A total of 99 consultants earned more than €350,000 each in 2023, HSE internal auditors have found.
A new report, released on Monday, confirmed one consultant working in a public hospital received €963,000 in payments over the year.
The HSE said on Monday, following publication of the internal audit, that while some levels of high earning were unavoidable, “it is clear that in some cases this has reached unacceptable levels which cannot continue into the future”.
The HSE internal audit report indicated that the average remuneration for the highest-earning 99 doctors was €416,000.
It said that across several disciplines cost drivers leading to such high earnings included payments to compensate for rest days and the provision of cover for posts that were vacant or where other doctors were on leave.
Auditors said while at local level there were records setting out exceptional payments made to medical consultants, there was “no evidence of a centralised or national oversight mechanism to ensure consistency, transparency or accountability across health regions”.
The audit said that standard allowances paid to consultants under their contract with the State can significantly increase their total remuneration above basic pay levels. These could include additional payments for serving as clinical directors or for being on-call or for overtime.
Auditors examined a sample of payroll in relation to the group of 99 consultants across several disciplines who received more than €350,000 in 2023.
The report found that among histopathologists sampled, the average payment was €578,000. It said among doctors in emergency medicine who were sampled as part of the audit process, the average payment was €562,000.
Among the radiologists sampled, the average payment was €520,000.
The HSE said on Monday that plans were being progressed to implement a recommendation in the report that its chief executive should issue a direction to top managers in each health region that they must keep a central e-register of all local pay consultant arrangements that fall outside the new public patient-only hospital consultant contract.
“The register is to be validated quarterly by the regional director of finance, and reauthorised annually by the regional executive officer, with any item not re-approved automatically lapsing”, the HSE said.
The internal audit report also revealed that one consultant in 2023 received €1.6 million as a termination payment. This included €1.37 million for loss of potential private earnings for a period of three years and eight months during which the doctor concerned was suspended.
The auditors also reported that the HSE received rebates from pharmaceutical manufacturers of €343 million in 2023.
Standard rebates accounted for €96 million and Public Access Scheme rebates accounted for €247 million.
“Management should perform a review of all supplier accounts whereby the rebates are calculated using data from the suppliers instead of data from community pharmacists and assess whether this is appropriate and record the monetary value of differences noted for review and approval,” it was suggested.
“Management should also document in their standard operating procedures, the processes to be undertaken when disputes arise with suppliers over rebates and the steps and approvals required to update rebate calculations in line with supplier calculations.”
The HSE said it “actively engages with all suppliers in relation to the timely settlement of rebate invoices in compliance with the policy positions of the State in relation to those rebates.”