Cash-starved NHS still has money to pay its doctors pounds 131,000 a year

The highest paid employee in the NHS earned pounds 131,000 last year, pounds 43,000 more than the Secretary of State. Jeremy Laurance, Health Editor, looks at where the money in the health service comes from - and where it goes.

Dr Willie Harris, a consultant in sexually transmitted diseases and, until last month, medical director of St Mary's NHS trust in west London, earned more from the NHS last year than any of its one million-plus employees.

In addition to his consultant's basic salary of pounds 53,645, he has a distinction award, taking his total earnings for his clinical work to pounds 88,000. On top of that he earned pounds 43,000 for his work as a manager for the trust. Mr Harris also runs a thriving private practice at 77 Harley Street.

His total NHS earnings of pounds 131,000, disclosed in the Fitzhugh directory of NHS Trusts, published today, made him the highest-paid director of an NHS trust in 1996-7. He earned pounds 41,000 more than St Mary's chief executive, Ms Pat MacCann.

Dr Harris stepped down from the post of medical director of St Mary's at the end of last year and has been replaced by Dr David Mitchell, a consultant physician.

This year, the highest paid NHS employee is expected to be Dr Jonathan Nicholl, a consultant renal physician, who took over as chief executive of the University Hospital Birmingham NHS trust in June. As medical director of the trust last year, combined with his consultant salary, he earned pounds 128,000. He received a pay rise on promotion to chief executive but his current salary will not be disclosed until after the end of the financial year.

Figures in the Fitzhugh directory show that four London NHS trusts spent more than pounds 10m on management and administration - University College, Guy's and St Thomas', the Royal London, and Hammersmith.

Four trusts had management costs in excess of 10 per cent of their income, also all in London: the Tavistock and Portman Trust (providing psychotherapy), the Bethlem and Maudsley psychiatric hospital, the Royal Brompton heart hospital and the Royal London Homoeopathic hospital. Ministers have said they intend to bear down on hospitals with excessive management costs.

The NHS earned almost pounds 250m from private patients in 1996-7, 14 per cent up on the previous year, but still less than 1 per cent of its total income. Six NHS trusts earned more than 10 per cent of their income from private patients, headed by the Royal Brompton hospital, where they accounted for 23.5 per cent. The biggest earner from private patients was the Royal Marsden cancer hospital, as in previous years, with income of pounds 11m. Eight other trusts earned more than pounds 5m from private patients.

Britain's 526 NHS trusts began the current financial year carrying an overspend of pounds 55m from the previous year. As they began 1996-97 with a surplus of pounds 59.7m they spent more than pounds 100m more than budgeted for in that year. Frank Dobson, Secretary of State for Health, announced an extra allocation of pounds 300m last autumn to tide the NHS over the winter.