Pay for NHS chiefs to be linked to performance with ‘no more rewards for failure’, Wes Streeting says – as it happened
Streeting says pay rules for NHS chiefs to be changed so they are linked to performance, with ‘no more rewards for failure’
Wes Streeting, the health secretary, has announced that pay arrangements for NHS trust chief executives will be changed so they are linked to performance.
Commenting on the announcement, which is due to be confirmed in a speech later this week, Streeting said:
I’m prepared to pay for the best and I will defend financial incentives to attract and keep talented people in the NHS. It’s a big organisation that should be competing with global businesses for the best talent.
But there will be no more rewards for failure. We have got to get a grip on runaway spending and make sure every penny going to the NHS benefits patient – changes will not be popular but it’s a case of reform or die.
The change will affect VSMs (very senior managers), like trust chief executives.
Explaining how pay will be linked to performance, the Department of Health and Social Care said in a news release:
In his review of the NHS, Lord Ara Darzi found the only criteria by which chief executive pay was set is the turnover of the organisation. Neither the timeliness of access, quality of care or effective running of the organisation factored into pay. NHS integrated care systems had built up deficits totalling £2bn in just the first four months of this financial year, leaving the incoming government with a financial blackhole which had to be dealt with at the budget.
A new pay framework for VSMs will therefore be published before April 2025. This will clamp down on poor performance, while rewarding senior leaders who are successfully turning their services around.
Key events
Afternoon summary
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Wes Streeting, the health secretary, has said that pay arrangements for NHS trust chief executives will be changed so they are linked to performance. There will be “no more rewards for failure”, he said. (See 5.24pm.)
Streeting says pay rules for NHS chiefs to be changed so they are linked to performance, with ‘no more rewards for failure’
Wes Streeting, the health secretary, has announced that pay arrangements for NHS trust chief executives will be changed so they are linked to performance.
Commenting on the announcement, which is due to be confirmed in a speech later this week, Streeting said:
I’m prepared to pay for the best and I will defend financial incentives to attract and keep talented people in the NHS. It’s a big organisation that should be competing with global businesses for the best talent.
But there will be no more rewards for failure. We have got to get a grip on runaway spending and make sure every penny going to the NHS benefits patient – changes will not be popular but it’s a case of reform or die.
The change will affect VSMs (very senior managers), like trust chief executives.
Explaining how pay will be linked to performance, the Department of Health and Social Care said in a news release:
In his review of the NHS, Lord Ara Darzi found the only criteria by which chief executive pay was set is the turnover of the organisation. Neither the timeliness of access, quality of care or effective running of the organisation factored into pay. NHS integrated care systems had built up deficits totalling £2bn in just the first four months of this financial year, leaving the incoming government with a financial blackhole which had to be dealt with at the budget.
A new pay framework for VSMs will therefore be published before April 2025. This will clamp down on poor performance, while rewarding senior leaders who are successfully turning their services around.
Waiting lists would be lower if government had agreed NHS request for 10,000 extra hospital beds, Covid inquiry hears
Hospital waiting lists would be lower if the government had given the health service permission to expand the number of hospital beds in the middle of the Covid pandemic, Amanda Pritchard, the NHS chief executive, has suggested.
As PA Media reports, in July 2020 the NHS sought 10,000 “non-temporary” hospital beds to deal with recovery from the first wave of the crisis and the future surges in case numbers. But the request was refused by the Treasury, headed at the time by Rishi Sunak, and by Downing Street, where Boris Johnson was PM.
Giving evidence to the Covid inquiry Pritchard said that the decision was “disappointing” and that the nation “could be in a different position” when it comes to the backlog of pre-planned hospital care.
According to the latest data from NHS England, an estimated 7.64 million treatments were waiting to be carried out at the end of August, relating to 6.42 million patients.
Questioning Pritchard, counsel to the inquiry Jacqueline Carey KC, said:
In July of 2020, NHS England sought 10,000 non-temporary beds to deal with recovery and the potential future surges … the funding for those beds was not approved by Her Majesty’s Treasury.
