Consultants earning more than €350k more than doubled over year

The HSE audit found there is no oversight mechanism at a national level for consultant payments 'to ensure consistency, transparency, or accountability across health regions'.

The number of consultants employed by the HSE who earned more than €350,000 per year more than doubled in just one year, according to an internal audit report.

A HSE internal audit report specifically targeted at reviewing the pay packages of consultants and ensuring they had been properly approved found that 99 doctors earned more than €350,000 in 2023, up 57 from the 42 recorded in 2022.

The combined remuneration for those 99 consultants was €41m for the year, or €416,000 on average. The salary package of the highest-paid of those consultants fell slightly from the previous year, but still stood at €963,000. Some 10 consultants earned more than €500,000 over the 12 months, up from eight in 2022.

The audit found there is no oversight mechanism at a national level for consultant payments “to ensure consistency, transparency, or accountability across health regions”.

It found that, across clinical disciplines, the high payments were repeatedly driven by the same factors, including compensatory rest payments — those paid for long hours worked without scheduled breaks — and locum cover for unavailable physicians.

The auditors called for the institution of a single live register for “exceptional” payments to consultants to be validated quarterly by the HSE’s regional finance director. It also called for the “systematic wind down” of payments to consultants outside those of the HSE’s framework, and for all vacant consultancy posts to be filled.

Budgetary controls

A separate audit found an “unsatisfactory” level of assurance that the governance of consultant appointments is adequate and effective, after it found that only 18 out of 40 posts reviewed had had a business case for their retention approved.

As of March 2025, some 112 consultants working in Ireland were not included on the Irish Medical Council’s specialist register — a prerequisite to be eligible for consultant posts within the HSE. Some 24 of those consultants had been working in their roles for more than five years.

The HSE also found a “limited” level of assurance that there are “adequate budgetary controls in place” to ensure adequate and effective governance of spending within the health service.

It noted that pay budgets within the HSE “are not reflective of current levels of agency staff usage and overtime” across the service, and that a reliance on supplementary estimates — where the Department of Health approves additional funding above and beyond that allocated during the government's budget — “may indicate a weak budgetary control environment”.

The audit said “underlying and embedded” budget deficits are making it “increasingly difficult” for the various HSE areas to achieve breakeven and to remain ”within their initial budget allocations”.

Budget overruns in the health service have caused consternation at government level in recent years, with the Department of Public Expenditure undercutting the budget expectations of the HSE by some €1.5bn in October 2023 as a result of that overspending.

Meanwhile, a further internal audit found systemic issues around the HSE’s approach to home births. It noted that it was “unclear who had responsibility for the governance” of the home birth service, while “no agreement” was in place in terms of safe travel time or distance for pregnant women desiring a home birth from their nearest maternity service.