Rewards for failure – what the increasingly privatised NHS brings

Yet again we witness another rewarded for failure, the Chief Executive of Southend University Hospital has picked up an extra £20K in a year that has seen her A&E department branded amongst the worst in the UK.

Jacqueline Totterdell (RGN, RSCN, BSc (Hons), MBA) claims she “is committed to continuing the drive for ‘Southend Excellence’, working collaboratively with our partners and supporting our staff to fulfill their potential.

Her staff’s potential evidently is not reflected in decent pay rises – whilst Ms Totterdell struggles to get by on £175K, her staff have been offered a below inflation 1% rise.

Over-rewarding the already rich is a familiar feature of the Conservative-led Government, who are also intent on seeing the NHS sold off. Administrators and executives getting huge salary hikes is something we may have to get used to. We may also have to get used to a reduction of available procedures as market forces increasingly override medical need.

Public health care should not be seen as either a business opportunity or a means of personal enrichment.


One Response to Rewards for failure – what the increasingly privatised NHS brings

  1. This highlights the fundamental problem with a “blue in tooth and claw” market-forces system.

    Pay is determined not by quality and results but by rarity.
    Nurses (good/bad/indifferent) are not that relatively rare
    NHS senior executives (good/bad/indifferent) are relatively rare

    Given that you have to have someone at the top (if only to theoretically carry the can when things go wrong) it is rarity that pumps up the salary.

    In some professions there is a conspiracy to maintain that rarity. And this often means that the quality “in the pool” is very variable.

    Now if we could find some way to ensure that it is only the really good executives that are rare:
    – we might find that there is a sufficient supply of bad and indifferent ones to at least fill vacancies that have to be filled – but fill them at a price commensurate with their (low) rarity.
    – there might then be an incentive for the indifferent to try and become good, and for the bad to go elsewhere.

    We need some way to effectively determine whether senior executives are good bad or indifferent. The trouble is that holding them to account “for organisational results” is a blunt instrument as organisational results arise from a (unknown – or not understood) combination of external factors and the impact of the senior executive team over a (unknown – or not understood) period of time – and individual impact is also unknown or not understood. Given that it seems that “remuneration” (salary and a massive string of benefits) is often set by “the club”, I suspect that there is little interest in resolving this problem. Leaving these factors as “unknown or not understood”, gives lots of wriggle room (© Vince).

    Then there is the fact that every organisation likes to think it is “upper quartile” or better in performance and therefore its executives should also be paid upper quartile pay. The trouble is as everyone moves onto “upper quartile pay”, the upper quartile increases. A nice ratchet (or should that be racket) effect.

    (I admit that this does not explain why footballers are paid a kings ransom – but I think they are in a world of their own paid for by Sky TV and BT television subscribers.)

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