NHS Chief Executive Salary 2026/27: What a Chief Executive Earns

Last updated: 8 November 2026 · Figures verified against the NHS England 2026/27 VSM pay ranges (01/2026).

By the NHS Bands Pay editorial team

Searches for NHS chief executive pay usually come from one of two places: curiosity about a headline figure in the news, or a serious question about what the most senior job in a trust or an integrated care board actually pays. Both are fair questions, and both are answerable from published figures, because chief executive pay is one of the most transparent parts of NHS pay. Every trust and integrated care board must publish its senior salaries in its annual report, and NHS England publishes the national pay ranges that set the limits. This page brings those two sources together for 2026/27: the published ranges for trust and integrated care board chief executives, what chief executives actually earn on average, what the figures mean after tax, pension and National Insurance, and how a chief executive's pay is decided. It covers England only. Scotland, Wales and Northern Ireland set senior pay under their own arrangements, and this page says so where the England framework stops. Chief executives sit outside Agenda for Change, so none of the band figures on this site applies to them. The comparison that matters is with the top of Agenda for Change, Band 9, and with consultant pay, and both are set out below.

What “chief executive” means in the NHS

In the NHS, “chief executive” is a specific job under a specific pay framework, not a loose description of any senior manager. Under the Very Senior Managers pay framework, the chief executive is the Level 1 role: the overall accountable officer of the main board of a trust, or of a group of trusts. In a foundation trust the chief executive is the accounting officer. The title carries personal accountability for the organisation's finances, its performance and its quality of care, and it is the only role in a trust that answers directly to the board as a whole rather than to another executive.

The framework draws a clear line between the chief executive and everyone else at the top. Level 2 covers the executive directors who report directly to the chief executive: the chief operating officer, the finance director, the nursing director, the medical director and their equivalents. In a group model, Level 2 also covers the chief executives and managing directors of individual hospitals or business units inside the group, and the framework is explicit that they should not be paid more than a stand-alone chief executive of an equivalent-sized organisation. Level 3 covers the other very senior manager posts that report to Level 1 or Level 2. In most stand-alone trusts, Level 3 roles are paid on Agenda for Change rather than on the VSM framework, which is why most senior managers you meet in a hospital are on a band, not on VSM terms. The VSM framework guide sets out all three levels in full, with the executive director ranges alongside the chief executive ranges on this page.

Medical directors deserve a sentence of their own, because they sit across two pay systems. A medically qualified director can choose whether to move to a VSM contract or stay on medical and dental terms with a management allowance, and many stay on medical terms because consultant pay plus the allowance can exceed the VSM range. Medically qualified chief executives appointed after 1 April 2025 are offered VSM terms only, with flexibility to be paid further up the range if the VSM rate would otherwise cut their previous medical pay. That rule is one of the reasons the framework's ranges matter in practice: they set the ceiling for a negotiation that starts from a consultant's existing pay, not from zero.

The most important fact for anyone reading this page is the simplest one. Chief executive pay is not Agenda for Change pay. There are no bands, no spine points and no increments. The pay is a spot salary, set individually by the organisation's remuneration committee inside the published ranges, and reviewed each year. A chief executive does not move up a scale by staying in post; the committee decides each year whether the salary moves, and by how much, within the framework. That is a different world from the banded system that covers almost everyone else in the NHS, and it is the reason this page quotes ranges and means rather than a single salary.

Trust chief executive pay ranges 2026/27

For provider trusts, the framework sorts organisations into five bands by annual turnover, from Band A for trusts turning over up to £250 million to Band E for trusts turning over more than £1 billion. Each band carries three figures. The minimum is the floor for a new appointment at that size. The operational maximum is the top of the normal range. The exception zone sits above the operational maximum and can only be reached through a formal pay case. The table below gives all three figures for each band, with the monthly equivalent of each figure alongside.

Read the table from the bottom up, because that is where the scale of the job shows. A chief executive of a trust turning over more than £1 billion sits in Band E, with a minimum of £253,033 a year, or £21,086.08 a month, an operational maximum of £287,538, or £23,961.50 a month, and an exception zone running to £318,245, or £26,520.42 a month. At the other end, a chief executive of the smallest trust sits in Band A, with a minimum of £149,520 a year, or £12,460.00 a month, an operational maximum of £207,027, or £17,252.25 a month, and an exception zone to £223,330, or £18,610.83 a month. The gap between the two ends is wide: the Band E exception zone figure is more than double the Band A minimum, which is exactly what the turnover test is meant to produce, because a £1 billion organisation carries a different weight of accountability from a £200 million one.

