Transparency and top-ups


The public deserves clear unambiguous answers on top-ups paid to senior personnel within voluntary hospitals and health agencies. The issues include where the money was sourced; who authorised payments; whether the relevant authorities deliberately breached government pay policy and if the Health Service Executive was complicit. An internal investigation by the Department of Health does not answer. The most appropriate and effective way to investigate the issues would be through public hearings by the Dáil Committee of Public Accounts.

The kernel of the controversy is not that top-up payments were made, but that they were made in secret and from unorthodox sources. Conflicting accounts from the HSE and the Central Remedial Clinic concerning official knowledge of such breaches highlight the need for a full investigation. The Department of Health knew in 1998 that executives were being paid above established rates.

Special arrangements and buckshee payments are embedded in the health system. Attempting to bring in a “public only” contract for hospital consultants in 2007, Professor Brendan Drumm said there was no other country in the world where public service doctors were paid full-time and also allowed earn two or three times as much in private practice. The consultants won that confrontation, retaining an effective closed shop and their public-private practices. Many continued to ignore a cap on private patient treatment in public facilities, without obvious penalty.

A lack of Government appetite to police voluntary and charitable organisations and their financial affairs has added to the problem. A Charities Act became law in 2009, but action is only now being taken to implement it. A regulator will be established “in shadow form” in the coming months, but the office may not be fully operational until the end of 2014. In the meantime, charities that operate in a fully transparent fashion must suffer the negative consequences .