Some hospitals have been making substantial extra payments to consultants without HSE approval, it has been confirmed.

The practice has emerged as part of the HSE's current examination of 'business cases' made by health agencies, including many hosptials, to continue 'top-up' payments to some senior staff.

The Irish Times has reported that the HSE has rejected a considerable number of the 200 business cases made by these agncies, which include hospitals, to retain top-up paymehnts.

It has also emerged that the HSE, in its examination of extra payments, discovered that a number of clinical director positions held by consultants in some hospitals and agencies were 'unapproved'. These positions carry with them payment of allowances on top of basi pay of around €40,000 a year.

In letters sent yesterday, the HSE has told voluntary hospitals and agencies where business cases were rejected, they should stop making additional payments from the middle of next month.

The HSE has now confirmed that there are a number of clinical director posts across the system that are not approved posts.

Some consultants still earning over 200k