Published: 24/04/2003, Volume II3, No. 5825 Page 21

Your news focuses on Scotland and Wales are timely as the 1 May elections draw near ('A place apart', pages 12-13, 10 April; 'Noises off ', pages 14-15, 17 April). Post-devolution, the Scottish Parliament gives more focus and scrutiny to health and community care issues than was possible under Westminster. To a large extent, it has worked.

However, despite repeated assertions that their contribution is valued, senior managers' salaries are one area where the Scottish Executive's influence has been baleful. On average, salaries lag behind our colleagues in England by 15-20 per cent. Recent HSJ advertisements illustrate this:

Chief executive, North Cumbria (essentially two district general hospitals, and our nearest neighbour): staff 4,500, revenue budget£128m, salary circa£115,000.

Chief executive, Argyll and Clyde (a new unified health system): staff 8,750, revenue budget£550m, salary range£79,000-£105,000.

It is an understatement to say both authorities present a very real challenge. But this imbalance and its inequity have been raised constantly by trade unions with little effect. I cannot imagine many prospective parliamentary candidates wishing to champion this anomaly in the run up to the May elections.

The Institute of Healthcare Management is not a trade union but a professional organisation supporting the management community.

With salary ceilings for chief executives in Scotland relatively low, the headroom for executive directors, senior and middle managers is considerably reduced.

Will Agenda for Change and possible additional banding at the top end provide an equitable solution?

Donald McNeill Secretary IHM Scotland