A financial regulator has revealed that the NHS is paying bosses on temporary contracts as much as £480,000 a year. On 7 December, The Times [paywall] and The Sun reported this as further evidence of a failing health service. But the revelations clearly point to another conclusion. And they should lead to stronger scrutiny of the effects privatisation has on public services.
Jim Mackey, chief executive of NHS Improvement, sent a letter to hospital leaders. Seen by The Times [paywall], it contained several key revelations. The disclosures focused mainly on staff hired through professional service companies. These act as a kind of agency, placing executives into senior positions on a temporary basis. The letter stated that:
- Hospital finance directors were paid as much as £1,800 a day, twice as much as permanent staff in the same position.
- Interim medical directors were paid £2,000 a day, or £480,000 a year. Again, twice as much as the permanent salary.
- Stand-in chief executives received £408,000 per year.
- Temporary nursing directors got £264,000.
there is not enough evidence of need – or indeed that the quality of leadership being ‘purchased’ is of sufficient quality – to justify such high pay rates.
Cause and effect
Right-wing newspapers have sought to portray the scandal as evidence of public sector wastefulness, but there are other forces at work. Previous revelations in 2015 showed that Tim Bolot earned nearly £1m a year, as interim finance director of the failing Medway Foundation Trust. This forms part of a broader pattern.
Public service privatisation, be it in education, prisons, or railways, brings with it a deterioration of service. Often, this is combined with pay increases for the most senior positions, even while cutbacks are made to provision. This pattern is expected within a model that holds maximisation of profit for shareholders as its sole aim. The banking industry is the greatest example of this.
As healthcare is slowly privatised by stealth, with chunks of its management turned over to private companies, this same process can be seen in the NHS. It is not (as The Times, The Sun and The Telegraph claim) an indictment of public ownership. Quite the opposite. In a fully nationalised, well-funded, well-resourced health service, this would be far less likely to happen.
While profit creation and the law of the marketplace may be appropriate for some industries, they are wholly destructive in others. The real conclusion looks stark.
Privatisation does not fix public services, it appears to break them.
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