NHS leaders are experiencing more work-related stress and lower morale, and are increasingly likely to want to leave their jobs—with the government’s sweeping reforms of the NHS in England a major factor—according to a new MiP survey.

The survey, part of MiP’s evidence to the Senior Salaries Review Body (SSRB), which recommends executive NHS pay levels in England, found that over two-thirds of board-level managers felt unwell due to work-related stress in 2025—up from just over half last year—with 72% going to work despite feeling ill.

Nearly three-quarters say the government’s reorganisation of the NHS is undermining their ability to focus on patient priorities. “This is the most unsettling and chaotic time I have experienced in my 25-year NHS career,” one respondent said.

MiP’s evidence said morale among board-level managers is now at its lowest point, with less than a third saying they “always” or “often” looked forward to going to work—down from nearly half last year. Only 5% believe politicians value their work and many said that negative rhetoric is further damaging morale. “The NHS is a toxic environment right now,” one member said.

More than half (55%) frequently think about leaving their job, with 49% currently job-hunting and over a third (35%) intending to leave as soon as possible, the survey found.

MiP also warned that the pay overlap between executive and Agenda for Change grades has reached “tipping point”, threatening retention and the ‘natural pipeline’ for senior roles. Only one in five executives surveyed said they were satisfied with the pay gap. Some long-serving ESMs now earn less than AfC Band 9 colleagues and the lack of on-call payments means the real overlap is even greater.

Only 2% of respondents said the new VSM pay framework, introduced earlier this year, made them feel more motivated, while more than a third said it had the opposite effect. Many criticised the link between organisational performance and annual pay awards, describing the framework as “punitive” and “manager-bashing”.

Not a single respondent said the new pay system would make them more willing to take a job at a struggling organisation—a declared aim of the framework—while a third said they would now be less willing. Respondents described the two-year incentive period as “unrealistic”, as turnaround efforts typically require three to five years.

MiP also called for automatic adoption of annual pay awards by employers, arguing that the new pay framework—which allows for locally-determined bonus payments in certain circumstances—had failed to take the “subjectivity and politics out of pay decisions”.

Several respondents said “the optics” of executive pay rises were still difficult for trusts to manage. “My trust is subject to an inquiry into care failures, losing a thousand posts and has Band 2 staff struggling to make ends meet,” said one. “Most remuneration committees will feel obliged to do nothing other than implement a nationally mandated award.” //