NHS management

The NHS Chief Executive for England says as a commentator might that she would like the government to settle the  nurses and doctors pay dispute. Many of us would like to see that happen, as it will take a happier workforce to deliver the targets to get waiting lists down , treatments and operations up.  A backbench MP can say that, a member of the public can urge that, a journalist can write articles about it. I find it most odd that the CEO says it. She after all hires and fires staff members, settles pay and job gradings, supervises promotions and training, and directs staff to the places where they can do most good to deliver the services  the NHS needs to look after  the public well.

To suggest that there is a simple row between medics and Ministers over how large a percentage increase in pay there should be leaves open the question of what is the CEO’s view of how much such a rise should be? Surely she and her advisers know what the jobs market tells them about pay levels, and her daily contact with medics should give her insight into what they want by way of pay and conditions to end their strikes. She also knows what increase she has agreed for her budget this year and must  have a view on what is affordable. Management is usually about making difficult decisions about how many people to hire, how much to pay them, how to deploy them and how to energise them to raise productivity. With over 400 senior managers on six figure salaries there are people who can help her with these decisions.

If the CEO is working well with Ministers then you would expect her to be influential over helping set a pay offer. This advice would be given privately and she would either win the argument or accept the Ministers judgement having put her case. This would then be a united NHS management offer, bringing together both politicians and senior managers. More importantly many of the demands of the medics in the public version of the pay negotiations we have all heard are about non pay issues. They want better work rotas, more support from other staff, better conditions and the right supplies and equipment. These are all issues that fall to the managers more than the Ministers to resolve, working within budgets and signing contracts with external suppliers.

Ministers rightly have to take the overall responsibility for what happens and what is achieved. They need to work with senior managers closely. I hope the managers will find a way to influence and then support Ministerial policy, which tends rightly to concentrate on overall aims and targets. Real and cash health spending have shot up since 2019. The issue is what are patients getting for it, as well as why cannot all that money buy more contentment with jobs and remuneration packages?  £233 bn for public sector UK health is a lot of money which needs to buy more happiness.


  1. Mark B
    July 4, 2023

    Good morning.

    The NHS is just a political football. Trouble is, no matter which way the government plays it it is going to score an own goal.

    1. Lynn Atkinson
      July 4, 2023

      They set up the rules of the game. If they are in a no-win situation we have to wonder at their incompetence! Obviously in view of that as much of the running of the country needs to be removed from Government.

    2. Ian+wragg
      July 4, 2023

      At the ahead of 77, I have just suffered my first real illness.
      I requested a doctors home visit and was treated as some sort of crank.
      I was told by the surgery and 111 to go to A&E despite being usable to leave the vircinity of the toilet for more than a few minutes.
      All I can say is if your white working class over50 and become ill, be afraid, very afraid. The NHS isn’t there for you

      1. Mark B
        July 4, 2023

        Sorry to hear that mate. Take care.

      2. Mickey Taking
        July 4, 2023

        welcome to the shock that NHS doesn’t do home visits – day time at least. Some surgeries pay for out of hours support – well they are rather well paid, aren’t they?
        Belonging to a large practice in Sir John’s constituency, we have put up with this even prior to the merge and move to ‘new’ premises which are a ghost town now – lots of empty consulting rooms..

        1. Berkshire Alan
          July 4, 2023

          M T
          Know exactly the practice you are talking about, yes it would seem it has almost been impossible to get an appointment for the last number of years, they have used the usual system of having to ring at 8.00am and wait on hold for an hour to get through, only to be told no appointments, ring back again in the afternoon, or again the next morning, only to go through the same ritual again.
          If you are lucky you may get a call back from the Doctor, but at their convenience, sometime during the day (no time slot given) so if you happen to be at work or on public transport, you will need to share all of your problems with a crowd of strangers.
          A new system has been promised, but not aware if it is up and running yet.
          Agree the sugary and waiting rooms always appear to be empty, as can be seen when calling in at the pharmacy, which is in the same building.

      3. iain gill
        July 4, 2023

        dont be in agony and need morphine, cos thats not urgent enough to do anything but wait until the next day. we wouldnt leave dogs in that much pain, but the NHS does. its rotten to its core.

      4. Lester_Cynic
        July 4, 2023


        I’m so sorry to hear that, I’m also concerned about the situation and I’ve looked into the possibility of getting a private GP appointment, apparently Bupa can get you to see a private doctor even if you aren’t a member… usually within a day, it’s very expensive @ £79 for 15 minutes but that might be something to bear in mind for future reference
        But given your condition that’s obviously not an option for you now

        I hope that you manage to get a speedy resolution

      5. Shirley+M
        July 4, 2023

        Ian, become potentially terminally ill and you will be amazed how hard certain sections of the NHS work to avoid giving you any treatment at all. Lies and deceit apply in the NHS too. I will say that recently the emergency services have given me first class treatment but then learn that our local (barely competent) pharmacy is stopping delivery of prescriptions so there will be dozens of elderly people driving/bussing it to pharmacies instead of one van driver catering for almost all.

        1. Mark
          July 4, 2023

          On Friday I go to the funeral of a long time friend: I was best man at the wedding. She had suffered from MS for over 40 years. But when she was diagnosed with cancer the NHS did not want to know.

      6. John Hatfield
        July 4, 2023

        And I guess that at 77 (I’m older than that) medical insurance is simply too expensive. I suppose if you are well off you can always pay for a visit on a one-off basis. Even getting an appointment at the NHS surgery involves a long wait.

      7. BOF
        July 4, 2023

        Sorry to hear of your illness. I was in a bad place aged 77 with a very serious neurological condition. I arranged a private consultation at great cost but a wonderful doctor got me into hospital, NHS, where I was for 19 months. Keep pushing until you are under the right people.

    3. Cuibono
      July 4, 2023

      Oh I don’t know.
      They could try providing us with a HEALTH SERVICE as opposed to a govt. propaganda nudge machine?
      Think of all the £££££s they’ve extracted from the public since 1948.
      And created in the process a nation of terrified hypochondriacs.

      1. iain gill
        July 4, 2023

        the NHS spend on twitter adverts must be massive

        1. glen cullen
          July 4, 2023

          but its not there money

    4. formula57
      July 4, 2023

      The NHS accounts for about 40 per cent. of government spending so the day is coming when the Prime Minister (not Sunak, but his successor but three or four) will be obliged to tell the British people they can no longer afford the NHS.

