Sir, – In Martin Wall’s recent article he explained that politicians on the PAC expressed concern about potential funding issues arising from insurance companies withholding money due as a result of private patients being treated in public hospitals. (“Hospitals write off millions as health insurers decline to pay invoices,” June 22nd.)One of the unintended consequences of Slaintecare, I suspect, is that the hundreds of millions of euro that the voluntary hospitals raised from those private activities will now be lost and will need to be funded by the exchequer.Voluntary hospitals receive 70-80 per cent of their funding from the State and they are expected to raise the remainder themselves.In the case of maternity hospitals there is no opportunity for private patients to receive their care anywhere else, so in addition to women losing choice, the hospitals will take a double hit in that they lose the income but retain the activity and therefore the cost.The other issue which I think is poorly understood is that this income, previously available to our leading hospitals, was used to respond to urgent issues quickly, eg the covid pandemic, the cyber attack. It is also used to develop and improve services for all patients without having to go cap in hand to the HSE, to set national standards and act as benchmarks for HSE hospitals. To fund research and to allow these hospitals to lead and be at the forefront of clinical care so that they attracted the best and brightest healthcare professionals.Almost all the national centres of excellence are situated in voluntary hospitals. This did not happen by accident.There are many excellent initiatives within the Slaintecare plans and one cannot argue that equality of care and access to quality care should not depend on ability to pay.However, the loss of voluntary hospitals’ independence by the slow and steady cutting of funding will ultimately result in poorer quality of care to all patients, an inability to attract world-class professionals from abroad, and will reduce our ability to respond to patients’ needs and improve our services for all.Is this really what we want? – Yours, etc,SAM COULTER-SMITH,Former master of the Rotunda,Former chair of the Institute of Obstetricians and Gynaecologists at RCPI,Former governor of the Rotunda Hospital,Blackrock,Dublin.