Scotland’s NHS gravy train: part 2 – Crisis? What crisis? The NHS’s big bucks are bigger than ever


By Kenneth Roy

A Scottish Review survey of Scotland’s 14 regional health boards shows what the people who run the NHS really think of pay restraint in the national interest. Far from top salaries being pegged, many continue to rise in disregard of public opinion and the political will. It seems that, at the most senior levels of the NHS, financial hardship is regarded as a malady to be endured by others.

SR looked specifically at the number of employees in the four largest boards – Greater Glasgow and Clyde, Lothian, Grampian, Tayside – who earned between £50,000 and £100,000 a year to the spring of this year, the latest period for which figures are available. (There are, of course, many people in the NHS who earn considerably more than £100,000 a year – but their numbers are small compared with those in the bracket we chose for our survey).

The number of clinicians earning between £50,000 and £100,000 a year declined slightly – from 3,123 to 3,083. But in the same pay range, at the same four boards, the number of non-frontline staff actually increased – from 850 to 1,004 – at a time when the strongest signals were being sent by the governments in London and Edinburgh about the need for extreme moderation.

What is the explanation for this 18% growth in the face of so many warnings? Your guess is as good as ours.

Meanwhile, in a more rarefied atmosphere, seven clinicians in Greater Glasgow and Clyde, three in Lothian, six in Grampian, are enjoying an NHS salary of more than £200,000 – how much more none of the boards divulges publicly.

In Tayside, by contrast, no one earns more than £200,000. Its famously well-paid medical director, Dr Bill Mutch, has gone to live in reduced circumstances on a pension of £100,000 a year, leaving Dr Drew Walker, the director of public health, as the board’s top earner at £195,000.

The departure of Dr Charles Swainson from Lothian has prompted a reassessment of the medical director’s salary. His successor Dr David Farquharson was paid £60,000 in his first three months in the job; from this figure we deduce that his annual salary is £240,000 – £50,000 less than Dr Swainson’s. But Dr Farquharson probably isn’t complaining – he can look forward to several increments. Lothian’s James Barbour, on £200,000, is the highest-paid chief executive among the 14.

The NHS, a product of post-war egalitarianism, has become a profound symbol of inequality. At the lowest end of the spectrum, a cleaner in an NHS hospital is paid around £13,000 a year while a medical director earns up to a quarter of a million.

Even in these straitened times, big buck increases are not a thing of the past. Dr Carol Davidson, director of public health at NHS Ayrshire and Arran, enjoyed a salary hike from £180,000 to £205,000 – the increase in itself would have paid an experienced nurse for a year – although the medical director, Dr Robert Masterton, appears to have volunteered for a pay cut. Since his current salary is £245,000 compared with £260,000 last year, the extent of his suffering may be limited. Now that Dr Swainson has retired, Dr Masterton has moved to the top of SR’s earnings league.

Down in the Borders, medical director Dr Ross Cameron got a whopping £30,000 a year rise from £170,000 to £200,000. Amazingly, he is still not this board’s highest earner, this honour going to the director of public health Dr Eric Baijal on £210,000.

Perversely, the smallest boards are among the most generous. Consider the £190,000 for the director of public health in the Western Isles, Dr Sheila Scott; the £175,000 for the medical director in Orkney, Dr Marthinus Roos; the £170,000 for Shetland’s director of public health Dr Sarah Taylor.

Beside these pay-outs in areas of low population, the money for the top guys at the health board often described as the largest in Europe, Greater Glasgow and Clyde, is positively stingy. Medical director Dr Brian Cowan had to make do with a pay rise of £7,000, taking him to £168,000; and director of public health Dr Linda de Caestecker, who told the Herald newspaper a few years ago that she would consider taking a pay cut if others did the same, settled for a £6,000 increase to ‘only’ £154,000 – £36,000 less than her opposite number in the Hebrides. There must be a logic about all this. Who knows what it is?

The international context to the SR survey is the study published this week by OECD (Organisation for Economic Co-operation and Development) which shows that the pay gap between the highest and lowest earners in the UK has grown more quickly than in any other high-income country.

The NHS, a product of post-war egalitarianism, has become a profound symbol of inequality. At the lowest end of the spectrum, a cleaner in an NHS hospital is paid around £13,000 a year while a medical director earns up to a quarter of a million. With this level of disparity, protestations that we are ‘all in this together’ ring distinctly hollow.

A year ago, Scotland’s health secretary Nicola Sturgeon took a brave decision to call a temporary halt to the medical profession’s discredited scheme of ‘distinction awards’ which beefed up the earnings of consultants, often suspiciously late in their careers. As the annual bonus counted towards their pension, the scheme could not help looking like a lucrative alternative to a long-service medal. Those already in possession of a distinction award continue to rake it in, but no new awards are being given for the time being.

If the scheme is reintroduced, there is someone ideally positioned to restore it to its former glory – its medical director. And who might that be? Why, none other than the man who was until recently the highest-paid NHS worker in Scotland: the one and only Dr Charles Swainson.

We are back where we started.

Click here for part 1


The top 10 earners

  • 1
    Robert Masterton
    Medical Director, NHS Ayrshire and Arran
  • 2
    David Farquharson
    Medical Director, NHS Lothian
  • 3
    Eric Baijal
    Director of Public Health, NHS Borders
  • 4
    Carol Davidson
    Director of Public Health, NHS Ayrshire and Arran
  • 5eq
    James Barbour
    Chief Executive, NHS Lothian
    Ross Cameron
    Medical Director, NHS Borders
  • 7
    Drew Walker
    Director of Public Health, NHS Tayside
  • 8
    Sheila Scott
    Director of Public Health, NHS Western Isles
  • 9
    Lesley Wilkie
    Director of Public Health, NHS Grampian
  • 10
    Tim Davison
    Chief Executive, NHS Lanarkshire

Source: annual accounts, 2011, NHS boards

Courtesy of Kenneth Roy – read Kenneth Roy in the Scottish Review