      (Per the King’s Fund 2022/23 spending estimate is £180.2 billion and per Main Estimates Government spending plans (09563) Resource DEL (also referred to as ‘day-to-day spending’) for that same period is £456 billion.)

    5. Lifelogic
      July 4, 2023

      Well it is a political football but it also kills nearly all competition as rather hard for businesses to compete with ‘free’ at the point of use.

      They take your money off you in vast taxation level (still increasing hugely due to Sunak/Bailey caused inflation eating your allowances and salary away) and deliver what they think you need if and when feel like it. THEY have your cash already so you cannot go elsewhere so just take it or leave it and shut up.

      We might treat you eventually if you do not die first.

    6. IanT
      July 4, 2023

      We had Banks that were too big to fail but we also have an NHS that is seemingly too big to manage.

      In a large commerical Corporate organisation, the CEO is ultimately responsible for the well being of Customers, Staff and Shareholders. There was much publicity given recently to the 15 yeart staffing plan announced by Mr Sunak. Personally, I was amazed that this level of planning (and budgeting) had not been previously undertaken. Really? How do you run an organisation of 1.2M people without one?

      My experience of the NHS was that the top-level management operated at a ‘Theory’ level, leaving most of the practical managment (and decisions) to Trust managment. If there were clear performance metrics across Trusts, it wasn’t too obvious back then (although this may have changed). In my view the CEO of the NHS should set performance targets at Trust level (rather than an overall ‘National’ one) and have the power to change senior Trust managment when required. For one thing, this might stop ineffective senior managers departing a failing Trust and popping up elsewhere a few weeks later. The NHS is in reality a large Corporation with 150+ Divisions, many roughly equivalent (in manpower and budget) to some of our larger private companies. Maybe we should be recruiting (to the head of this business) someone with experience of managing large corporations rather than simply being in ‘healthcare’.

  2. Lynn Atkinson
    July 4, 2023

    The Ministers have failed by appointing a useless CEO. She ticked boxes, had a nice smile and broke a ‘glass ceiling’, but views herself as an employee – ‘a victim’ subject to the decisions of her Bosses in Whitehall who are themselves ‘employees’.

    I suggest the ‘pay grade’ of the CEO is way above her ‘delivery grade’. But then that can be said for all of them.

    I suggest it’s time entrepreneurs were encouraged to invest in health care delivery (guaranteed not to be nationalised at any point), funded by an insurance scheme administered by Ministers, who would ‘auction’ tranches of the country as a whole so no British person was excluded from healthcare free at the point of delivery. All NI funding would go to the insurance which would also cover those who could not pay. And the assessors would oversee the medical delivery the Doctors advised – all interested parties would need the best treatment because they make money out of healthy people – or at least ‘not-sick’ people’.

    Big Pharma must be constitutionally excluded from this process.

    I told a Dr friend of mine that all foreign Doctors and nurses should go back to their own countries which needed them. She nearly fell over and said it could not be done – then I said ‘all foreign patients would go too’. That stopped her she repeated my statement while she rifled through her patients working out the percentage of foreigners. ‘That would work’.

    Seems we would have an excess of medical care available for British people, they pay already for that service and deserve to get it. Why should British people pay for foreign doctors to come here to treat their own native patients in British hospitals at our cost?

    It’s MAD and unsustainable.

  3. Peter Wood
    July 4, 2023

    Perhaps the question should be: who is responsible for resolving pay raises in the NHS?

    Don’t blame the NHS CEO when her boss, the health minister, wants the personal gratification of appearing on TV so often, thinking he’s so important and the only one who should be heard. Of course she’s going to step out the way.

    PCP– Not fit for purpose…

    1. IanT
      July 4, 2023

      But I do blame her Peter. She’s the one who should be running this organisation.

      My wife was taken ill recently and I’m very pleased to report that the paramedics were with us within 20 mnutes and after several days (in RBH) she was diagnosed and operated on very quickly. She’s now home and recovering well, for which I am very grateful. As far as I’m concerned, our local healthcare provision is very good but clearly this is not true everywhere else.
      I’m sorry but you can’t blame the Health Minister for variations in individula Trust performance. That has to be Senior NHS Management. I can tell you that the service provided in another (near-by) Trust is nothing like as good as ours. You only have to sit in a ward for a short while to see the differences (and I’ve done that in both). The NHS is like a giant franchise (a Health McDonalds?) and whilst they might all sport the same ‘brand’ – they don’t all offer the same service levels. Some Trusts are simply better managed than others and perhaps it’s time the senior management of the NHS started to take responsibility for this issues and fired poor performing Trust management.

      1. Peter Wood
        July 4, 2023

        Please note, I referred to pay raises, not service levels. Very pleased to hear your family is recovering as hoped.

        My point is, when your boss steps in to do your job, or a particular part of it, you can’t be blamed if it turns into a dog’s dinner.

        1. IanT
          July 5, 2023

          Well the ‘Minister’ is the one who takes most (if not all) of the flak over wage claims etc. Peter

          However, I can’t see how he/she can actually control the inner workings of an organisation that employs 1.2M staff that cost £66B in wages (FY 20/21) – an average cost of £55K per head. But how does he decide what is a reasonable ‘staffing’ level.
          In business, higher wages would be paid in return for higher productivity e.g. same wage bill spread over fewer staff. It seems to me that the Unions simply want more money for doing the same work but that doesn’t make any long term sense. Everyone has to work ‘smarter’ – which also means that the staff have to be managed ‘smarter’.
          The ‘Minister’ cannot do that – it has to be the NHS management that does it. I accept it’s a Catch 22 situation. You need money to invest in automation & equipment but very often there are simple things that can be done to improve productivity at little or no cost. Businesses have no choice in these matters, it’s improve or go bust. Where are the incentives for the NHS senior management to improve if they never get their feet held to the fire?

  4. turboterrier
    July 4, 2023

    Throwing yet more money at the NHS doesn’t guarantee eradicating the underlying staffing problems within.
    I have not not heard one senior executive officer talk about tackling the massive waste within the system to save money and help change working conditions.

