Hospital executive top-up payments: what we have and haven’t been told

This time last week, “top-ups” referred to payments made by mobile users requiring phone credit. But in recent days the definition has broadened to include additional privately funded payments paid to the top brass of voluntary hospitals and other health bodies.

These organisations, defined as section 38 agencies, are the subject of a Department of Health report that contains the raw data from a HSE internal audit
of the earnings of senior management.

The audit findings first came into the public domain in late September; however, a major controversy over the issue of executive remuneration in the health service was sparked on Monday when The Irish Times revealed that an annual €30,000 top-up allowance paid by Our Lady's Children's Hospital to its chief executive was funded from the profits of shops on the hospital campus.

The days that followed brought more revelations about 13 organisations that were found to have been paying additional privately funded salaries/allowances
to senior managers.

Last night, a statement from the Department of Health said that of the 44 health service organisations questioned on whether they complied with public sector pay policy, 36 have provided the HSE with a reply. In 24 cases, the organisation "has returned a status of non-
compliance" and 12 have categorised themselves as compliant. Eight have yet to indicate their status.

The Department of Health and the HSE issued a new policy circular in late September stating that "non-
exchequer sources of funding may not be used to supplement approved rates of remuneration". One of the questions thrown up by the revelations of the past week is who knew about these top-up payments that the Government has now determined to be unacceptable.

Something else that remains unclear is how
such private payments are being funded. This has led
to concerns of salaries and allowances being supplemented by charitable donations, although a number of organisations, including the National Maternity Hospital, have stated categorically that this is not the case.

So what now? Taoiseach Enda Kenny has insisted that "unauthorised and unapproved top-up payments from non-exchequer sources . . . must and will stop",
a position Minister for Health James Reilly mirrors.

Two Oireachtas committees have now announced investigations into the revelations.

One of them, the Dáil Public Accounts Committee, is to call officials from the Department of Health and the HSE to appear before it and will write to all Government departments to inquire if similar payments are in place in other public bodies.

Whatever the outcome, expect "top-up" payments
to be in the headlines for a long time to come.