The must-read stories and debate in health policy and leadership.


Proving it’s not only size that matters, a new analysis of trust chief executive salaries by HSJ highlights these are sometimes well out of kilter with the organisation’s turnover and, for hospitals, their status as a major teaching/tertiary centre or a district general.

As one of our readers comments, “Why should CEOs of larger hospitals be paid more than DGHs?” Clearly other factors are at play – although, where frameworks do exist in senior NHS management, organisational scale tends to be a big factor.

On our salary scatter chart, a cluster of chiefs in the north east and Cumbria stand out, with their pay being on a par with the bosses of the big city academic centres (indeed, earning slightly more than Sir Len Fenwick of nearby Newcastle Hospitals was paid in 2016-17, before he was sacked for misconduct). The turnover they are accountable for is substantially smaller than the big centres, even after taking account of the fact that two of them run two organisations (Stephen Eames leads Cumbria’s acute and mental health trusts; Ken Bremner both Sunderland and South Tyneside’s hospitals).

Of course, that does not mean their task is straightforward. Cumbria’s problems in particular have been some of the most severe nationally, and Mr Eames has been leading a huge turnaround and service change effort. 

This group of trusts issued a joint statement making their case: “The salaries of our chief executives and executive leadership teams are decided by independent nominations and remuneration committees and this is to ensure they are in line with publicly available salary benchmarking information.”

They said the region “consistently performs amongst the best in the NHS against national standards” despite growing demands and “very challenging health inequalities which exist for people living in this part of the country”.

We were also keen to look at gender disparities in executive director pay, and found that in 2017-18, the average pay for women chief executives was around £176,000 while men averaged £183,000. In some cases, this seemed to reflect that they were running smaller trusts, especially mental health and community providers.

Only four of the 15 highest paid chief executives were women (and they all ran trusts with turnovers of more than £1bn) while the two most highly paid chief executives were women, Tracey Batten at Imperial College Healthcare Trust and Marianne Griffiths, who runs both Western Sussex Hospitals Foundation Trust and Brighton and Sussex University Hospitals Trust.

Calls for clearer frameworks for chief executive pay in the NHS arise fairly regularly, and one factor in their favour would be more clarity and transparency about trusts in different sectors, and the gender pay gap – a point made to HSJ back in October by NHS women leaders champion Sam Allen.

Gone but not forgotten

Healthcare Environmental Services’ confirmation that it has ceased operations marks the exit of what was one of the biggest players from the clinical waste sector.

HES, which suffered a swift downfall after it was found to be stockpiling a huge amount of waste (including anatomical), served between 40 to 50 trusts across the country.

These trusts are now paying up to three times more for their waste disposal service after their contracts were moved away from the embattled firm, which will result in unexpected financial pressure.

Parts of the primary care sector are also affected, including in Cumbria and the north east, where HES had been awarded a contract in 2017 to take on waste management services. With the benefit of hindsight, it is ironic that HES’ rival Stericycle lost a court case last year in which it argued HES had bid abnormally low for the contract.

Amid the very public verbal battle between HES and the government, emergency plans have been enacted, which have seen temporary containers installed outside affected organisations, as well as special transport and incineration permits being granted to other providers in a bid to reduce the excess waste which HES was tasked with disposing off.

It is not known how long this will take, nor how the other waste management companies will cope with the extra demand.

But the events of the last three months have shown the importance of not forgetting about an often deprioritised industry.