Where does the buck stop with the health service?

With the ongoing crisis in our public health infrastructure it is important to remember one key element which is not examined in depth, especially in periods of strike action; accountability of management. The media narrative being spun by some that a disgruntled workforce of nurses have exacerbated a crisis ought to be heavily countered and discredited as it is simply untrue.

As documented by every outlet during a sitting Stormont administration and since then during the hiatus, the health crisis has been a long time coming with no easy fix in sight nor seemingly within the will of those possessing the political capital to make the tough choices. Pay parity was one such tough choice which has since went down like a lead balloon with what seems like a convenient DUP narrative of allowing Jim Wells’ name to be dragged through the media and Michelle O’Neill’s attempt at defending her record by crying “1% pay rise” many times on talkback.

Accountability is something that NI can hardly boast among our great achievements in the world. O’Neill and Wells, both former health ministers, have attempted to defend their records by taking positions that are the inverse to the actual policies they signed off on while in office. Such is the bizarre nature of our politics that we allow this kind of behaviour and a frustrated media tries to make this plain whenever the parties actually decide to be scrutinised by it – see Nolan’s ongoing dramatization over the DUP refusing an interview with him.

It is not just elected representatives who have built careers within an accountability vacuum, there exists an executive class within our publicly funded institutions who are rarely called out and have little public recognition in proportion to their public responsibility. There is very much pay parity for this group with the rest of the UK, the argument that this is necessary because of the level of talent needed at this level does not hold water when many of these people come up through the ranks in NI anyway. The PSNI are a rare example where there tends to be a talent pool which is UK wide for a UK wide senior police salary, look at the CEO of any council or the CEO of any health trust here and this is not universally the case.

Here is a synopsis of three high bracket salaries within the NI health apparatus according to the taxpayers alliance, reported last December in the Belfast Telegraph:

“Northern Ireland’s three best-paid public health employees received six-figure sum salaries totalling £452,500.”

From the same Belfast Telegraph Article:

“Overall, the TaxPayers’ Alliance said that 266 UK public health staff earned more than £100,000, a rise of more than 19% on three years ago.”

Written in December 2018, this is all the more jarring as it was patently obvious that the impending crisis was reaching fever pitch with warnings already sounding that we would be facing the present situation in winter 2019. I have witnessed people on less than 20k per annum being disciplined for missing emails or client deadlines, we have those on benefits incurring sanctions which push them into debt. This is how some see accountability; it stinks in the eyes of many that nurses are lucky to get a rise of 1% when execs soaked up 6.3% a year during a period of collapse.

I do not for a moment doubt that the work of these people is immensely difficult and they may feel it a personal attack to be calling their salary into question. However, in a publicly funded body that does not exist for a profit motive, salary can only be measured in proportion to health outcomes. In the private sector we could debate at length the credence of a CEO being remunerated while a company is not performing but this is something heavily scrutinised within corporate governance procedures by shareholders, with our NHS we are all shareholders so where is the scrutiny? Is it enough to simply demand ministerial intervention? Both sides of the strike are now demanding Julian Smith put up the cash for pay parity, but where is the accountability for heath executives who have patently failed to retain staff, failed to manage waiting lists and failed to exercise budgetary discretion to meet nurses demands?

Photo by Negative Space is licensed under CC0