MANAGERS in NHS trusts with poor performance are picking up six figure pay packages, the TaxPayers’ Alliance has discovered. Their NHS Rich List 2025 report shows that in 2023-24 there were 1,694 senior managers receiving over £100,000 in total remuneration across 224 NHS trusts.
Total remuneration includes salary, expenses, benefits, bonuses and pension contributions. Looking at salaries alone, 1,557 had entitlements of at least £100,000, including 279 receiving between £200,000 and £300,000 and 17 who received over £300,000. There were 512 senior managers in the NHS on a higher salary than the Prime Minister.
While few would disagree with paying doctors and nurses appropriately for the often difficult jobs they do, the NHS Rich List shows that managers in hospitals with poor A&E performance and long waiting times from referral to treatment (RTT) are still picking up handsome remuneration packages at taxpayers’ expense. Waiting times have risen; the number of patients waiting more than a year is now 15 times higher than in 2010. A&E performance has also declined, with 40 per cent of patients waiting more than four hours.
Wes Streeting announced that NHS leaders will be facing a new ‘carrot and stick’ performance drive. This push for NHS reform will link NHS leaders’ pay rises to how well they cut waiting lists and deliver improvements to patients. So now he has this evidence let’s see if he demands some immediate cuts. Or will the bosses of the various NHS trusts (themselves overpaid) be reluctant to trim their own sails? What power does Mr Streeting have over them?
It’s hard to see that he will receive much co-operation. The TPA’s research reveals that there were 1,261 senior managers with salaries between £100,000 and £200,000, 279 with salaries between £200,000 and £300,000 and 17 with salaries over £300,000. Will they cut back their own salaries?
Will University Hospitals Plymouth’s chief executive, who had the highest salary in 2023-24, receiving £382,500, be shamed by this? The trust was ranked 95 of 136 in England for A&E waiting time.
Or what about Paul Bachoo. His was the highest salary for a senior manager in Scotland at £242,500. He is the acute medical and portfolio lead at NHS Grampian. The trust was ranked 12 of 14 for treatment referrals and 10 of 14 for A&E waiting times.
The worst performing trust by percentage of A&E attendances within four hours or less was East Cheshire, with just 50.6 per cent of patients being seen within four hours. The trust had 8 senior managers who received over £100,000 in total remuneration, including the director of people and culture, Rachel Charlton, who received £367,500 in total remuneration.
The worst performing trust according to referral to treatment median waiting times was Cambridge and Peterborough, at 32.1 weeks. This trust had eight senior managers receiving over £100,000 in total remuneration. Their chief medical director, Catherine Walsh, received £387,500 in total remuneration.
