Senior Salaries Review Body 2026/27: written evidence from NHS Providers

NHS trust leaders are central to delivering the government’s ambitious reform agenda. The 10-year health plan (10YP) sets the vision, but without a delivery plan it falls to local leaders to turn ambition  into reality for patients, communities and staff. To succeed, government must properly value those leaders including through fair, competitive pay.

Our headline recommendation is that very senior managers (VSMs) should receive annual pay uplifts in line with inflation, consistent with equivalent senior roles across other sectors. This is the minimum required to sustain recruitment, retention and motivation at a time when demands on NHS leadership  have never been greater.

Alongside this, we ask the SSRB and government to:

• Support a strong leadership pipeline – ensure the forthcoming 10 Year Workforce Plan (10YWFP) explicitly includes NHS managers, with a national approach to talent development and succession planning, supported by a new independent leadership body.
• Ensure fair and consistent reward – refine the VSM pay framework so that it promotes teamwork, avoids unintended bias, minimises unnecessary ministerial sign-off thresholds, and prevents delays in segmentation from undermining morale and retention.
• Use league tables responsibly – ensure the new oversight framework and provider segmentation system supports improvement without unfairly penalising leaders, harming morale, or deterring recruitment into challenged trusts.
• Promote diversity and inclusion – reaffirm government commitment to the Equality, Diversity and Inclusion (EDI) Improvement Plan, and ensure proper capacity is in place nationally to deliver it, so board leadership better reflects the workforce and communities it serves.
• Strengthen recruitment to challenged trusts – complement the 15% pay premium with meaningful career development and cultural improvement, to avoid short-term “job hopping” and build sustainable leadership capacity.

Trust leaders are balancing reform, intense operational pressures, financial restraint and industrial relations turbulence, all while under increasing scrutiny. They are stepping up to deliver for patients and communities.

Government must now step up in return, ensuring their pay, development and professional environment are fit to attract and retain the leaders required to transform the NHS.