  5. turboterrier
    July 4, 2023

    The time is rapidly approaching that honest questions have got to be asked regarding how much longer can the NHS survive in its present format because the costs are unsustainable.
    It is not is there a better way? It has to be there has got to be a better way.tu

    1. Lifelogic
      July 4, 2023

      Is there a worse way than the ‘free’ at the point of use communist NHS?

      1. Al
        July 5, 2023

        Free at the point of use would work better if the hospitals would remember to bill tourists’ travel insurance, rather than insisting that asking Americans, Canadians, Australians, etc. on holiday to pay for their care through the insurance they bought for that purpose is somehow racist (no matter the patients’ race).

        Or have a system to recover the reuseable medical equipment they give out… (e.g. Crutches should not be one-use implements.)

  6. Bloke
    July 4, 2023

    Maybe the NHS Chief Executive for England would like the Govt to do the whole of her job so that she could be paid for doing even more of nothing useful.

  7. Nigl
    July 4, 2023

    It is classic weak public sector management wanting to be liked and thinking that if she is not, because she is not agreeing with everything her staff wants, she cannot do her job.

    Plenty of research shows that actually people want management to take difficult decisions that instead of being liked, earns their respect. It’s tough but that’s why you get paid a lot.

    There is generally zero respect for management across the NHS and wider public sector.

    Being able to blame the government is an easy way to avoid responsibility and instead of standing up and pointing out what you have done, ie saying that the budget was agreed with her, now up to hear to allocate it, your weak ministers sit on their hands, in turn earning zero respect from us.

  8. Michelle
    July 4, 2023

    Cynical of how things are run now, I have to wonder how and why such a CEO gets to be a CEO.
    Ditto that for many of the managerial staff, of which there are too many.
    The latter seeming to be a common complaint from nurses themselves.
    A retired nurse recently explained to me the waste in training therefore money with the degree courses. The old way sorting out who was suited to nursing much earlier making things much more efficient. I think it would be a good idea for Ministers to listen to them, because it seems that even basic things such as hygiene (so important surely) are going to the wall, while cultural relevance seems far more important a topic. Is this why people catch all sorts of bugs in hospitals now that were unheard of before??
    All this is important to efficiency, quality and of course finances.

    As mentioned already the NHS is a political football, used to pull on the heart strings of the public. So, no sensible suggestions or truths will ever be acted on while it is just another left wing political monolith, and more money will disappear down the drain along with people’s health and lives.

    1. turboterrier
      July 4, 2023

      You are sòòooooo correct.
      My wife had replacement hip surgery.
      Days of being discharged had to return to A&E because of swelling. Very young foreign doctor with designer shoulder bag drew circles around her scare if redness spreads outside the line come back Next morning despite having nurses in to do the dressing all who said it was fine we called the GP end result quick drive to A&E. Told by reception you will have to wait no chair’s available house full. Managed to get a wheel chair and told the women to get the head of the section to get something sorted as the pain and swelling was increasing . Got put into a side ward and had the experience of two nurses no hands procedure and one dropping her notes on the floor picking them up and laying them on the bed a sister turned up no hand drill told me she would only converse with the patient.2 hours later consultant arrives the full month protect clothing and hands procedure.Told sister what meds were needed and left. Nearly another 2 hours I was leaving as a ward bed had been found and met the sister who with some alarm realised that the meds required hadn’t been administered. I told her that she was the only one in the room at the time so it was down to her and she ought to get her eyes tested as yet again she was handling my wife with no hand procedure dispite 7 posters in the room highlighting the importance of clean hands. On the ward was given the wrong meds and had a seizure. The hospital did nothing not even an apology.

  9. DOM
    July 4, 2023

    Tory MP deftly avoids criticising Neo-Marxist health unions whose actions are endangering the lives of patients, which of course is a criminal offence under the law.

    John knows full that NHS managers are powerless in the face of union hardliners stoking discontentment amongst naive NHS staff so why doesn’t he and his idiot party point to this fact and expose the unions who are at the heart of most of the public sector instability we are seeing?

    You can always rely on the post-Thatcher Tories to spout, conciliaTORY half hearted bollox on every issue. No wonder the Marxist unions control the public sector

    State employees compared to private sector employees enjoy PRIVILEGES beyond their wildest dreams

    John and his party have more in common with union leaders than they do with your average private sector manager or CEO

    1. turboterrier
      July 4, 2023

      Loads of discounts from many stores and outlets at the producing of their identity cards.

    2. rose
      July 5, 2023

      Post Thatcher we underwent the Blair revolution. I often wonder how she would have managed inheriting that.

  10. Nigl
    July 4, 2023

    On a related topic, back in the day I was asked to conduct an attitude survey in a large DHSS office by the senior team who realised morale, outputs, retention rates etc were very poor with a view to improving their management.

    The results were so bad showing they were considered weak, lacked respect etc, they usually are first time around but a good base to work up from, that they hid the results.

    They failed to understand that this would err make them look weak and confirm/compound reasons for lack of respect.

    They deserved everything they got. The staff deserved more.

    1. turboterrier
      July 4, 2023

      Had a similar experience working with combined assessment unit in Scotland.
      The provision survey started to highlight the problem. The Chief Medical Lead of the department went over her consultants head complained to the Directors and the project was binned. The consultant realised what and who the problem was tried to get independent data to prove his concensandremove her. With 4 months he left to work in England.

  11. Shirley+M
    July 4, 2023

    NHS managers refuse to manage the NHS to best effect. MP’s and Ministers refuse to govern the UK to best effect.

    What’s new?

    1. glen cullen
      July 4, 2023

      Manager don’t refuse …they’re just pushed aside by doctors

  12. Peter Gardner
    July 4, 2023

    SIr John is right to point to non-pay issues. The fact is that the NHS is a ghastly organisation to work in. Abraham Maslow researched motivational factors in the workplace extensively in the mid 20th century and found that pay is what he called a hygiene factor: low pay de-motivates people but above a certain amount higher pay does not motivate people. Far more important are factors such as job satisfaction. It is hard to know as an outsider at what level NHS pay sits. If the pay rise merely stops people throwing in the towel and going off to work elsewhere, as seems to be the case, higher pay is not going to improve morale. Better management would, even if pay is somewhat lower than the job merits. The CEO should be well tuned in to the reasons for low morale. She should also be well tuned in to why poor management is causing dissastisfaction and taking action to improve morale. Poor management impacts the medical staff more than any other NHS employees. Paying more to compensate for poor management simy means the tax payer forks out more for the same third rate health outcomes. If the CEO isn’t tuned in and acting to improve management and thence morale, a new manager is required.

