Small victories in transparency
The work of the Public Accounts Committee may finally lead to some proper oversight of how our health system operates. Here is my column from Medical Independent from 6 February 2014. Obviously, the €750,000 pay-off to Mr Paul Kiely, ex-CEO of the Central Remedial Clinic (CRC), dominated proceedings at the Public Accounts Committee (PAC) on 16 January 2014. Especially as Mr Kiely had appeared before the same committee in December admitting a generous pension pot of €200,000, over half a million short of what he actually got.
St Vincent’s Healthcare Group (SVHG) appeared that afternoon and although this session was lower key, there were also some less explosive, but equally interesting revelations.
After years of questioning and denial about breaching public sector pay rules, SVHG issued a statement late on 23 December 2013, that Mr Nicky Jermyn, the group CEO is being paid a total of €293,000. This is well above the Government’s pay cap of €200,000. The €293,000 is made up of €136,000 of public money, €136,000 privately funded and a €20,000 car allowance.
The St Vincent’s board chairman, Mr Noel Whelan, insisted at the PAC that they issued their statement in the ‘public interest’, against legal ad-vice from their senior counsel, Mr Michael McDowell. At the same time they insisted that they “were compliant” with public pay policy, because the top-ups came from private funds. Much of the PAC’s attention was on this high salary and how he could be CEO of a public hospital as well as a private hospital and the group CEO.
Mr Whelan told the committee that the board had set up a new “public interest” sub-committee and that they had now “entered a process with the HSE” through which they believed the additional pay issues of four staff would be resolved, in the near future. St Vincent’s board had already decided to separate the two roles of public hospital CEO and St Vincent’s group CEO.
Yet, despite three hours of heated discussion, many outstanding issues remain – under the new arrangement would the public hospital CEO be reporting to the group CEO, outside of all public accountability structures? Can the group CEO work in the public interest as well as overseeing the private hospital?
Other important issues also emerged. The non-compliance of hospital consultants working across public and private hospitals in the group was also raised. Group CEO, Mr Jermyn said they were “in compliance with the consultants’ contract”. However, the HSE disagreed. Under the current contract, only those with B* contracts can practice in private hospitals outside of the public hospital, such as St Vincent’s Private Hospital. However, Mr Jermyn implied the opposite – that all those with type B contracts could practice across the two hospitals. Fewer than 10 out of 200 consultants in the group have public only, type A contracts. That means 190 consultants have B or B* contracts or the old type 2 contracts. But there was no clarity on how many type B contracts consultants there are and no acknowledgement that they are breaking their contract. When subsequent clarification was sought, St Vincent’s “are not elaborating on remarks at PAC” was the response.
Details were also given on perennial money makers that are hospital car parks. Their “public car park” brings in €2 million per year, which they said is used to pay operating expenses, pay off capital and loans. SVHG set up a special purpose vehicle to build the public car park on site in 2001. This was financed by a term loan from Ulster Bank of €20 million and a €4 million ‘grant’ from the Department of Health. The public car park management is outsourced. The car park is there 13 years, so it would be interesting to know what happens when the loan is paid off, where does the €2 million from public car park go – to the group or the public hospital?
It also emerged that the SVHG used the assets of the public hospital to leverage funds for building the new private hospital in 2009/10. It was clarified that there is now no financial exposure for the State.
All the issues raised at the PAC are symptomatic of the State’s failure to provide such services (whether disability or hospital care) and their willingness to contract them out to voluntary providers without sufficient checks and balances in place. The issues that were raised are also indicative of the complicated public and private provision of hospital care in Ireland that the Department of Health and ministers have willingly overseen for decades.
St Vincent’s, CRC and numerous others face many more questions from the PAC on these and other issues. Responses so far from the Health Minister and the HSE suggest that perhaps for the first time, these thorny problems in Irish healthcare will finally be dealt with. And about time too.