Since the collapse of our economy around five years ago, as a nation we have become very astute at counting other people's money.
Some might think we've become a little too obsessed with this. Does it really matter if a few bob extra has been paid to certain top people here and there in the health service over many years, when you consider the other huge problems and scandals in our health service?
The following statistic revealed recently on irishhealth.com probably represents a much greater scandal:
More than 8,000 children are waiting over a year to see a consultant in outpatients at Crumlin and Temple Street Hospitals, with around 1,500 of these patients waiting waiting one to three years to see a heart specialist.
After of all the controversies in recent years over access, safety and financial propriety in our health service, our scandal-measuring faculties are probably becoming a bit strained.
However, it's safe to say that the top-up debacle is a serious issue, not only in view of its inherent lack of transparency and bureaucratic arrogance, but due to the fact that most of the recent scandals are essentially linked.
They all tell us a lot about what is wrong with the way the health service is run and the abject failure to date of any real attempts to reform it.
The public furore over unauthorised top-up payments to senior health staff, and perhaps most worryingly, the dubious use of some charity funds to boost these salaries in one high-profile agency, the Central Remedial Clinic, is justified and can no longer be dismissed as mere media hype or political point scoring.
These revelations of not very high standards in high places has done little to convince a financially battered public that a 'democratic revolution' has taken place since February 2011.
If such a seismic change in public policy had occurred since the advent of the current Government we would no longer be paying some of the great and the good at the top of our health service salaries that the country can financially ill-afford, and probably couldn't really morally afford during the boom times.
Those at the upper end of the health service will protest that they too have not been immune to pay cuts, tax increases etc. This is fair enough to a certain degree.
However, the average member of the proletariat will be forgiven for querying how much of a revolution has really taken place if the system still rewards some hospital consultants with over €200,000 per annum for public work.
Or why it rewarded a recent CEO of the CRC with €240,000 p.a, and other perks, some of them from the organisation's fundraising arm, or why it benefited the current head of the HSE, who is himself trying to get to the bottom of the top-ups mess, with a six-figure sum in unauthorised top-ups over a number of years in respect of his previous health service post.
Or exactly why Tallaght Hospital paid five senior staff around €700,000 in top-ups between 2005 and 2010, at a time when the hospital was suffering severe cuts and was embroiled in serious patient safety issues. This hospital, by the way, is still paying some unauthorised top-ups to certain staff.
Or why the system has sprinkled allowances and extra payments, both authorised and unauthorised, of various sizes, on senior staff throughout the health service far back as the mid-1990s, without ever seriously asking what the public is getting back in return.
The public knew little or nothing about this extra pay or under what criteria, if any, it was being disbursed.
This has been the seam running through the perpetual dysfunction of our health service in recent years- not just lack of accountability and transparency, but a Governmental and bureaucratic arrogance bordering on contempt for the public that pays for the service.
In the case of the top-ups, it appears that in many cases, they were not compliant with Government pay policy but with L'Oreal policy- because they're worth it.
It may take some time to get to the bottom of how this ATM machine for top health service staff was allowed to operate with such profligacy for so long.
And it should be remembered that while the current controversy involves voluntary agencies lightly governed at arm's length by the HSE, senior HSE staff themselves were rewarded with controversial large bonuses up to 2009.
Perhaps it might be worth considering investigating the top-up scandal not through the HSE and the Department of Health, which through a very laissez-faire attitude, were partially complicit in the controversy, but through an independent inquiry.
In the meantime we could be forgiven for asking - what exactly are we getting for all this extra money? It's not exactly as if our health service is in every case a shining example to the outside world.
While there are many examples of good practice and 'islands of excellence' in the system, one could be forgiven for asking whether the €4 million spent each year on public and 'privately-sourced' top ups for senior staff running health agencies is money well spent, authorised or otherwise.
Some top-ups are being paid to staff in hospitals which have been the subject of patient treatment controversies, overcrowding and long waiting lists.
To some this may seem a brutal over-simplification.
Those running these institutions will point to the unprecedented state funding cuts that have made the provision of a decent level of service almost impossible. In other words, their jobs, understandably, seem to be getting more and more difficult all the time.
But this again leads to an overwhelming question - is it morally right to pay people extra to run services that are already suffering unprecedented funding cuts? Is around €140,000 for example (the current Government guideline for pay for a CEO of a moderate-to large sized health agency) not more than enough to pay someone to run any organisation that might be cutting back services for the sick or the disabled?
Do you really need to be paid more than Enda Kenny or the Prime Minister of Spain to run a medium - sized health agency of dubious efficiency in a small peripheral European country?
And, of the course, the obvious rhetorical question: is it morally or legally right for your agency to set its own pay policy with little or no reference to Government rules?
It is undoubtedly true that the health cuts of recent years have now led to a situation whereby any half-sensible commentator believes that more of the same next year would be unsustainable, However, where money has actually been targeted, whether for staff 'incentive' pay or to cut waiting lists, it appears to have had little effect.
Moving away from the morality of paying top-ups to senior staff in agencies suffering cutbacks, we can take waiting lists as another example of money not so well spent.
The initiative to cut waiting lists has been a key plank of James Reilly's improvement programme for the health service since he assumed office in 2011.
It has been expensive - €85 million spent on waiting lists in 2011, €40 million in 2012, although the amount allocated has dropped considerably this year.
Included in the amount spent on waiting list and ED trolley wait initiatives is around €2 million on external experts brought in to assist the process.
The drive to cut waiting lists, despite the money spent, has come badly off the rails, with the numbers waiting over nine months for an operation increasing ten-fold compared to a year ago and numbers on outpatient lists still growing.
While there has been a reduction in trolley numbers, there is still considerable ED overcrowding in some hospitals, and in some cases, trolleys are simply being taken out of EDs and put onto wards.
Health Minister James Reilly announced in May that he was essentially throwing more money at the problem by providing a further €18 million to help waiting lists.
It is not clear whether this funding has materialised yet or whether, if it has been invested, it will lead to significant reductions in waiting lists.
James Reilly's target of having nobody waiting over a year for an outpatient appointment or eight months for an inpatient or day case procedure seems like a pipe dream at this stage.
The top-ups and waiting list issues are but two examples of how throwing money around has not eased health service problems.
And we have no guarantee that Dr Reilly's promises to abolish the HSE, provide free GP services, set up independent hospital trusts and insure the entire population will provide us with good value from whatever monies are are left to spend on healthcare after the current period of retrenchment ends.
Sick kids wait years to see consultant
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