    1. turboterrier
      July 4, 2023

      Peter Gardner
      After one iffy procedure I wrote to the CEO praising two of her people who went over and beyond. Six months later in the day clinic spoke to them and neither knew what I was talking about.
      So much for the Internal Market.

  13. PeteB
    July 4, 2023

    Mark, this is so true. It has given an easy target to beat the Tories whenever they are in power – generally on a crusade of “NHS short of funding”.

    Reality is that the UK health servioce funding per capita is pretty aligned to the rest of the developed world, yet outcomes are at the bottom of the league.

    The model is broken but nobody dare say it and certainly no politician has the strength to reform and restructure – or at least not in the direction required.

  14. Sakara Gold
    July 4, 2023

    Less than 40% of the 1.4 million NHS employees are doctors, nurses, consultants, specialists like radiographers etc or qualified lab people. The remainder – 60%+ – are employed in layer upon layer of administration. The NHS operates much like the civil service – office empires are built, the more people you have working for you the more important you must be.

    The function of the NHS is to provide jobs for women who wish to return to work after having children. Many are under the misapprehension that the NHS exists to heal the sick; nothing could be further from the truth. The NHS could lose 150,000 middle managers and nobody – let alone the patients – would notice

    1. Lifelogic
      July 4, 2023


    2. turboterrier
      July 4, 2023

      S G
      +++++ MANY

    3. Lynn Atkinson
      July 4, 2023

      Additionally huge amounts of cash are spent in the Accounting firms to ‘manage change’ I.e to manage. So any management is probably bought in!

  15. BOF
    July 4, 2023

    The Minister could discuss with the NHS CE the pointless diversity managers and their appointees. They contribute nothing to health care and interfere in the work of useful staff.

    Scrapping them would free considerable amounts of money for pay rises for nurses and doctors.

  16. Mickey Taking
    July 4, 2023

    Sunak’s first priority.
    It is aiming to halve inflation of 10.7% – which was the figure for the fourth quarter of 2022 (October to December).
    When the pledge was first made, many people expected this to happen anyway.
    However, inflation has stayed stubbornly high and was unchanged – at a rate of 8.7% – from April to May.
    Sunak’s second pledge to “grow the economy” will be met if the economy is bigger in the fourth quarter of 2023 than in the previous three months. not normally seen as a difficult pledge, because the UK’s economy is usually growing. The economy has got smaller in only four quarters in the past 10 years.
    But there has not been a lot of growth recently. In the last four quarters, GDP grew only 0.1% three times and shrunk 0.1% in the other quarter. The UK economy is still smaller than it was before the pandemic.
    Sunak’s third talks about debt falling, it almost always mean as a proportion of GDP.
    The idea is that debt is falling if it is growing more slowly than the economy.
    But that has not been happening recently. The latest figures show that debt is above 100% of GDP for the first time since 1961.
    Sunak’s fourth claims: “NHS waiting lists will fall and people will get the care they need more quickly.”
    His pledge only refers to waiting lists in England, because Scotland, Wales and Northern Ireland manage their own health systems. The overall number of patients waiting for treatment in England is still rising – from 7.33 million in March, to 7.42 million in April.
    Sunak has said that his plan to tackle small boat crossings is “starting to work”.
    However, the bulk of arrivals usually turn up in the summer months so we will not know until later in the year whether or not his plan is working.

    1. Mickey Taking
      July 4, 2023

      held back Sir John? Doesn’t fit well with the program?

      1. Mickey Taking
        July 4, 2023

        so will you now accept what you didn’t previously?
        A scorecard on our PM’s promises and progress made ought to be uppermost on most voters’ minds?

  17. Roy Grainger
    July 4, 2023

    One group of doctors are striking for a 35% increase. (They are still doing private work while “on strike” of course). It is interesting to look at their justifications for this absurd figure. One is that the threshold for higher rate tax hasn’t kept pace with inflation so they want a pay increase to pay the additional tax that results from that – effectively they want to be paid on the famous “netto” basis previously only demanded by one or two world class footballers in which no tax increase results in them having less money at the end of the day – they don’t want to contribute extra to the economy at all when taxes have to go up for all the rest of use. It is a very selfish position – maybe we should start by benchmarking their pay against equivalent doctors in the main EU countries and reducing it accordingly ?

    Actually part of the problem is the government, supported by the BMA, caps how many doctors can train in UK so of course that bids up salaries.

    Interesting fact – in many EU insurance-based health systems the government plays no part whatsoever in setting doctor’s pay – and of course their health outcomes are better than UK too.

  18. Donna
    July 4, 2023

    When it comes to saving the NHS, I think we’re all supposed to go outside, clap and bang pots and pans. That’s certainly what the Not-a-Conservative-Government encouraged us to do in 2020.

    Now the only option is to kneel and pray because neither the NHS CEO or the Government are capable of doing what is really necessary: scrapping it and starting again, with a complete reform of the funding model.

    We don’t have a National Health Service, free at the point of delivery. We’re paying for and operating an International Health Service (of sorts) free at the point of delivery to anyone who pitches up in the UK and has paid not a penny into the system.

    1. Shirley+M
      July 5, 2023

      + many Donna. Also, why do illegal migrants get a weekly doctors visit while the tax paying public rarely get to meet a GP. Cash cows are ignored at your peril!

  19. Sharon
    July 4, 2023

    Mark B says the NHS is a political football- he’s right! Unfortunately, because nursing and being a doctor is (or should be) a calling, the two will never mix well. Hence the staff are unhappy and leave. Then add into the mix all the very annoying wokeness and bureaucracy that most people don’t agree with… then add in the shear size of the NHS with all its bureaucratic offshoots. It’s a mess!

  20. Cuibono
    July 4, 2023

    Apparently the CEO of the NHS is accountable to Parliament for money spent.
    So what is going wrong?

  21. Lifelogic
    July 4, 2023

    Junior doctors start on circa £30k and often have about £10k of interest accruing on their 5 or 6 years of student debt. Even if they got a 35% increase they could still be left with a negative sum to live on after this interest, rent on a small room, tax, NI, prof. body fees, council tax, commuting costs, pension deductions, heat, light… are they expected not to eat?

