Kicks for free?

April 19, 2007


As I was getting my morning massage from the lovely Lola before being driven in the Bentley to my Lunch at the club to prepare for a relaxing afternoon’s golf, I hear on the wireless that the NAO has looked at the consultant contract and discovered that NHS consultants are being paid 25% more than they were for rather less work. I was disgusted because I thought my salary had gone up by at least 50%. Still, mustn’t grumble.

Then I heard that nice Mr Humphrys reading out an email from my esteemed colleague Francis Wells, who is a well known cardiothoracic surgeon (cue strains of “holding out for a Hero”) at Papworth Hospital. He seems to think its only right that the NHS pays him something for saving lives in the middle of the night compared to folks like yours truly who only minister to the sick during the day. What rubbish!. Mind you JH said the email was written from the hospital at 2am, which was when I was just staggering out of the Blue Summer Suite (great tip from me old blogosphere pal newmania) with Lola and her friend Marika. Maybe he has a point…

Anyway the Lambo’s back from the garage and I’m off to take it down to Cap Ferrer for the weekend (well it is Thursday). I just want to leave you with this thought: Trotskyist-turned Blairite former health secretary Alan Milburn (where are you now-all is forgiven, please come back) made 2 basic mistakes:

First he assumed that all GPs were stupid and inefficient, so he set their contract with financial incentives (QAFF) to hit certain basic targets, assuming they would achieve about 60-70%. Good GP practices are now hitting 95-100% of their targets, which is a key reason they are making so much money.

Second, He assumed that most consultants are clever, but were abusing the NHS and getting paid for sitting around in the golf club before sauntering down to Harley street to make a few quid on the side. (I fired my secretary for giving my diary to the DoH inspector), so he set consultants’ remuneration based on hours worked rather than any performance target, (was he worried we might hit performance targets?). Unfortunately it turns out that only a few people were abusing the system (and probably still are) and the rest were so incensed by the attitude of the SoS and department that we decided to claim for the hours we actually work rather than what he thought we were doing, but we didn’t have any incentive to work any harder or, critically, to change the way we work. Came as a bit of a shock to old Alan, I hear.

It’s all about giving people the right incentives and understanding what your starting point is and where you want to get to. Well, 0/3 ain’t bad. It’s just about average, in fact.

Au revoir

Not now Lola, can’t you see I’m trying to concentrate



  1. Mens Sana, I love humour
    So ok if I take the Bentley for the weekend, since I presume you won’t be using it.

    Incentives and pay are one thing!
    But let us not forget that if we paid doctors 10% less we could afford to employ 10% more doctors for the same budget
    Whereas if we pay the doctors 30% more, then we have 20,000 junior doctors screaming because we can’t offer them jobs on the NHS? – huh? am I missing something.

    As for this man from papworth who we pay whatever he asks for – to save lives? – maybe
    To do a wonderful job, I’m sure – and then to have a load of patients waiting for surgery they cannot afford.

    If I were him. I would train ten or twenty like ME, and reduce the cost of surgery – so we could treat more patients for less

    Mind you I think I prefer a Consultant job.
    I think £300,000 a year plus a Bentlet thrown in, oh and let’s not forget relocation costs, you know a million pound home in Cambridge with a mortgage of less than a hundred thousand.

    You know I can probably save more lives than the man at Papworth, simply by not killing as many as that south korean kid in the US. Life & death is so relative.

    But seriously for £300,000 a year I could do better than Mary Archer or the Chief Executive at Addies, with my eyes shut, with one hand behind my back, from a caribbean ‘Virgin’ island, and with my free hand on a laptop.

    oh lolita – no hands! (lol lolita make me smile!)

  2. The Bentley’s all yours-Help yourself, keys with Lola

    Of course you are right that we could afford more doctors if we paid them less, and in a competitive world you would still have no trouble filling medical schools, but this is a case of the law of unintended consequences. If the DoH had understood how the system operated in the first place, they would never hve got themselves into the position they are in now. They didn’t mean to pay us so much, it just sort of happened. Sounds a bit like Des Browne!

  3. But For the nth time you need to tone down your ideas of how much we actually earn. And relocation costs are not exactly in the league you describe.

  4. Very funny Mensana. Two things
    I think we could halve the rewards and fill the posts If that meant sourcing from abroad why not , thats what the wealth “Producing” sector has to do to compete.
    Secondly Doctors work no harder than everyone else and as somneone who went to a University with a large medic tribe allow me to chortle at the supposition they are less greedy or socially ambitious. I cannot abide this faintly beatific approach to debating tax payers money. It is simply a matter of paying the least possible or the same job like any other aquisition. The language and assumptions have to change and this whole quasi mystical causiness about the health provision must be dismantled. It leads to absurd expectations. I sometimes think people believe they are goingto live forever or that pain can be legislated away.

    Costs must be driven down and this is a good place to start but I do not of course blame Doctocrs for maximising their earnings . They are like everyone else and like the rest of us scarecely reliable sources of information about their own worth.

    Now I must admit I feel a bit mean confronted with indefatigable good humour and a most amusing post but there we are .I `m afraid that is the way it appears to me . I blame New Labour which being a colation of public sector Proffesionals and Old Labour has little notion if how hard it is to make the money they steal

  5. Hi Mens Sana,
    I’m not suggesting that is how much Consultants earn
    I’m suggesting that is how much I think I’m worth.

