Guidance released by NHS Improvement suggests that the best performing chief executives at the largest NHS acute trusts could legitimately command salaries of over £250,000.
This salary ceiling is included in new guidance on pay levels for very senior managers in the NHS, which provides indicative salaries for the highest ranked manager roles in acute, specialist, mental health, ambulance and community trusts.
The guidance illustrates that there is a potential 34% gulf between the median pay of chief executives in small acute trusts and those at very large trusts.
According to the data, a small acute trust, with a turnover of up to £200 million annually, could pay its chief executive a median salary of £167,500.
Meanwhile, a chief executive at a very large acute trust, with a turnover of £500 million per year, should pay its chief executive a median salary of £225,000.
NHS Improvement has published the data alongside new guidance setting out rules for how senior managers should be paid.
It cautioned that the indicative rates were still under discussion and liable to change.
Health secretary Jeremy Hunt had launched a crackdown on senior executive pay in the NHS in 2015.
Each trust was asked to justify why any new very senior manager should be paid more than the prime minister (£142,500).
The Department of Health said more than one-fifth of all NHS directors earn more than the prime minister’s salary.
Indicative salaries are being published ahead of a new pay framework due to be drawn up by the Department of Health.
But many will be concerned about what could be deemed an unfair gap between managers’ pay.
NHS trusts are expected to use the salaries listed as a guide when they seek approval from NHS Improvement for the pay of the utmost individuals in the healthcare system.
However, foundation trusts can effectively ignore the guidelines and set their own pay if they wish to do so.
Another issue likely to come out of the study is the excessive salaries being paid to the top individuals in the healthcare system, particularly at a time when many workers are feeling the pinch.
Overall pay for chief executives in small acute trusts could range from £141,000 up to £182,500; the higher range of which is around eight times the average salary of nurses in the NHS.
The picture painted is one of inequality, which will concern both healthcare professionals and the authorities.