• NHSI denies it approved deal – but did offer advice
  • East Sussex Healthcare Trust said Ian Miller had “specialist skills”
  • Trust ended the financial year with a £55m deficit, £11m worse than previous year

An acute trust paid an interim manager more than £300,000 for six months work – despite a national crackdown on excessive pay rates, HSJ can reveal.

NHS Improvement – which announced it was introducing an approval process for highly paid interims seven months before Ian Miller took up the post at East Sussex Healthcare Trust – has denied it approved the pay deal but admitted it offered advice on daily pay rates.

Mr Miller worked at ESHT as financial improvement director between April and September last year.

His pay of £311,077 for the six months work was revealed in the trust’s annual report for 2017-18.

It is equivalent to almost £2,400 a day for 130 working days, less bank holidays, in the six months he was at the trust, which has been in financial special measures since October 2016.

NHS Improvement had recommended the appointment of a financial improvement director.

In a statement, the trust said: “NHS Improvement actively supported the trust in this recruitment through agreement on the job description and person specification, and attendance at the interview panel, alongside agreement on the terms and conditions of the appointment.”

An NHSI spokesman said: “At the time the trust appointed Ian Miller, NHS Improvement did not approve the salary of these appointments.

“We did, however, provide advice to the trust on what was considered an acceptable day rate for someone of a similar position. The figure quoted appears to be higher than expected on the basis of this advice.

“Since this time, NHS Improvement has introduced a formal process for the approval of salaries for roles of this nature, appointed by trusts, to ensure that interim costs are consistent and represent best value for money.”

NHS Improvement introduced an approval process for interims costing more than £750 a day in late 2016, with then chief executive Jim Mackey saying the rates paid were not justified.

Mr Miller was previously paid £47,000 a month for working as interim finance director at Barts Healthcare Trust in 2015. He left around the time his cost – at that time paid to a firm he was director of – was revealed.

In 2013-14, he worked at Maidstone and Tunbridge Wells Trust for five months at a similar cost per month. In 2010, he worked for South East Coast Strategic Health Authority, at a rate equivalent to around £400,000 a year.

Since he left Barts, Mr Miller has also worked at Norfolk and Norwich University Hospital Foundation Trust where he was turnaround director in 2016.

In March 2017, ESHT was forecasting a deficit of £36m, excluding sustainability and transformation funding. By November 2017 – two months after Mr Miller left – it was £4.7m adverse to plan, with nearly half of this due to not meeting its cost improvement plan.

The trust ended the financial year with a £55m deficit – £11m more than the previous year. 

East Sussex Healthcare Trust said: “At that time, the trust needed proven specialist skills and Ian Miller has significant experience of transforming NHS trusts in similar financial situations. In 2017-18, the trust delivered £22m of cost improvements, and Ian’s role was to support the development and delivery of this programme.”

How temporary pay rates have been squeezed

  • November 2015 – new caps on agency rates introduced for many frontline NHS staff by NHSI.
  • July 2016 – both NHSI and NHS England tighten control on NHS finances, including a new financial special measures regime and caps on interim managers’ pay in clinical commissioning groups and commissioning support units. Pay above these caps has to be approved by NHSE.
  • October 2016 – NHSI introduces an approval process for interim very senior managers employed through agencies. Any costing more than £750 a day has to be approved by NHSI.
  • December 2016 – NHSI tells trusts that any interim board members should be on payroll – not employed through an agency or personal service company – following clarification from Her Majesty’s Revenue and Customs. NHSI chief executive Jim Mackey warns he will take action for unacceptable pay rates.