    Are they expected to work 40+ hours a week in a high stress job and end up poorer at the end of the year than they started. Is it any wonder 50 leave the NHS within two years?

    1. Lifelogic
      July 4, 2023

      Meanwhile NHS diversity and net zero experts often on £100k plus.

    2. Lifelogic
      July 4, 2023

      50% leave that is.

    3. Roy Grainger
      July 4, 2023

      It’s not only the ones on 30k asking for 35%, it’s the ones on £130k too,

  22. Javelin
    July 4, 2023

    NHS is a cash cow for small businesses such as PPE suppliers, stationary, uniforms, recruitment. It’s the same with management jobs. An easy number for all those administrators that have been kicked out of the private sector by computerisation.

  23. Ian B
    July 4, 2023

    Good morning Sir John
    “She after all hires and fires staff members, settles pay and job gradings, supervises promotions and training, and directs staff to the places where they can do most good”
    This Conservative Government keeps wondering off, looking for personal self gratification by interfering and creating political motivated ‘virtual signals’ on things that they know nothing about. They could for a change get their head down and manage, create a robust and sustainable economy, but that would be doing real work.

    In NHS terms what ever happened to the concept of GP’s, where the money trail starts being the purchaser of services of the NHS? The Hospital trusts then had to deliver to earn.

    1. Ian B
      July 4, 2023

      @Ian B

      The thought that extremely high paid individuals at the head of departments, had a function of managing any department, be it the NHS, Education, the Treasury doesn’t exist. Just as those in this Conservative Government being the overall manager. At best the Health Minister should have called in the NHS Chief Executive for England and said you have your budget – sort it. There is a lot of waste in the NHS as elsewhere, why do the have departments to oversee ‘discrimination’ which are about pure politics?

  24. agricola
    July 4, 2023

    47% of NHS employees are none medical, a gross overload I would suggest. Between the minister of health and any hospital trust these none medical scribes are the most expensive and numerous burden the NHS carries. That many of them are diverse none jobs is all too apparent, get rid.
    Ask the management of Toyota to investigate the running of the NHS, a1947 concept left mostly unchanged until now 2023. Keep the civil service and any other worthies well away from any enquiry or commission. If they look around the World at national health care I feel sure they will find a much better example on which to model ours for the next fifty years. The criteria should be, what works best for the patient and medical staff.

  25. ChrisS
    July 4, 2023

    I watched the Amanda Prichard interview at Sunday’s 9am programme on the BBC and I have to say that Pritchard came over as condescending and complacent, I thought she was more like the head of a primary school that the boss of what is the UK’s biggest business. Evidently she has no experience of working anywhere outside of the NHS, so she is hardly going to bring anything new to the job. NHS management must have breathed a sign of relief when one of their own was appointed to lead the service. Her degree in modern History is hardly an appropriate qualification either! I was deeply unimpressed. The job should be held by a business leader from the private sector. ( And I don’t mean someone like the current boss of John Lewis ! )

    There has always been far too much political involvement in the NHS.
    In particular, Ministers should not be involved in negotiating pay. It is the equivalent of dragging in shareholders to negotiate with the unions.

    Nevertheless, Prichard is paid £265,000 plus an additional £74,000 in pension contributions to manage the service so she should budget for pay awards that she thinks are reasonable. If she were a CEO worthy of the job title, she should then submit her annual budget to ministers . If the government cannot afford to meet the cost for whatever reason, or she settles pay awards at a higher level than she has budgeted for, she should have to make savings elsewhere to keep within her budget. That’s her job.

    1. Lifelogic
      July 4, 2023

      Amanda Pritchard is hugely unimpressive. But then so were the last two that I recall. Rather like Andrew Bailey and Mark Carney who were also rather incompetent at the BoE.

  26. a-tracy
    July 4, 2023

    The public can’t really form a view on it because it is unclear what is happening.
    A twenty-one-year-old nurse from university starts on £28,407 without London weighting, shift allowances, weekend enhanced rates and other great perks and benefits. Most intelligent, working-class girls I know, if they have these facts and that with 2-4 years experience and their hard work, can earn £30,639 and £32,934 at the top of that band, would think that is an excellent salary, that’s without telling them the holidays, full sick pay, great pension etc.

    Now we are frequently told by LL that Doctors only start on £29,000; how is that right when a nurse, after only three years of training, gets nearly £29k? At what year of training does a Junior Doctor start getting paid £29k? Is it year 5 (after four years of undergrad), so we are expected to believe they only get £500 extra for that extra year’s training and all the additional responsibility they take on? What precisely does FY1 involve? Are there weeks off back in the classroom?

    We are asked to support us paying more taxes to sink into this organisation when the woman in charge isn’t managing it and justifying her pay decisions. I’ve had enough of it. Threatening customers with no treatment whilst still expecting us to pay for no service is getting beyond the pale now.

    1. Berkshire Alan
      July 4, 2023

      The Royal College of Nursing website shows the basic pay rate scales for nurses, but does not show the exceptional benefits of the pension scheme, or any extra rates for additional/specialist work etc etc.

  27. George Sheard
    July 4, 2023

    The trick in the NHS if you are senior position is to take early retirement and get a pension and a early retirement lump sum and then go back to the same job a couple of weeks latter. On a much higher pay than originally.
    That’s what I have seen happening

  28. Ian B
    July 4, 2023

    It says it all when members of the Conservative Party in Parliament, that’s MP’s that got voted in on the premise of get Brexit done – then refused that simple task. Hits the Media yesterday saying that it is now time to bring the UK back under the control of the unelected, unaccountable EU. Does that mean the Conservatives in Parliament don’t like thinking, don’t like responsibility and don’t like the idea of a proper democracy. Is that why we have had to endure all these fudges and punishment because this Parliament with a so-called Conservative Government needs the EU to guide them.
    Are Conservative MP’s are now brave enough to speak out and to champion rejoining the EU, because that is the lead they are getting from their Leadership?

  29. Original Richard
    July 4, 2023

    The NHS proves Robert Conquest’s second and third laws of politics and demonstrates to us how the whole country will look if it continues to move further left.