And Pritchard replied:
We had done some modelling work over that summer to looking at from a best estimate, what it would take to be able to run with a sort of constant number of patients in the service who were Covid positive, create the necessary headroom then to respond to normal winter pressures, but crucially also to have the space to do the, not just urgent, but also non-urgent, non-Covid work, so that we would be able to do that recovery work that we’d begun to start in the summer.
Carey said:
I think the prime minister’s private office was involved in the decision to refuse and said, effectively, they wanted more use to be made of Nightingales [emergency temporary hospitals], the independent sector, to go back to discharging patients if necessary, using flu vaccinations to hopefully deal with any flu upsurge there would be, and that there would be capacity looked at in the spending review … What were the consequences of that 10,000 bed requests being refused, from your perspective?
And Pritchard replied:
It was, as you say, very disappointing, because what it meant in practice is that where we could now be in, I think, a very different position on elective recovery.
If we had had that capacity, we could certainly have treated thousands more patients if we had had that additional headroom, as well as being more resilient going into the second wave and into winter more generally.
So subsequent to the pandemic, there have been some steps taken to increase core bed capacity, but clearly we could have done with that capacity at the time, and I think we’d be in a quite different position now.
Healey says Tories’ pre-election proposal to raise defence spending to 2.5% of GDP just unfunded ‘political ploy’
James Cartlidge, the shadow defence secretary, has criticised the government for not saying when it will get defence spending up to 2.5% of GDP.
In a Commons urgent question, Cartlidge said Labour has committed to outlining a pathway to spending 2.5% of GDP on defence, but said ministers have been “unable” to say whether they would deliver on the target in the current parliament. (See 10.15am.) He went on:
2.5% is not an end in itself, the key reason in April [why] we set out a fully funded, multi-year pathway to 2.5% was to enable the MoD to procure at pace and at scale the munitions we need to urgently replenish our stocks to war-fighting levels.
With the whole world wanting to buy more munitions, we cannot afford to delay any further.
Healey said the last government’s proposal to raise defence spending to 2.5% of GDP was not a plan, but just a “political ploy”. He said:
It was announced four weeks before they then called the general election. It was unfunded, it was a con on the armed forces and on the British people who gave their answer emphatically by sweeping away Tory MPs in many of the proudest military communities and constituencies across the country.
During the UQ Healey also repeated the point he made in his interviews this morning about how, if Donald Trump has urged Russia to avoid escalation in Ukraine, that is a positive development. (See 8.59am.) Healey said that was a “very good first step”.
The Kremlin has since claimed that the call between Trump and Vladimir Putin, as reported in the Washington Post, never took place.
Sinn Féin’s Michelle O’Neill says being branded traitor for attending Remembrance Sunday ceremony ‘difficult’
Michelle O’Neill, the Sinn Féin first minister of Northern Ireland, has said it has been “difficult to hear” fellow republicans criticise her participation in the Remembrance Sunday ceremony at Belfast City Hall.
As PA Media reports, O’Neill’s comments came after a banner with the word “Traitors” on it was erected at her constituency office in Cookstown, Co Tyrone, at the weekend.
Republican activists in Cookstown, Tyrone have made the anger of the Republican Community at the latest act of treachery by Michelle O’Neill and the Sinn Féin leadership clear by hanging a banner on her office pic.twitter.com/1U9VXd0Wcg
— Anti Imperialist Action Ireland (@AIAIreland) November 10, 2024
O’Neill broke new ground for her party by attending the event commemorating fallen members of the UK armed forces at the Cenotaph in Belfast, where she laid a laurel wreath. However, she has faced criticism from some people in the republican and nationalist community. As PA reports, more than 100 relatives of IRA members and civilians killed by the security forces and loyalists during the Troubles signed a public statement, published in the Irish News, expressing “devastation” at her decision to attend.
