For the last six months or so, the Government and the HSE have been promising to sort out the whole issue of the €3 million-plus in top-up or unauthorised additional payments being made to senior managers in the health service.
The revelations surrounding remuneration levels at the Central Remedial Clinic (CRC), St Vincent's Healthcare group and other voluntary hospitals and agencies showed official pay policy was being widely breached for years.
To be fair, many of these top-up payments have now ended. A number of senior personnel have left the public system or else agreed to pay reductions. However, there are potentially significant legal problems emerging in relation to whether the HSE can force voluntary hospitals and agencies to end the practice entirely. It has now emerged that in the case of eight senior managers, assertions have been made that they have a legal and contractual entitlement to continue to receive these payments.
The HSE has explicitly asked agencies claiming legal obligations to continue making top-up payments to "prove it" by producing the documentary evidence. If they do and rule out making such payments to others in the future, the HSE will bring their case to the Department of Health and the Department of Public Expenditure and Reform. Such developments will undoubtedly pose a dilemma for the Government.
Closing down unauthorised payments to senior health executives is a popular cause. The public was outraged by what it learned about the CRC, where donations were being used to supplement official salary levels. The HSE in April rejected more than 100 business cases submitted by agencies in relation to top-up payments.
Any move by the Government to adopt a pragmatic approach and allow some senior executives to retain additional payments on a personal-to-holder basis would undoubtedly be met with outrage in some quarters. This would be particularly so if the State had in future to pay for top-ups previously generated from private sources and if top-up payments became pensionable.
On the other hand, it is questionable as to whether engaging in costly legal action over the payment of relatively small additional allowances, in some cases, would be the best use of scarce resources.
The Government could use financial emergency legislation to force through cuts, as proposed by Sinn Féin. However, there is a fear in some parts of Government that a court could take issue on whether there still is a financial emergency in place, given the talking up of the economy by Ministers over recent times.
Before a decision is made on the issue, one thing the HSE and the Government could do is to set out clearly the origin of the funding for many of these additional top-ups. The Irish Times has reported previously that proceeds from sweet shops had been used in some instances. The Minister for Health has spoken in the past of revenue from car parks being used. However, no full list of private sources of top-up payments has ever been produced.