    Eventually diversity will completely replace meritocracy even throughout the clinical side.

    1. Original Richard
      July 4, 2023

      PS :

      The NHS’s problems stem directly from the clinical side losing control to the admin side.

      It needs to return to when consultants and matrons were in charge and nurses learnt the job earning money and gaining experience on the wards and not piling up debt for 3 years learning just theory on a university course.

  30. formula57
    July 4, 2023

    You do not then suspect as I do that she has conferred with Ministers where “…she would either win the argument or accept the Ministers judgement having put her case” but her advice did not prevail and yet she does not think Ministerial judgements are going to work?

  31. Berkshire Alan
    July 4, 2023

    Afraid this is what happens when politics and Ministers get involved, instead of dragging in the CEO to make the press statements.
    Likewise have we heard anything from the head of the so called pay review body who did all of the calculations, which were then sent to the Government for approval.
    Afraid its pass the buck time if you can, and for this sort of attitude the taxpayer pays thousands of them, £ hundreds of thousands a year.
    Afraid the whole of the pay, and the grading system in the NHS perhaps needs a complete rethink.

  32. Jude
    July 4, 2023

    Maybe she has discussed & advised Ministers of her expectation based on her knowledge. Possibly she has advised to pay way more than we can afford. As a CEO if the figure offered is below her proposal. Then she needs to find the extra by cutting waste & virtue signalling jobs. Otherwise the only other option is she is not CEO standard.

  33. MFD
    July 4, 2023

    This woman needs a review of what she considers her job to be – I think she is being payed too much for a lazy clerk!

  34. a-tracy
    July 4, 2023

    John, please just give us the facts. Which NHS trusts are failing the most on waiting times, who is in charge of them, why are they so bad in Manchester for example.

    1. hefner
      July 4, 2023

      telegraph.co.uk, 11/03./2023 ‘Ten NHS trusts responsible for nearly half of UK’s patient backlog’.
      bbc.co.uk, 13/04/2023 ‘NHS tracker: Find out about hospital waiting times in your are’.

      1. a-tracy
        July 5, 2023

        Yes, I found it thanks Hefner shortly after I typed my message, I forgot where I’d read it originally.

  35. oldwulf
    July 4, 2023

    I saw a comment on social media:

    “The NHS has first rate front line staff and a third rate bureaucracy.
    Politicians need to sort out the bureaucracy so that the vast amount of taxpayer money which the NHS receives, may be spent wisely.”

    Sounds about right.

  36. Gabe
    July 4, 2023

    BEN MARLOW in the Telegraph.

    “The electric car ‘revolution’ is a disaster before it’s begun
    Politicians are forcing electric cars on a public that doesn’t want them”.

    Indeed the government picking and subsidising “winners” yet again. Oh and keeping your old petrol car causes less CO2 than switching to new EV (causing one to be made) in nearly all cases. Should that (quite wrongly) concern you. The same applies to heat pumps, over the top insulation requirements and much else.

  37. Ed M
    July 4, 2023

    My mother has just come out of NHS hospital after 10 days of treatment / care for cancer. Her nursing care was AWESOME (I’ll never forget the hard-working, kind and sweet nurse, Theresa – but others like her, too. And remaining calm and good-natured whilst severely ill patients were groaning with pain, getting sick – and dying). The care she received from doctors was also awesome but a bit lower than that of the nurses.

    Our only complaints were with problems to do with logistics which was purely the fault of managers / the system / culture – where there is a lack of clear, strict hierarchy and accountability etc.

    But the nursing care itself was 9/10 (and the technology and treatment used to zap our mother’s cancer seemed awesome too but too early days to see the results of that yet.

    A big thank you the nurses and doctors of the NHS.

    1. Berkshire Alan
      July 4, 2023

      The front line staff in my experience have always been good, it is as you say the administration, management, and logistics that is absolutely dire

      1. Ed M
        July 4, 2023

        @Berkshire Alan,

        Well said.

        An excellent private doctor I know said – between the lines – the real problem with the NHS is due to negative cultural factors in our society in general. Factors such as being against hierarchy / a lack of accountability and so on.

        This ties in with what I was saying about the real problem with our country isn’t politics but the demise of traditional values such as: Family Values / Discipline / Men being men and women, women / Work Ethic / Patriotism etc.

        Which is why I keep going on why at next Tory Party, the number 1 question should be how do we spread healthy Conservative values into Education, the Arts & Media and so on. That Conservatism shouldn’t just be a political movement but a cultural movement in general.

        And then when people start taking responsibility for their lives, eating healthily, taking exercise, being properly productive at work, working on their relationships with family and neighbours, patriotism – and so on, taxes will PLUMMET. If everyone did their bit, you’d hardly have any taxes at all! Of course, it’s easy to fall into Utopianism. I’m aware at that. But at the moment we’re falling into Dystopianism. Dystopia is becoming more and more a reality. And politics, alone, isn’t nearly strong enough to tackle this. It requires the support too of the churches and those in Eduction, the Arts and Media with more healthy Conservative values and working together more with politicians in Parliament. Something like that.

  38. Bryan Harris
    July 4, 2023

    Well said.
    Where NHS management are not working with ministers to improve the NHS they should be released from their job as they would be inadequate for it.

    From personal experience, I concur that NHS staff at the sharp end are frustrated and tired of poor management decisions and actions. They deserve much better.

    The PMs plans for the NHS lacked any information on ‘Improvements’ – He needs to start with those at the top of the NHS, cut out the deadwood and allow better management techniques to filter down to the lower levels.
    Can we have any faith that this might happen?

  39. Peter
    July 4, 2023

    “ With over 400 senior managers on six figure salaries there are people who can help her with these decisions.”

    They are a large part of the problem.

    In earlier times I am led to believe that our NHS hospitals managed perfectly well under the leadership of people like Sir Lancelot Spratt and matron Hattie Jacques, both of whom offered frontline medical experience and common sense rather than bureaucracy.

  40. a-tracy
    July 4, 2023

    Real terms in 2022/23 prices – Planned spending for the Department of Health and Social Care in England is £180.2 billion in 2022/23. The majority of the Department’s spending (£152.6 billion in 2022/23) is passed to NHS England and NHS Improvement for spending on health services.8 Dec 2022. The Kings Fund.


