Private and public patients Sir, – The action by the Rotunda, a voluntary maternity hospital, to “authorise” doctors on public-only contracts to continue private practice, in direct contravention of moving towards a single-tier public health policy based on equality of access rather than ability to pay, has proven a step too far.The National Maternity Experience Survey 2025 recorded that participants rated most highly care where they got to know their provider, including women giving birth in a midwife-led unit, women giving birth at home or women attending a private obstetrician. The issue is not private versus public care, but the urgent need to resource and expand midwifery-led continuity-of-care models with consistent care from one midwife or a small team of midwives for healthy women, or a multidisciplinary team approach for women known to be at high risk.Relationship continuity in maternity care significantly improves clinical safety, lowers medical intervention rates, and increases maternal satisfaction.This is in stark contrast to the fragmented industrial model currently prevalent in our maternity services, where the woman sees multiple care providers, leading to duplication of care, omissions of care, and decisions being made about the woman without her involvement.The decision by the Rotunda Hospital to circumvent the contractual conditions of consultant public-only contracts, despite being 90 per cent State-funded, was not woman-centred, nor did it promote meaningful choice for all women, but only those with ability to pay. This decision, now overturned, exemplifies the governance issues inherent in voluntary hospitals, who think they have “special exemptions” when it comes to Government healthcare policies. – Yours, etc,DR MARGARET DUNLEA, Assistant professor in midwifery, Trinity College Dublin.DR LIZ FARSACI, PPI manager, Trinity College Dublin.Sir, – While I would not condone any consultants breaking the terms of their contract, I would urge a note of caution for any “reflex armchair socialist”. As a consultant urologist with both clinical and medicolegal experience of obstetric complications, I am all too familiar with what on occasion can be catastrophic outcomes for mothers (and babies) of suboptimally managed deliveries. Many factors may be involved, including inexperience, excessive workload and poor supervision in small units where small numbers of consultants cannot reasonably be expected to provide round-the-clock, personally delivered care. Trainee experience can only be acquired via properly supervised education and training. Lack of same can lead to poor decision-making and poor anticipation of potential complications. In addition, some young trainees may for a variety of reasons be slow to call for help in a timely manner. In the UK, there is now a national inquiry under way into poor obstetric outcomes throughout the country, so it seems logical that we may well have similar issues at home. Furthermore, all concerned are aware that care standards throughout the country could be “uneven”. Until guaranteed high-quality 24-hour consultant-delivered care is uniformly available throughout all of our obstetric units, I would urge caution for what many are now apparently wishing for. – Yours, etc,GERRY LENNON, Cabinteely,Co Dublin.