An emergency department consultant was paid €757,000 by the HSE last year, including over €500,000 in historical compensation for working on rest days in previous years, according to a Health Service Executive audit report.
The sum, the highest ever paid by the HSE in one year to a member of staff, included €199,282 in basic pay, €36,309 in on-call payments and €522,185 in compensatory rest day payments. The consultant works a one night in two rota and can claim for up to six hours per call, according to the time of the week, at an hourly rate of €100.
A second consultant, a surgeon, was paid €680,375, including basic pay of €180,000, €13,000 in lieu of rest days, €40,000 for onsite work during on-call weekends and two payments of €146,000 under local agreement, for providing additional clinical diagnosis.
Six hospital consultants received compensatory rest day payments of over €100,000, according to the audit report. Although the payments were in compliance with their contracts, HSE auditors say a 2014 agreement compensating consultants on older contracts for rest days has resulted in “some exceptionally large payments”.
READ MORE
Last year, 68 consultants earned over €300,000, with 17 of them sharing €1.86 million in compensatory rest day payments. The only other person in the health service earning over €300,000 was then HSE chief executive Paul Reid.
This compares to 238 staff earning over €300,000 in 2020, 135 in 2019 and 15 in 2018.
The report lists a number of non-compliant payments made to some consultants. This included two cases where €161,000 was paid, with an agreement for payment of a further €100,000, for accumulated untaken annual leave and compensatory rest days, contrary to the conditions of employment of the staff.
In seven cases, a €30,000 cap on call-out payments was breached, resulting in a total cost above the cap of about €224,000.
The report also notes that €712,000 in National Treatment Purchase Fund payments was paid to nine consultants, in amounts ranging from €12,000 to €142,000. While the payments were judged compliant, the report notes: “Additional Government funding exists for these schemes to address treatment waiting times for public patients. These payments related to work additional to normal contract commitments by consultants in HSE hospitals”.
Auditors were unable to determine whether over €4 million paid to consultants under “numerous” local agreements in different parts of the health service were properly approved.
The reasons givens for the payments included reading x-rays, additional clinics or hours, the 2021 cyberattack or overtime paid at a double rate.
HSE management have accepted the auditors’ findings and begun an action plan to address them, including an end to non-compliant payments.
The number of high earners soared after a medical consultants successfully sued the State over an alleged breach of the 2008 consultant contract. Under the settlement, consultants were given a pay increase as well as retrospective payments.
The deal has cost the State €101 million, of which €100 million had been paid out by the end of 2020.
The list of consultants earning over €300,000 includes 24 radiologists, 10 psychiatrists and eight surgeons.
A separate HSE audit report into the pay of Mr Reid and 10 other members of his executive management team found all travel claims and credit care payments were appropriately approved.
Mr Reid and chief clinical officer Dr Colm Henry were both paid a €50,000 allowance in accordance with their contracts. Mr Reid had the use of a fully-expensed 191D BMW for which he paid maximum benefit-in-kind, the report stated.