Notice also that the bands overlap. Band D's minimum of £230,030 is lower than Band C's operational maximum of £253,033, and Band E's minimum of £253,033 is exactly the same figure as Band C's operational maximum. That overlap is deliberate. Turnover decides the band, but the committee sets the salary inside the band, so a well-regarded chief executive of a large Band C trust can be paid more than a new chief executive of a small Band D trust. The band is a frame for the decision, not a salary in itself, and two chief executives in the same band can sit tens of thousands of pounds apart.

A note on older figures is worth making here, because the internet is full of them. The 2026/27 ranges on this page sit about 6.35% above the previous framework ranges: the Band A minimum has risen from £140,595 to £149,520, a rise of £8,925, and the Band E exception zone figure from £299,250 to £318,245, a rise of £18,995. Some pages, including the VSM framework page on this site, still show the previous ranges. The figures on this page are the 2026/27 ranges published by NHS England, and they are the ones to use for the current pay year.

ICB chief executive pay ranges 2026/27

Integrated care boards are sorted differently from trusts. Their bands are set by weighted population rather than turnover, because a board's job is to plan and fund care for a population, not to run a hospital. There are four bands, from Band A for boards covering under 1 million weighted population to Band D for boards covering more than 2 million. The same three points apply: a minimum, an operational maximum and an exception zone.

At the top of the scale, the largest ICB chief executive range runs higher than the largest trust range. Band D runs from a minimum of £279,163 a year, or £23,263.58 a month, to an operational maximum of £301,496, or £25,124.67 a month, with an exception zone to £323,829, or £26,985.75 a month. That top figure is £5,584 a year above the largest trust chief executive's exception zone figure of £318,245, and it is the single highest published figure in the VSM framework. At the bottom, the smallest ICB chief executive minimum of £195,414, or £16,284.50 a month, sits £45,894 a year above the smallest trust chief executive minimum of £149,520. Integrated care boards start higher because even the smallest board carries system-wide responsibility for a whole population's care, not a single organisation's services.

The executive directors who report to an ICB chief executive have their own published ranges, split by the same population test. There is no exception zone published for them: the framework gives a minimum and an operational maximum only.

Two details in that table are worth noticing. First, the chief finance officer is the highest-paid executive director in every band group, ahead of the chief nurse officer and the chief medical officer, who are paid identically to each other. Second, the chief finance officer of a large board can earn more than a chief executive of a small trust: the Band C and D operational maximum of £203,231 sits above the trust Band A minimum of £149,520 and close to its operational maximum of £207,027. That is not an anomaly. It is the framework working as designed, paying for the size of the job rather than the title on the door.

What chief executives actually earn

Ranges are not salaries, and the gap between the two is the most useful fact on this page. The Department of Health and Social Care's evidence to the Senior Salaries Review Body, covering the 12 months to March 2025, puts mean basic pay for chief executives at around £211,988 a year per full-time equivalent, with mean total earnings of around £231,355. That mean sits inside the published ranges, between the trust Band A operational maximum of £207,027 and the Band B operational maximum of £230,030, and a long way below the exception zone figures that make the headlines. Most chief executives earn nothing like the top of the range, because most trusts and boards are not the largest ones, and because the exception zone is genuinely exceptional: it needs a formal pay case and, above £170,000, a submission to NHS England.

The average across all very senior managers is lower still. Average VSM basic pay is £150,290 per full-time equivalent, or £142,420 per person, with total earnings averaging £155,152 per person. That average covers every VSM group, not just chief executives, and it is pulled down by executive directors in smaller organisations. Within the groups, chief executives are the highest paid, followed by executive directors: finance directors averaged around £156,739 in basic pay, and directors of nursing around £143,714, in the same evidence. These are mean averages across all trusts, so individual salaries vary widely with organisation size. A chief executive of a small community trust and one running a £1 billion-plus teaching hospital group sit at opposite ends of the published ranges, and the mean sits between them.

The difference between basic pay and total earnings also matters. Total earnings include pension benefits and any other elements on top of basic pay, so a headline figure of £300,000 for a chief executive's package may include pension accrual that is not take-home pay. The gap between the chief executive mean basic of £211,988 and the mean total of £231,355 is £19,367 a year, and most of that gap is pension. When you see a chief executive's pay in the news, check whether the figure quoted is basic salary or total remuneration, because the two are often tens of thousands of pounds apart. The section on finding a specific salary, below, explains how to read the published figures properly.

