Overtime pay in HSE hits €639k a day as hospitals deal with chronic staff shortages
Senior doctor earned an extra €123,694 on top of basic pay amid health service staff shortages
A doctor earned €123,000 in extra pay last year as a chronic staff shortage pushed the health service overtime bill to €639,269 a day. Extra hours worked by a range of staff cost €175m in the first nine months of 2016, new figures secured by the Sunday Independent reveal.
It means huge sums are being paid to an elite group of medics on top of their basic pay.
An associate specialist topped the overtime league table in 2016, taking home an additional €123,694 for working extra hours.
Three registrars shared an overtime pot of €267,700, and a consultant ear, nose and throat surgeon pocketed an additional €82,973.
Internal records show that, in 2015, €220m was ring fenced for spending under this heading by the HSE. A senior registrar received the highest payment of €140,970. Next on the list that year were three other medical personnel, who earned €114,396, €101,759 and €101,695 respectively.
A senior house officer received an additional €100,770.
In addition, accounts for the first 10 months of 2016 showed the top-10 earners in the HSE shared a total overtime pot of €851,398, meaning they each potentially enjoyed a pay boost of €85,139.
Brian Turner, a health economist attached to University College Cork, described the individual overtime payments as "mind-boggling".
He warned the long hours being worked by certain staff raised questions over the level of patient care. "In some cases workers have trebled their salaries," he said. "The relativities between the overtime payments, and the maximum points on individual salary scales, are an eye-opener.
"The maximum point on the senior registrar scale is just over €75,000. On the registrar scale it's just over €60,000. So when registrars are earning one-and-a-half times their basic salary in overtime payments, it begs the question what kind of hours are they working? Does it have implications in terms of safety and delivery of care?"
While Mr Turner said he would have thought from general perception that the overtime bill might even be higher, the figures highlight the potential for a general "reduction in pay costs".
"If they recruit more people and pay them at the normal rate, it would mean a reasonable amount of money could be put back into providing care, as opposed to spending it in overtime payments. This also emphasises the need not only for increased physical capacity in terms of bed numbers, but for sufficient doctors and nurses to staff these beds."
He said the data suggested an overhaul of work practices may be required to achieve greater savings. "It's hard to know without digging down deeper into the individual situations," he said.
"There could be an element of understaffing, and people having to work because there's nobody else available. If this is the case, it would emphasise the need for recruitment and retention."
But existing work practices and lack of employee flexibility could also be a factor in high overtime payments.
The model used by the HSE in calculating overtime rates depends on the grade and discipline. Staff in management or senior roles are generally not eligible for overtime. Overtime payment is generally on an hourly basis - at a rate of an hour and a quarter pay for every hour worked.
It is paid when, for example, a doctor has worked more than 39 hours a week, over an averaging period of four weeks.
Those employed on Consultant Contract 2008 are only eligible for an allowance if they are first rostered on-call on a Saturday, Sunday or bank holiday. At that point, their employer can require the consultant to work up to five hours' overtime in a day. This is paid at the rate of an hour and quarter allowance for each hour worked.
In a statement, the HSE said the figures should be considered in an "overall context", taking into account increasing demand for services, "ongoing challenges" recruiting and retaining staff, as well as efforts to reduce agency costs.