system, for example, if Dr. O'Dwyer was away at a conference or something-----I covered her and she covered me.

I, as a private consultant, may provide emergency care. I accept that.

I covered her and she covered me. No money passed hands. For the emergencies specifically, there was an arrangement where if a patient of mine came in emergently, they were dealt with by the emergency on-call team, which did involve a consultant.

At that time, when Professor Daly became aware of those payments being made, did he see a problem with them?

No, because-----

No. That is fine.

I think it is important to clarify that people were on type-B contracts. They are allowed do private practice.

One hundred percent.

Absolutely, but they are allowed do private practice and in that, they are allowed have private practice cover arrangements that, as Mr. Hussey said, are totally independent of the hospital.

My final question is to Dr. Henry. When that consistency of implementation review is completed, does he intend to publish it?

Yes.

Will he make it available to the committee and break it down site by site?

Yes.

This is taxpayers' money. Taxpayers have a right to know if the contracts they are paying into are not being adhered to 100%.

I apologise. I have one last question for the Rotunda. Dr. Henry has been very clear; those €1,500 payments were in breach of contract. Will there be any consequences for the consultants who, according to the HSE, are in breach of their contracts?

First of all, it is not €1,500. It is an amount that is agreed between the consultants and-----

Okay. Let us say it is a variable amount. Will there be any consequences for being in breach of their contract?

For the public-only contract holders.

Yes.

No, because they were doing emergency call. If they were doing standard call, then the board had made a decision to allow that. The board changed that decision and it is not happening now. The emergency rota has been adjusted so that no public-only contract holders will ever be asked to cover a private delivery.

I thank Professor Daly. Does Dr. Henry agree with the assessment that there should be no consequences for those who are found to be in breach of their contracts?

For anyone who is in breach of a contract, as far as we are concerned, it goes through a process up to and including any disciplinary action. A contract is a contract.

Does Dr. Henry think that should happen in the circumstances of the third-party payments?

We have made it very clear now that there is to be no breach of the POCC, either through direct review and payment by private payments or a third party. That is our position and we are going through a verification on that now. We expect to see full compliance. That is my answer.

I thank Dr. Henry.

Thank you, Deputy. At this point, I suggest we take a quick break and resume in five minutes. Is that agreed? Agreed. We will resume at 10.50 a.m.

My apologies for not being here this morning for the presentation. I was in the Dáil dealing with an issue regarding paediatric care in Cork with the Minister for Health. I will open by saying it is important that we convey a clear message this morning that in fairness to everyone who works in the maternity services in all 19 units across the country, they go out to provide the best possible care to every patient who attends. It is important that we get this message across, whether it is a public patient or private patient. I do not believe there should be a level of negativity about the level of care being provided by consultants, nursing staff or junior doctors. The whole focus by every person working in the maternity services is to provide the best possible level of care and it is important that we get this message across.

I fully accept that where someone has a public only contract they are not entitled to do any private work of any description in the hospital setting. With regard to flexibility and people working in maternity services, over the years there has always been flexibility about staff supporting one another. What I am concerned about with regard to all of this examination of public contracts is that we are sticking strictly to the rules of the contract. I will give the example of a case of something I know happened in a hospital, and it was not in the Rotunda Hospital or CUMH. A consultant was dealing with a patient while a registrar took another patient to theatre for a caesarean section. The registrar ran into serious problems in dealing with the caesarean section and called for the assistance of the consultant, who was already tied up with another patient. However, there was another consultant on site who argued that he was not going to provide care because his time in the hospital finished at 5 p.m. This happened at about 5.15 p.m. Everyone here accepts there has to be flexibility. Could we now run into problems with the public-only contract whereby people stop this flexibility? I am a bit concerned about the way this occurred.

I will take this and I would welcome contributions from Dr. O'Dwyer. As doctors we have an ethical commitment to provide care to people; it does not matter what the contract is or where the situation is, we have an ethical requirement to provide care. While I do not know any of the details around the example Deputy Burke has given I would have serious concerns about it. In terms of the Rotunda Hospital, we have standard care and emergency care. Emergency care cannot be denied under any circumstance; whether someone is an old contract holder or a new contract holder they have to give emergency care or else, to be honest, they should be struck off.

Does Professor Daly accept what I am saying that it could happen if we start interpreting contracts word for word?