Chief executive take-home pay

The ranges above are gross pay. What a chief executive actually keeps each month depends on the same deductions as everyone else, applied at the top of the scale: a 12.5% NHS pension contribution, because every chief executive salary sits above the £67,669 threshold for the top pension tier; income tax at 20%, 40% and 45%; and National Insurance at 8% up to £50,270 and 2% above it. The table below works through four points on the ranges using the same method as the take-home pay by band guide: pension first, then tax on the remainder, National Insurance on gross pay. The figures are before any student loan deduction, which is covered in the worked example after the table.

Three things stand out. First, at every salary in this table the personal allowance is £0. The allowance tapers by £1 for every £2 of income above £100,000 and disappears entirely at £125,140, and pensionable pay after the 12.5% pension deduction still sits above that figure even at the smallest trust minimum, where adjusted income is £130,830. Second, the share kept falls as pay rises, from 53.6% at the Band A minimum to just under half at the top of the ranges, because more of the pay falls into the 40% and 45% tax bands. Third, the pension contribution is the single largest deduction after tax: £18,690 a year at the Band A minimum and £40,478.63 a year at the largest ICB exception zone figure. That contribution buys a pension, not a loss. At the 1/54th accrual rate of the 2015 scheme, a year on the Band A minimum accrues £2,768.89 of annual pension, and a year on the largest ICB exception zone figure accrues £5,893.43. The employer adds 23.7% on top: £35,436.24 a year at the Band A minimum and £75,424.07 a year at the largest ICB exception zone figure. For the full pension picture, see the pension contributions by band guide.

Student loans rarely change the picture at this level, because most chief executives are decades past their student years, but the maths is worth showing for readers who do carry a loan. On the Band A minimum of £149,520, a Plan 2 loan takes 9% of earnings above the £29,385 threshold, which is £10,812.15 a year, or £901.01 a month. Take-home falls from £6,677.00 a month to £5,775.99 a month. The student loan calculator works out the deduction for any salary and plan, and the student loan repayments on NHS pay guide explains the thresholds.

How a chief executive's pay is set

The decision sits with the organisation, not with a national pay scale. Each trust or integrated care board has a remuneration committee, usually made up of non-executive directors, which sets the chief executive's salary as a spot figure inside the published range for the organisation's size. The committee looks at the size and complexity of the organisation, the experience of the candidate, the pay of comparable chief executives and the need to recruit and retain. The salary is then reviewed each year. There is no automatic annual rise: the committee decides whether the salary moves and by how much, within the framework, and the framework itself is uprated periodically with government pay decisions.

Two controls sit above the local decision. The first is the exception zone. Pay above the operational maximum needs a formal pay case, setting out why the organisation's circumstances justify going beyond the normal range. The second is the national backstop: any proposed VSM salary above £170,000 must be submitted to NHS England as a pay case, and for integrated care board chief executives the trigger is exceeding the operational maximum instead. Cases that do not comply with the framework go to the Department of Health and Social Care for final approval. That is the mechanism behind the headlines when a trust board proposes a salary that Whitehall considers excessive: the proposal does not simply take effect, it goes through a national check first.

Two further rules complete the picture. Responsibility across two or more organisations can attract a pensionable premium of up to 10%, which is how the framework handles a chief executive who runs a group or holds a joint appointment. And the published ranges are single national figures with no separate London element: a chief executive of a London trust is paid from the same ranges as one elsewhere, with the organisation's size deciding the band. That is different from Agenda for Change staff, who receive a High Cost Area Supplement in London, and it is one of the quieter differences between the two pay systems. For the full framework, including the executive director ranges, see the VSM framework guide.

Chief executive pay against the rest of the NHS

Put the chief executive ranges next to the rest of NHS pay and the shape of the system becomes clear. The top of Agenda for Change is Band 9, at £129,783 a year in 2026/27. The smallest trust chief executive minimum of £149,520 sits £19,737 a year above it, or 1.15 times Band 9 top. The largest ICB exception zone figure of £323,829 is 2.45 times Band 9 top. Against the bottom of the banded system, the gap is wider still: the largest ICB exception zone figure is 12.81 times Band 2 pay of £25,272, and the smallest trust chief executive minimum is 5.92 times Band 2. Those multiples are arithmetic, not a judgement. They show the distance between the ward and the boardroom, and they are the reason the ranking on the highest paid jobs in the NHS page puts chief executives at the top.

