BMJ 2013;347:f6710 doi: 10.1136/bmj.f6710 (Published 7 November 2013)

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NEWS NHS doesn’t know how many managers were made redundant and rehired after coalition’s changes Adrian O’Dowd London

The NHS has no way of knowing how many managers have been made redundant and rehired, because the figures are not collected, NHS England’s chief executive told MPs this week when he appeared before the parliamentary health committee.

The MPs asked David Nicholson what the cost had been of making people redundant and then rehiring them as a result of the government’s reorganisation of the NHS. Nicholson said, “In terms of NHS England, as far as we know—and we employ over 5000 people—no one has been rehired after taking a redundancy package by NHS England.”

However, he admitted that no one would know exactly how many people had been made redundant and then rehired somewhere in the NHS as a result of the reorganisation instigated by the previous health secretary, Andrew Lansley. He added, “CCGs [clinical commissioning groups] do not collect that information in the same kind of way. I don’t have that information.”

MPs asked about recent news reports that the Department of Health had urged a pay review body not to recommend pay rises for high earning managers in the NHS, given that there were 398 managers earning as much as £225 000 (€270 000; $360 000) a year.1 They also asked Nicholson his view of comments made by NHS England’s medical director, Bruce Keogh, that some of those managers “deserved” big salaries. Nicholson said, “We are talking about some of the biggest and most significant transformational change that the NHS has ever seen and we do need really good, top drawer people to lead that. “If we constantly denigrate and criticise them, it’s hardly surprising that they respond to that. We all have a responsibility to support those people in incredibly difficult jobs. If people would stop constantly reorganising the NHS, we’d have less of the turbulence that we have.” Nicholson said that he would not have used the word “deserved” but added, “If you were talking about the chief executives of large organisations, large NHS trusts, and foundation trusts, they are amongst the most complicated and difficult jobs in the world.

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“There was a system set up by the government (not by me), signed off by ministers, which appraised every job through an external evaluation and put a salary against it—and that’s what people have got. We should not be surprised by the salaries that people have got.”

Nicholson also said that the NHS was on track to make £4bn worth of efficiency savings in the current financial year but that this was below the level desired by NHS England. MPs on the Health Committee, holding an evidence session for their inquiry into public expenditure on health and social care, asked where the NHS was on its trajectory to make £20bn of savings by the end of 2014-15, the so called Nicholson challenge.

Nicholson said, “In the first year we delivered £4.3bn worth of savings, and we’ve done just over £5bn for the next two years. For this year we are on target to deliver just over £4bn, which is what we expected to do.” However, Paul Baumann, NHS England’s chief financial officer, also giving evidence, said, “The £4bn that we will deliver this year is against a target of £4.2bn. The bit of it that we are struggling to deliver in full is the transformational part of commissioner savings, where we are about 20% off the target of those.”

Baumann said that most of this year’s savings were sustainable but that it would be increasingly important to increase the part played in future savings by transformational change—that is, the more substantial long term changes to NHS services, such as centralising services and providing more community based care.

Nicholson said that on management cost savings NHS England was on target to deliver £1.5bn savings a year recurring. 1

Department of Health. The Senior Salaries Review Body (SSRB) review for 2014: written evidence from the Health Department for England. Oct 2013. government/uploads/system/uploads/attachment_data/file/246136/evidence_to_ssrb.pdf.

Cite this as: BMJ 2013;347:f6710 © BMJ Publishing Group Ltd 2013


NHS doesn't know how many managers were made redundant and rehired after coalition's changes.

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