Many hospitals and other health agencies who have told the HSE they are in compliance with public pay policy are not in fact in compliance, the HSE has admitted.
The Dail Public Accounts Committee was told today that 30 of the 42 agencies who had responded to queries from the HSE had said they were compliant in terms of whether they were making unauthorised 'top-up' payments to senior staff.
But ,according to HSE chief Tony O'Brien, only seven of these were in fact considered to be compliant, and he did not accept the declaration of compliance from many agencies. Further checks on compliance were being made by the HSE and sanctions would be imposed where necessary, the PAC was told.
The meeting was told of the widespread extent of unauthorised pay in hospitals and other agencies. Over €4 million was paid out by health agencies in top-up pay from HSE and non-HSE sources in 2011, the Committee was told.
However, as some of these controversial payments date back to the 1990s, the total payout could be many multiples of this, the PAC meeting was also told.
The PAC was also told that health agencies paying top-ups from private sources had not yet given a clear picture what these private sources were in every case.
HSE Assistant Director of Internal Audit Dr Geraldine Smith told the PAC that the controversial additional payments to some senior staff dated back to around 1996.
In relation to well-publicised top-up payments at the National Maternity Hospital, Holles Street, Ms Smith told the Committee that the information given to the HSE to date from the hospital did not indicate that one of the sources of what it listed as allowances represented private patient income.
She said the privately-funded sources of extra pay indicated by the hospital to date included rents, licence fees and other income, but the hospital had not mentioned private practice income. There were four such allowances identified in the recent HSE audit.
Holles Street Master Dr Rhona Mahony recently stated that a €45,000 extra payment made to her was in fact in respect of income from private patients.
At the PAC meeting, Chairman John McGuinness said it was also planned to call in health agency CEOs and Department of Health officials to account for themselves on breaches of pay compliance policy.
The Committee was told the HSE would be engaging in a rigorous verification process in cases where agencies were not in compliance with pay policy. Twelve agencies had reported themselves to date as not in compliance.
However, HSE Director General Tony O'Brien said after checking to date by the health executive, it was not satisfied that self-declarations by some agencies as being pay-compliant were valid.
He said the HSE for the past year had been adopting a more robust approach with health agencies on verifying pay compliance.
Mr O'Brien said based on a compliance check by the HSE, of the 42 responses received to date, 30 agencies had categorised themselves as compliant and 12 non-compliant.
He said, however, that of the 30 claiming compliance it should be noted that only seven agencies were considered by the HSE as being in compliance; 15 agencies indicated remuneration being paid which was not in compliance with pay policy and seven agencies were identified through the information provided to HSE auditors as paying non-compliant remuneration.
One agency submitted formal approval from the Department of Health for the non-compliant allowance being paid, and to date one agency had not yet responded to the HSE's queries, he said.
Mr O'Brien said the HSE was trying to resolve the top-up pay situation as quickly as possible.
The PAC was told that there was little or no 'paper trail' available of authorisations from the Department of Health or the HSE for top-up payments dating in some cases back to the mid-1990s, although there may have been verbal approval in some cases.
Mr McGuinness said verbal approval was not acceptable and there was no documentation for top-up payments.
Mr O'Brien said it was is those who purported to authorise such payments in these agencies rather than those who received them who had serious questions to answer.
"Our focus is on the governance of the agencies that have acted, or in some instances may have acted, outside their authority in inappropriately offering and then paying amounts that are neither sanctioned nor authorised."
He said the HSE had already begun making funding deductions from voluntary agencies equivalent to payments that were deemed non-compliant.
Mr O'Brien said top-up payments were not being made in hospitals or agencies under the direct control of the HSE.
He told the Committee it was not acceptable there were certain individuals, who perhaps through no fault of their own, were treated potentially differently from the vast majority of health staff when it came to pay rates.
Mr O'Brien said the HSE was now insisting on a policy of open disclosure on pay compliance. There was evidence that in some cases there was a 'nod and a wink' culture in relation to implementing top-up payments, he added.
He said financial sanctions equivalent to the amount of non-authorised payments made would be imposed on agencies that did not comply with policy.
Mr O'Brien said it was evident that there were persons who made decisions on unauthorised payments who knew that they required prior approval when they entered into these pay arrangements, but no formal approval had been given.
The PAC was told the 12 organisations that had indicated to the HSE they were in breach of pay rules had given no explanation of why they had breached this policy.
Mr O'Brien admitted that it was 'theoretically possible' that there could be other extra payments made to staff by health agencies which have not yet come to light; for example, payment for long-term accommodation arrangements for certain staff.
Questions were raised by Independent TD Shane Ross about the substantial revenue accruing in voluntary fundraising for the Central Remedial Clinic (CRC), which also receives funds from the HSE and from Lotto monies.
Mr O'Brien said while he did not have enough information to reach a conclusion, it would seem that questions needed to be asked about this.
Questions were asked at the Committee about the generous remuneration of the CEO of the CRC, which amounted to €266,000 including top-ups and pensions, and questions were asked on whether top-up pay in this case came from fundraising.
PAC Chair John McGuinness described this as 'not acceptable.'
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