HSE says 1.6m in top ups should end

The HSE has rejected 'business cases' made for the retention of nearly 150 allowances and extra payments made to senior staff in voluntary hospitals and other Section 38 agencies it funds.

Among the allowances the HSE says should cease are €33,250 to Tallaght Hospital's Deputy CEO, €51,617 paid to St James's Hospital's Director of Postgraduate Medical Education, €28,035 to the chair of the Mater Hospital's medical executive, €39,000 to Holles Street Hospital's Secretary/Manager and €37,500 to its Director of Midwifery.

Other large allowances also set to go include the National Haemophilia Director at St James's allowance of €43,468. and an allowance of €30,080 paid to the Director of the Education and Research centre at St Vincent's Hospital.

The decision to discontinue more than €1.6 million in allowances paid to senior management and medical staff is made in a review the HSE has carried out of the business cases presented to it. Many of the allowances which face the axe are paid to hospital consultants.

In looking through the long list of previoususly unauthorised allowances which the HSE has deemed should now cease, questions inevitably emerge about how these allowances came to be paid in the first place and what was the rationale behind them.

There are a number of 'on-call' payments for example, listed for administrative/managerial posts. Most outside observers would have presumed that only clinical posts would attract on-call allowances.

Also, there will be inevitable questions as to why voluntary hospitals and agencies were for many years so generous with the amount of public money given to some of their staff while patient services were regularly cut. And about the apparent absence of any official sanction from the HSE for this profligacy.

And while the total amount paid out in top ups is relatively miniscule in terms of the total health budget, their payment does raise questions about the governance and management arrangements in these institutions over the years.

Given that hospitals are currently being reorganised into groups and eventually into independent trusts, the top-ups controversy also underlines the need for robust oversight of the operation of these trusts.

The report on 'business cases' followed a HSE audit published last year which showed that €3.2 million in unauthorised 'top-ups' were being paid by hospitals and other voluntary agencies on top of official salaries.

The HSE invited these bodies to present business cases for the continuation of the 'top-ups'.

The health executive says some of the allowances must cease by July, while others are to be suspended pending a review. Some of the allowances were paid from external, non-HSE sources.

The HSE rejected the vast majority of the business cases put forward for the retention of allowances.

Its report also discovered some extra payments which were not discovered in the previous audit.

The HSE plans to cut the funding of hospitals who fail to stop paying the allowances targeted in the report.

Such threats, while understandable in some respects, are also a bit puzzling. Why should patients suffer for the sins of others?

The HSE may face legal challenges to the ceasing of some of the allowances, either at hospital or individual staff level or both.

Hospitals may argue that it will be difficult to attract staff to and retain staff in management posts in the absence of allowances in respect of extra duties. To some extent this argument makes sense, but from the (perhaps still unemployed) 'man in the street' viewing the state of the health service at present, it would get short shrift.

Agencies would also argue that the allowances, which were in many cases for specific roles, have been axed in a very peremptory manner, without any detailed explanations as to why they were no longer tenable in individual cases, and that the continuance of extra pay for extra duties is important for running and improving hospital services.

The HSE, however, would argue that as the top-ups were not officially authorised in the first place and were in breach of public pay policy, the argument for continuing them was always going to be something of an uphill struggle.

And, the HSE may also argue that despite the recently improved economic climate, health service funding is still at a premium.

The HSE could therefore not be seen to be sanctioning extra pay for many already relatively well-paid senior staff while the health service is still in financial crisis mode.

The health executive has told hospitals that they themselves, as the direct employers of the staff concerned, must take ownership of the implementation of the decisions to cease allowances.

The HSE has also stipulated that in making new appointments to posts, it should be a condition in future of any job offer that the employee does not receive any any unapproved allowance.

In a recent interview with irishhealth.com, HSE Director General Tony O'Brien admitted that the HSE may not have acted as quickly it could have to deal with the lack of pay compliance in Section 38 and 39 agencies.

He said the payment over many years of unauthorised top-ups in many hospitals and agencies "was a manifestation of what is now a bygone era, a nod and a wink culture and a sense of lack of accountability."

"It's been necessary to bring this to a conclusion fairly rapidly. We can't afford to have this a distraction from the business of improving healthcare."

Given the likely legal resistance from some hospitals and agencies to the axing of top-ups, the process may be slightly less rapid than Mr O'Brien had hoped for.



[Posted: Mon 14/04/2014]


Copyright © 2021. All rights reserved. We subscribe to the principles of the Health On the Net Foundation