• Costs can top £300,000 a year for off payroll interims
  • CCGs under directions some of the biggest spenders
  • NHS England claims total spend has declined

Some of the most cash strapped clinical commissioning groups in the country have paid out hundreds of thousands of pounds for interim executives – despite a promised NHS England crackdown on their use, an HSJ investigation has revealed.

HSJ looked at the annual reports of the vast majority of CCGs and found interim executives were costing some CCGs up to £600,000 a year – and some individuals were costing the equivalent of a yearly rate of £350,000.

Some of the highest spends were at CCGs that are under legal directions – meaning NHS England is directly involved in approving high level appointments. NHS England has also had to approve all off payroll appointments costing more than £600 a day in CCGs since August 2016.

Coastal West Sussex CCG has been under legal directions since 2016-17 but employed Margaret Ashworth at a cost of £295,000 for under 11 months in 2017-18 – equivalent to more than £330,000 a year. Her predecessor as interim chief finance officer, Neil Cook, cost £35,000 for less than two months – equivalent to £240,000 a year. It also employed Ralph McCormack as executive lead for stabilisation and transition at a cost of £275,000 for the year.

The CCG had a deficit of £21.8m at the end of the financial year, £6.4m adrift of the original plan agreed with NHS England.

At East Surrey CCG, which has been in legal directions since 2015-16, interim chief finance officer Ray Davey cost £205,000 for seven months. The CCG had a deficit of £24.9m.

Since 2016, all off payroll staff at director level in CCGs have had to be approved by NHS England. Any interim costing over £900 a day – about £225,000 a year – has to be approved by the NHS England commercial executive committee. Lower rates have to be approved at regional director level.

In 2016, NHS Improvement told trusts that all board level appointments should be on payroll, regardless of length, to comply with Her Majesty’s Revenue and Customs rules. CCGs, however, were allowed to continue using off payroll senior managers – despite long standing NHS guidance that these should be limited to six months except in exceptional circumstances.

A spokesperson for NHS England said: “Since 1st August 2016, all local health organisations whether under legal directions or not have been operating under new guidance setting out clear, tough new controls on the use of interim staff.

“NHS England’s annual report for 2017-18 shows a £33m reduction in CCG spending on contingent labour that includes the use of interim managers, NHS England also reduced its spend on contingent labour by £37m.”


Interim executives costing more than £150,000 as a yearly rate in 2017-18

Methodology HSJ took information from CCG annual reports, some of which give a cost range including VAT and agency fees. We then used these to calculate an indicative yearly rate for comparative purposes. Some CCGs pointed out that yearly rates would not fairly represent holidays etc.

Coastal West Sussex CCG Margaret Ashworth, interim chief finance officer for 10.75 months costs £295,000 equivalent yearly rate £329,000. Neil Cook, interim chief finance officer for 1.75 months costs £35,000 equivalent yearly rate £240,000. Both figures include VAT and agency spend. Also employed Ralph McCormack as stabilisation and transition lead for the year at £275,000. The CCG said its senior management team was now filled with permanent members of staff from the CCG and the wider commissioning system.

East Surrey CCG Ray Davey, interim chief finance officer £205,000 for seven months, yearly equivalent £351,000 (through agency). The CCG said its senior management team was now filled with permanent members of staff from the CCG and the wider commissioning system.

Bristol, North Somerset and South Gloucestershire CCG Glyn Howells, interim chief finance officer £100,000 for six months, yearly equivalent £200,000. On payroll. The CCG said the appointment was made as the three individual CCGs worked towards a merger and Mr Howells was employed as an interim replacing three existing finance directors and the turnaround director until the permanent chief financial officer was able to take up her post.

Bexley CCG Mike Proctor, interim director of commissioning £195,000 for 9.75 months yearly equivalent £240,000 through an agency. The CCG said: “Following the departure of the CCG’s director of commissioning in 2017, a short term arrangement to appoint an interim director of commissioning was put in place to ensure business continuity. This timeframe also enabled the CCG to work in partnership with the local authority to create and recruit to a new shared post. In less than a year, the newly established role – a director of integrated commissioning – was recruited to and in post. Funding this new role is shared between the CCG and London Borough of Bexley.

Enfield CCG Mark Eaton, director of recovery whole year £205,000, Noreen Dowd, interim chief operating officer for four months £70,000 yearly equivalent £210,000. Both off payroll and include VAT and agency fees. The CCG said: “As an organisation under legal directions, NHS Enfield CCG is required by NHS England to have a director of recovery post until such time as the CCG has achieved financial recovery and legal directions are removed. The interim chief operating officer role was required whilst the substantive post was appointed to”.

Oldham CCG Noreen Dowd interim accountable officer for 2.5 months at a cost of £70,000, yearly equivalent £336,000. The CCG said this was to allow for the appointment of a new accountable officer, a joint role with Oldham Council. “Noreen was brought in because of her particular experience of leading change within commissioning environments in a range of management roles in the UK and internationally. Her work has focused on change management, including introducing an integrated care system with new roles and governance, bringing together health and care commissioning, ensuring financial sustainability and introducing a place based approach to improving health outcomes.”

Harrow CCG Paul Jenkins, interim chief operating officer whole year £200,000 (off payroll for first half of the year, on payroll the rest). CCG also paid £26,118 in VAT for the first half of the year. Mr Jenkins was covering for a substantive post holder who was on external secondment. The CCG said: “Payment made to Mr Jenkins was comparable to other similar posts in other NHS organisations and agreed via the NHS England’s interim approvals process.

West Norfolk CCG Mark Wheeler, interim chief finance officer cost £100,000 for 6.25 months, whole year equivalent £192,000 including agency fees and VAT. Off payroll. The CCG said: “Our approach to employing an interim while we completed the permanent recruitment process was approved by NHS England.”

Barnet CCG Matt Backler, deputy finance director for 3.5 months £80,000 full year equivalent £274,000 (later joined staff). Andrew Colledge, interim deputy finance director £50,000 for 3.75 months, yearly equivalent £160,000. Neil Snee interim director of commissioning for three months £65,000 full year equivalent £260,000. All off payroll and inclusive of agency fees and VAT. Barnet CCG said: “We required specialist expertise for a defined length of time. The salary/fees paid to the interim staff was to attract the right talent to the CCG and was also reflective of their experience.”