Against consultant pay, the picture is more interesting, because the two systems overlap. A consultant at Threshold 4, after 14 years as a consultant, earns £150,569 a year in basic pay in England in 2026/27. That is £1,049 a year more than the smallest trust chief executive minimum of £149,520. A senior consultant on basic pay alone earns slightly more than a chief executive of the smallest trust. The gap opens at the top: the largest ICB exception zone figure of £323,829 is 2.15 times a Threshold 4 consultant's basic pay, or £173,260 a year more, and the mean chief executive basic pay of £211,988 is £61,419 a year above a Threshold 4 consultant. Add a consultant's awards and the gap narrows again: a Threshold 4 consultant with a National 3 Clinical Impact Award of £42,000 earns £192,569 a year, and with a legacy Platinum award at the top of its range, £227,889. The consultant salary guide and the consultant take-home guide set out those figures in full.

None of this makes chief executive pay typical. Very few staff ever reach these roles, and the route runs through years of senior leadership, not through a pay scale. A nurse or allied health professional who moves into a chief executive role leaves the band system behind entirely: the pay stops being incremental and starts being negotiated, and the pension tier, the tax position and the public scrutiny all change with it. For most staff, the useful comparison is not with the chief executive's salary but with the next step on their own ladder, which is why the Band 9 pay guide and the Band 8d pay guide are the right pages for senior managers still on Agenda for Change.

Scotland, Wales, Northern Ireland and national roles

The VSM framework on this page covers England. Scotland, Wales and Northern Ireland set senior pay under their own arrangements, and this page quotes no figures for them, because none are verified in the data behind it. The four-nation position on Agenda for Change pay is set out in the pay scales by country comparison, and the nation guides carry the detail: Scotland pay, Wales pay and Northern Ireland pay. Scotland's two-year deal of 4.4% then 3.75% and its 36-hour week, Wales' 3.3% award with its Real Living Wage floor, and Northern Ireland's recommended but not yet implemented 3.3% award are all covered there, and none of them changes the England chief executive ranges on this page.

National roles are a separate case again. The chief executives of national bodies such as NHS England are not covered by the trust and integrated care board framework in the same way, and their pay is disclosed in NHS England's own annual report and accounts rather than through these ranges. If you are looking for the salary of the NHS England chief executive, or of a chief executive of another national body, the annual report is the place to look, not this page's tables. The same applies to chief executives of organisations outside the NHS proper, such as arm's-length bodies, which follow their own senior pay arrangements.

How to find a specific chief executive's salary

If you want the salary of a named chief executive, the answer is the same every time: check the organisation's annual report and accounts. Every NHS trust, foundation trust and integrated care board must publish a remuneration report in its annual report. The report names the senior managers and discloses their salary bands, their pension benefits and any bonuses, and it is the authoritative, audited source. It is free to download from every trust's and board's website, usually under a publications or about us section. Search for the trust name plus annual report and remuneration report, and look for the most recent year.

Read the report with the distinctions on this page in mind. Salary bands are published in £5,000 bands, not to the pound, so the report gives a range rather than an exact figure. Pension benefits are disclosed separately from salary, and a total remuneration figure can include pension accrual that is not take-home pay. Bonuses, where they exist, are disclosed separately too. A headline that says a chief executive earned £300,000 may be describing a package that includes tens of thousands of pounds of pension benefit on top of a basic salary inside the published ranges. The ranges on this page tell you whether the basic salary sits inside the framework; the remuneration report tells you what the individual actually received.

One more caution applies to older reports. The framework ranges are uprated with government pay decisions, so a salary that looked high against the ranges of two years ago may sit comfortably inside the current ranges. Always compare a salary with the ranges for the same year, and check the date on the NHS England publication before drawing a conclusion. The ranges on this page are for 2026/27, and they are the ones to use for the current pay year.

Frequently asked questions

How much does an NHS chief executive earn?

It depends on the size of the organisation. Under the published Very Senior Managers pay framework for 2026/27, a trust chief executive's range runs from £149,520 a year in the smallest trusts to £287,538 a year at the operational maximum in trusts with turnover over £1 billion, with an exception zone to £318,245. An integrated care board chief executive's range runs from £195,414 to £301,496 at the operational maximum, with an exception zone to £323,829. What chief executives actually earn is lower than the top of the range: the Department of Health and Social Care's evidence to the Senior Salaries Review Body puts mean basic pay for chief executives at around £211,988 a year, with mean total earnings of around £231,355.

