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ICS salaries face eight-month wait for ministerial sign-off

Published on: 5 Oct 2023

Ministers took nearly four times as long to sign off integrated care board directors’ appointments as those of NHS trusts last year, HSJ has found.

The Department of Health and Social Care revealed the figures in a freedom of information request submitted by HSJ. We asked how long government ministers took to answer ICB pay applications for very senior managers above £150,000 in 2022-23.

Government pay advisers have previously said the local NHS is suffering from a “direct operational impact” due to the delays.

The average time ministers took to answer a case for applications made in 2022-23 was 173 working days – at least eight months – the data shows. In the same period for NHS trusts, the average was 47 working days, though this may have been an underestimate as some trust cases remained outstanding.

The longest sign-off for an ICB very senior manager case was 273 working days – meaning when non-working days are included, it took well over a year. Meanwhile, the fastest response time was 10 working days. The response did not name the individuals concerned.

The DHSC approved 17 of the 25 cases it received during 2022-23, rejecting the other eight, resulting in a 68 per cent approval rate. It’s not known whether the rejected candidates dropped out or took a lower salary. For trusts in the same period, only one application out of 74 was rejected.

ICBs were created in law in July 2022, and many were still filling executive director roles through that period — although they also made redundant many senior clinical commissioning group directors. The DHSC said it did not receive any senior pay approval cases from NHS England for 2023-24.

HSJ revealed in August that ministers took more than 300 working days to sign off on a senior trust leader’s appointment. However, the average time to answer a case was 47 working days and all of the cases were accepted bar one.

Sarah Walter, director of the NHS Confederation’s ICS network, said: “Delays in ministers responding to and approving senior appointments leave big gaps in ICBs’ teams and slows down their work.

“This new data… will be worrying reading for ICB leaders.

“We would urge the government to speed up this process so ICBs can get on with their work and deal with the significant challenges the NHS faces.”

In its report this year, the SSRB said delays in confirming salaries for some leaders’ appointments were a “further hindrance to NHS leadership”.

It added: “Senior posts remain vacant for an unnecessarily long time, which is having a direct operational impact. We think the current system needs urgent reform.”

The requirement for ministerial approval on senior leadership appointments above a salary threshold was introduced by the former health and social care secretary Jeremy Hunt in June 2015, with the £150,000 bar set in January 2018.

Earlier this year the Care Quality Commission reported ministers to the National Audit Office over months-long delays to board appointments. Other arms-length bodies, including NHS Blood and Transplant and the UK Health Security Agency, were reported to be facing similar challenges.

Several NHS England non-executive director appointments remain outstanding following interviews in the spring.

HSJ found in June 2022 that ministers had also opposed nearly 50 proposed pay deals for senior NHS managers over a three-year period, but could only block four.

In response, the DHSC told HSJ that most of the unsuccessful pay cases were rejected due to the ICB not applying the framework correctly, or because the evidence was not strong enough to support it outside the framework guidance.

Adjustments have also been made to streamline the clearance process, including batching pay cases together so that several can be dealt with at once, and increased resources to work on VSM casework.

A new VSM pay proposal framework is also being progressed to support the efficiency of the approval process but no further details have been revealed so far.

UPDATED: This article has been updated to include information from the DHSC