Hospital Services

94. Deputy Barry Ward asked the Minister for Health if she has considered the impact that a withdrawal of private maternity care services will have on women's choice in maternity care; and if she can offer reassurances to women that have genuine concerns about this proposal and particularly those that have experienced or are likely to experience difficult or high risk pregnancies. [71452/26]

The principle of not along private healthcare to piggyback on or profit from public healthcare infrastructure provided by the taxpayer is a totally sound and important principle. I admire the work the Minister for Health has done in furthering that principle but in relation to maternity care where there is no private option available to women now, what assurances can we give to women who want to choose private maternity care but cannot in the absence of such being available?

I thank the Deputy for his question and for acknowledging that there is no area of care where there is more public subvention into private care than maternity care, realistically. I can go through the costs in great detail but that is the reality of it. However, I do recognise this is a change and change causes concern. Change in respect of maternity care causes particular concern because there is nothing that motivates people more strongly than the care of their own children. I recognise the change does cause concern for some private patients but the reform supports equitable access for everybody based on their need. All women deserve the best clinical care based on the need with which they present. All women with complex pregnancies will continue to receive the appropriate consultant-led care. Maternity care in Ireland is provided in line with the national maternity strategy. That model provides three pathways, depending on three different clinical needs. There is the supported care pathway which is for women with normal-risk pregnancies. It is midwife led, with care provided by a multidisciplinary team. The assisted care pathway provides obstetric-led care for women with medium-risk pregnancies. There is a specialised care pathway which supports women assessed as having high-risk pregnancies. Care for women with high risk pregnancies is led by a named consultant within the multidisciplinary team. It is a single consultant within the multidisciplinary team. The really important thing there is that it is a team because as women who have already been using private maternity care recognise, that individual is not always available for the birth. Particularly where there is complex care, it is really important that it is managed by a team so that everybody understands what the different issues are and can step in as necessary, already fully briefed. Women are supported through each pathway according to their need. Patient safety is the overriding priority. Indeed, the whole emphasis behind the national maternity strategy is improving patient safety and the experience of women. Multidisciplinary team-based care and one-to-one support throughout labour are prioritised. Our objective is safe, high-quality maternity care for every woman in Ireland.

I acknowledge what the Minister said and the importance of the need-based approach. Anybody would acknowledge that women who are having children must get the care they need and that is appropriate for them. However, there is a value to being able to choose private maternity care. Some of the benefits that come with that, for example, are: having the same consultant throughout the process, through the antenatal process and into postnatal care; being on a first-name basis with that person; and knowing them personally and that they know your case. Of course, there can be a team that knows your case as well but some women want to choose to have the person they have had all of the way through. There are also things like waiting times for scans and other antenatal treatments. The difficulty for women who are working or who are self-employed is that they cannot spend many hours or even a whole day waiting for services and I believe that happens. I have been told that people in the public system sometimes have to wait for a long time even though they have an appointment time. Choosing private care allows them to get around that. There is a choice issue here that is not a judgment on the public system but it is the opportunity for some women to choose that private option. They cannot if we remove it from them.

The Deputy ran on an election manifesto that supports Sláintecare and this is a key part of that which predates the Deputy's entry into the Dáil. I know he is very much an advocate for Sláintecare and for an equitable system within which all women can access the same quality care, as I know he is an advocate for not enabling private work to, as he said, piggyback on the public system. The reality is there is no barrier to private maternity care except that it is not profitable. There is no way in which the private system can fund it because the scale of the State subvention, most particularly through the clinical indemnity scheme with which the Deputy will be familiar with as a barrister, is such that it is not possible to provide it privately. Indeed, as the Deputy will be aware, maternity care was provided privately in Mount Carmel, but it cannot afford to do so. This is also the case in respect of transplants and neurological surgery. It cannot happen privately, profitably. It can happen as there is no barrier to it but it cannot be the case that the public system continues to subvent private consultants operating in public hospitals with the benefit of all of the public infrastructure, critical care, neonatal intensive care, all of the nursing midwifery staff and the underpinning of the clinical indemnity scheme, and to do so at the exclusion of all of the other women. What is better is a safe system for every woman.

I do not disagree with the Minister. I see that. However, as the Minister pointed out, maternity is different in that regard because the private option is not available. If somebody wants to get their hip done, there are multiple private and public options available to do that. Is there not room for a derogation in relation to maternity? I met with the Our Maternity Choice campaign. They have a petition signed by nearly 8,000 women, many of whom chose the public option but because they are at high risk or had complications or trauma, want to choose the private option. Everything the Minister said is correct and it is not a statement of confidence in the service, because the low mortality rates in this country are testament to the quality of midwives and of maternity care. There are additional services that are available through private care that women should be allowed to choose and there are women who want to make that choice. In circumstances where the principle is sound but its application removes the choice from people, should we not be making a pathway for them to actually make the choice they want to make? They should be allowed to make that choice for the various reasons I have outlined, as well as for their simple comfort and confidence.

How would the Deputy fund that? What would the additional cost of that be to every taxpayer and patient in Ireland? How is that equitably distributed? I was in the Women's Health Hub in Tralee, a new place dedicated to women's health, speaking to women who have received continuity of care through midwife-led care and who have escalated and de-escalated through the clinical pathways based on changing need. For example, a woman who was committed to having a home birth had the same midwife and continuity all the way through and when her needs escalated she moved into a consultant-led pathway with her midwife right beside her. She had that continuity of experience. I respect that the Deputy and I represent a constituency where more people opt for private care than any other, so I totally acknowledge his entitlement to reflect that on behalf of his constituents. For all of the women in Ireland, it is important we have a safe and equitable system and for all of the patients of Ireland we have to make sure there is a public system that is funded by the taxpayer and delivers for all of them. Again I will ask: how much is the amount of money the Deputy thinks is appropriate to invest in private consultant obstetricians at the exclusion of delivering broad, safer care for all of the women of Ireland?

I would like to respond to the question that was asked. It is important to note the service was already being provided and I understand the Minister has a job to do in balancing finances in her Department more than most but there is an issue of choice here that it is not being made available to women. Rather than putting it back on me to come up with the figures for how it is provided, we need to provide the choice to women and the Minister knows this. I am sure she is getting the same emails I do.