Callum McGoldrick is investigations campaign manager at the Taxpayers’ Alliance
Two years of Starmer gave us little to cheer about. Unemployment rising, taxes higher and tens of billions more in spending. One defining achievement of his premiership, according to the man himself, was the 400,000 decrease in NHS waiting lists.
Yet, as ever with health service statistics, the reality is far less impressive. That reduction owes far more to administrative trickery, patients quietly removed from lists, falling referral numbers, or people turning to quicker, private clinics, than to any genuine surge in NHS productivity. It is for this reason that we must assess just how much the health service’s bloated leadership class is taking home, especially as patient care remains stuck in the doldrums.
The line we constantly hear from the left is that the NHS is underfunded and that we must reward hard-working senior bosses with the giant salaries that they would get at exec level at a Fortune 500 company and so on.
As we can see from the TaxPayer Alliance’s latest rich list, the NHS has absolutely no problem in handing out these giant salaries. In 2024-25, 1,758 NHS managers received £100,000 or more in total remuneration, an almost 4 per cent increase on the previous year. 574 had a higher salary than the Prime Minister himself. 17 had salaries over £300,000.
But what about results? In the third quarter of 2025-26, major A&E departments saw only around 60 per cent of patients within four hours, falling drastically short of both the 95 per cent constitutional target and the government’s interim 78 per cent target. Non-urgent treatment waiting times show a similarly dismal picture. The constitutional standard dictates that 92 per cent of patients should begin treatment within 18 weeks, a benchmark last met in September 2015. By October 2025, only 62 per cent of patients were starting treatment within that window.
Things look even worse when assessing individual trusts. East Cheshire was once again the worst performing trust in England based on A&E waiting times. In fact, its performance significantly worsened with the ‘seen in four hours’ target being met only 43 per cent of the time compared to the previous year’s 50.6 per cent. Their chief executive was rewarded with an extra £200,000 in this time, seeing his total remuneration go from £172,500 to £377,500.
Of course hospitals are not just measured on A&E performance, but the reward for failure in other areas is equally as damning. RTT (the time taken from referral to treatment) is a key metric for determining how well hospitals manage with outpatient treatment. Cambridgeshire and Peterborough had the worst RTT waiting time of 149 trusts, ranking last for the second consecutive year. Their chief medical director had a total remuneration of £322,500.
Outside of England, Lanarkshire ranked 14th out of 14 for A&E waiting times in Scotland; their medical director received £462,500 in total remuneration. The medical director at Ayrshire and Arran had the highest salary of any NHS boss in Scotland with £247,500. The trust was ranked 11 of 14 for A&E waiting times in Scotland.
The chief executive of Betsi Cadwaladr University Health Board had the highest salary of any senior manager in Wales in 2024-25 at £262,500. The health board was ranked 6 of 7 for RTT waiting time and 7 of 7 for A&E waiting time in Wales.
Beyond performance, the necessity of certain job roles should also be questioned. Barts paid £232,500 to the ‘group director of inclusion and equity’. The directors job involves leading the trusts ‘WeBelong strategy’, the gist of which seems to be overseeing six staff networks, and ‘promoting diversity and equity’. The job holder, Mr Ajit Abraham, is a surgeon at the trust. Perhaps patient results would be better if his time were devoted to that full-time.
In May 2025, the government announced a new carrot and stick approach to NHS leadership, promising to link senior managers’ pay more closely to operational results. We were promised that executives delivering improvements would be rewarded, while those presiding over failing trusts would see pay rises docked.
Yet, when bonuses and massive pay raises are still being handed out to leaders running the worst-performing trusts, it is clear that this policy is failing to deliver. If NHS executives want to demand corporate-level salaries fit for FTSE 100 boardrooms, they must be subject to corporate-level accountability. In the private sector, persistent operational collapse results in immediate pay cuts or dismissal, and certainly not a £200,000 pay bump.
Fudged figures, increasing executive salaries and declining performance. This is the true legacy of Starmer’s two years presiding over the NHS. The new health secretary, Yvette Cooper, is yet to lay out any new plans to boost performance, but one thing is very clear: increasing salaries to ever new highs is not the answer.
