The billion Euro man

The man whose signature has approved the payment of billions of euro in the Irish health services over the last 43 years has put away his pen, shut down his computer and, in his own words, changed gears and moved on to a new life, writes Maureen Browne.

Paddy Burke
Paddy Burke

But Paddy Burke, who retired in September as HSE Asst. National Director in charge of the Primary Care Reimbursement Service (PCRS) takes with him the forensic analysis which has been his trademark over all these years, which he said were “busy, interesting, pressured” and have “gone in a flash.”

A native of Banagher, Co. Offaly, Paddy Burke joined the Central Pricing Bureau in 1973 when he was 17. The Bureau had been established as an adjunct of the Department of Health to deal with a number of pricing processes as part of the establishment of the Health Boards under the 1970 Health Act, and subsequently morphed into the General Medical Services Payments Board.

The GMS Payments Board was set up as a statutory board to facilitate the delivery of many primary care services which were delivered through GPs and pharmacists. It paid doctors and pharmacists participating in the medical card scheme and was in effect the first shared services in the health system.

“We pay out more than €9 million every day to the 7,000 contracted GPs, Pharmacists and Dentists, with very few problems.

The Health Board CEOs saw the opportunity for the GMS Payments Board to carry out further work in the area of long term illness and drugs cost subsidisation and the Board of Directors, which for about 20 years was chaired by Donal O’Shea, CEO of the NWHB, the NEHB and the ERHA, effectively ran this national operation. When the HSE was established, the GMS Payments Board was collapsed into it in 2005 and the PCRS established.

Originally the GMS Payments Board was in Phibsboro Tower in Dublin’s northside. Data coming in from doctors and pharmacists was captured onto punch cards and as time passed on to big 8” floppy discs, which were processed by the Department of Finance data processing bureau in Kilmainham. In 1993 the GMS established its own computer systems, which are connected directly to GPs and Pharmacists.

“The PCRS now spends about €2.5 billion annually and has one of the biggest and one of the best IT systems in the health services and probably in the Irish public service. We process about 80 million transactions a year, on a scale similar to the Revenue Commissioners and the Department of Social Protection.”

There were many changes over the years. In 1989, the GPs moved from a fee per item method of payment for medical card holders to a capitation payment, and in the late ‘90s HeBE was established to facilitate the Health Boards working in unison, and in 2005 the PCRS was established as a part of the HSE.

In relation to medical cards, in 2013 we dealt with about 8 million pieces of correspondence.

“I spent a lot of years listening to the many problems with the medical card system. The fact that it was delivered through 100 areas led to inequality with people on hardship grounds, some got it faster than others. In 2003, every CEO of every Health Board and the GMS Payments Board were dragged into the PAC to answer criticisms of waste and duplication of medical cards in the system – it was alleged that duplicates cost between €5 – €10 million per annum. This waste has now been dealt with and the system has been centralised with a strong local dimension and additional efficiencies and savings have been achieved. For example, five years ago the processing of medical cards cost €14 million per annum now it is €4 million, so year on year you have an additional €10 million saving. More than ninety per cent of medical card applications are dealt with within 15 working days. There are some intractable cases which take longer but the rules must be applied.

“We pay out more than €9 million every day to the 7,000 contracted GPs, Pharmacists and Dentists, with very few problems, and over the 45 years since the central payments service was established we have never missed a payment deadline”.

Paddy Burke believes that some media coverage of these affairs lacks balance. “For example, in relation to medical cards, in 2013 we dealt with about 8 million pieces of correspondence – about 4.7 million being received and the balance being sent out. With that volume, it is not really surprising if some pieces of information are misfiled, although of course they should not be. But it is wrong to take 200 cases and base the organisation’s reputation on these. We have to have openness and accountability in the system but it has to be in context. It is good to see there is now a proper dispute based resolution linked into the under 6s contract, which is a very good thing.

“Between 2009 and 2015, the HSE reduced expenditure under the primary care schemes by more than €3.6 billion. This is a billion euro out of the base year by year. We were told we would have to save €113 million in the medical card scheme and the perception seemed to be that we in the PCRS were the policy deciders, whereas we simply apply the policy and the rules.

“The GMS contract is there since 1989 and as the recession hit, more and more people became eligible for medical cards, which increased from 1.4 million to 1.9 million eligible persons over this period. In effect, we added in half a million more people with fewer public servants on the ground, so we should look at the phenomenal amount of service provided by dedicated public servants.”

Paddy Burke enjoyed his time in the health services. “I started in operations, and then was in charge of finance and then head of Internal Audit in the GMS and qualified as an Internal Auditor. I started straight from secondary school and when the Payments Board decided to move from the Department of Finance Bureau and build its own computer systems I completed a degree in Computer Applications, a Masters in Project Management and a postgraduate in Corporate Governance. The health services provided me with a very good education. I was busy and interested and – like most of my colleagues – under pressure and the time went in a flash.”

He and his wife, Noreen, who is an artist, have long been interested in antiques and curios. “We now plan to turn it into a glorified hobby, which will keep us occupied, with less serious decisions in a light hearted environment.”