There were no chandeliers in the public ward where I spent my first days as a mother, at the oldest continuously operating maternity hospital in the world. The room echoed with cries, the well-worn floor bouncing under footsteps, the windows looking out on Dublin’s city centre.

Now the Rotunda hospital, where I’m due to give birth again soon, is counting down to its 1 millionth baby. It is also at the centre of a bitter debate over plans to reform Ireland’s two-tier state healthcare system, so that those who pay to “go private” in public hospitals no longer gain an unfair advantage over those who don’t.

A chandelier is the background for the Rotunda Private’s soft-lit webpage, which lists fees of up to €4,500 to be treated privately in this public hospital. Maternal healthcare in Ireland is provided free by the state, and there are no stand-alone private maternity hospitals in the country. But in the public hospital system, patients who can afford it can pay to access continuity of care with a private consultant, private scans and the right to request a private room after birth.

Ireland is an outlier in Europe by not providing free universal primary healthcare. But at least in public hospitals, its two-tier arrangements could finally be ending. A radical overhaul of the state healthcare system seeks to ensure equal access for every citizen. The “Sláintecare” plan was launched nearly 10 years ago with cross-party support and aims to deliver equal access to health services based on individual patient need, not on ability to pay. But it has still not been fully implemented.

Under the reform, hospital consultants on new public-only contracts are barred from carrying out private work in public hospitals. More than 60% of consultants have signed up to the new contracts in exchange for pay that can exceed €300,000 (with on-call duties and overtime). With no private maternity hospitals, giving birth is finally set to be made entirely public.

But a backlash has exposed both a worryingly low obstetrician-to-patient ratio, and the resistance of these highly paid senior........

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