John Bannon
A shameful practice
I have just read Kenneth Roy’s article on the pay of executive members on NHS boards (SR 236). A very interesting article indeed and in all my years in the NHS I could never understand why, when we had NHS trusts, the medical director, who reports to the chief executive, was on a higher salary than the NHS trust chief executive and yet neither the medical director nor the nursing director had line management responsibility for any staff members apart from their own administrative staff.
With NHS boards, the salaries paid to directors of public health are shocking and again they only have line management responsibility for their own administrative staff and a few advisors and yet are paid more than the chief executive. In Glasgow, Robert Calderwood has responsibility for a budget of over £5 billion and a staff of almost 50,000. How can there possibly be any justification for paying a director of public health more than the person who is the accountable officer, namely the chief executive?
Has anyone ever seen a job description for a medical director or director of public health? Can any non-executive director tell you what the role and remit is of a director of public health or medical director? It is absolutely disgraceful for such posts to receive salaries greater than that of the chief executive with whom the buck stops – a very shameful practice indeed and one which ought to stop. What also shocks me is that some such individuals actually receive a great deal more than the cabinet secretary who has responsibility for the NHS or, indeed, a great deal more than the prime minister. Someone really ought to take a closer look at salaries in the Scottish NHS as people are being paid a salary which the majority of people can only dream of.
When you look at the renumeration of some non-executive directors you can see we now have two types of non-executives: those who receive the basic £8,000 and others who receive special responsibility allowances with some receiving an additional £14,000. Do the latter actually do more than some of the non-executives receiving the bare minimum? I believe not.
The time has now come for a short-life working group to look at the salaries and renumeration of all board members and ensure that the public is receiving value for money. Why is there a difference in the role of someone serving as a non-executive director receiving £8,000 and yet their English counterpart now receives £13,000 – why the difference? Perhaps someone, somewhere, can enlighten us and justify why the person running the country or the cabinet secretary for health receives a great deal less than a director of public health whose job is to do…oh well I don’t know, but perhaps one of the 14 in Scotland can enlighten us.
John Bannon is a former member of Greater Glasgow and Clyde
Health Board
Anonymous
Confessions of a middle man
We are right to be concerned about the plethora of middle men used by health boards and many other government-funded organisations, but this is not a new phenomenon.
Thirteen years ago as a country GP I was alarmed and disgusted by the change being imposed on the public by new arrangements for out of hours cover. The result of my public opposition was that I could not continue in my practice, and in order to ‘help’ my decision, I was made an offer which, with a young family, I could barely refuse. I was asked to use my 25 years’ experience and my business degree to provide ‘consultant’ services to the local health board at consultancy fees. I had previously (with my colleagues) done exactly the same for nothing.
Now I was given generous expenses and a handsome daily fee. I said nothing I had not said previously, and I am sure I changed nothing. After three months I had earned as much as I had earned as a GP in the previous 12 and I had an increasing feeling of nausea and guilt as front line services continued to be under-funded and there was mushrooming of meaningless appointments. When a ‘consultant manual hygiene adviser’ (hand washing guru) was appointed at more than a senior sister or district nurse, I regained my moral compass and left to assist a troubled children’s charity through a period of change. A rather more useful and rewarding experience.
Later in my career I was, with a small group of dedicated individuals, on a regional ‘board’ of a large public-funded body and received a small honorarium to feed back local views and professional expertise to the management. I think it was no boast to claim that we provided thousands of pounds of expert advice and saved our colleagues from making expensive mistakes. We had a good relationship with management and staff and I believe that we returned benefits many times greater than the cost. Often we just provided a route for the staff to use their skills and experience to improve existing activities. Needless to say the organisation has now axed these groups as part of a cost-saving exercise, and replaced us with a more expensive group of paid consultants who produce reports on various topics.
What is my lesson from these two experiences?
It is a simple but fundamental truth that in well-run organisations, as I believe the NHS and many of the publicly funded bodies fundamentally are, their staff are their greatest asset. The skills and experience of their existing staff can identify problems and suggest improvements to streamline activities. All they need is a willing management and a way to feed staff views to those that make decisions. Many years ago most workplaces had a suggestion box, now the staff just murmur their discontent around the water cooler or on social websites.
No external consultant can have the depth or breadth of experience to recognise the improvements that existing staff, from cleaners to chief executive, recognise every day. What we need is to identify and support these ‘intrapreneurs’ or people with common sense as they should be called. If we use them wisely we could improve morale, benefit services and control cost. There have been a few private organisations that have tried this approach with great success, but imagine the revolution there would be if it were introduced to Scotland’s public services. Interestingly I have not seen anything similar in any political manifesto.
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The Library
Recent articles
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16.04.10
Issue no 237
We are now
living in a
foreign land
Kenneth Roy
on the significance for
Scots of the first of the
leaders’ debates
[click here]
Confessions of a middle man
Reactions to SR editorials
on the NHS in Scotland: the
salaries being paid, the
consultants being hired
[click here]
A police suspect
at 83
Barbara Millar
on the remarkable life
of Libby Wilson
[click here]
Tedious
and Brief
The election campaign
in
100 words a day
every day
[click here]
Cheated and abandoned
Tessa Ransford
An indictment
of
broadcasting
in Scotland
[click here]
From Thursday’s edition:
Bob and Rose
Our Old Tory/Old Labour election diaries
[click here]
for R D Kernohan
[click here]
for Rose Galt