Leaders' Questions

Reports in The Irish Times today make the disturbing revelation that more than one quarter of the country's health and disability agencies are in breach of public pay policy. There are related stories in the Irish Independent and other media. Given that it is only a few months since the Haddington Road agreement, it beggars belief the allowances have been sustained and, more importantly, kept from public view and hidden under the carpet. It appears they have been exempt from the cuts applied to all other public servants and those who work in various Departments. The Taoiseach will recall that the Minister for Public Expenditure and Reform declared a fatwa on all allowances more than 18 months ago; for example, he pursued people in the mental health sector who were getting a sleepover allowance of only €8 per night. All of these allowances, from footwear allowances to a range of others in public services, were considered fair game. However, it appears these Premier League allowances were exempt from the review and are tolerated on an ongoing basis. Many of the people who receive services from these agencies have witnessed savage cuts to disability and other services. Thousands of children suffering from delays in development have to wait up to access vital specialist and assessment services. Day and residential services have been cut and there is reduced access to respite care services.

In the case of people working in the sector, the salary of newly qualified nurses was reduced by 20%. In many instances, the basic income of nurses does not equate to the average top-up allowance the executives are being awarded. Fairness is at the heart of this. We are saying to newly qualified nurses that they must survive on €23,000 and that it is okay for someone at the top to take €30,000 above and beyond two sets of income they may be in receipt of, one HSE-funded and one agency-funded. It reduces a sense of collective approach, solidarity or that everyone is suffering at the same level. What is consistently happening is that those at higher pay echelons are being exempted from the kinds of cuts does on low and basic income is in the public service and elsewhere have had to endure.

Were the Taoiseach and the Minister for Health aware of the allowances in the health and disability agencies? Were the allowances brought to the attention of the Minister for Public Expenditure and Reform, Deputy Howlin, and what was done about them? What does the Government intend to do about them now?

These issues are emerging as a result of an audit carried out by the HSE of section 38 agencies, which are hospitals and disability agencies. I do not know when these were originally sanctioned or when they came into being. This Government is attempting to weed out additional sweeteners and expenditure in the health service at a time when any funding, Exchequer or private, should be going into the provision of services to patients and not to unsanctioned payments to senior managers. Front-line staff working in the health services are working within the Government's pay policy and playing their part, a critical part, in the reform of health services through new working practices and rosters. The same rules must and will apply to senior managers as those on the front line. We need a clear picture of the position. On foot of a circular sent out in September by the Department of Health, clearly restating public pay policy, the HSE wrote to all agencies, of which there are 38. On 30 September, copies of the HSE audit, which I have here, were circulated to each of the agencies setting out Government pay policy. The agencies were requested to respond by 28 October, ensuring compliance. Some 33 agencies responded, some with a holding position and others requesting to seek legal advice. On 5 November, the HSE wrote to the agencies reiterating the requirement to respond and to ensure compliance with the deadline of today, 19 November. Before I came to the Chamber I checked on this and, of the 44 agencies involved, seven have confirmed compliance, 13 have confirmed non-compliance and others need more time to determine compliance, require more time to get legal advice or have not responded. The information sent out as part of the documentation circulated by the HSE states:

The Department of Health Consolidated Salary Scales (1 July 2013), as sanctioned by the Minister for Health, sets out current salaries for public health service staff. These salary scales must be strictly adhered to and in no circumstances should an employee receive remuneration in the nature of pay and allowances of any amount greater than the amount prescribed. Non-Exchequer sources of funding may not be used to supplement approved rates of remuneration.

It is very clear and straight.

Will heads roll?

What I and the Minister need is for the agencies involved to respond fully to the HSE double request that they comply with the public pay issues outlined here. Clearly, non-Exchequer funding to top up allowances is not allowed. Therefore, I expect the HSE to provide the Minister for Health with a full picture. The report will be published on the Department of Health website and will be discussed as a matter of some urgency in the Oireachtas Joint Committee on Health and Children. People in the health service, above anyone else, have taken serious structural changes, to their credit, in an attempt to reform the health system. We cannot have those at higher levels being in receipt of allowances outside the agreed public pay service scale. That picture will emerge fully and clearly in the report to coming from the HSE to the Minister for Health shortly.

The Taoiseach said the same rules must apply; they do not apply. There seems to have been a vow of silence on the issue in the lead-up to the Haddington Road agreement. I recall the major attack on allowances by the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, which went on for six to nine months without any mention of these super allowances for people at the top. The concentration was on the footwear allowance, the clothing allowance and cuts to EMTs and extra allowances for emergency workers on the frontline. That was the entire focus. A letter written on 18 June from the national HR unit at the Department of Health to the national director of human resources at the HSE calls for the application of the reduction in remuneration to certain public servants on salaries of €65,000 and above. The table afterwards relates to the HSE element of the salary and is silent on anything outside of that. It seems that there was an awareness of these additional top-up allowances but people left well enough alone during the Haddington Road agreement negotiations and during the Minister's review of allowances.

