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PAC Chair says HSE is 'not fit for purpose'

John McGuinness called on the HSE’s Director General and the Secretary General of the Department of Health to resign.

Image: Screengrab/Oireachtas TV

Updated: 4.50pm

THE CHAIR OF the Public Accounts Committee has accused the HSE of being unfit for purpose.

John McGuinness stated that the HSE’s mishandling of the discretionary medical card issue “has led me to believe you’re not fit for purpose”.

He called on Tony O’Brien, the Director General of the HSE, and Dr Ambrose McLoughlin, the Secretary General of the Department of Health, to resign.

Over 16,000 people lost their discretionary cards from January 2013 – April 2014, with 1,200 lost so far this year. Some 900,000 cards are expected to be reviewed in 2014.

Fine Gael Deputy Kieran O’Donnell said he doesn’t think he’s “ever been more angry” than he is about people losing medical cards while salary top-ups to a number of individuals working in the health sector may be paid.

“People are being told in a crowded pharmacy shops, where they’ve probably been going for 30 years, that their medical card has been pulled.”

There appears to be one law for the ordinary Joe Bloggs out there and another law for another cohort of society.

O’Donnell said that medical cards were being withdrawn from over 70s if they didn’t reply to a review letter within a month. He remarked that it didn’t make sense that the process of finalising the top-ups issue was taking so long by comparison.

Screenshot 2014-06-12 at 12.19.57 PM Kieran O'Donnell Source: Screengrab/Oireachtas TV

O’Brien told the committee that no individual has proven they are legally obliged to a top-up payment – yet.

He said that of the 143 people in section 38 agencies potentially entitled to keep their top-ups, 58 cases have yet to be resolved.

“It’s very easy for you to say you’ve got a legal obligation, it’s up to you to prove it … Nobody’s provided the proof,” he stated.

When pressed by Fine Gael TD Paul Connaughton on what would happen if someone does provide proof, O’Brien said that it would have be “examined on a case by case basis”.

He added that it ”would be wrong for me to pre-judge that” and said he hoped to be able to provide the committee with a “substantive and full report in early July” on the issue.

This morning the Irish Times reported that the HSE has recently written to health agencies and voluntary hospitals informing them that their staff may be entitled to retain the top-up payments if they can prove they have a contractual entitlement to them.

In April, the HSE rejected around 100 such applications.

O’Brien said that the people potentially entitled to the top-ups were on salaries of approximately €80,000.

He noted that it was “not their own doing” that they may be entitled to the payments


Labour TD Robert Dowds stated  that this “clearly has to be resented by staff affected by the Haddington Road agreement”.

“If someone has a contractual entitlement, they have a contractual entitlement,” O’Brien noted.

When asked about the issue of top-ups in St Vincent’s Hospital, he said that there was a “mutually shared objective” for them to be compliant with the new rules.

In March, the hospital’s CEO Nicholas Jermyn stepped down after it emerged he was paid more than €292,000 a year, with €136,000 coming from public funds.

Screenshot 2014-06-12 at 11.44.26 AM Robert Dowds Source: Screengrab/Oireachtas TV

O’Brien noted that he received a report from the Central Remedial Clinic’s interim administrator John Cregan on the body’s finances two weeks ago but would not discuss it today, saying that the committee would likely receive the document early next week.

In December, the PAC found out that the CRC was supplementing salaries to the tune of €280,000 a year which applied to five members of staff – the CEO, clients service manager, the administrator, the manager of HR and the manager of IT.

Review letter

O’Brien admitted that the language used in letters sent to people whose discretionary card was under review may have led to a “misunderstanding” where they thought they were being asked if they or their child still had a lifelong condition.

He said that the reviews, which are currently suspended, intended to establish the “whole picture” of a person’s health.

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“We’re not seeking to add to their distress in any way,” he added.


The committee was informed that the HSE’s budget overspend this year could be as high as €500 million.

O’Brien said that the body’s net expenditure fell by €931 million, or 6.8%, from 2009-2012. A further reduction in 2013 brought the total five-year reduction to €1.06 million, or 7.8%.

He noted that despite a cumultative reduction in expenditure in acute hospitals of €515 million from 2009-2013, combined inpatient, day case and births activity increased by around 15% and emergency department presentations were up by about 6%.

In 2013 there was a deficit of €71 million in relation to areas such as medical cards and GP fees.


In a heated exchange, McGuinness accused McLoughlin of attempting to “stonewall” him.

When McLoughlin said he was “not in a position to answer” whether or not he thought the HSE’s budget was sufficient, the Fianna Fáil TD replied: “You are but you won’t answer it … I’m not surprised that you won’t answer it.”

Screenshot 2014-06-12 at 12.05.48 PM Dr Ambrose McLoughlin Source: Screengrab/Oireachtas TV

McLoughlin reiterated that he couldn’t comment, stating: “As a civil servant I’m obliged to carry out the decision of the government and the [health] minister.”

I reject absolutely and completely that I have acted improperly.

He added that the HSE was “squeezed to the bone” and had lost about €3 billion in funding and 3,000 staff since 2008.

McGuinness said he understood this fact. However, he stated that the HSE’s mishandling of the medical card issue “has led me to believe you’re not fit for purpose”.

“It is shocking what’s gone on, it’s not a political point – that’s for the house in there. This is an administration point,” he said.

Originally published: 12.48pm

Related: HSE boss: We never asked parents to prove children still had lifelong conditions

Read: 7 things we learned from the CRC’s grilling by the PAC 

Related: St Vincent’s Hospital CEO paid €136.5k on top of HSE salary

Read: Number of discretionary medical cards falls by over 16,000

About the author:

Órla Ryan

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