• DHSC required to sign off salaries exceeding £150,000
  • In 2018-19, 65 salaries exceeded this limit – none were rejected and only three attracted comment from ministers
  • Eleven of the 65 salaries also exceeded NHS Improvement’s “established pay range”

Health ministers rubber stamped the pay of 65 senior NHS executives last year, HSJ has learned.

Since 2015, ministers in the Department of Health and Social Care must sign off on all new executive salaries for NHS trusts which exceed the prime minister’s salary of £150,000. Ministers also have a right to comment on proposed salaries at foundation trusts which exceed the limit, although they cannot reject these. 

Information obtained by HSJ through a freedom of information request revealed that in 2018-19, 65 salaries were submitted to the DHSC under this process, 31 from trusts and 34 from FTs.

None of the applications were rejected. Three of the FT applications attracted comments but it is not known if the comments had any impact on the salary paid. 

Eleven out of the 65 applications last year were also for salaries above NHS Improvement’s “established pay range”, which takes into account the type and size of trust involved. None of these attracted comments from ministers.

The DHSC declined to name the organisations involved, arguing that disclosing them would contravene data protection principles as it could identify the individual concerned. This is despite the pay range of senior NHS staff being regularly reported by trusts.

Salaries which exceeded the “established pay range” included:

  • The deputy chief executive of an ambulance trust with a proposed salary of £162,075 in March 2019. Although there is no guidance on the pay levels for deputies, the top pay given for a chief executive of an ambulance trust is £157,500;
  • The chief executive of a small community trust with a proposed salary of £170,502 in December 2018. The upper point of the established pay range for the job is £154,000;
  • Nursing directors for a very large acute FT had a proposed salary of £174,000 in January 2019, despite the upper point of the pay range being £157,500;
  • The chief executive of a medium sized mental health FT with a salary of £192,250, almost £10,000 above the top point of the pay range; and
  • The chief executive of a medium acute trust of £215,000 in August 2018, when the top point of the pay range is £202,500. 

The remaining six applications were for salaries within a few thousand pounds of the top point of the established pay ranges, including one for £270,000 for a chief executive of a very large FT. 

The three posts which ministers commented on were:

  • Proposed pay of £175,000 for the chief executive of a medium acute FT in February 2019;
  • Proposed pay of £173,500 for the medical director of a medium acute FT in February 2019; and
  • Proposed pay of £189,855 for the chief executive of a medium acute FT in October 2018.

All three salaries were within NHSI’s established range. 

Saffron Cordery, deputy chief executive of NHS Providers, said the high salaries could “reflect the difficulties many trusts encounter in recruiting and retaining senior leaders”.

“These are hugely responsible and challenging roles,” she added. “We need the best people. But we know that the pressures they face, coupled with a historic culture of blaming individual leaders for failures beyond their control, can be a powerful deterrent.

“Public sector pension rules which penalise higher earners in the NHS may also be a factor in why trusts are having to raise senior pay thresholds to attract suitable candidates.”

The DHSC did not directly answer HSJ’s question about the 11 salaries exceeding the established pay range but instead said: “Local NHS organisations are best placed to decide what to pay their staff in order to recruit, retain and motivate the most talented and hard-working staff.

“As such, NHS trusts are free to set their own pay rates for their chief executives and executive directors within certain guidelines. However, we rigorously scrutinise any salary at or above £150,000 a year and have seen a reduction in the highest pay levels.

 “The overwhelming majority of NHS trusts chief executives and executives’ pay is in line with our clear guidance and we have seen a reduction in the highest pay levels.

 

“In order to retain and motivate talented and hardworking individuals to work in the most complex and challenging roles, trusts can decide locally what to pay their most senior staff, but we rigorously scrutinise any salary at £150,000 or more a year to hold trusts to account in these exceptional circumstances.”

NHS Improvement’s established pay range splits acute trusts into four categories, according to turnover. It also suggests specialist trusts can pay a premium of 15 per cent over these rates but it is unclear if this applies to any of the trusts in the FoI release.

The DHSC’s FoI response also refers to a new category of “extra, extra large” acute trusts which have a turnover of more than £750m for which there is no published pay range.

This process for approving salaries was introduced in June 2015, when Jeremy Hunt wrote to trust chairs questioning whether board members should be paid more than the prime minister, which was then £142,500.

In the first six months of the policy, 15 trusts asked for 17 executives to be appointed on salaries more than this.

 

12.39 28 August: additional quotes from DHSC added.