BRIS-48

Ensure equal security of tenure for trust senior managers and NHS professionals

Bristol Heart Inquiry · Bristol Heart Inquiry — Final Report · Issued 18 July 2001

Government responseNot tracked (historical inquiry)

DeliveryDHSC and NHS England say partially delivered (Feb 2026)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

The security of tenure of the chief executive and senior managers of trusts should be on a par with that of other senior professionals in the NHS.

Bristol Heart Inquiry, Bristol Heart Inquiry — Final Report · 18 Jul 2001 Source PDF →

Government response

●No formal government response recorded

The Index has not yet recorded a verbatim government response to this recommendation.

Delivery

●DHSC and NHS England say partially delivered · 27 Feb 2026

DHSC updated a pay framework for very senior managers in 2013. Guidance is currently provided by NHS England (2018) and NHS Employers . Work to develop a new VSM pay framework is in development.

A very senior manager (VSM) is defined as someone who holds an executive position on the board of an NHS trust or NHS foundation trust or someone who, although not a board member, holds a senior position typically reporting directly to the chief executive. This typically includes the chief officer, finance officer, chief nurse and similar senior staff.

VSMs are employed on locally agreed contracts not subject to national collective bargaining for pay frameworks or other terms, although many generic terms such as annual leave and redundancy are linked to NHS Agenda for Change terms. Medical directors are typically employed on consultant contracts, whose pay framework and other terms are subject to national collective bargaining.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025)

Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Partially implemented – Ongoing”. Table row: section 6.2 No. 48, PDF page 94.

What other bodies have found

In their own words. These do not change the delivery statement above.

●Thirlwall Inquiry legal team · 15 May 2024

The Government agreed with this recommendation in principle.

In its January 2002 response, the Department of Health said it was considering this issue in more detail as part of work to develop a new framework for senior managers’ contracts.

From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024)

Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 6.2 No. 48, PDF page 89.

How this page is built

The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.