This year has seen a notable difference in the remit group’s enthusiasm for their work. In 2024, almost half (47%) always or often looked forward to going to work, but in 2025 this has dropped to just 30%.

Almost three-quarters of the remit group say that they are ‘always or ‘often’ frustrated by their work (2024: 62%) and that relationships at work are becoming more strained (up 8% from last year).

The lack of recognition for the work that managers do is also demotivating the remit group. Members consistently told us that they feel undervalued by government and this is contributing to the feeling that, as one respondent said, ‘the NHS is a toxic environment right now’.

Only 5% of members believe that politicians value their work to any extent which is broadly in line with last year (7%).

We were told that ‘support from government rather than constant blame’ would go a long way in motivating senior managers.

MiP knows that senior NHS managers are resilient and the issue of low recognition for their work is not new. However we are concerned that the framing of the government’s system changes as a tool to remove waste and bureaucracy in the NHS is having a significant detrimental impact on the morale of the remit group.

We believe that without action, not only will it remain extremely difficult to recruit the talent the NHS needs to deliver on its priorities, but that more and more of the remit group will vote with their feet and leave the NHS whenever an opportunity presents itself. As one member told us:

‘The persistent government narrative of managerial roles being bureaucratic and of little value is hugely demotivating not only to senior managers but to all those who work in vital but non-clinical roles right across the NHS.

The current changes, which staff and managers saw in the media before the senior teams were able to speak to them, have been handled so badly by the government and senior players within NHS/DHSC and it will be unsurprising to see those who have worked in roles for many years with vast knowledge and experience choosing to leave the service – which to my mind will only result in yet more difficulties for patients as performance can only decrease as a result.’

Some members have indicated they are waiting to see how the organisational change at their employer pans out. While some are not immediately looking for a new job due to the uncertainty surrounding all parts of the NHS system, many would consider leaving if and when a redundancy situation arises in their organisation, with less than a third of the remit group saying they would not consider redundancy.

Over half (55%) of the remit group ‘always’ or ‘often’ think about leaving their job and 49% indicated they are currently looking for a new job.

Over a third (35%) said they intend to leave their role as soon as possible.

Most MiP members do not believe that the new VSM pay framework’s performance elements, particularly the withholding of annual pay awards, make any difference to the motivation of senior staff. As one chief executive said, ‘It has not made a jot of difference … we got another beating [in the media] and then moved on’. A CPO agreed saying that the new rule on annual awards had had no impact on motivation or performance of executive directors in her trust, saying ‘none of my colleagues get up to do a bad job’. If anything, the emphasis on linking the annual pay award to organisational performance had done little more than make people feel ‘naffed off’.

This feeling was shared among survey respondents, with only 2% saying the new framework made them more motivated in their role, with over a third saying it has had opposite effect.

During our interviews with the remit group, Senior leaders pointed to other more impactful influences on motivation and behaviour, especially the National Oversight Framework and associated performance management. Some also felt that there was a renewed focus on appraisals, with a clearer line drawn between personal objectives and organisational strategy, which would be beneficial. The new appraisal scheme, one of the Messenger review recommendations, was mentioned by some members as having an impact. 360-appraisal was being adopted, although the time taken to undertake these activities was seen as significant.

Some senior leaders felt that the pay measures in the framework are seen as ‘manager bashing’ and add to the perceptions among other staff of the risks, pressures and lack of respect for those working at board level. One director characterised the response of talented reports, when encouraged to aspire to the next level, as ‘Why on earth would I want a VSM job?’

Another indicated that the framework was the last straw for them and they are now seeking employment outside of the NHS. Referencing the arrival of the framework this year, the member said ‘then a new punitive pay framework, and being treated by government as if we’re lucky to get paid anything. It’s put me over the edge and that’s why I can’t carry on in the NHS’.

A recurrent theme in members’ views was the absence of national job evaluation guidance to support using the VSM pay framework. One CPO thought that trusts would probably seek external consultancy advice on job evaluation, which were likely to be limited in use, as such reports tend to focus on grading the relative responsibility of executive posts rather than giving clear recommendations on what to pay. Many members expressed concern about the lack of equality impact assessment, in both basic salary and bonus decision-making.

We also asked senior Agenda for Change members for their views on the VSM pay framework and if it makes jobs at this level more attractive to them. Only 13% said it makes these roles a more attractive proposition compared to 39% who felt the new framework actually made these roles less attractive.

Challenged organisations

One of the main aims of the new framework is to encourage talented leaders to take on roles at challenged organisations, but no one who responded to our survey said it would make them more willing to take on these roles with a third (34%) saying they would be less willing.

The new arrangements to encourage directors to take jobs in challenged organisations present several problems, according to board leaders. Some believe the two-year window is unrealistic, given that challenged organisations are unlikely to turnaround in two years. Three to five years is widely seen as the realistic timeframe.

As one respondent said:

‘I would like to see some career protection rather than pay or bonuses per se, so I would feel happy to take on the risk of a “failing” organisation without fear of committing career suicide!’