It is a cover-up. It is disgraceful.

There was knowledge that cuts being effected elsewhere were not being effected here and the situation was left to drift. The picture is well known and we do not have to wait for a fuller picture. Can the Taoiseach indicate the policy and what actions the Government will take with these agencies to make sure they fall in line with everyone else in the public service?

What is required is for the letter sent out by the HSE to each of the section 38 agencies to be adhered to and to be seen to be adhered to. We cannot have a situation where those further down the line, who have taken serious change in the restructuring of the health system, have borne the brunt of the situation while some people who have received non-Exchequer top-up payments amounting to, in some cases, more than the basic salaries of those further down.

Top-up payments of this nature first came to light in May 2012, when HIQA published a report into governance at Tallaght hospital and it emerged that an employee of Tallaght hospital was receiving an additional €150,000 in payments since 2005. In total, five senior management staff had received €739,000 in top-up payments between 2005 and 2010.

Did they pay it back?

In May of last year the Minister for Health requested that HIQA carry out an internal audit on all section 38 funding recipients to ensure similar unsanctioned payments were not being made in other locations. The HSE audit report concluded that there were 36 types of allowances being paid to 191 senior managers at an annual cost of €3.224 million. Some of the allowances were for clinical directors in compliance with salary scales as negotiated under the 2008 consultants agreements.

In some cases, private funding was used to top up approved rates of pay, and 13 agencies pay additional remuneration or benefits such as company cars, car expenses or pension contributions to a total of 34 managers, with a value of €912,472. The Minister for Health, Deputy Reilly, and the Minister for Public Expenditure and Reform, Deputy Howlin, issued correspondence which is very clear in indicating that salary scales must be strictly adhered to and in no circumstance should an employee receive remuneration in the nature of pay and allowances of any amount greater than the amount prescribed.

They are on the Taoiseach's watch. The Minister for Health is asleep at the wheel again.

This is emerging because of the internal audit being carried out. I will not mention the name of any individual but we need the full picture of all the section 38 agencies.

We need honesty.

Today is the last date for receipt of the information from the 44 agencies that were written to, and all the responses have not yet been received.

We are way over time.

Let me confirm to the House that when the report is submitted by the HSE to the Minister for Health, it will be published on the Department website and it can be discussed by the Oireachtas Joint Committee on Health and Children and the Dáil. The position is very clear and public pay service agreements should not and cannot be breached by unapproved non-Exchequer payments such as those detailed in some of the emerging information.

It is happening under the Taoiseach's nose.

Deputy Mattie McGrath should try to keep quiet.

Tá sé soiléir do gach aon duine nach bhfuil sé ceart ná cóir go bhfuil daoine áirithe i gcúpla áit áirithe atá ag fáil pá atá i bhfad ró-ard. Tá sin ag briseadh rialacha an Rialtais. Dúirt an Taoiseach nach raibh a fhios aige faoi seo. The master of the of the Rotunda is receiving a package of more than €300,000. We have the master of the National Maternity Hospital receiving a package of more than €281,000 and the chief executive of the Central Remedial Clinic receiving more than €242,000. This is when thousands of children with developmental delays and behavioural issues are waiting over a year to see specialists. It is when this Government has so far failed to provide funding for bilateral cochlear implants for profoundly deaf child and babies with tracheostomies in Our Lady's Children's Hospital at Crumlin will spend a second Christmas in hospital - although they have been declared well enough to go home - because the HSE has not sanctioned safe levels of home care. In the meantime exorbitant top-ups are being given, for example, to the chief executive of the children's hospital at Crumlin.

It is not right, as people know if there are savage cutbacks to disability services or hard-pressed families are forced to fund-raise to help provide services for children. Surely the moneys gathered on the campuses or hospitals should be used for services rather than topping up the salary of very well paid executives. My question is straightforward. How long have the Taoiseach and the Minister for Health been aware of this issue and, equally important, what does the Minister intend to do about it?

It is a fair question. This came to light last May in respect of the governance of Tallaght hospital. Following the information I have given to Deputy Martin, the Minister for Health ordered an internal audit in respect of all the section 38 hospitals and agencies involved. As I have already indicated, today is the closing day for the receipt of return information following the internal audit, with a very clear letter having been sent to each of the chief executives.

Deputy Adams is aware that there is clearly a difference between HSE-run hospitals and voluntary hospitals. The HSE knows what it is paying chief executives in respect of all the HSE hospitals, and these payments are strictly in compliance with the public pay service agreements. In regard to voluntary hospitals under the section 38 arrangement, the HSE has a contract with each of these agencies. It is only appropriate that the Minister and the HSE should have at their disposal the truth in the information as requested twice by the HSE to each of the agencies involved. I hope the report can be published quickly, furnished to the Minister, put up on the public website and discussed in the Oireachtas.

