As of 1 January, most consultants working under public-only contracts will no longer be permitted to treat private patients within public hospitals.
This change will apply across all medical specialities, but it is expected to have a significant effect on access to private maternity care in the long term, as there are no standalone private maternity hospitals, reports RTE.
“We find that one in four women choose to access private care and not public care,” said Master of the Coombe Maternity Hospital in Dublin, Professor Michael O’Connell, reports RTE.
“Going down the line, that choice will be taken away,” Professor O’Connell added, though he assured patients that little would change on 1 January, reports RTE.
This situation arises because there are currently two different types of consultant contracts in place.
Contracts issued prior to March 2023 allow consultants to continue practising privately in public hospitals, reports RTE.
By contrast, the ‘public only consultant contract’ (POCC) was introduced in March 2023.
Consultants who moved from the older contract to the public-only contract in 2023 were given until 31 December this year to stop treating private patients in public hospitals, reports RTE.
For consultants who signed public-only contracts after 1 January last year, the transition period was reduced to six months.
As a result, from 1 January 2026, the vast majority of consultants working under public-only contracts will no longer be allowed to provide private care in public hospitals, reports RTE.
This raises questions about the impact on obstetrics, where private maternity care by consultants is only available in public maternity hospitals.
“There won’t be any great change initially,” Professor O’Connell said, reports RTE.
This is because consultant obstetricians who have mainly provided private maternity care at the Coombe Maternity Hospital remain on pre-2023 contracts that still permit private practice in public hospitals.
“It’s just down the line, over time, as those on the older contracts retire, they’ll be replaced with the ‘public only’ contract,” Professor O’Connell said, reports RTE.
He said that as this transition continues, women will eventually lose the option to choose private in-patient care within public hospitals.
Maternity care specialist and advocate Krysia Lynch said that while pregnant women value having choices and may be concerned about losing this option, there is also a need to improve access to and awareness of alternative maternity services, reports RTE.
“This was a choice, it was a very popular choice among people who have private health insurance and one of the reasons people made this choice was that they wanted to get continuity of care, they wanted to see the same person all the way through their care,” Ms Lynch said, reports RTE.
She added: “However you could also argue that it wasn’t really a choice because it was only available to people who could afford it and pay for it,” reports RTE.
“Ireland has very few maternity choices, we don’t for example have birthing centres, we have very few birthing pools, we don’t have early transfer home in the postnatal period, where people are taken care of in their own homes, as standard,” reports RTE.
Ms Lynch also said that women often lack information about some public health services, including VBAC (vaginal birth after caesarean section) clinics and DOMINO schemes delivered by community midwives.
“We have been led as a society to believe that this is our only choice and actually it isn’t and it shouldn’t be,” Ms Lynch added, reports RTE.
According to the Department of Health, two-thirds (67%) of all consultants are now working under public-only contracts, although no specific figures are available for consultant obstetricians.
A spokesperson said the public-only consultant contract was “a key step in delivering universal healthcare, ensuring public hospitals are used for public patients and care is based on medical need, not ability to pay”, reports RTE.
State-owned insurer VHI confirmed that from 1 January 2026 it “will not process claims for private activity in a public hospital where the consultant has completed their transition period” under the public-only consultant contract.
A spokesperson also said that “Vhi’s understanding, based on recent correspondence and guidance from the Department of Health to all insurance companies, is that there will be no extensions/exceptions to the transition period for POCC (public only contracted) consultants to cease their treatment of private patients in public hospitals regardless of their speciality or location”, reports RTE.
A spokesperson for Laya Healthcare likewise confirmed it had been “informed by the Department of Health that the 31st December 2025 deadline for the end of private practice by public-only consultants in public hospitals will be enforced”.
“We understand that there will be no extension to this deadline, and we are planning on that basis,” the spokesperson added, reports RTE.
Both insurers also confirmed they will continue to cover claims for members receiving private treatment in public hospitals where the consultant holds a pre-2023 contract that allows private practice.
Professor O’Connell said these developments could also have consequences for hospital finances, reports RTE.
“Eight percent to 10% of our budget comes from private bed income… that will have implications down the line,” he said, reports RTE.
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