    And relocation costs, I’ve ‘exaggerated’ to make a point regarding some of the anomalies concerning housing subsidies and affordable housing – being skewed towards those who shouldn’t need it (to keep inflated house prices high) – and taken away from those on lower incomes who cannot even contemplate the price of a studio flat, and are being compelled into renting – not from affordable Council Housing, but private rent from Housing Associations – who surprise, surprise are often subsidised by the Housing Corporation (or Council rents).

    But this is another issue, runnning parallel with how privatisation of health care (the NHS) and Council Housing – reality on the ground – is seriously disenfranchising & disadvantaging those on lower pay.
    By pandering to those on middle or higher incomes, and the “I’m all right jack” mentallity or legacy of Thatcherism to which Blair subscribes to, and clearly believes himself to be the ‘true’ inheritor of.

    It is ironic though that we still artificially limit the places in medical school (now with higher tuition fees) – and yet somehow we still managed to have 20,000 junior doctors crying that they were not offered jobs on the NHS. Catch twenty two – more doctors should mean more competitive wages – but no, we’d still rather train less and pay them more, rather than train more and pay them less.

    Patient care should start with a doctor, and I mean more than the fifteen minutes to supply a prescription which some other PhD in some lab has created. The growing costs are gowing away from personal contact with patients (bar a few obvious exceptions) – to people being treated at a distance.

    Ultimately just give us the £90 billion from the nhs, but we don’t want the nhs patients – IS what privatisation will (and is) leading to.

    PS – Is it too much to ask Lola to pick me up at 8.00

  6. I agree doctors are no harder working than anyone else-indeed many rather less so nowadays. We have the same motivations as anyone else and I certainly have no aspirations to sainthood

    I don’t however agree that taxpayers money is about spending the least possible-it’s about getting best value for money, which is different. But we do have to know what we want to get.

    We already source a lot of doctors from overseas. Indeed there is a bit of a scandal at the moment as it seems we may be trying to get rid of them. There is of course an ethical issue about taking doctors from other countries who may need them more. Again no principled objection from me, though it is important that people can communicate with their doctor

    My point is that of course we will seek to maximise our earnings-that is human nature. It is therefore sensible to link our earnings with productivity or results, as is the case in the private sector and not to hours present in the workplace. Finding the right incentives is the best way to get doctors to maximise productivity, and surely its not necessarily wrong if a significant part of the incentive is money

  7. Q9 I make a prediction about the 20,000 junior doctors: they will all end up with jobs. They may not get the jobs they want, but who can guarantee that.

    Having said that I think they have not been well treated, but perhaps I am overly sympathetic to my own kind.

    I think that limiting the number of places in medical school has worked very well effectively to guarantee jobs for all UK doctors. I think it is probably anticompetitive and has led to a lot of young people who would have been great doctors losing out.

    I would love to spend more time with my patients, and would happily see 1/2 the number of patients for twice as long, but of course I have a perverse incentive not to encourage a system in which you employ twice the number of doctors for 1/2 the money to allow just that, so don’t expect me to offer to take a 50% pay cut-I wouldn’t be able to afford Lola

    As regards housing it is a huge problem around Cambridge. It is hard to see how a nurse or paramedic, or indeed a university lecturer will be able to afford to buy a house here. But of course this is driven by the demand caused by the successful local economy, not by consultants relocation allowances!

    But what is wrong with renting? it’s only in the UK that we are obsessed with home ownership. It’s not necessarily wrong that a higher number of people are in rented accommodation

  8. And NM I couldn’t agree more about the underlying problem. A bunch of political researchers, social science PhDs, Union officials and public sector workers. No surprise that they don’t know how to run a business…or a ministry

  9. The incentive should be that they can be replaced if they are not up to it.No no no you cannot have a priciple that we offer carrots and carry a big ..carrot, you will get ..what we have got . I am highly suspicious of the actual difference sourcing skils from abroad would make and we are not getting the cost savings we could here at the moment anywayI must admit the NHS is not exactly a core interest of mine so I will follow along and see what crops up.

    I see from your post answering Q9 that market solutions is something that just didn`t happen for you .

  10. I disagree that the only incentives should be negative ones. Outsourcing medicine is not like outsourcing a call centre, more like outsourcing a lawyer or an accountant. It is perfectly possible and standards may be acceptable but you are unlikely to get high standard professionals from another country unless they have a positive (financial) incentive, and the last thing we want is the worst doctors from overseas looking after us.

    Incentives should be a mix of carrot and stick. As I have said before one solution would be to pay consultants nothing at all but to require them to work for the NHS in order to be able to practice privately. In the south of England this would be quite practical, but probably not in the North unless the number of people with health insurance is increased

  11. Well said, can I please be your chauffeur!

  12. Ellee what an offer: I have fired Lola-you can start tomorrow!

  13. “one solution would be to pay consultants nothing at all but to require them to work for the NHS in order to be able to practice privately. In the south of England this would be quite practical, but probably not in the North unless the number of people with health insurance is increased”

    I did actually propose that once, “doctors and dentists should have to treat nhs patients to get a ‘local council’ licence to practice. Needless to say it did not go down well.

    How about we scrap the nhs, and only those who can afford to pay get treated – conservative heaven?

    No it is only conservative heaven if we can have the £90 billions from the nhs – and choice – choice not to treat patients who cannot pay.

    Fortunately there is no sickness or death in heaven, so doctors will finf themselves a little redundant, or maybe they’ll find they already had their fill on earth, there’s nothing for them to bleed up north!

  14. Hmmm…Not sure if that is this Conservative’s heaven

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