Chief executives at England’s 10 worst-performing NHS hospital trusts were paid more than the Prime Minister last year, according to published performance rankings and media analysis that examined trust pay disclosures.
The government on Tuesday published a league table ranking all 134 trusts in England on a range of operational and financial measures for the first time, naming the trusts rated poorest overall. Analysis by The Times, cited in reporting, found that the chief executives at the 10 lowest-ranked trusts received salaries in excess of £200,000 in the most recent year, compared with Prime Minister Keir Starmer’s salary of £172,000.
The newly published table placed Mid and South Essex Foundation Trust as the worst-performing large hospital trust, followed by Worcestershire Acute Hospitals NHS Trust. Other trusts in the bottom ten included Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust and the Countess of Chester Hospital NHS Foundation Trust. The table assesses trusts across seven areas, including waiting times for operations, cancer treatment performance, time spent in A&E, ambulance response times and financial position.
The Times’ analysis singled out individual pay packets. Professor Andrew Hardy, chief executive of University Hospitals Coventry and Warwickshire NHS Trust, was reported as receiving between £275,000 and £280,000 and led a trust ranked third-worst nationally. Jonathan Brotherton, who became chief executive at University Hospitals Birmingham NHS Foundation Trust in July 2023, was listed as paid between £260,000 and £265,000 with an additional employer pension contribution of about £165,000 to £167,500. Jane Tomkinson, the permanent chief executive at the Countess of Chester, was estimated to have an annualised salary in the range of £210,000 to £240,000 based on trust accounts covering periods when she served as acting and then permanent chief executive.
Health Secretary Wes Streeting said the publication of the league table aimed to increase scrutiny and accountability. "Trusts with the greatest challenges must accept more scrutiny and targeted support to identify weaknesses and strengthen their game," he said, adding he wanted chief executives "looking over their shoulders." Streeting said some senior managers at persistently poorly ranked trusts could face dismissal or pay sanctions.
The rankings come after a report from the Care Quality Commission, the NHS regulator, warned that corridor care had become a "regrettable reality" in hospitals and that patients’ health had deteriorated while they waited months for treatment. Patient groups welcomed the greater transparency, saying local populations should be able to see where services are failing. Representative groups for hospital managers cautioned that increased scrutiny could put frontline staff at risk of being used as "instruments of blame" for broader system failures.
The Blackpool Teaching Hospitals NHS Foundation Trust, ranked 125th out of 134, was highlighted in the coverage because of a separate police investigation into possible corporate failings at Blackpool Victoria Hospital’s stroke unit. Lancashire Police said it was considering offences including corporate manslaughter, corporate ill-treatment and wilful neglect; the inquiry followed prosecutions of five healthcare workers, two of whom were jailed after being convicted of sedating patients or conspiring to sedate them.
Trust accounts and annual reports are the primary public sources for chief executive pay disclosure; some trusts report pay bands rather than exact figures. The government’s league table also factors in financial health, meaning trusts that deliver good clinical outcomes but run larger-than-expected deficits can score lower overall.
Ministers framed the reforms as an attempt to reduce regional disparities in waiting times and care standards. "A patient at Countess of Chester shouldn’t have to wait months longer for treatment than one in Northumbria," Streeting said, describing the variation in performance as a "postcode lottery" he intended to tackle by raising standards nationwide.
Health sector figures and union representatives signalled that how the government implements follow-up measures—whether through targeted support, leadership changes or financial penalties—will be watched closely. Trust leaders have warned that long-term workforce shortages, rising demand and constrained capital investment remain central constraints on improving performance, and said those factors should form part of any national response.
The league table marks a new level of public accountability for NHS providers, setting out comparative performance data that ministers expect will be used to target support and intervene where necessary. Follow-up announcements are expected as the department of health considers next steps for trusts rated persistently poorly and how to link performance outcomes with leadership accountability.