One CPO worried that the two-year period for recruitment incentives could engender a trend towards job-hopping, when stable leadership is what challenged organisations need. Some respondents pointed out the unfairness of the cut off for the recruitment measures which saw directors who joined in the year or so before the cut off excluded from the measures. This was seen as unfair. Several board leaders also questioned how easy it will be to take away recruitment incentives at the end of the period, especially in hard to fill posts.

Pay bands and overlap with Agenda for Change

Pay overlap issues with Agenda for Change remain a consistent issue for both VSMs and ESMs. One CPO commented that the new framework had enabled her trust to introduce an ‘appropriate gap’ between Agenda for Change and VSMs roles, however this has not been seen throughout the whole of the remit group.

The vast majority of our respondents say that pay overlap issues is a concern with only 22% saying they are satisfied with the difference in their salary with Agenda for Change colleagues. This is in line with last year when only 23% said they were satisfied with the difference in pay.

Frustration is turning to apathy for the remit group who do not believe that any action so far has adequately addressed this issue. Last year, the remit group received a lower pay award than colleagues on Agenda for Change which many feel will further exacerbate the weak differential.

We heard how some senior managers who have been ESMs for years are seeing their pay eroding to the point that Agenda for Change band 9s are now paid more.

Some respondents felt that the financial size of organisations – and associated management challenges – was not adequately reflected in the pay bands. One CPO felt that the failure to uprate the organisational turnover bands was part of the problem. Some board leaders also felt that removing the banding by job had created some problems and loss of clarity.

We heard how the pay overlap is made worse with staff who are part of an on-call rota. The overwhelming majority of the remit group receive no payment for their time on-call compared to AfC staff, which means the pay overlap in practice is likely much higher than the pay ranges suggest.

One member said: ‘Covering on call does not attract additional pay and that can be very time consuming and restrictive. There is variation on other benefits offered as well and this needs standardising, such as car allowance’.

This issue is also increasingly noticed by senior Agenda for Change managers. In 2024, only 44% of senior managers on Agenda for Change terms and conditions believed the increased responsibilities and pressure of board-level roles was reflected in their salary, however this has dropped even further to just 31% in 2025.

There has also been an increase in Agenda for Change managers saying the demands at VSM/ESM level makes them worried about working at this level – up from 69% in 2024 to 84% this year.

MiP believes that pay overlap issues is now reaching a tipping point and action must be taken to address this. If the issue persists we are concerned that not only is there a risk to retention for current VSMs and ESMs, but the growing perception of Agenda for Change staff that salaries are not justified for the levels of responsibility will impact recruitment and the natural talent pipeline for these roles.

Optics of local decision making on pay

The political and presentational difficulties for local remuneration committees in making objective pay decisions in the interests of their organisations has emerged this year as a key theme and concern. The national VSM pay framework has not helped local employers to take the subjectivity and politics out of pay decisions, with one respondent commenting that that was never the government’s intention.

Several respondents said that trusts, particularly challenged trusts, will nearly always find it hard to manage ‘the optics’ of pay rises for executives. As one executive director said, ‘my trust is subject to an inquiry into care failures, losing a thousand posts and has band 2 staff struggling to make ends meet. Most remuneration committees will feel obliged to do nothing other than implement a nationally mandated award.’ One experienced CEO agreed, saying that the national framework needed to remove the need for local subjectivity as far as possible, comparing the treatment of executives with the national frameworks for Agenda for Change and medical staff.

Automatic adoption of the pay award by employers should be the minimum requirement said many members.

Pay progression

The absence of job evaluation guidance, the red tape associated with salary review and the lack of any mechanism for pay progression were seen as particular problems for remunerating new directors. One chief executive we interviewed said, ‘Our nurse director was new to board-level and on a learning curve. Two years on I can see her development and her growing capacity to take on more responsibility. There’s no easy way to reflect that in her pay, certainly when compared to medical or Agenda for Change staff who have clear progression expectations.’

Talent management

Talent management, a focus in the Messenger review, was widely seen as ‘hit and miss’ and unsystematic. Funding for senior management development is being sharply curtailed. Access to development opportunities was determined largely by ‘what type of boss you have’, rather than through an organisational or system-wide framework. Some members felt that the forthcoming leadership and management framework and supporting curriculum might help systematise development, but it would still require a programme and funding to have bite.

Only a quarter (24%) of current Agenda for Change members believed they have had or can access the training and development needed to progress to VSM/ESM roles.

One member said that “clear training, openness about opportunities and how vacancies are filled… opportunities to shadow and progress” would be welcome to support talent moving up the system.

Governance

There remain considerable variations in understanding of the VSM pay framework among the remit group (and among the non executive directors making decisions in remuneration committees), according to several members.

A third (34%) of the remit group are not clear on how their pay was set upon appointment and only 29% feel that their employer’s remuneration committee makes decisions about my pay fairly and openly.

One member who had moved from a foundation trust to a trust also noted the loss of autonomy around remuneration decisions for executives. She felt this gave foundation trusts a considerable edge in recruitment.

The remit group called for ‘transparency in the banding approach’ and to make it available to staff.

Recommendations 

MiP would welcome recommendations from the SSRB addressing the following issues: