Skip to main content

CEOs could get £30,000 bonus for joining troubled trusts

Published on: 21 Jul 2022

Senior managers could be paid one-off bonuses to take over the most troubled NHS organisations, according to draft proposals being considered by government and NHS England.

A new very senior manager pay framework – which is in development but believed to be nearly complete – provides for a “non-consolidated salary uplift of up to 15 per cent”, with local remuneration committees able to determine rates “within applicable ranges”.

The plans are disclosed in the latest report by the senior salaries review body, published on Wednesday night.

The SSRB said there should be “clear criteria” for defining challenged systems and organisations, and that it assumed there would only a “small number of them at any time”. No details have been confirmed by Department of Health and Social Care or NHSE. A 15 per cent payment for a £200,000 CEO salary would equate to £30,000.

Former health and social care secretary Sajid Javid has said more top leaders should take on struggling organisations, and should be paid more for doing so, aiming to raise standards. This was also supported by the review of management and leadership that he commissioned from General Sir Gordon Messenger.

According to the SSRB report, the proposed VSM framework also includes:

  • The introduction of development pay, and retention pay, to help support those new in post, and retain others;
  • Removing “earn-back” – under which managers lose part of their pay if if they do not hit given targets or requirements;
  • Increasing the proposed salary threshold at which central NHSE and ministerial approval is required to pay a salary, from £150,000 to £170,000. The SSRB said it still felt this was “too low”. Having to wait a long time for national approval for relatively commonplace senior salaries has been a common bugbear for local and national NHS organisations; and

The new framework is yet to be published but sets out a unified pay range for all trust directors and organisations, local and national, regardless of their role or organisational type.

In its report, the SSRB indicates the new VSM framework – if and when it is introduced – is likely to benefit community and mental health trust leaders, and directors of nursing, as well as some other unspecified groups, whose pay is “significantly out of line with the new VSM proposals”.

All trusts and integrated care boards will be asked to adopt it on a “comply or explain” basis, although the SSRB warned that any “unwarranted variation” from either risks creating “inconsistency” and a “lack of cohesion”.

The report also noted the proposed framework gave pay ranges determined by organisations’ annual turnover. While other options were explored, such as “organisational complexity,” these were not considered to be feasible.

Top trust and ICB salaries out of kilter with ALBs

The SSRB report repeated its previous recommendation that the VSM rules, used for local trust and ICB senior managers, should be joined with the separate framework used for “executive senior managers”, who are senior officials in national DHSC arm’s length bodies.  

It said top pay for national ESMs – which applies to NHSE among others – was “well below” the VSM pay ranges applied in local trusts and ICBs.

VSM figures rise to £265,000 at the top of current provider ranges and £275,000 for ICBs; whereas the national ESM top band has an operational maximum of £207,050 and exceptions up to £222,200, the SSRB noted. 

It said: “The top of the ESM scale is comparable to existing second-in-line salaries in the largest trusts.

“Therefore, chief executives and posts and next-in-line VSMs from very large ICSs and provider trusts would not be attracted to ESM posts on salary alone, whereas moving from ESM to VSM should find the VSM pay framework more attractive.”

The report has called for the two to be combined or, alternatively, appears to suggest the salaries be brought more into line with each other.