'Nod and wink' pay culture in hospitals, says HSE chief

He revealed only seven of 42 agencies complied with the rules, as others ran up millions of euro in so-called top-ups.

“Clearly, we see in some of the responses, evidence of what was perhaps ’a nod and a wink’ culture,” Mr O’Brien said.

“(A culture) of, ’I’ve had a word with somebody, they said it would be alright, I haven’t documentation but sure, we’ll do it anyway’. That clearly has to be consigned to history.”

Mr O’Brien told the Oireachtas Committee of Public Accounts that the HSE had received responses from 42 of 44 agencies to date.

Of those, 30 agencies categorised themselves as compliant and 12 non-compliant.

But, among the 30 claiming to adhere to the rules, the HSE deemed only seven to be compliant.

It found the remainder had made payments in one way or another and did not meet public pay policy.

Mr O’Brien said it was clear that in cases where unauthorised additional or so-called top-up payments were made to senior staff members, those responsible “must have known they required approval”.

The executive wrote to the 44 hospitals and health agencies in September asking whether their pay arrangements to staff comply.

Under the rules, bodies that receive public funding must not supplement approved pay rates with either money from the state or non-Exchequer sources, such as charitable donations.

The institutions had until last week to return information to the executive explaining their position.

Mr O’Brien said the HSE would now work closely to ensure the institutions that breached the pay rules repay the amount of top-ups lavished on staff.

This is likely to be done by deducting the amount from public funding given to them.

“We need to establish how into the future we can continue to reassure ourselves that those things are not part of the way the game, if we can use that term, is being played,” he said.

Meanwhile, the 12 institutions that confirmed non-compliance themselves were named during the committee hearing.

They were: Carrigaline, Dublin Dental Hospital, Royal Hospital Donnybrook, Adelaide and Meath Hospital, Coombe Women’s Hospital, Our Lady’s Hospice, Cappagh National Orthopaedic Hospital, St Michael’s House, Rotunda Hospital, The Sisters of Charity of Jesus and Mary/Muiriosa Foundation, National Maternity Hospital and the Central Remedial Clinic.

The payments controversy erupted after health watchdog Hiqa discovered last year that a senior manager at Tallaght Hospital was paid an additional €150,000 in payments since 2005.

The Health Minister ordered the HSE to conduct an audit of pay at the 44 hospitals and agencies.

They had until last Tuesday to return all the information requested.

Last week, Rhona Mahony, the top doctor at the National Maternity Hospital at Holles Street, said she had been vilified and faced unwarranted criticism over her earnings in the row over top-up pay.

She insisted her wages are strictly in line with public-sector rules and that any additional money she earns is from her private practice.

Dr Mahony said she earned an additional €45,000 in private fees last year and accused the media of labelling it a “top-up”.

She said the rest of her salary was strictly in line with her contract at Holles Street and complied exactly with wider health service rules.