Almost 100 hospital consultants earned more than €300,000 last year, with one, working in emergency medicine, being paid €974,000, according to a Health Service Executive report.
The number of high-earning consultants — paid in excess of €300,000 — grew by 41 per cent last year compared to 2021, HSE internal auditors found, despite ongoing efforts to curb spending on high earners.
The 96 high-earning consultants last year earned a cumulative €36 million, giving an average pay of about €372,000. Almost half earned more than €300,000 in 2021 and 2022.
Excessive extra payments may compromise patient safety where consultants are stretched, the report warns, and asking consultants to perform additional tasks may infringe the European Working Time Directive.
The €974,000 paid to the highest earner last year compared to €758,000 the highest earner received in 2021, an increase of 28 per cent.
Under the terms of their contract, consultants can earn allowances and other payments on top of their basic salary, including on-call and overtime payments, and a clinical director’s allowance.
One consultant was paid €522,185 in compensatory rest day payments last year, while two staff received a total of €161,000 for annual leave and rest days not taken, which were deemed non-compliant.
Although on-call payments are capped at €30,000, seven such payments breached this cap, and were deemed non-compliant with the terms of employment.
Responding to the report, HSE management said a shortage of consultant staff in certain specialties and regional areas is a primary driver behind high earnings. In addition to payments and allowances, it said in some areas local arrangements are made to support vulnerable services or respond to crisis or emergency situations.
Notwithstanding this, intensified efforts were required to manage the situation and put services on a more sustainable footing, it explained.
Two-thirds of high-earning consultants work in acute hospitals, 21 per cent in community operations and 3 per cent in corporate national services.
Mental health services
Of the 20 consultants in community operations who were paid above €300,000, 19 were psychiatrists. The report says this highlights a particular staffing issue in mental health services.
Almost 70 per cent of high earners working in the acute sector were in regional (model 3) hospitals.
Two regions, which are not identified, accounted for 60 per cent of all high earners. One hospital accounted for 21 per cent of those on the list of high earners, but again this detail is redacted in the report.
The auditors warn there has been limited progress in implementing an earlier plan on consultant high earners and say management attention is needed to address the control environment around additional payments.
A planned central register listing all local agreements has yet to be fully established and national reporting of high earners or local agreements has yet to begin.
They also warn of reduced staff morale where pay inequality exists as well as increased staff turnover if the additional work leads to consultant burnout.