Top-up payments


Sir, – Since transparency and accountability requires that the truth be told, I wish to contribute to the national debate regarding the so-called “top up” payments.

When the staffing of the Adelaide and Meath Hospital, incorporating the National Children’s Hospital was being determined between 1996 and 1998, the question arose of how to achieve the very best leadership for the hospital and in particular attract and retain the services as chief executive officer of a medically qualified administrator with extensive experience and international recognition. We, the board of the hospital, were encouraged by the Department of Health at that time to aim high. The recruitment process produced one candidate with credentials matching all the requirements and it was decided to offer him the position.

In the negotiations which took place with the candidate, it quickly became apparent that the salary approved by the Department of Health for the position would not be sufficient to attract the candidate to accept the position. Conversations about the situation took place with the Department of Health in which it was made clear the department could not and would not sanction a salary higher than the approved scale permitted.

It was also made clear that the department would not interfere if a salary higher than the scale could be offered, as long as the additional amount did not come from the public purse. A package was put together within this parameter and the candidate was appointed. He resigned some time later. And it appeared to me that he did so because of the constraints of the procedures, protocols and processes then operating in the Irish health service at a number of levels. He is an Irishman who gained his experience abroad. He continues to operate and perform on the international stage. This was not the first time that such a package was constructed for the chief executive officer of an Irish health institution.

The lessons to be learned from this experience are legion and obvious. Central to them is the issue of both personal and corporate hypocrisy. Like all the rest of us, politicians and civil servants must take care lest their hands are not clean, their hearts are not pure and their souls are not lifted up unto vanity. In pursuing transparency and accountability, the truth, the whole truth and nothing but the truth should be pursued by all parties and that requires great humility. – Yours, etc,



(Secretary to the AMNCH

Board 1996-1999),



Co Offaly.