"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 13 January 2011

BBC News

OK so the last post said I was proud of the BBC, this one is not so complimentary.

Last September Mark Thompson, the director-general of the BBC, visited Number 10. This caused a bit of a stir since the BBC were putting together programmes to explain the cuts. The DG claimed that the impartiality of the BBC was not affected, but it seems to me that since then BBC News have softened on the cuts, and are all too keen to tell us how "necessary" the cuts are (when have you ever heard a commentator suggest that perhaps a higher contribution from tax may be a good idea?). And in particular, even though a year ago the public were clearly satisfied with the NHS, the BBC seem so positive about Lansley's policies for the NHS, and do not mention at all that they are unnecessary and costly.

I've noticed BBC News has a tendency to churn out reports about the NHS that, well, seem to be of tabloid "quality". Let's be frank, 24 hour news is demanding. The BBC journalists have to fill pages on the site as well as radio and TV bulletins. If someone is willing to do some of the work for them, it is tempting for them to accept the help. (For a decade I used to write monthly and fortnightly columns for up to four different magazines and the hardest part was to come up with the initial idea. Once I knew what the article would be about it was then only a matter of finding the facts and writing about them. Rarely would I get a suggestion from an editor about an article subject, but when I did I was always grateful.)

The Department of Health has 40 press officers. That is a lot of people when you consider that the NHS has its own information website specifically for information and statistics about the service. This website should be the first stop for any journalist who wants to write about the NHS, so it makes you wonder what the DH Press Officers do all day. Perhaps they are being helpful to BBC News by thinking up stories for them?

Take for example this one. "Lucrative NHS overtime for consultants questioned". The title is certainly sensational, although I guess if it was in a tabloid the title would be something like "Fat Cat Docs Screw The NHS".

On first sight the article says that some hospital consultants have been "playing the system" over waiting list initiative payments (WLIs) and could make £100,000 in overtime payments. The BMA deny the accusation and point out that if there are any large payments it is due to poor management. For added spice, the radio version of the report has an interview with Prof Maynard, a health economist at York University, who rather helpfully drew a comparison with the banking crisis by saying that the WLI payments are same as bankers' bonuses. So to summarise, you get the impression that all NHS consultants were fiddling their timesheets to get up to £100k a year in overtime and this was either due to greedy docs or incompetent managers. The "bankers' bonus" quote from Prof Maynard was a nice extra bit of tabloid demonisation!

So let's look a bit deeper, and look at the facts. The article says
Basic pay for consultants stands at just under £90,000 a year on average.
The Pay in the NHS parliamentary briefing paper says:
The basic consultant pay scale consists of eight pay points, ranging from £74,504 per year to £100,446pa.
These figures are from the NHS Information Centre which gives figures for average basic salaries, as well as average salaries including performance awards and overtime. The parliamentary briefing paper, says that for total pay:
Consultants’ median annual NHS earnings for the period April to June 2010 were £111,700; mean earnings were £120,400

The BBC article says:
Figures seen by the BBC show that, in some cases, consultants are making more than £100,000 a year. 
Nice touch that "figures seen by the BBC", why can't we see them too? Are these "figures" secret? If so, why? The parliamentary briefing paper I linked to above is freely downloadable, so why didn't the BBC link to it? That phrase is typical of lobby correspondents who are passed unattributable information. If this statement is referring to total pay then it is an underestimate since the median pay for NHS consultants is £112k. I suspect this is implying that consultants can earn this amount of money in overtime. Further down in the BBC report it says:
At Coventry and Warwickshire NHS Trust, one ear, nose and throat specialist made more than £105,000 in 2009-2010 in overtime. Another three consultants from other areas made in excess of £80,000.
That's where the "more than £100,000" comes from. But notice that they give just four cases.

According to the NHS Information Centre there are 33,000 consultants (as of Sept 2010). Yet the BBC could only find four cases, and they could not find any aggregated figures (the average payment of overtime for consultants).

The NHS Information Centre says that the average (mean) basic pay salary for a consultant is £90,200. In other words the "average" consultant earns an extra £30,000 in performance awards and over time. Not quite £100k, but still very nice money. However, the performance awards (in effect rewarding skill and excellence because once awarded the consultant is paid the award each subsequent year) vary between £2,957 and £75,796, so it is likely that this is more likely the source of the extra £30k payment above basic salary.

Now here's the odd thing. The BBC article says:
Overtime rates vary, but are often about £600 for four hours
Again, nice money. So how many hours would you have to work to earn an additional £100k? I work it out to be 668 (rounded up to give whole four hour periods). Assuming a 48 week year that means working 14 hours extra a week. Bear in mind that we are talking about NHS consultants who are typically employed on contracts of 4.5 days a week and they are allowed to work the other 2.5 days in the private sector, why would they spend two of those days doing NHS overtime? It doesn't make sense. There may well be one consultant (or even four) in the NHS who is willing to work these hours, but it is hardly likely to be typical.