The position is very clear. The Minister and the HSE have made it clear to the agencies that they are not entitled to have unapproved non-Exchequer funding used as a top-up arrangement which breaches the public pay service agreement. The letter quite clearly states:

Section 38 providers should provide written confirmation to the HSE that:-

1. Remuneration payable is in accordance with the Department of Health consolidated salary scales.

2. Non-Exchequer sources of funding are not used to exceed approved rates of remuneration.

3. The payment of all unsanctioned payments has ceased.

4. The recoupment of any overpayments will be pursued as expeditiously as possible.

That is the position.

Is it not part of the problem that the Cabinet is in breach of Government guidelines in the pay being awarded to some special advisers? Is that not a difficulty for the Government? Some of the reports in the media suggest the Department of Health has been aware since at least 1998, although I do not know the truth of that. The reports indicate that from 1998 some of these organisations have paid chief officers over and above HSE pay scales through other resources. In the children's hospital at Crumlin, a €30,000 top-up came from the proceeds of the shop. Is this where fees for car parks are going? Are they going to elite personalities? More top HSE executives are on salaries of over €100,000 this year than there were last year. The problem is there is still a culture of privilege, which permeates into this institution and the Government which the Taoiseach is charged with leading.

Does the Taoiseach agree there needs to be leadership by example and this culture of privilege is fuelled by the actions of the Ministers in breaching pay guidelines at a time of major hardship for the vast majority of citizens? I hope the refusal to provide bilateral cochlear implants or help children with disabilities will be rectified if we are still providing large top-ups. This is a call that the Taoiseach should act on in dealing with and getting rid of this culture of privilege.

The call has been made and we are acting upon it. The Minister and the HSE are awaiting receipt of the information requested. I repeat that on 30 September a circular letter was sent from the national director of human resources in the HSE and it could not have been any clearer. It required that the agencies involved respond in writing by today to the HSE and that:

1. Remuneration payable is in accordance with the Department of Health consolidated salary scales.

2. Non-Exchequer sources of funding are not used to exceed approved rates of remuneration [to give rise to rates of individual remuneration that exceed Department of Health consolidated pay scales].

3. The payment of all unsanctioned payments has ceased.

In addition, where appropriate, such as under the Financial Emergency Measures in the Public Interest Act, this should be dealt with as expeditiously as possible. The information arose from the analysis of last May, followed by the instruction by the Minister for Health to carry out an internal audit. That audit has been sent to all the agencies involved, with two clear, strong and straight letters, and a reply is to be received by today so the Minister and the HSE can have a clear picture of what is involved. As I mentioned to Deputy Martin, people in the Department of Health and across the public service have seen serious change and their lifestyles impacted upon.

At certain levels, unapproved payments have been made from other sources to top up people's salaries. I hope that is clear. When the report comes to the Minister from the HSE it will be published and debated. The HSE has contracts with the section 38 agencies and can follow through in respect of the recoupment of any such unauthorised allowances as part of the contract.

There will be more cuts.

I wish to continue with the same theme, as it is important and the Taoiseach has not really given an answer. Last week it was reported that seven children at Our Lady’s Children’s Hospital, Crumlin, who are ready to go home and whose parents have been trained to bring them home cannot do so because the HSE cannot provide home care packages for them. The mother of one child has to come from Kilkenny every Monday, go home on Thursday and come back at the weekend with her family to be with her child at the hospital. It is an outrage that such a thing can happen in this day and age.

We have found out that the CEO of Our Lady’s Children’s Hospital, Crumlin, is getting a €30,000 top-up payment in addition to his HSE payment of €110,000. The secret top-up is taken out of receipts from the shops in the hospital. I am sure the people working in the shops only get the average minimum wage.

In a statement the hospital board complained that the information had been given in confidence to the HSE. It seems that board members were upset that a secret payment had been made known to the public at a time when there are cuts in services for children and when staff are expected to take more cuts on foot of the Haddington Road agreement. The arrangements were seemingly made between the boards and the CEOs. There are political appointees on every single hospital board in this country. There are a Labour Party councillor and a Fine Gael Party councillor on the board of Our Lady’s Children’s Hospital, Crumlin.

One could ask whether they were complicit or whether they knew about it. Did they vote on it and just not tell anyone about it, or were they not there?

Of course they did.

It is outrageous. It is disgraceful.

These are serious questions that must be answered about the payments that have been made.

We now also have senior HSE sources saying the level of cuts required next year will be approximately €1.2 billion, which is double the figure presented by the Government in the budget only a month ago. Three members of the Cabinet are responsible for the health service and various aspects of it, but it seems no one is responsible.

