Ministers have opposed nearly 50 proposed pay deals for top NHS managers in the last three years – but were only able to block four of them – figures obtained by HSJ have shown.
Trusts are required to apply for government approval if they want to appoint a very senior manager on a salary that is at or above £150,000. However, while ministers can block (reject) deals in NHS trusts, they can only advise against them (referred to as “not supported”) for foundation trusts or clinical commissioning groups.
A freedom of information request to the Department of Health and Social Care found 278 cases were submitted by local NHS organisations under the rules in the last three years, between 2019-20 and 2021-22.
Across the three years, 48 of the total 278 were “not supported”. However, they were only able to formally “reject” four of them, because the others were at FTs or CCGs.
It is not known whether the local organisations awarded the pay deals or not, but significant numbers of directors in FTs are paid more than £150,000, as are some in CCGs.
The DHSC told the senior salaries review body in its evidence last year that it had been “successful” in curbing the highest pay levels for the country’s highest-earning senior managers.
Chief executive posts comprised more than half (53 per cent) of the total number of proposals submitted over the three-year period, followed by medical directors (23 per cent) and then finance directors (10 per cent).
The requirement for ministerial approval was introduced by former health and social care secretary Jeremy Hunt in June 2015, when the threshold was first set at £142,500. It was increased to its current level in January 2018.
The number of requests made was substantially up in 2021-22 compared to the previous two years, potentially because of job moves or pay deals delayed due to the first year of the pandemic. The share “supported” or approved was up in 2021-22.
Jon Restell, chief executive of the Managers in Partnership trade union, told HSJ the figures showed the process was for “politics and presentation” and was “now just unnecessary”.
This was, he felt, because the relatively low number of refusals and “not supported” showed the pay proposals had already gone through a due decision process before reaching government.
He said: “What it does mean is that it can mean very difficult and strained recruitment conversations when you’re trying to fill a post because it’s effectively bureaucracy. There’s no urgency once it [gets sent for approval]. It’s just another decision sitting on desks.
“Back in a provider context, where you might have more than one candidate, or candidates, who have got more than one job offer, it really does make a difference.
“They [trusts] can’t give certainty to those candidates, and now from these figures, the answer always comes back generally yes.
“It’s a pointless delaying feature of the system, which I think is either pointless or is either having a negative impact on recruitment in filling these jobs.”
The DHSC was approached for comment.