    Monday 01 March 2021- The NHS is funded mainly from general taxation supplemented by National Insurance contributions (NICs). I wonder how much those held in high regard, like Germany, take in their equivalent ‘NI’ charge to business and clients. Do their charges stop at retirement age? Do they have a minimum earnings before the contribution of £12,570?

    The Kings Fund says how much is spent on the NHS from General taxation and claims less than 20% is from NI? But it doesn’t say how much is from International travel insurance, GHIC, EHIC etc. It isn’t for the NHS Staff to be generous with our money and claim they haven’t got enough and just want more from our pot without creating more for themselves.

    1. Berkshire Alan
      July 4, 2023

      To Sir John
      You did publish some time ago how much taxation income it took to run the NHS, from memory I think you said it was the entire income tax receipts, plus other tax reciepts, perhaps you could remind us again

      1. a-tracy
        July 5, 2023

        Alan, the increase in the NHS hasn’t just been the £350m on the side of the bus, it’s actually been £536.5m.

        Kings Fund https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

        Spending in 2016/17 = £124,700,000,000.00
        Spending in 2022/23 = £152,600,000,000.00

        Difference = £ 27,900,000,000.00

        Increase per week = £536,538,461.54

        See 3.4 The revenue and capital resource limits for NHS England

  41. Richard Jenkins
    July 4, 2023

    The NHS CEO is a product of the NHS management development scheme. The evidence is that the scheme does not produce people who know much about managing.

  42. Mickey Taking
    July 4, 2023

    The NHS Chief Executive for England ought to be concentrating on the future structure of the NHS!
    The only way performance will be improved and staff identifying with goals and key performance indicators is to break it up more clearly into divisions dealing with aspects of the health response ie Cancer, Skeletal, heart, organs, sight, hearing etc.
    Currently the admin is generally considered to be a shambles by everybody I’ve ever asked about it, and supported by personal experience. There is little evidence of joined up tracking of events, treatment and timescales. This must improve if the patient’s treatment from start to finish is held within one responsible body.
    Everybody wants improved pay and benefits, why do NHS staff( and railway workers) for some reason think they should get a better package than anybody else?

    1. a-tracy
      July 4, 2023

      The perks need costing up properly on how much they are worth pa and added into a list of full costs of each person. If they want to give up a perk for more money today then so be it, benefits should be choice. i.e. someone who rarely takes sick leave and has good health won’t value the cost of full sick pay coverage, it is a massive cost to the level provided work out its value so they appreciate its value, you can’t even buy a similar insurance cover in the private sector to measure it.

  43. Bert+Young
    July 4, 2023

    Management of the NHS has been in a mess for years . It is too large an organisation to be managed from the centre and it has not had the best of individuals with the right experience overseeing and directing its operations . The needs and variations that exist in different parts of the country are as considerable today as they were 30-40 years ago ; little change and improvements have happened . The NHS has to directed and managed by separate regions and overseen by appropriately qualified individuals .

  44. Cuibono
    July 4, 2023

    Begging kind indulgence.
    A petition ( yes…I know potential uselessness etc etc but…) from GB News.
    About saving cash from extinction.


    Although…has this legislation already solved the problem?
    Financial Services and Markets Act 2023

    1. Lester_Cynic
      July 4, 2023


      I don’t usually sign petitions because they’re usually ignored but I have signed this one because with GBNews behind it it probably stands a better chance of success

      1. Cuibono
        July 4, 2023

        I think you are spot on.

    2. glen cullen
      July 4, 2023


  45. forthurst
    July 4, 2023

    Why is the health service in this country run by a History graduate? Why is it considered appropriate that the administration of the medical profession is by Arts graduates. Is that the norm with our continental neighbours who all have far better, more cost effective health services than ourselves?

    The maladministration of this country is a consequence of the bizarre belief that someone who has no education in an activity can be deemed a ‘generalist’ and put in charge of it.
    Its time to reform education so that someone who spends three years at university leaves with some knowledge or skill which can be usefully employed. The foreigners who come here for a university education understand this and take the places which should be occupied by British people too many of whom are studying rubbish subjects like Psychology.

    1. Peter
      July 4, 2023


      You are Lifelogic in disguise and I claim my five pounds.

      1. Gabe
        July 5, 2023

        No prize it is not me, but Forthurst is indeed also very sensible. Clearly not all history, PPE and art graduates are useless at running things and making rational decision but as a general rule? Though I suspect the NHS has thousands of doctors working for them who would do a far better job that Amanda Pritchard. Why was she chosen? Was it when Handcock PPE was health Sec or Hunt PPE?

  46. Derek
    July 4, 2023

    LOL, NHS CEO management is an oxymoron.
    Do all such CEOs of departments in the Public Sector pass the buck to their respective Ministers? If so, why are they there in the job that pays a high salary when they appear to do very little? The NHS is not short of money at all it is severely lacking in proper professional management for sure. Is it not time for the Minister to seriously cut the excess numbers of surplus administrators and use the savings to fund the salary increases for all of those real workers in the front line?

  47. Christine
    July 4, 2023

    “With over 400 senior managers on six-figure salaries”

    And, there lies the problem. We see the same across the public sector. A bloated management structure that serves nobody but themselves.

    1. glen cullen
      July 4, 2023

      53,000 NHS consultant doctors on over six figure salaries

      1. Mickey Taking
        July 6, 2023

        should that read ‘telephone consulting doctors’ ?

  48. Ian B
    July 4, 2023

    ‘while year-on-year inflation fell in Japan, the US, France, Germany, Canada and Italy, in the UK it climbed from 7.8pc in April to 7.9pc in May, according to the OECD’

    Tell me, which of those low inflation countries did their Governments raise the tax take on their industries by 31.5% and as a result caused prices to rise(therefore inflation) to cover the additional burden?

    1. hefner
      July 4, 2023

      Corporation tax was indeed increased from 19 to 25%, a relative increase of 31.5%. Because of that increase (and independently of any other factor) the price would increase by 6%, not 31.5%.

      1. Martin in Bristol
        July 4, 2023

        Just because corporation tax goes up by 6% it doesnt mean the selling price will go up 6%
        You need to know what proportion of the selling price is this tax amongst all the other elements that goes into making up the price.
        And just as importantly, what elasticity of supply and demand in the specific market place that product operates because this will affect the ability of the compny to force through your 6% price rise.
        Surely you must know this hefner.