Callum McGoldrick is investigations campaign manager at the Taxpayers’ Alliance
Two years of Starmer gave us little to cheer about. Unemployment rising, taxes higher and tens of billions more in spending. One defining achievement of his premiership, according to the man himself, was the 400,000 decrease in NHS waiting lists.
Yet, as ever with health service statistics, the reality is far less impressive. That reduction owes far more to administrative trickery, patients quietly removed from lists, falling referral numbers, or people turning to quicker, private clinics, than to any genuine surge in NHS productivity. It is for this reason that we must assess just how much the health service’s bloated leadership class is taking home, especially as patient care remains stuck in the doldrums.
The line we constantly hear from the left is that the NHS is underfunded and that we must reward hard-working senior bosses with the giant salaries that they would get at exec level at a Fortune 500 company and so on.
As we can see from the TaxPayer Alliance’s latest rich list, the NHS has absolutely no problem in handing out these giant salaries. In 2024-25, 1,758 NHS managers received £100,000 or more in total remuneration, an almost 4 per cent increase on the previous year. 574 had a higher salary than the Prime Minister himself. 17 had salaries over £300,000.
But what about results? In the third quarter of 2025-26, major A&E departments saw only around 60 per cent of patients within four hours, falling drastically short of both the 95 per cent constitutional target and the government’s interim 78 per cent target. Non-urgent treatment waiting times show a similarly dismal picture. The constitutional standard dictates that 92 per cent of patients should begin treatment within 18 weeks, a benchmark last met in September 2015. By October 2025, only 62 per cent of patients were starting treatment within that window.
Things look even worse when assessing individual trusts. East Cheshire was once again the worst performing trust in England based on A&E waiting times. In fact, its performance significantly worsened with the ‘seen in four hours’ target being met only 43 per cent of the time compared to the previous year’s 50.6 per cent. Their chief executive was rewarded with an extra £200,000 in this time, seeing his total remuneration go from £172,500 to £377,500.
Of course hospitals are not just measured on A&E performance, but the reward for failure in other areas is equally as damning. RTT (the time taken from referral to treatment) is a key metric for determining how well hospitals manage with outpatient treatment. Cambridgeshire and Peterborough had the worst RTT waiting time of 149 trusts, ranking last for the second consecutive year. Their chief medical director had a total remuneration of £322,500.
Outside of England, Lanarkshire ranked 14th out of 14 for A&E waiting times in Scotland; their medical director received £462,500 in total remuneration. The medical director at Ayrshire and Arran had the highest salary of any NHS boss in Scotland with £247,500. The trust was ranked 11 of 14 for A&E waiting times in Scotland.
The chief executive of Betsi Cadwaladr University Health Board had the highest salary of any senior manager in Wales in 2024-25 at £262,500. The health board was ranked 6 of 7 for RTT waiting time and 7 of 7 for A&E waiting time in Wales.
Beyond performance, the necessity of certain job roles should also be questioned. Barts paid £232,500 to the ‘group director of inclusion and equity’. The directors job involves leading the trusts ‘WeBelong strategy’, the gist of which seems to be overseeing six staff networks, and ‘promoting diversity and equity’. The job holder, Mr Ajit Abraham, is a surgeon at the trust. Perhaps patient results would be better if his time were devoted to that full-time.
In May 2025, the government announced a new carrot and stick approach to NHS leadership, promising to link senior managers’ pay more closely to operational results. We were promised that executives delivering improvements would be rewarded, while those presiding over failing trusts would see pay rises docked.
Yet, when bonuses and massive pay raises are still being handed out to leaders running the worst-performing trusts, it is clear that this policy is failing to deliver. If NHS executives want to demand corporate-level salaries fit for FTSE 100 boardrooms, they must be subject to corporate-level accountability. In the private sector, persistent operational collapse results in immediate pay cuts or dismissal, and certainly not a £200,000 pay bump.
Fudged figures, increasing executive salaries and declining performance. This is the true legacy of Starmer’s two years presiding over the NHS. The new health secretary, Yvette Cooper, is yet to lay out any new plans to boost performance, but one thing is very clear: increasing salaries to ever new highs is not the answer.