Checking up on hospital payouts

The disparities between what hospital staff are actually paid and payment ceilings are causing controversy and confusion

OVER THE past few weeks it has emerged that not all is as it seems when it comes to earnings at the top level of the health service.

In mid-March St Vincent’s Healthcare Group confirmed for the first time that some senior mangers working in the publicly funded St Vincent’s University Hospital were not confined to the official salary ceiling of €145,000. In effect, they had additional private practice arrangements which allowed them to receive top-up payments from elsewhere in the group.

In addition, last week the former head of human resources in the HSE, Séan McGrath, blew the whistle on the scale of total earnings being received by consultants working in public hospitals.

Officially, the Government had previously acknowledged that “some” academic consultants were receiving more than the official €200,000 pay ceiling. Mr McGrath revealed that when allowances and other payments were taken into account, there were up to 500 senior doctors earning more than €200,000. He said one consultant had received €400,000. Obviously if this is correct, those with high earnings would extend beyond the 80 or so academic consultants around the State.

Separately there has also been recent controversy over the true extent of executive pay at the top of some voluntary organisations, funded in part by the Exchequer.

The Government has committed to the concept of greater transparency and, to be fair, there is now more openness about how public money is spent.

However, the case regarding St Vincent’s showed that the official information was, at best, incomplete and the true position emerged only as a result of a particular set of circumstances.

Last June a Fine Gael backbench TD Derek Keating submitted parliamentary questions to the Minister seeking details of salary payments and bonus arrangements for the chief executives of hospitals around the State.

Such questions are routinely answered within weeks but this one bounced around between the HSE and the Department of Health until the following September. Eventually a table was provided which stated that the chief executives of most of the larger hospitals, both voluntary and HSE-run institutions, were on a salary level of €145,959.

However, late last year the Minister for Health James Reilly asked Bill Maher, the acting chief executive of St Vincent’s University Hospital, to take over the running of the Galway group of public hospitals on a secondment.

The Department of Health sought, and received, approval from the Department of Public Expenditure to pay Mr Maher a salary of up to €195,000 for the post. It said that, “as would be expected, his secondment from St Vincent’s University Hospital had to be on a basis of no reduction in earnings”.

However, the pay level the Department of Health proposed to pay was €50,000 more than the official rate for the job of chief executive of St Vincent’s (and St Michael’s in Dún Laoghaire) which it had set out itself in the reply to the parliamentary question only a couple of months before.

Eventually St Vincent’s Healthcare Group (which runs the publicly funded St Vincent’s University Hospital and St Michael’s as well as St Vincent’s Private Hospital) confirmed for the first time that three of its senior executives were being paid for private work on top of their public commitments.

It said that “three senior managers in St Vincent’s Healthcare Group have private contractual arrangements with the group for additional work carried out over and above their public sector obligations”.

“Compensation for this additional work does not involve any public funds.”

A spokesman for St Vincent’s Healthcare Group said details of these private contractual arrangements were “private”.

The Department of Health said it was not aware of similar arrangements being in place for what is effectively private practice for senior managers in publicly funded hospitals.

It said the issue would be looked at as part of the move towards new networks of public hospitals which are to be introduced under the Minister’s reform plans.

It did not say whether it had been aware of the arrangements when it answered the parliamentary question and whether it, or the HSE, had specifically asked hospitals about this issue when it was preparing its answer. Nor did the Department of Health say whether it was aware of the total earnings involved with the managers concerned, who are officially considered to be public service personnel.

Details of the existence of additional payments for private work for public hospital managers came when there was already controversy over the salaries for senior figures in some voluntary agencies.

Dr Reilly told the Dáil last month that a recent review by the HSE had found “some anomalies in the salary scales being paid” in a number of voluntary agencies.

“The HSE review found such anomalies across a number of grades of staff and it also included a small number of chief executives. These issues are being followed up by the HSE. My Department has also asked the HSE to review other payments, including allowances.”

The disclosures by Mr McGrath last week also show that the full picture regarding earnings among consultants had not been revealed previously.

Official HSE figures, which were obtained subsequently by The Irish Times, maintain that an average consultant salary is €180,000. However, other allowances can apply. For example, there are 55 consultants in clinical director roles which attract a further €46,000.

In addition, consultants share nearly €16 million in “on-call” and “call-out” allowances as well as €7.5 million in continuing medical education payments.

The Minister has signalled that he would prefer to concentrate on making savings to the health budget by securing greater flexibility on the part of consultants rather than going down the road of further pay cuts, as proposed in the programme for government.

The Department of Health acknowledged last week that not everyone, including some of Dr Reilly’s cabinet colleagues, had agreed with this stance.

However, in light of the disclosures by Mr McGrath, the Minister is likely to come under pressure to specify the precise level of overall earnings among public hospital consultants.

Critics are likely to argue that the full picture in regard to existing earnings is needed before an assessment can be made as to whether Dr Reilly’s preferred option of work practice changes and greater flexibility is a more cost-effective measure than further pay cuts.