        1. hefner
          July 5, 2023

          I said ´independently of any other factor’.

          1. Martin in Bristol
            July 5, 2023

            Yes hefner I noticed.

            The price will not rise automatically by 6% as you claim.
            Please give sources for your claim that it will.
            On every occasion.
            In every industry.

      2. Ian B
        July 5, 2023

        @hefner Back on subject, did this Conservative Government put up taxes for UK Industry or not?

        Then the maths, 19% plus an increase of 6% only comes to a total tax of 20.14%. 19% plus 31.5% is the full rate of 24.98%(rounded to 25%) so this Conservative Government put up taxes by 31.5%. – that is all that was said. Costs have to be covered, that is all that was said. How it pans out at the retail end is a whole other subject.

        All cost increases are inflationary this Conservative Government has caused the inflation they are now seeking to mitigate. There are many other things this Conservative Government have done or through neglect have caused, which all add up to them as being the prime cause of UK inflation.

        The alternative was to create an economy that in turn causes more wealth, pressure then of the need for taxes, there for the level of wage rises and surprising to some eases less inflation.

  49. Ian B
    July 4, 2023

    More evidence of the Conservative Government fighting UK businesses and stopping them growing.

    Sir Jim Ratcliffe wanted to buy a Swiss Company in and agreed offer, the UK blocked him so the US has bought it instead.

    ‘In a statement today, Sir Jim said the intervention was further evidence that the regulator and Government were stymying British businesses.’

  50. Ian B
    July 4, 2023

    Ever wanted to know where the BoE priorities lay, here is today’s big Media announcement from them.
    ‘Bank of England says people of any gender identity can be pregnant | Threadneedle Street pledges to dedicate a floor of its office to gender-neutral lavatories‘

    1. glen cullen
      July 4, 2023

      Utter madness …but just following instruction from this government

  51. Derek
    July 4, 2023

    I read today that the Treasury is blocking a plan by the Home Secretary to charge immigrants £2000 per year to use the NHS, on the grounds that such action would hurt the economy.
    We citizens should despair at our civil service, deliberately it seems. increasing the numbers of immigrants so their fiscal figures will look good. Government expenditure counts towards our GDP despite such freebies to non-Brits run at a loss to the Nation. Is it no wonder that we are so much in debt? Over £2 Trillions.
    Labour PM Callaghan once told us ‘you can’t spend your way out of recession’ I’d add that we cannot borrow to fund the non-productive forever.
    However it seems the Chancellor and the Treasury believe PM Jim wrong because of their belief in Modern Monetary Theory.
    I fear they are wrong and doubly fear that they do not have a Plan ‘B’ to save us. The Financial markets and the FX will decide if they were right or not and I do not think we have much longer to wait.

  52. Mickey Taking
    July 4, 2023

    A very fundamental decision is being made by banks – that is to close accounts held by people they don’t like politically. Where will that stop? Which union leaders who are seriously damaging the economy and way of life for innocent citizens are being treated in the same manner?
    Is an immediate Bill required to restrain banks from doing that?

    1. Roy Grainger
      July 4, 2023

      And it appears while banks refuse to tell customers why they have closed their accounts they are happy to pass the relevant information to the BBC. Of course this follows the example of the Civil Service where despite numerous after-the-fact enquiries I don’t remember a single leak investigation identifying anyone at all, even during Covid when leaks had a direct impact on health policy.

  53. SimonR
    July 4, 2023

    I really don’t know why NHS pay is within the purview of Ministers. It feels like buck passing by those who should be responsible. The NHS hierarchy seems utterly insulated from any difficult decisions that they might have otherwise been held accountable for. Give the relevant NHS bodies their budget and let them decide how much of it to spend on staff.

  54. Berkahire Alan
    July 4, 2023


    Just yesterday my wife and myself had separate letters from our Bank saying they will be cancelling our overdraft facility having looked at our income.
    Given we are both pensioners our income is what it is, simply steady, it has certainly not gone down, or up much
    We were a little surprised but not concerned, as neither of us fortunately need such a facility, we never asked for one in the first place they simply gave it to us decades ago when they had money to throw around, so we accepted it as it was no cost to us.
    Co incidence, or are the Banks starting to get worried about something John. ?

  55. Jim+Whitehead
    July 4, 2023

    The Elephant in the Room is the CQC, the overarching regulating (read ‘interfering’) body feared by all, all the way up to the very top and down to the very bottom.
    You want the Health Service to be stiffed by bureaucracy and regulatory overload?
    Insufficient regard for race, equality, diversity in the Health Service?

    CQC at your service, with a Sargasso Sea of suffocating mandates and requirements covering all that you ever thought of and more besides.
    Woe betide the clinical unit, large or small, which wishes to get on with the job of healthcare and meeting the needs of patients.
    Ask any Doctor, dentist, nurse, or ancillary.
    As any of the management team.
    Be prepared to learn something.

  56. XY
    July 4, 2023

    The good thing is that people are beginning to see that “our” NHS is actually rubbish; that it is beyond redemption in its current form.

    When we can have a proper national debate about what should come next, there may be some hope for us.

    Hint: if it is to succeed, it must involve the private sector.

  57. Jim+Whitehead
    July 4, 2023

    Correction, “Ask any of the management team”

  58. mancunius
    July 4, 2023

    In days gone by, in any stubborn public sector strike by unions, the BBC would delve into a nearby street to find the ‘vox pop’ of a working-class ‘member of the public’ inevitably saying: ‘Werll, I think they sh’d give ’em wot they want’ – always with heavy emphasis on the last three words. The anonymous class-warrior’s political loyalties had blinded them to the fact that they would be financially affected by the demanded pay rise, via inflation and higher taxes.
    These days, the BBC’s Tarquins and Cressidas need not venture beyond the portals of Broadcasting House: they can just invite a senior NHS manager into the studio to give them much the same answer.

  59. glen cullen
    July 4, 2023

    Watching the PM today at the HoC liaison committee ….and its still full steam ahead for net-zero and he’s please about leading the world and the subsidy of ‘contract for difference (cfd)’

  60. rose
    July 5, 2023

    I was astonished when I heard this woman, whom I had never heard before. How could she be employing 1-2 million people?

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