Could Deputy Collins ask a question, please?

The situation is a shambles. The people in charge should be sacked. Is it not time for the Taoiseach to make changes?

I read the report last week about a number of children in Our Lady’s Children’s Hospital in Crumlin with tracheostomies. I understand parents have been trained to deal with the very difficult issues that arise for them personally due to their young children requiring such serious operations. They need to be able to deal with suction of the children’s air passages. Our Lady’s Children’s Hospital, Crumlin, has done extraordinary work with babies and young children for many years. When parents are trained to deal with the problems that arise frequently in babies and young children, it is important for hospital staff to be fully satisfied that all the facilities in respect of home care packages - not least of which is the training given to parents, which I am sure is exceptional - are entirely focused on the protection, comfort and development of the baby or child. I have asked the Department of Health for a report on the issue. I would be happy to talk to Deputy Joan Collins about it again.

In respect of the chief executive she mentioned, no more than anyone else, I have read the reports. I already answered questions from Deputy Martin and Deputy Adams on the matter. We need a complete picture of all of the section 38 agencies, of which there are 44. Today was the last day for receipt of the information. It is clearly stated in the circular letter and the internal audit information sent to all the agencies that non-Exchequer funding such as the receipts mentioned by Deputy Collins should not be used for top-up payments that are in breach of the public service pay contract.

There is a contract between the HSE and the voluntary hospitals. As we move towards hospital groupings, which will evolve into trusts, it will be possible to deal with all such situations in the future. We have a problem currently. I do not have the information because it will not be available until the close of business today. I hope that will be the case. When the report is furnished to the Minister for Health, he will publish it and it can be debated and dealt with in the context of the contract that exists between the HSE and the voluntary hospitals and agencies.

The Taoiseach’s reply is, again, not good enough. It seems that those people who were used to living Celtic tiger lifestyles have kept them. In the meantime, people on the front line and at the coalface have had to take massive cuts in their wages and conditions. There are political appointees on all of the hospital boards. Were the appointees aware that the top-up payments were being made to CEOs and other hospital staff? Was the issue discussed by the boards? When Deputy Eric Byrne was a councillor, he was a member of the board of Our Lady’s Children’s Hospital, Crumlin, for many years. He was replaced by Councillor Michael O’Sullivan. Did those people report to their party leaders that such practices were going on? If they knew what was going on, why did they not report it? If they did not know, why did they not know about it?

It is not in order to question the integrity of any member of a board.

I am asking the Taoiseach a direct question.

Deputy Collins knows that as well as I do. She does not need me to tell her. That is totally out of order.

It is a really important question. The Taoiseach said he had only become aware of such a practice now, but given that there are political appointees on the boards, he should have known about it before if the matter was discussed. It is not good enough to come to the Dáil today to say otherwise. The Taoiseach should admit in the Dáil that it is an outrage, that it will not happen again and that it should never have happened. He should also explain how we will get the money back from those people.


Hear, hear.

That is what we want - the money back.

I am not aware of when this kind of arrangement was first approved and how far back it goes. I do not agree with the practice. The instruction from both the Minister for Health and the HSE to the section 38 hospitals and agencies is very clear and is not in contention. It was said that they must comply with the direction that non-Exchequer payments could not be made to chief executives, putting them in breach of agreed public pay policy.

Public pay policy is decided by the Government in negotiations. Such payments are paid for by the taxpayer. The buildings - in this case, hospitals - where such people work are also paid for by the taxpayer. We cannot and will not have a situation in which chief executives breach the public service pay agreements through unauthorised non-Exchequer payments.

The top-ups were agreed by the board.

In the HSE-run hospitals it is very clear what people are paid, but because the voluntary hospitals are run by boards - yes, with political appointments - they operate in a quasi-independent way. Unauthorised top-up payments are now subject to a contract that can be assessed against public pay levels. That instruction has gone out following the internal audit of the HSE.

I hope we understand a few basic principles in everyone’s interests. Those further down the line in the health service, who have accepted serious structural change involving roster reform and pay reductions, will not be treated any differently from chief executives-----

-----with regard to the information that is now coming to light because of the internal audit carried out on the instructions of the Minister for Health. We must sort out the issue and that is what we will do.

That completes Leaders’ Questions. The next item of business is questions to the Taoiseach. I note that in the Distinguished Visitors' Gallery we have representatives of the Power family, who are present for the expressions of sympathy on the death of the late Paddy Power, a distinguished Member of this House.

Unfortunately, I do not know whether it is as a result of a breakdown in communications that the expressions of sympathy are listed after Taoiseach's questions. My only difficulty is that some of the Deputies for the Kildare constituency are not present and may be under the impression that expressions of sympathy are not taking place. My comments are just to let the Deputies know the position. I am sorry if there is any delay.