Haggles over pay for top-level posts in new health service structures

Manoeuvring behind the scenes on pay rates and revised roles for new health chiefs, writes MARTIN WALL

The Government has been deliberating for some time about the future structures of the health services, including changes at the top of the HSE and the establishment of new hospital groups.

The process about the groups has been delayed, largely as a result of a backlash in the southeast at proposals to incorporate Waterford into the group around hospitals in Cork city.

However, less known is that there has also been some to-ing and froing behind the scenes about the pay rates for top-level posts in the new health structures.

Last October the secretary general of the Department of Health, Ambrose McLoughlin, set out his blueprint for the future structures in a letter to the secretary general at the Department of Public Expenditure and Reform, Robert Watt.

Mr McLoughlin proposed a senior management team comprising a director general, a chief operations officer, chief finance officer, national director of health and wellbeing, national director of primary care, national director of acute hospitals, national director of mental health, national director of human resources and workforce development, national director of quality and patient safety, and national director of support and shared services.

Proposed hospital groups

He said a number of other national director posts, dealing with communications, clinical programmes, cancer control programmes and internal audits, would continue “for the present” but would not constitute part of the senior management team.

Mr McLoughlin said these arrangements would operate for about three years.

In relation to the proposed hospital groups, he suggested that each would require the appointment of a chief executive who would report to the national director of hospitals in the HSE.

He also said it was proposed to revise the roles of existing HSE regional directors and that they would become regional performance directors, “emphasising the need for a performance management focus”.

As reported in The Irish Times last weekend, Mr McLoughlin also proposed introducing a bonus scheme for the new hospital group chief executives.

“The deputy CEO [of the HSE, who will be appointed director general of the organisation on the passing of required legislation] and I wish to consider further how we might best attract people, including potentially those from outside Ireland, to head up hospital groups for a contractual term of, say, three to four years.

“I would be keen to explore with you the feasibility of offering a more flexible package in order to attract the right candidate, eg a base salary but with higher on-target earnings associated directly with improved performance in finance and/or operations.”

He proposed that the new HSE director general would have a salary of €195,000 but that this would be reviewed at the time of his formal appointment.

He suggested the chief operations officer and the chief financial officer would be paid €188,744, the other HSE national directors €158,296 and the hospital group chief executives €145,959.

The Department of Public Expenditure and Reform in reply agreed to sanction the hospital chief executive pay at €145,959 but totally rejected the concept of bonus payments.

“Performance award schemes were abolished by the then government in 2009 and the restoration of those or similar performance-related remuneration structures for those posts could not be accommodated within existing public service pay policy.

“The adoption of such a policy for particular posts in the HSE in isolation from a wider public service policy initiative would not, in our view, be sustainable in current circumstances.

“It should be noted in this context that the reported public service experience over the last few years has not shown any general problem in attracting talented and experienced mangers to the Irish public service, notwithstanding the general constraint on pay levels and grading.”

Appointments approved

The Department of Public Expenditure approved the appointment of the proposed five HSE national directors on a salary of €158,296.

However, it rejected the Department of Health’s proposed pay level for the chief financial officer. Instead it sanctioned a rate of €172,495.

It also said it would approve a salary of €172,495 for the post of HSE chief operations officer.

The Department of Public Expenditure and Reform also said the proposed reorientation of the roles and functions of existing HSE regional directors “would not merit or give rise to any additional remuneration costs”.

“In this regard, you will appreciate that current Government policy on public service pay is predicated on the ongoing need to reduce the pay bill by extracting and reducing pay costs throughout the public service.

“This consideration must be reflected in all proposals for management restructuring within the health service at all levels including those below hospital group CEO level.”