Consultant paid €522k more than base salary in 'compensatory rest' payments, report finds

The same consultant, an emergency medicine consultant, was eventually paid €758,000 last year — nearly four times their basic salary of €199,000.

The HSE paid a single consultant €522,000 more than their base salary in ‘compensatory rest’ payments in 2021, an internal report has found.

The same consultant, an emergency medicine consultant, was eventually paid €758,000 last year — nearly four times their basic salary of €199,000 — a rate of over €50,000 per month in compensatory payments, making them the highest paid HSE employee in 2021.

Compensatory rest payments relate to a new contract agreed with consultants in 2014, and see consultants performing on-call duties given two hours in rest compensation for each incident attended before midnight.

Those rest periods are supposed to be taken as time off within eight weeks of being awarded — if they are not, they are paid in the form of compensatory rest pay. Seven separate incidents of consultants being paid more than €100,000 per annum via that system were noted in 2021.

Remuneration

The emergency medicine practitioner who was paid €522,000 in compensatory rest payments was one of only two of the seven such consultants considered by the investigation to be paid in that manner.

Their remuneration of €522,000 dwarfed that of the other worker meanwhile, who received just €38,706 in compensatory payments.

An internal audit investigation report of the HSE’s 68 highest earners, seen by the Irish Examiner, meanwhile shows that numerous ‘local agreements’ are in place between individual hospitals and community healthcare organisations and consultants “resulting in some employees earning significantly above their salary scales”.

'Properly approved'

Those agreements cost the HSE more than €4m in 2021. However, the internal audit investigation was unable to determine whether those arrangements had been “properly approved” or not.

Some of the reasons for the additional payments included: reading X-rays; extra hours due to a lack of consultants; covering for vacant consultant posts; splitting vacant post salaries among consultants; overtime paid at a double rate; and the 2021 cyber attack.

Altogether, €3.1m was paid to 67 consultants for ‘on call’ pay in 2021. However, the vast majority of that money did not relate to on-call payments “in the strict sense”, per the report, with various arrangements having been categorised as ‘on call’.

What's your view on this issue?

You can tell us here

On-call payments are supposed to be capped at €30,000 per annum — however, the report notes seven instances where that cap was breached at a cost to the HSE of €224,000 in 2021.

Of the 68 employees considered by the report, some 24 of them, or 35%, were radiologists. A further 10 were psychiatric consultants, with the remaining 34 split evenly between disciplines such as surgery, obstetrics, paediatrics, and public health.

One radiologist was paid €140,000 in 2021 for the reading of 17,400 x-rays, the report said.

Conclusions

The report concluded that in terms of the 68 workers earning more than €300,000 apiece, “value for money may not be achieved where excessive extra payments have been noted”.

They added that patient safety could “be compromised” where consultants are overstretched, while “staff morale may be reduced where pay inequality exists”.

They recommended that an action plan be developed “to address the deficiencies and uncertainties identified” by the audit.

That action plan recommends that all payments not in compliance with the hospital consultants’ contract should be ceased.

“Non‐compliant payments will be investigated and corrective action taken,” it states, adding that a quarterly review process will be put in place “to monitor compliance going forward”.

Separately, local agreements put in place between consultants and hospitals “due to service exigencies or resource deficits” should only be “temporary in nature”, the report said.

The HSE said it accepted the action plan recommendations and acknowledged the “shortcomings” in its control environment regarding consultant payments, a fact which it is “committed to address”.