The pay differential between top civil servants and NHS leaders is “utterly absurd”, according to a senior official who has worked across both services.
Mark Fisher made the switch from the civil service to the health service in 2022, having served in various senior positions in the Cabinet Office, including director general of the Grenfell Tower Public Inquiry and director of the Office for Civil Society.
He was chief executive of the NHS Integrated Care Board for Greater Manchester for almost four years before retiring in March, a role in which he was paid between £280,000 and £285,000 per year.
Reflecting on leadership across the public service, he has contrasted that pay packet with that of senior civil servants such as the cabinet secretary, whose salary was listed as between £225,000 and £230,000 last year.
He told CSW: “When I moved from the Cabinet Office to the NHS my pay more or less doubled, which I always thought was a bit ridiculous. Not that the NHS overpays but that Whitehall underpays. An ICB leader is paid more than the cabinet secretary which I always thought was utterly absurd if you look at the weight of the job.”
The ICB he ran was one of the largest in the country and commissioned around £7bn worth of services, though it directly employed only around 1,500 staff. The cabinet secretary ultimately oversees more than 500,000 civil service staff.
Fisher said the pay differences limit the flow of leaders between the NHS and other public services, which means the mindset of leaders in the health service can be too “insular”.
He added: “I think it's a sadness that we don't see that many people coming from outside into senior NHS jobs. Conversely, NHS leaders are by and large brilliant and could well lead other parts of public service, but that doesn’t happen a huge amount.
“I think it's all to do with the fact that NHS leaders' pay is tied to Agenda for Change, to doctors’ pay and things. So the NHS has always managed to be a more generous payer than the civil service, which is hugely constrained by politics, and the service differential has just grown over the years. We’ve ended up in a place which I think is a bit absurd if you look at the weight of some of those jobs.”