Holles St say they are ‘not accountable’ to the HSE. So how could we let them run the new NMH?

WHEN Dr Rhona Mahony was chosen as Master of Holles Street National Maternity Hospital, her appointment was universally welcomed, including by this newspaper. It seemed that, as the hospital’s first female Master, she had eviscerated the glass ceiling in this peculiarly maledominated world.

Dr Mahony was also unusually publicity-friendly compared to many of her peers and predecessors. She gave media interviews in which she spoke eloquently about everything from the challenges of her role to her love of fashion.

In 2013, however, a HSE audit said Dr Mahony had received an unauthorised salary top-up of €40,000, in apparent breach of public sector pay policy. This money, the HSE said, was on top of the publicly funded salary of €238,000 she already received in her role as Master.

Moreover, Dr Mahony, like almost every senior obstetrician, also treats large numbers of private patients – each paying a consultant fee of between €3,500 and €5,000. Top consultants are estimated to earn more than half a million euro a year in fees from private patients. While Dr Mahony’s spokesman last night declined to say what she earns from private practice, she nevertheless hardly seemed to need an extra €40,000 salary for her work as Master.

Serious questions were asked, therefore, about where Dr Mahony’s additional €40,000 came from, and whether it was in line with public sector pay policy.

Of course, she was far from the only hospital master or chief said to be getting a top-up. The others, by and large, took on board the HSE findings and made a business case for why the extra salary was justified: in almost every case, the HSE accepted their arguments.

RATHER than accept the HSE findings, however, Dr Mahony went on the attack. Armed with the services of an expensive Dublin PR firm, she furiously denied the HSE’s findings – even though these were based on the evidence supplied by Holles Street. The PR company issued a carefully worded statement which appeared to suggest that the money was simply the fees she got from seeing private patients, although, as we have seen, €40,000 is in reality just a fraction of this income. In addition, Dr Mahony attempted to portray herself as the victim, claiming – without any supporting evidence – to have been ‘vilified’.

And there the matter seemed to end. For almost four years, little more was heard of the top-ups. But it was far from the last controversy which would surround Dr Mahony.

Earlier this year, she became embroiled in an extraordinary public row over the proposed new National Maternity Hospital, which is to be built adjacent to St Vincent’s Hospital in Dublin. Dr Mahony accused the chairman of the Institute of Obstetrics and Gynaecology, Dr Peter Boylan, of making untrue claims about the initial plans – which would have involved handing the €500million hospital over to the Sisters of Charity.

Quite aside from the aspersions being cast on such an eminent consultant, Dr Boylan is her own brother-in-law – yet Dr Mahony was not afraid to question his integrity on the public airwaves.

Eventually, Dr Boylan was effectively forced to resign from the board of Holles Street, but his public stand did result in the nuns agreeing to relinquish control of the new hospital.

Nevertheless, under current plans the hospital will still be run by a private company, which will be controlled by four senior figures from Holles Street and four senior figures from St Vincent’s. And it is, in large part, on this basis that the final findings of the audit into Holles Street make for such disconcerting reading.

It should be borne in mind that the audit process took more than two years, and involved extensive and lengthy correspondence between the HSE’s Internal Audit section and Holles Street, of which Dr Mahony, as Master, is the CEO.

There was also extensive correspondence between the auditor and Dr Mahony herself.

The broad sweep of the audit findings can be summarised as follows:

1) The payment of €40,000 to Dr Mahony in 2012 was not, as she has repeatedly claimed, just the transfer to her of income which had been generated through her private work at the Semi-Private Clinic adjacent to the hospital. Multiple pieces of documentary evidence showed that the payment was referred to by all concerned as Dr Mahony’s ‘salary’.

2) On this basis, the audit found that the payment was not compliant with public sector pay policy.

3) The audit found that the €40,000 was originally paid to Dr Mahony out of a Holles Street bank account, ie. with taxpayers’ money. This money was not repaid by the Semi-Private Clinic until two years later – and only after the auditor had started asking questions about it.

4) No standard invoicing documentation to support this €40,000 payment has ever been provided, the audit said – eg. a written authorisation for the money to be paid out. (Appropriate taxes were paid on it, however.)

5) The bank account used to make the payment was not a regular payroll account, the audit concluded, despite Dr Mahony’s claims to the contrary. The use of this bank account ‘lacks transparency and openness’, it found.

6) The scope of the HSE probe was limited, the audit concluded, in part because of ‘restricted access to documentation, the provision of incomplete/partial documentation and the non-provision of documentation by NMH’.

7) The audit also found that there is a ‘concerning’ relationship between the hospital – run by Dr Mahony – and the SemiPrivate Clinic, which is owned and run by senior Holles Street staff, also including Dr Mahony. It says the ‘undocumented arrangement’ between the two bodies ‘highlights significant potential conflicts of interest’. This relationship, it says, ‘leads to a situation whereby the best interests of the State-funded entity are not achieved due to the competing interests of a private entity owned by senior NMH staff’.

8) The audit says that Holles Street has still not explained in detail the origin of top-up payments to three other staff members, and that these payments are also not compliant with public sector pay policy.

Now, of course, it must be noted that Dr Mahony and Holles Street reject almost every single one of these audit conclusions. They insist they provided ample documentation, and deny they didn’t co-operate fully; they say the auditor is wrong about both the purpose of the €40,000 payment, and the nature of what it represents; they insist they are not in breach of public sector pay policy, and they say the auditor simply fails to understand the very nature of a voluntary hospital. Perhaps most extraordinarily of all, they assert that Holles Street ‘is not accountable to the HSE’.

Certainly, a reading of the report would see that the auditor has listed in detail the multiple occasions on which both Dr Mahony and the hospital declined or were unable to provide specific documents, which would have cleared up any possible misunderstandings. In one letter, Dr Mahony flatly says that ‘it is not appropriate’ to provide the documents requested – even though, in an earlier meeting with the head of the HSE, she is recorded as having explicitly pledged to provide the documents necessary to prove her claims.

It should also be noted that, despite her many protestations, Dr Mahony herself refused to meet the auditor ahead of the report’s publication to try and iron out any possible misunderstandings. Frankly, if Dr Mahony is going to insist that the audit is wrong, it is up to her to provide the evidence which proves her arguments. If she cannot or will not do so, it is hard to see how she can complain about the audit findings.

ALL of this is concerning enough, given that Dr Mahony is in charge of running our country’s biggest maternity hospital, an entity which receives more than €50million a year from taxpayers. We have to know that the CEO of such an organisation understands that, as soon as you take a cent from taxpayers – never mind €50million a year – you ARE accountable for everything you do. After all, if she and her fellow staff do not wish to be accountable to taxpayers, they are perfectly entitled to set up their own private maternity hospital, where they can run things how they wish.

All of this is even more concerning, however, given the role that senior Holles Street staff are due to have in running the new NMH – built by taxpayers but owned by a private company. There would not be a single taxpayer representative on the board of this new hospital.

Given what we have seen in this audit, the question has to be asked: if Dr Mahony and her colleagues were given management roles in this new hospital, would they still believe they are ‘not accountable to the HSE’? Would they be prepared to hand over documents requested by auditors? Would they take the steps required to remove even the possibility of a conflict of interest between their work and the operations of any private medical businesses they also run?

Sadly, on the evidence to date, the simple answer has to be no. Holles Street have declared themselves resistant to the notion of full accountability to taxpayers: how can we allow the State to gift them a brand-new, publicly funded hospital to run as they see fit? So unless she can show that she is now and will always be ‘accountable to the HSE’, it is clear Dr Mahony – for all her talents – cannot be given a management role in the new, publicly funded NMH.