Asked about the statement from republicans criticising her, O’Neill told a press conference this morning:
Of course, it is difficult to hear that, particularly from people who I know all of my life, but I also absolutely accept that they’re entitled to feel how they feel, particularly if they’ve lost a loved one.
So I accept and understand exactly where people are coming from.
However, I can’t be distracted from the role that I play. I want to drive our society forward. I want to build a shared future. I want to take as many people with us on that journey as we possibly can, but I’ve committed to being a first minister for all, and I will live up to that at every turn.
Asked if it was difficult to be called a traitor, O’Neill said:
Look, people are entitled to express their view, and I can accept where they’re coming from, but I also have a role to play, and I’m determined to keep driving us forward.
And here is an extract from the statement signed by republicans.
It is beyond belief that any so-called Tyrone republican would wish to lay a wreath in honour of these forces who caused mayhem and murder on hamlets, hills, villages, and towns – the killing grounds of Tyrone where the cries for truth and justice about collusion, state murder, and counterinsurgency haunt the entire county and hundreds of families.
Have you all totally lost the run of yourselves or is it really power at any cost?
Because when you get to the pinnacle of wherever it is you want to be you’ll have compromised so much, you’ll be no different from the staters and Blueshirts that executed republicans and hounded those who held dear to the words and sacrifices of Tone, Connolly, Pearse, Sands, and Hurson.
Sir Wyn Williams, the inquiry chair, asks about a sentence in Badenoch’s second witness statement. In the statement Badenoch says:
The Post Office, on the other hand, is caught in this awkward halfway house, where it is given only enough to exist in a state of permanent starvation.
Q: If the Post Office is going to continue to exist in a state like this, can it continue to exist at all?
Badenoch says it can carry on like this, but she says that that would not be best for the Post Office.
She says there are things going wrong on both sides.
She says she does not think the Post Office spent money wisely on Horizon. That would jsutify the Treasury withholding money. But if the Post Office is always reliant on the Treasury, which also has to fund things like health and schools, it will always lose out, she says.
Q: Is the Post Office worth saving?
Yes, says Badenoch.
The challenge is to work out how to fund it, she says. But she goes on:
Should we have a Post Office? Yes, I think it is a cultural institution that’s absolutely essential for us to keep and I support it wholeheartedly.
And that’s the end of her evidence.
At the inquiry Kemi Badenoch is being questioned now by counsel representing some of the victims of the scandal. Asked who will fix the machinery of government, if it is broken as Badenoch claims it is, Badenoch says that she is in a “minority” in thinking this. She says she has been making this argument for a long time, but the government does not agree. The fact that she is leader of the opposition, not in government, suggests she is not winning the argument, she says.
Badenoch says wanting less government regulation not same as being opposed to rule of law
Beer asks Badenoch about this passage in her second witness statement.
Second, there is an explanation for why things are slow in government. There is a cautious, risk-averse culture within the civil service, which is systemic and baked-in. This is a rational – and probably inevitable – response to the vast array of statutory and public law demands that regulate the process by which government makes decisions, and reflects the ever-present risk of government decisions being judicially reviewed, undermined and unwound by the courts. The natural reaction to that is to do lots of preparatory work to make sure that all the bases are covered to limit the risk of something going wrong further down the line. There is also an understandable focus on providing value for money when spending taxpayer money (which obviously involves trade-offs). This emphasis on caution slows down decision-making. It’s not that civil servants are slow-going or lazy or don’t care – the risk-averse culture is a natural reaction to the legal demands placed on government. They are required to spend a lot of time considering the various impacts, seeking and assessing various representations, taking into account and weighing all relevant information, making sure all possible alternative options have been thought about, making sure that the entire process is evidenced and so on. As I say, this has become a baked-in, systemic feature of the system. If we want our government to make decisions faster, we need to reduce some of the public law burden – and if we choose not to do so, we must accept that this has consequences for the speed and efficiency of government. Every time we create more public law to hold government to account, it is slower to deliver for people. This is a real issue across government, and needs to be confronted. So whilst it is easy to imagine that government could have clicked its fingers to get compensation out the door, that fails to recognise the systemic and cultural complexity of decision-making in government.