What is the highest salary an NHS chief executive can earn?

The highest published figure for 2026/27 is £323,829 a year, the exception zone top for a chief executive of an integrated care board covering more than 2 million weighted population. For a trust chief executive, the highest published figure is £318,245 a year, the exception zone top for a trust with turnover over £1 billion. Both figures sit in the exception zone, above the operational maximum, and reaching them needs a formal pay case. Salaries above £170,000 must be submitted to NHS England as a pay case in any case, and cases that do not comply with the framework go to the Department of Health and Social Care.

Are NHS chief executives on Agenda for Change?

No. Chief executives sit outside Agenda for Change entirely, on the Very Senior Managers pay framework. Their pay is a spot salary set individually by the organisation's remuneration committee, within the published ranges for the size of the organisation. There are no increments, no spine points and no unsocial-hours enhancements. The top of Agenda for Change is Band 9, at £129,783 a year in 2026/27, and even the smallest trust chief executive minimum of £149,520 sits £19,737 a year above it.

How is a chief executive's pay decided?

The local remuneration committee sets the salary as a spot figure inside the published range for the organisation's size, based on turnover for a trust or weighted population for an integrated care board. The framework sets three points for each band: a minimum, an operational maximum and an exception zone above the operational maximum. Pay inside the exception zone needs a formal pay case, and any proposed VSM salary above £170,000 must be submitted to NHS England as a pay case. Responsibility across two or more organisations can attract a pensionable premium of up to 10%. The salary is reviewed annually rather than rising by increments.

What does an NHS chief executive take home?

On the smallest trust minimum of £149,520 a year, a chief executive takes home about £6,677 a month after a 12.5% pension contribution of £18,690 a year, income tax of £45,705 and National Insurance of £5,001. That keeps 53.6% of gross pay. At the top of the published ranges, a trust chief executive on £318,245 takes home about £13,162.37 a month, and an integrated care board chief executive on £323,829 takes home about £13,377.00 a month, keeping just under half of gross pay. At every salary in this range the personal allowance is £0, because pensionable pay after the pension deduction still sits above £125,140. These figures are before any student loan deduction.

Do NHS chief executives get London weighting?

There is no separate London element in the published VSM ranges. The ranges are single national figures: a chief executive of a London trust is paid from the same ranges as a chief executive elsewhere, with the organisation's size deciding the band. That is different from Agenda for Change staff, who receive a High Cost Area Supplement of 20% of basic pay in inner London, 15% in outer London and 5% in the fringe, within published minimum and maximum amounts.

How much does an integrated care board chief executive earn?

In 2026/27 an integrated care board chief executive's published range runs from £195,414 a year in the smallest boards, under 1 million weighted population, to £301,496 a year at the operational maximum in the largest boards, over 2 million weighted population, with an exception zone to £323,829. That top figure is £5,584 a year above the largest trust chief executive's exception zone figure of £318,245. Integrated care board executive directors have their own ranges: a chief finance officer runs from £148,515 to £178,664 in smaller boards and from £171,964 to £203,231 in larger ones.

Where can I find a specific chief executive's salary?

In the organisation's annual report and accounts. Every NHS trust, foundation trust and integrated care board must publish a remuneration report that names its senior managers and discloses their salary bands, pension benefits and any bonuses. It is the authoritative, audited source and it is free to download from the trust or board's website. Read the total remuneration figure with care: reports separate basic salary from pension benefits, so a headline package figure can include pension accrual that is not take-home pay.

Sources and independence

Source: NHS England, NHS provider and integrated care board (ICB) pay ranges for the financial year 2026/27 (01/2026).

Source: NHS England, The NHS very senior managers pay framework: implementation questions and answers.

Source: Department of Health and Social Care evidence to the Senior Salaries Review Body, pay round 2026/27, as reported on the VSM framework guide on this site.

Source: NHS Employers pay circular 2026/27 for Agenda for Change scales; GOV.UK for income tax, National Insurance and student loan thresholds.

NHS Bands Pay is an independent guide and is not affiliated with the NHS. Figures were verified against the official NHS England publication on 8 November 2026 and can change, always confirm with the relevant official body before making financial decisions. The VSM framework covers England; Scotland, Wales and Northern Ireland set senior pay separately.