NHS spending is set to reach £215.6 billion in 2025-26, rising 3.2 per cent per year in real terms from 2023-24. Even after accounting for changes in population size and age, NHS spending will be 24.5 per cent higher than it was in 2013-14.[1] Yet despite having significantly more resources available, outcomes have continued to deteriorate. Waiting times for hospital procedures have risen, with the number waiting for more than a year rising by 15 times compared to 2010. A&E performance has also declined sharply, with the number waiting more than four hours increasing sixfold to 40 per cent.[2]
Responsibility for this decline has been placed squarely at the feet of NHS senior management, with health secretary Wes Streeting declaring that “poor performance is too often tolerated in the NHS” and warning that there will be financial implications for senior managers if trusts do not improve.[3] His comments came even as senior managers received an above inflation five per cent pay rise in 2024.[4]
This note examines the remuneration of senior managers across NHS trusts in 2023-24 and compares it with their trust’s performance on A&E and referral to treatment (RTT) waiting times for January 2025.
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Key findings
- In 2023-24, there were 1,694 senior managers receiving over £100,000 in total remuneration (comprising salary, expenses, benefits, bonuses and pension benefits) across 224 NHS trusts.[5]
- Of these, 1,557 had a salary over £100,000,[6] comprising:
- 17 who had salaries over £300,000
- 279 who had salaries between £200,000 and £300,000
- 1,261 who had salaries between £100,000 and £200,000
- 512 senior managers had a salary greater than the prime minister’s £172,153.[7]
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[1] Issa, Z. & Raymond, A., Health care funding, The Health Foundation, 11 November 2024, www.health.org.uk/publications/long-reads/health-care-funding, (accessed 6 May 2025).
[2] Darzi, A., Independent Investigation of the National Health Service in England, Department of Health and Social Care, 12 September 2024, p.4.
[3] Baker, T., NHS league tables and cancelled pay rises for managers among government health reforms, Sky News, 13 November 2024, news.sky.com/story/nhs-league-tables-and-cancelled-pay-rises-for-managers-among-government-health-reforms-13253282 , (accessed 25 Nov 2024).
[4] Kituno, N., Senior managers to get 5% pay rise, Health Service Journal, 29 July 2024, www.hsj.co.uk/workforce/senior-managers-to-get-5-pay-rise/7037516.article, (accessed 1 April 2025).
[5] This will include clinical staff if they are also senior managers, like chief medical officers and medical directors.
[6] Salary used instead of total remuneration due to abnormally large pensions distorting the top of the range.
[7] Edgington, T & Clarke, J., What does the prime minister do and how much are they paid?, BBC, 10 July 2024, www.bbc.co.uk/news/uk-politics-48497953, (accessed 30 April 2025).