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Ministers approved two integrated care systems’ requests to pay their chief executives more than £240,000, HSJ can reveal.

Published on: 14 Dec 2022

Ministers approved two integrated care systems’ requests to pay their chief executives more than £240,000, HSJ  can reveal.

A total of 30 business cases have been submitted by 13 ICSs since system leaders were told they had to apply for permission if they wanted to pay above fixed “operational maximums” for executive roles.

It indicates that the large majority of ICS CEOs and directors are paid within the maximum rates, which range from £197-270,000 for CEOs, and from £121-182,000 for other executive directors.

Most of the applications to pay above the limits were for medical directors – some of which were approved and some rejected – while a small number of ICSs submitted cases for more than one role (see table below), according to information released to HSJ.

Three systems – Humber and North Yorkshire; South Yorkshire; and Cornwall – made cases to NHS England and government officials to pay above the “operational maximum” for their CEOs.

The “operational maximums” are based on ICSs’ size according to weighted population: this is set at £240,000 a year at Humber and North Yorkshire, and South Yorkshire, respectively, and; £197,000 for Cornwall and the Isles of Scilly.

A Freedom of Information request to the Department of Health and Social Care revealed ministers had approved 11 requests, rejected seven and “noted” a further two, although details on those noted were not disclosed.

It is not clear whether any other CEOs or directors are being paid above the “operational maximums,” potentially avoiding the need for ministerial approval if they transferred from previous clinical commissioning groups or shadow ICSs.

Compared to provider trust CEOs, many of those in the post during 2021-22 were paid under £200,000, but a significant number were paid around £250,000, and a small number around £300,000.


HSJ  revealed in April that ICSs have to make the case to NHSE and government officials if they want to pay executives below CEO level on their new boards more than £170,000.

Leaked guidance showed set “operational maximum” pay levels that varied according to the populations covered by each system, with those covering larger populations having higher thresholds.

Officials warned system leaders that paying above the set thresholds would delay appointments, stating: “Appointment announcements should not normally be made until the outcome of the pay case has been agreed.

“Where DHSC or ministerial approval needs to be sought, candidates should be made aware that this will lead to a delay in confirming their appointment, in order to manage expectations.”

According to national guidance, operational maximum levels for ICS CEO roles can range from £175,000 up to £270,000, depending on the population covered. 

The DHSC provided information on 20 out of the 30 total cases submitted and said the other 10 were still outstanding. No further details were provided on the outstanding cases.

It is also unclear whether the individuals in those cases have taken up the roles already or not, nor on what salary.

A Cornwall and Isles of Scilly ICS spokeswoman said the system “does not discuss the financial remunerations of any individuals, at board level or otherwise”.

Devon ICS said one of the roles for which it submitted a business case reflected the “market rate for high calibre candidates and the importance of attracting someone who will tackle Devon’s longstanding challenges”.

A spokeswoman for the ICS said the other case, designated as “other,” related to “additional responsibilities” for the integrated care board.

Humber and North Yorkshire ICS confirmed they had two business cases approved by the DHSC but declined to comment further.

Leicester, Leicestershire and Rutland ICS told HSJ  that, despite the DHSC information stating that the case had been rejected, it was still awaiting a decision. A spokeswoman said: “We have yet to be notified of their decision.”

North East London ICS said it applied to pay above its maximum, “given market forces,” and that the same candidate was still appointed to the role, despite its case being turned down.

The ICS was the only system that confirmed this when asked by HSJ. In other cases, where the case was rejected, it is not clear if the individuals have taken them up anyway or turned the role down.  

Shropshire, Telford and Wrekin ICS told HSJ it had received no further update from the DHSC on its business cases and a spokeswoman said they could not comment further until the process was completed.

All other ICSs were approached for comment.

A DHSC spokesman said: “It’s important NHSE has the ability to attract the most senior and experienced leaders who undertake complex and wide ranging roles.

“Those paid above the operational maximum drive improvements in the largest and most complex areas. Each case requires close scrutiny and strong justification by NHSEI, with final approval by ministers.”

UPDATED, 12 December: This story has been corrected to reflect that Surrey Heartlands’ chief medical officer role is jointly shared by two people