What does NHS VSM mean?

In the NHS, VSM stands for Very Senior Manager, typically positions either leading an organisation (such as Chief Executive), members of an Executive board, or directly reporting to the Chief Executive.

NHS “Arms Length Bodies” (ALBs) such as NHS Blood and Transplant or the Care Quality Commission appoint their most senior managers to Executive Senior Manager (ESM) roles, which use a different pay framework to VSMs. Staff in VSM/ESM pay bands can include:

• Chief Executive or Deputy Chief Executive
• Medical or Clinical Director
• Financial Director
• Chief Operating Officer
• Executive Director of Strategy
• Chief Digital Information Officer

The average salary for NHS VSMs in 2022 was £140,531, whilst NHS ESMs earned on average £126,390.

Very Senior Manager salaries

VSM salaries are negotiated locally and exact figures on pay tend not to be made available easily. NHS England and Improvement publish detailed guidance on salaries for particular roles at different organisations here.

Executive Senior Manager salaries

There are four pay grades within the ESM framework:

• Grade 1 (£100,000 – £131,300) – examples of roles could include Deputy Chief Executive at smaller ALBs
• Grade 2 (£131,301 – £161,600) – examples of roles could include Director of Finance or Director of Communications
• Grade 3 (£161,601 – £191,900) – examples of roles could include Director of Workforce or Chief Executive at smaller ALBs
• Grade 4 (£191,901 – £222,500) – examples of roles could include Medical Director or Chief Executive at larger ALBs