Updated using information from the comments:
"the salaries quoted for consultants are for a week of 10 sessions of four hours each. Most consultants agree to work between one and four extra sessions at a pro rata rate, of around £200 per 4 hours. There is also a supplement of between 1 to 8% for on call availability at nights and weekends."
So at £200 for 4 hours it would take a lot more overtime to earn the £100k that the BBC quote. However, the supplement is clearly an important source of income. Take an extreme case (extremely unlikely) of the "average" consultant on £90k on call every weekend and every evening. That means earning about £7200 more. Nowhere near £100k.

I think it is acceptable to say that the BBC have written an article on entirely exceptional cases and that a journalist investigating consultant pay from primary sources would not have produced an article highlighting a situation that is so atypical. Even though the "figures" were given such a prominence on BBC radio bulletins and on their website, the story is essentially made up.

There are lots of interesting nuggets of information in the data on the NHS Information Centre website, as well as in the parliamentary briefing paper I linked to above. For example, the following statement comes from the parliamentary briefing paper:
HM Revenue and Customs conduct periodic analyses of the private practice income of consultants by linking tax return data with information from the NHS workforce census. These are used to inform PCT funding allocations. The most recent detailed analysis of consultants’ private income took place in 2003/04. It found that the ratio of average (mean) private income to NHS income was 0.45; that is, on average, consultants supplement their NHS income by an additional 45% through private practice.
This is far more interesting. Almost half of consultants' income comes from private work. That is, the "average" consultant earning £120,400 from the NHS earns an additional £54,000 from private work giving an "average" total income of £174,000. Note that the £54k will come from at maximum 2.5 days work. Few consultants are likely to work 7 days a week, but let's just assume this extreme case. It would mean that they would get 45% of their pay for 36% of the week, and clearly this means that private work is paid at a higher rate than the NHS rate (a rate 45% higher). Of course if the consultant works fewer days a week for the private sector to get the 45% of their income then the private rate will be much higher.

This is not the sort of news that a government whose whole NHS policy is based upon the mantra that involving the private sector will bring down NHS costs would want to make public.

Updated using information from the comments:
Most surgical consultants have to meet malpractice insurance premiums of around £10-15K, room rental, secretarial and office fees, postage etc, not to mention tax out of this average income of £40K.
The important point that the briefing paper omitted is that the 45% is on gross income rather than a more accurate figure which is income after expenses. (Of course, tax will be on income after expenses, so the tax will be on less than £40k.)

However, I still think the investigation of private income of consultants is interesting, since it shines some light on the government's policy which is to expand this area of the health economy. We are told by the government that their policy will just work, and that ultimately it will be cheaper. I want to see the actual figures.

So why is the BBC making so much fuss about dodgy figures about overtime? If the BBC was impartial and wanted to give a clear, complete picture they would mention the private earnings in their article about "lucrative" pay, but they have not. The reason is that the government does not want the public questioning the rates of the private sector. The government wants to have the private sector fully embedded and providing NHS care before the public realises that it costs more than the NHS but, of course, by that time it would be too late to reverse the changes.

The premise behind the article was clearly written by a Department of Health official with the clear agenda to make the public think that the NHS is wasting money and that a "reform" is necessary. The BBC are simply providing Department of Health propaganda.


  1. As a surgical NHS consultant I was interested to read your blog commenting upon what I too felt was a rather lazy piece of journalism, citing just 4 consultants' incomes. If you want to see even lazier, several of today's papers have regurgitated the BBC story with no further work or checking, indeed the independent even gives the inaccurate impression that more than one consultant earned over £100,000.
    To inform your calculations further, the salaries quoted for consultants are for a week of 10 sessions of four hours each. Most consultants agree to work between one and four extra sessions at a pro rata rate, of around £200 per 4 hours. There is also a supplement of between 1 to 8% for on call availability at nights and weekends. Excellence awards will also add to the difference between salary and income.
    Regarding private practice, the average of 0.45 of nhs income is before any expenses. Most surgical consultants have to meet malpractice insurance premiums of around £10-15K, room rental, secretarial and office fees, postage etc, not to mention tax out of this average income of £40K. Private work is carried out without the help of junior doctors, and extends the need for on call availability to most of the week. Bearing this in mind you will see why many consultants will be tempted into waiting list work for the NHS, even on top of their average 50 hour week.
    Of course I'm not saying that we are badly paid, but unlike bankers the extras are only available if you put the work in, and most consultants are not appointed until they are nearly 40.

  2. Excellent work Richard - well done