Q: Are you saying, if we want government to make decisions faster, we have to reduce the public law burden?
Badenoch says she is saying that, every time you create law and demand accountability, you slow things down.
Q: Are you saying the rule of law stands in the way of the delivery of services by government?
Badenoch says she is not saying that. She goes on:
The burden of regulation is not the rule of law.
You can the rule of law without an excessive burden of regulation, but if you keep adding more and more rules that will slow things down.
It doesn’t mean that you don’t want the rule of law, but the rule of law has a purpose, and that is to create a fair system which everybody has treated equally, and where everyone can receive justice.
If you keep creating more regulations and people aren’t getting justice, then something has gone wrong, and we should be able to look at that without assuming that this is a criticism of the entire system of the rule of law.
It means that we should be able to look at how we can reform public law. The law is not above criticism. We should be able to say ‘Actually, this isn’t working, what can we do to improve it’, rather than what is happening now where people say, ‘Oh, it’s the rule of law. We can’t touch it. Let’s not do anything.’
Badenoch says reforming the Post Office would be a huge challenge. She says people do not want to work there because of the scrutiny they know they will face because it is a public organisation.
The French government has now issued its readout of what Keir Starmer and Emmanuel Macron discussed when they met this morning in Paris. It is quite a bit longer than the UK version (see 1.28pm), but not necessarily more revealing.
Badenoch ‘disappointed’ it took ITV drama to speed up Post Office payouts
Here is Mark Sweney’s story from Kemi Badenoch’s evidence to the inquiry this morning.
Q: Were you aware that Staunton was a strong supporter of the sub-postmaster executive directors when you decided to sack him?
Badenoch said she did not know that when she took the decision. But he said that to her in their call, she says.
Beer reads out the passage from Badenoch’s first witness statement where she explains the factors that led to the decision to sack Henry Staunton. Badenoch said:
On 24 January 2024, I received a written submission dated 23 January 2024 prepared by UKGI and Departmental officials, in which I was advised of specific concerns in relation to Mr Staunton’s conduct and his suitability for office. The specific concerns identified in the submission were:
(1) That he had repeatedly attempted to shut down a whistleblowing investigation into his conduct.
(2) That he had engaged in aggressive, intimidating and disrespectful behaviour to other board members and members of the POL executive team.
(3) That he showed continued poor understanding of the public sector aspect of POL’s work and poor judgement.
(4) That he had disregarded proper governance processes as POL’s Chair, most recently by announcing the appointment of a new Senior Independent Director for POL without following formal consultation with the Board, following Board processes or seeking shareholder approval as required.
(5) That he had failed to provide constructive support to POL’s CEO.
Asked why she sacked him, Badenoch refers to her earlier point about being seen to do the right thing. She says she did not want to give Staunton the chance to resign because she wanted a clear story about what happened.
Beer shows Badenoch the submission she received recommending Staunton should be sacked.
Badenoch says this is a good example of what she meant when she said earlier concerns were raised by officials in a “vanilla” form. (See 2.30pm.) She says officials had in the past raised concerns about Staunton with her. But they had not given her the full details.
Badenoch says, in the civil service, officials often give ministers a “vanilla version” of complaints about people. She says she prefers the “unvarnished” version.
Badenoch says, when she spoke to Henry Staunton, she had a more sympathetic view of him than she does now (in the light of the way he publicly attacked the way he was dismissed).
Here is the full version of the transcript.
Beer is now reading out extracts from the transcript. The full document is here, now on the Post Office inquiry’s website.
This is how it starts.
Beer turns to the converation where Badenoch told Staunton he was being sacked, in January this year.
He says Badenoch did not have a transcript of this when she did her witness statement. But the inquiry has now obtained a recording.
Badenoch says she did not know the call was being recorded. She does not know how common it is for a call like this to be recorded. It was probably recorded so they could have an accurate transcript.
