The NHS needs its management ‘fat cats’ more than ever

We should be thankful for those who stick out a neck knowing it could be sliced off

"Crowding out the handful of genuine expenses swindles and financial bungs paid out to keep mouths shut is the poisonous narrative that everyone earning a decent salary in the public sector must be nose deep in trough" (PA)

Of all the crises facing the NHS, it’s probably the least heart-rending, falling far short of our empathy with underpaid, overworked nurses and our camaraderie with junior doctors condemned to a pay cut. But our hospitals are also struggling to find enough well-paid chief executives and finance directors to keep them afloat. That’s no small problem; with the NHS strapped for cash, someone needs to be responsible for making sure what little there is left is spent wisely.

Since October 2014, 17 trusts have lost or are about to lose their chief executive, through public sacking, private resignation or retirement. But there’s nobody to replace them. Nobody wants the job. Why not? These roles are interesting, challenging, well remunerated, and involve contributing to the public good; what sort of work could be more rewarding?

But hospital managers have already worked out that the personal risks outweigh the professional benefits of taking on any such tough task. Put a foot wrong and you’ll be hung out to dry. Succeed, and you’ll still face the wrath of those who think you’re paid too much for playing an essential part in your society. As Rob Webster, chief executive of the NHS Confederation, put it last month: “In a toxic environment, the gravitational force of the media, the regulators and the politics can make the burden become too heavy, even for superwoman (or man) to carry.”

The problem has been brewing for half a decade, but must have worsened in recent days as the right-wing press launches a new onslaught against public sector “fat cats”. It doesn’t stop at health; this week the careers and personal lives of some of the most dedicated public servants have been pulled apart, from our town halls to our police service, to our universities.

Webster is right. If doing your demanding, draining job also runs the risk of having your holiday photographs plastered over a newspaper suggesting that you’re toasting your bloated salary with a fancy cocktail, there may be no remuneration package large enough to compensate. This latest series of shock stories is delivered under the guise of an (otherwise worthy) campaign in defence of the Freedom of Information Act; if it wasn’t for the right to know, squawks the Daily Mail, we’d never hear about these appalling extortions from the pockets of the British taxpayer.

However, crowding out the handful of genuine expenses swindles and financial bungs paid out to keep mouths shut – which would be a worthy use of the Act – is the poisonous narrative that everyone earning a decent salary in the public sector must be nose deep in the trough. That is not a new wheeze. Every few years the TaxPayers’ Alliance unveils its “town hall rich list” to the same end (though in 2014, it had to admit that the number of council employees earning more than £100,000 had actually dropped by 5 per cent in a year). What is damaging in normal times is now frankly dangerous mid-way through an austerity programme that requires sensitive, skilled leadership to avoid a social catastrophe.

Even David Cameron, it emerged yesterday, doesn’t realise what exactly austerity means for the people who use public services – that is, his citizens. In a letter to Oxfordshire County Council, the Prime Minister said he was “disappointed” it had considered closing museums, day centres and libraries to balance its budget. Why had it not prioritised “back office” cuts, he asked?

The response by the leader of the council, Ian Hudspeth, was worth every penny of the expense account he will now probably be “exposed” for claiming. The council was, he reminded the PM, already among the leanest in the entire country, having flogged off upwards of 40 per cent of its senior staff. “I cannot accept your description of a drop in funding of £72m or 37 per cent as a ‘slight fall’,” he wrote.

Cuts are termed such for a reason: they hurt. We should be collectively thankful for councillors like Hudspeth and the staff who serve beneath them; for those who stick out a neck knowing it could be sliced off. Spending on public services and their managers is reaching a new low in modern times, and yet still the doors stay mostly open. This is down to talent, commitment, dedication and honesty. They are all traits to be applauded. They are traits that deserve to be rewarded, too.