Salaries in the NHS have again been in the spotlight recently, this time after Health Secretary Jeremy Hunt outlined a new crackdown on earnings.
Hunt expressed a view that "a culture of excessive pay and payoffs" was a clear and present danger and that just as it had "damaged public confidence" in the BBC, another national institution was at risk.
His solution? Well for starters, he has announced plans to cap the wages of those in NHS quangos who earn six figure sums, while also capping redundancy packages. It's Hunt's next move in attempting to change the pay culture of the NHS and challenge the salaries of managers and consultants, around 8,000 of whom earned more than £100,000 in 2012. He's stated that the NHS needs "a collective reality check" on pay and that high salaries must be "the exception, not the rule."
Hunt lacks the powers to get hospital trusts to alter their pay rules but he's hoping to influence or perhaps cajole them into making changes. There are also moves by the Department of Health to halt a one per cent pay rise for all NHS staff in England having branded it unaffordable. Whether all of this happens is very much open to question but are the attempts to limit wages at the top end of the scale justified?
The whole issue of public sector salaries and benefits tends to provoke strong emotions. Faced with statistics about how many employees in the public sector earn more than the Prime Minister, many express disquiet, others express outright disgust. And when it comes to the NHS, those feelings are particularly pronounced.
"The money should be going to patient care," is a popular sentiment, prompted in part by recent highly-publicised failings such as the Mid-Staffordshire hospital scandal, together with issues such as concerns about hospital deaths increasing at weekends.
I don't think it's a bad argument either. At Fletchers, I see far too many examples of medical negligence, where a duty of care to a patient has been breached and people have undergone serious suffering as a result.
There's no doubt that many of these instances have been down to overstretched resources, as NHS staff struggle to cope with a lack of time and manpower to do their jobs effectively. The problem doesn't seem to be getting any better either judging by figures from the NHS Litigation Authority. The Clinical Negligence Scheme for Trusts (CNST), which handles all clinical negligence claims against member NHS bodies, has revealed a two per cent rise in expenditure for 2012/13, with the figure standing at a hefty £1.1 billion.
Against a background such as this, it's not surprising that calls for overstretched front line staff to benefit from a slashing of managers' salaries (or managers themselves) are widespread. NHS managers are perceived in certain quarters as typifying a waste of taxpayers' money - underperforming, overpaid and resting on their laurels while those on the 'shop floor' toil ever harder for less.
But in reality the picture may be more complex. In general, staff across the NHS work hard at all levels and in contrast to other industries and sectors, they literally deal with matters of life and death.
NHS managers aren't an exception to that and work in senior roles that carry with them a myriad of responsibilities, providing leadership and strategic direction, as well as overseeing day-to-day operational activity.
They will tell you how they also work long hours and have to deal with issues outside of those hours too, acting according to their seniority and being available to respond. There will of course be exceptions but don't many organisations have a sprinkling of people who aren't pulling their weight when compared to other colleagues?
In terms of salaries therefore, is the general rule for senior NHS employees along the lines of "you get what you pay for?" Surely there must be an element of needing to attract the best candidates with salaries that reflect the responsibilities and hard work that their role entails?
After all, capping wages (or dispensing with managers) could run the risk of senior jobs becoming less attractive. In theory there would be fewer high quality candidates and a greater workload where mistakes could potentially threaten the effective working of an entire department - and one of the things to suffer would be patients. So would you run the risk of more things going wrong, even more negative headlines and, far more importantly, needless deaths?
What we're left with is a conundrum whereby cutting senior staff salaries to improve patient care runs the risk of damaging patient care by leading to more failings in the upper echelons of the NHS. It's not a simple problem to solve but I'm absolutely confident that the issue isn't going to go away anytime soon.