The Health Service Journal reports that Integrated care systems must make the case to NHS England and ministers if they want to pay executives more than £170,000.

Whilst this isn’t necessarily new territory, it is expected to delay appointment announcements where DHSC or ministerial approval needs to be sought. NHSE’s executive pay framework sets “operational maximum” pay levels for executive roles in NHS Integrated Care Boards, which vary based on the population covered.

It is thought that central permission will also apply if the executive is transferring from a previous role on the same salary, as well as those appointed on a part time basis where the full time equivalent salary will breach the pay cap.

A recent job evaluation by PricewaterhouseCoopers proposed that ICB executive roles were “around or above” those in NHS providers in terms of role complexity. It also looked at the comparative flexibility of ICB executive roles, placing finance directors at the top, being considered the most complex role, with medical directors and directors of nursing just below. Other executive roles, including chief people officer, and chief digital officer, fell immediately below those, although they do note that the actual difference in complexity between roles on the board is not significant and considered the same in terms of career level.

Evidence to the senior salaries review body last year suggested that, in 2019, some salaries of finance directors in provider trusts exceeded the proposed ICB caps. At large acute trusts with a turnover of £750m or more, the median was £172,500 and the upper quartile £190,500.

The national pay framework for very senior managers’ is currently under review and expected to be updated later this year, which covers both ICBs and providers together.