The Minister for Health has suggested there could be an issue with the Rotunda Hospital continuing to be covered by State-funded clinical indemnity insurance if it continues to allow public-only consultants to offer private care.Jennifer Carroll MacNeill said there was an “open question” about insurance issues that the oldest and busiest maternity hospital in the State might face if it continues to flout Government policy. In a sharp rebuke against Prof Sean Daly, master of the Rotunda, the Minister declined to express confidence in the consultant obstetrician and questioned if the maternity hospital might owe refunds to women who received private care from public-only consultants. The Rotunda has until Monday to provide the HSE with an audit detailing how many consultants have been continuing to offer private care while on public-only contracts, and how much of this care the Rotunda has billed for. Failure to do so could trigger a process under the Rotunda’s service-level agreement with the HSE that could result in funding being withheld or withdrawn.The Rotunda, like all maternity hospitals, is covered by Clinical Indemnity Insurance which is offered by the State Claims Agency. This covers consultants on public-private contracts who offer private and semi-private maternity care at the hospital.[ Rotunda at loggerheads with Minister over public-only consultants having private patientsOpens in new window ]A spokesman for the State Claims Agency said this insurance applies to the entire hospital rather than individual consultants, so “the indemnity applies in respect of all consultant doctors, irrespective of the contract he or she holds”.Asked if there was a “problem” offering insurance to consultants on public-only contracts continuing to offer private care at the Rotunda, Carroll MacNeill said: “It’s an open question, and it is something that my officials had a conversation with the State Claims Agency about quite recently. I mean, it’s not for the consultants, but for the board of the Rotunda, who is the entity liable now.”Prof Sean Daly, master of the Rotunda Hospital. Photograph: Nick Bradshaw Speaking on RTÉ Radio 1’s Today with David McCullagh show, Carroll MacNeill said she believed women who have paid for private care from Rotunda from consultants who were on public-only contracts should be refunded. She said the HSE had sought details from the hospital on the number of women “who paid private consultants to receive a private service in the Rotunda, that the Rotunda was not contractually capable of giving. I think it’s important that those women are recompensed, and we have asked for those details.” [ Fintan O'Toole: Rotunda’s defiance of public policy shows us how some are born more equalOpens in new window ]She said she now expected compliance from consultants who were “paid richly” on public-only contracts. “This is a contract that intelligent people with the benefit of legal advice and much negotiation agreed to, and then individually signed, and I do expect it at a most basic level. I really do expect them to comply with the terms.”The Minister said she felt it was “egregious” that “instead of putting the resources into making sure that all women are getting the same care, led and with a consultant on site in the way that they’re capable of being rostered,” the Rotunda was proceeding with a plan to only have certain consultants on call for private women. She also criticised the Rotunda’s claim, including from Daly, that private care helps improve safety standards at the maternity hospital for all women. “I have to say that that argument is being advanced from people who would profit from a continuation of a private model,” Carroll MacNeill said. She said that any action against the Rotunda, including consideration of its state funding, would not “interrupt” the care of pregnant women who are currently attending the hospital. Asked if she had confidence in Daly, Carroll MacNeill said: “He has been a very capable obstetrician, both in the Coombe and in the Rotunda, and he cares about the Rotunda very deeply, and I expect that he will make sure that the Rotunda is operating in compliance with Government policy, and the contract that he personally has signed with the HSE.“I expect him to do that, and obviously they have until Monday to send back all of the information, so there’s every opportunity to make sure that that is so, and I’m sure that he is crossing his t’s and dotting his i’s to make sure that that is so. I have every expectation of that.”The master of the National Maternity Hospital at Holles Street backed the Rotunda, by calling on the Government to consider allowing new consultant obstetricians to remain on public-private contracts. Prof Jennifer Walsh said her hospital is receiving “formal complaints” from women who cannot book private care with a consultant who has retired, and possibly been replaced by a colleague on a public-only contract. She said she was not in favour of consultants on “well compensated” Sláintecare contracts being allowed to continue offering private care - which is the policy the Rotunda is currently pursuing. “And I don’t think I would even be suggesting that we move people on to that contract and then allow them to continue private care,” Walsh said. “But perhaps you leave people on the older contracts. Perhaps if a ‘B-contract’ holder retires, they’re replaced with ... a B contract holder.”A type-B contract is one that allows a consultant obstetrician to carry out public and private care within a public hospital“I’m not a policy maker; I’m a clinician,” Walsh said. “This isn’t a clinical problem; it is a policy issue. But I do think we need to hear what the women are saying.”She said women not being able to access private care in maternity hospitals was an “unintended consequence” of Sláintecare.