Top trust chief executives could command a £126k salary premium

The salary ceiling is included in new guidance on pay levels for very senior managers in the NHS. The guidance includes indicative salaries for 10 very senior manager roles in acute, specialist, mental health, ambulance and community trusts. The salaries are grouped according to size of organisation and into lower quartile, median or upper quartiles bands.

The guidance shows a potential 34 per cent difference between the median pay of chief executives in small acute trusts and those at very large trusts.

According to the data a small acute trust, with a turnover of up to £200m a year, could pay its chief executive a median salary of £167,500. A chief executive at a very large acute trust, with a turnover of £500m or more a year, should pay its chief executive a median salary of £225,000 (see table below).

NHS Improvement has published the data alongside new guidance setting out rules for how senior managers should be paid. It cautioned that the indicative rates were still under discussion and liable to change.

Health secretary Jeremy Hunt launched a crackdown on senior executive pay in the NHS in 2015. Each trust was asked to justify why any new very senior manager should be paid more than the prime minister (£142,500). The Department of Health said more than a fifth of all NHS directors earn more than the prime minister’s salary.

NHS Improvement said the indicative salaries were being published ahead of a new very senior manager pay framework due to be drawn up by the DH. NHS trusts are expected to use the salaries as a guide when they seek approval from NHS Improvement for very senior managers’ pay. Foundation trusts are expected to have regard to the salary levels although they are free to set their own pay.

Overall pay for chief executives in small acute trusts could range from £141,000 up to £182,500. For medium sized NHS acute trusts, with a turnover between £200m and £400m, chief executives could earn between £160,000 and £202,500, with a median salary of £182,500, a 9 per cent increase on pay compared to small trust chief executives.

Chief executives at large acute trusts, described by NHS Improvement as having an annual turnover of between £400m and £500m, could receive a median salary 8 per cent higher than those leaders at medium sized trusts. Their pay could range from £190,000 to £230,000. Pay for chief executives in very large trusts range from a lower quartile of £195,000 to £267,500. 

Specialist acute hospital trusts can apply a 15 per cent salary premium over small and medium-sized acute trusts.

For small mental health trusts, chief executives could earn between £147,500 and £161,000. This is £20,000 less than for small acute trusts.

For medium-sized mental health trusts CEOs could earn between £172,500 and £182,500, with a median salary 18 per cent higher than small mental health trusts at £177,500, compared to £150,000.

Mental health trusts with high secure psychiatric hospitals can apply a 10 per cent premium to salary levels.

Chief executive salaries by trust size