Unions have described a pay freeze for senior NHS managers as a 'slap in the face' for the people 'asked to deliver the most fundamental changes in decades'.

First Division Association health officer Jon Restell said the senior civil servants' union was 'dismayed' by an NHS Executive directive which says pay ranges for health authority, special HA and trust managers on national terms and conditions will be frozen at 1995 levels.

'Compared with the treatment of other public sector workers, the government appears not to value the key contribution of NHS managers in delivering reform,' he said.

Increases for individual managers can be negotiated locally, provided that they do not exceed the 2.7 per cent limit set for trust managers by health secretary Frank Dobson in January.

For a minority of managers who have done badly in their annual performance reviews, even local increases are ruled out.

NHS Confederation chief executive Stephen Thornton warned that the freeze would be damaging if doctors and nurses were given substantial increases next year.

The health service circular offers no rationale for the pay freeze.

Mr Dobson said in a letter to HA and trust chairs in January that he was determined to be 'as fair as we can' to all NHS staff.

But Unison national officer Alistair Henderson said: 'Managerial staff have been treated worse than other staff by restricting the performance- related pay they might be entitled to, and limiting their annual increase.'

Mr Henderson pointed out that nurses, administrative and clerical staff continue to receive increments within their pay scales in addition to nationally agreed annual increases. But managers were now being restricted to a maximum of 2.7 per cent.

Kensington & Chelsea and Westminster HA chief executive John James was not concerned at the news. He said he had been able to use the 2.7 per cent limit for trust managers to make differential awards.

Kensington & Chelsea and Westminster has awarded some managers up to 3.75 per cent this year, including performance-related pay. But Mr James accepted that HAs with less generous allocations would not be able to pay as much to individual managers.

The NHS Executive says 6,000 managers are affected by the circular, but Mr Henderson says this figure is an underestimate and 30 per cent of trust managers could be affected.

Mr Thornton said the freeze was not unexpected and, for this financial year, was 'perfectly reasonable'. He added: 'What happens next year is critically important because it needs to be seen in the context of what doctors and nurses are awarded by their pay review bodies. If there is a significant pay rise for doctors and nurses, including senior people, while there are severe limitations on managers' pay, there could be a serious effect on morale.'

The Institute of Health Services Management said general and senior managers were 'giving their all' and should be rewarded.

The Pay and Conditions of Service for NHS Management in Health Authorities (new national arrangements) and General and Senior Managers (residual national arrangements).

www.open.gov.uk/doh/coinh.htm.

See Comment, page 19.