PATIENTS and the disabled are at risk of suffering cuts in services as the row over generous top-ups to senior managers escalates.
The Health Service Executive (HSE) is warning that it will slash funding to St James's Hospital and St Vincent's Hospital in Dublin by 20pc from next week after both of them ignored attempts to bring their senior managers into line on public pay policy.
Three disability services – the Brothers of Charity South and South East and St John of Gods – are also refusing to comply with instructions from the HSE.
They are all rejecting orders to make a business case to the HSE for continuing to pay top-ups – of nearly €137,000 in the case of one senior manager.
A furious John McGuinness, chairman of the Public Accounts Committee (PAC), accused the state-funded hospitals and agencies last night of "thumbing their noses" at the health service.
The cut in funding will be imposed from next Friday, with potentially serious consequences for patient care – despite claims by the HSE that it should not affect the sick and vulnerable.
Another 27 agencies have agreed to make a business case to the HSE to continue paying top-ups to at least 88 senior staff.
But the number seeking to hold on to top-ups is still unclear as some business cases can involve more than one manager.
Just 10 of the 44 agencies which were subject to a controversial HSE audit on top-ups and unauthorised allowances in 2012 have now agreed to abandon the practice.
It emerged in recent months that seven senior staff in St Vincent's Hospital are getting top-ups.
St Vincent's Healthcare group chief executive Nicholas Jermyn – who is on a public salary of €136,282 – is getting a private payment of €136,951 for overseeing the private hospital, plus a car allowance of €19,000.
St Vincent's has since suggested that Mr Jermyn could resign from his public post – and remain over the private hospital – as part of a solution.
A spokesman said last night that St Vincent's was engaged in a process with the HSE and would not be making any further comment.
Information about St James's Hospital, supplied by the Department of Health, indicated that a raft of staff were getting additional allowances of up to €17,000.
A spokeswoman for the hospital claimed last night that the HSE's statement was "factually and legally" inaccurate and insisted that staff were not being paid top-ups. However, the HSE said unauthorised allowances were being paid to certain staff in St James's.
The HSE said its information was based on responses from the agencies, which had been asked to submit a business case for the allowances by February 10 last.
"Five agencies are deemed non-compliant as business cases have not yet been received," said the HSE.
They have now been told in writing that with effect from February 21 their cash funding will be cut by 20pc until such time as they submit a case for the extra allowances.
The business cases are being examined by an internal review panel of senior management in the HSE. If they feel that the allowance is justified, they will refer to the Department of Health and the Department of Public Expenditure and Reform, where the ultimate decision is made.
The HSE said last night that the reduction in "cash funding is not a budget cut and therefore should under no circumstances impact on the provision of services to patients or clients".
The latest developments led Mr McGuinness, whose committee is investigating the scandal, to brand as "completely outrageous" the HSE's failure to enforce full pay compliance in 33 voluntary hospitals.
"Based on the documents, I take it there are at least 88 people in the 27 agencies who are not in compliance, but it could be multiples of that. This thing is a disgrace," he said.
An outraged Mr McGuinness blasted HSE director general Tony O'Brien and his senior officials for their "abject failure" to bring order to the pay of senior executives in the sector.
"The HSE has utterly failed to bring these hospitals and agencies into line, it is completely outrageous," he said.
Mr McGuinness called on the HSE to provide the PAC with copies of all the business cases made, so it can ensure "value for money for the taxpayer".
Mr Harris said it was "wholly unacceptable" that just 10 of the 43 agencies were in compliance with the HSE's pay policy.
He added: "It is particularly worrying that five institutions have chosen to thumb their noses at the process and remain non-compliant, a year after the HSE audit report was produced.
"It is even more worrying that two of the five non-compliant institutions are two of the biggest hospitals in the country, St James's and St Vincent's."