Board-level managers in England are set for a 3% pay rise for 2026-27—lower than most other NHS staff—despite evidence that pay levels for senior managers have fallen sharply in recent years.

After a delay of more than two months, the government finally accepted pay recommendations from the Senior Salaries Review Body (SSRB) for very senior managers (VSMs) and executive senior managers (ESMs) in England in late May. The 3% award is higher than the 2.5% ministers said was “affordable” but below the 3.3% paid to NHS staff on Agenda for Change.

The SSRB also covers VSMs working in Wales and Northern Ireland, but at the time of writing only the UK government has formally accepted the its recommendations.

In its 2026 report, the SSRB highlighted the longer-term decline in senior manager pay. It reported that salaries for chief executives in NHS trusts have fallen by 13% in real terms in the last five years, while those for nursing directors have shrunk by 14%. In contrast, AfC Band 9 salaries have fallen by 6% and medical director pay by just 3% over the same period.

Commenting on the award, MiP chief executive Jon Restell said: “We welcome the fact the SSRB did not accept the government’s argument for a cap of 2.5% on the award, and that they have accepted the review body’s recommendation. However, our long standing policy is that VSMs should get the same pay rise as their colleagues covered by Agenda for Change.” 

The timetable has yet to be confirmed, but it is understood that guidance on implementing the award is currently being prepared for NHS trusts and ICBs.

This will be first award paid under on the contentious new VSM pay framework which links organisational performance to individual pay.

Executives working in organisations placed in segment five of the NHS Oversight Framework are ineligible for the pay increase unless they have been employed at their organisation for less than two years. The government is also considering extending the policy to organisations in segments three and four, with a decision expected to be reflected in forthcoming guidance.

MiP is opposed to withholding basic pay awards from executives in segment 5 trusts, “irrespective of their personal performance”, said Restell, “as well as any extension to trusts in segments 3 and 4. The SSRB has identified risks with the approach and we believe these support the case to review this element of the new framework.”

The government also accepted a recommendation from the SSRB to improve training and knowledge-sharing for remuneration committees and chief people officers in a bid to tackle the growing pay overlap between very senior managers and Agenda for Change staff. NHS England figures show that 9% of VSMs were paid less than the AfC Band 9 maximum in 2023-24 and the SSRB warned this figure was likely to have risen due to subsequent higher pay awards for AfC staff.  

“In discussion groups, and in evidence from NHS Providers and MiP, we again heard that individuals on AfC choose not to apply for VSM roles because the pay uplift would not match the increased demands and accountability,” said the review body report.

MiP members have consistently reported that despite funds being set aside in previous awards to tackle the overlap issue, the money is not being used locally and pay anomalies are still commonplace.

“We hope this extra training helps address pay overlaps but it will only work if the system allows remuneration committees to make corrective awards,” Restell added.

The Department of Health and Social Care has indicated that it will provide further guidance on pay overlap issues to trusts and ICBs later this year.