King's College London

Around half the public think newly qualified junior doctors are paid too little, rising to three in five among those who said they intended to vote Labour at the general election, according to a new study.

The research, by the Policy Institute at King’s College London, King’s Business School and Ipsos, is based on data from a survey of 2,251 people aged 16 to 75 in Great Britain between 21 and 24 June.

It finds the share of the public who feel new junior doctors are underpaid is virtually unchanged when they are told the reality of how much they earn, rather than relying on perceptions alone.

In the study, half the sample was asked – unprompted – their views on pay levels for NHS staff and other professions, while the other half was prompted with the average salary these jobs attract.

47% of those who were not given salary information said newly qualified doctors are paid too little, compared with 48% of those who were told their true pay of £32,398 a year.

Those who said they intended to vote Labour at the general election are much more likely than their Conservative counterparts to feel newly qualified doctors are underpaid, regardless of whether they are told their true earning:

• Without pay information: Labour 62% vs Conservative 39%.
• With pay information: Labour 58% vs Conservative 40%.

The public are more likely to think NHS staff are badly paid than well paid

Four in 10 (39%) people say NHS staff are badly paid, compared with three in 10 (29%) who say they are well paid. Around a quarter (26%) feel they are neither well nor badly paid.

While there is little difference in views among different age groups, 16- to 24-year-olds are most likely to say NHS staff are badly paid, with nearly half (46%) feeling this way.

But views vary depending on the specific role and salary

Newly qualified nurses

Whether or not they are told how much newly qualified nurses in the NHS are paid, the public are most likely to feel they do not earn enough.

53% of those who are not given salary information say they are paid too little, as do 49% of those who are told their average salary is £28,407 a year.

Senior doctors

Senior doctors, such as hospital consultants, typically earn £118,884 a year and are most commonly seen as being paid the right amount by the public as a whole.

Just 15% of those who are not told their salary say they are paid too little, while 10% of those are given this information feel the same. Around a quarter of both groups say senior doctors are paid too much.

Newly qualified healthcare assistants

51% of people who are not told the average salary newly qualified health care assistants – who assist nurses and doctors, for example by taking patients’ blood – say they are paid too little. But this rises to 60% among those who are told new HCAs earn £22,383 annually.

Matrons

When not told the salary of matrons (senior nurses), 35% of the public think they are underpaid – yet this halves to 17% when they know that they typically earn £57,349 a year.

Hospital chief executives

Three in five (61%) people think chief executives of the largest NHS hospitals are paid too much when they do not know their salary – virtually the same as the proportion who say the same when informed their average salary is £250,000 a year (64%). The largest NHS hospitals have a turnover of £750 million or more per year, comparable to the very largest UK companies.

One in six say trainee NHS managers are paid too little – but this nearly doubles to 30% when the public are told how much they are actually paid

When not provided with any salary information, 16% of the public think trainee NHS managers aren’t paid enough, yet this rises to 30% among those who are told they earn £27,701 a year.

However, the share who think they are paid about the right amount also rises considerably – from 35% to 49% – when the public are given this information.

Young people are much more likely to say trainee NHS managers are paid too little, particularly when they know how much they earn. When told this, 52% of 16- to 24-year-olds say these staff are underpaid, compared with 21% of those aged 55 to 75.

Voters for both of the two main parties are more likely to think trainee NHS managers are paid too little when they’re told their salary information.

Among those who said they intended to vote Labour, knowing trainee managers’ average salary makes them 20 percentage points more likely to say they are underpaid (39% vs 19%), while for Conservatives it makes a nine-point difference (21% vs 12%).

Yet at the same time, both sets of voters are more likely to feel trainee NHS managers are paid enough once when they know the reality of how much they earn.

Half the public say there are too many managers in the NHS, pointing to a lack of awareness about their role and the reality of staffing levels

The public are around four times as likely to say there are too many (46%) rather than too few (12%) managers in the health service.

However, there is a big age gradient in views, with seven in 10 (72%) 55- to 75-year-olds feeling there are too many managers, compared with just one in 10 (10%) 16- to 24-year-olds.

Taken together, under-35s are the only age group that are more likely to think there are not enough managers in the NHS rather than too many (27% vs 17%) – although the most common view in this age group is that there are about the right amount of managers (30%).

Views also differ significantly by political affiliation, with those who said they intended to vote Conservative at the general election (61%) much more likely than their Labour counterparts (43%) to say there are too many managers.

Research commonly finds people are less supportive of managers than frontline staff in the NHS, which may in part be due to a lack of knowledge about their role and lack of contact with them.

Understanding why people feel there are too many managers in the health service is key, and it’s clear there are several reasons.

Seven in 10 (70%) who hold this view say it’s because managers take up resources that could be used on caring for patients, while six in 10 (63%) say they create a bureaucracy that is a burden on other staff.

Smaller proportions doubt NHS managers’ performance, with 46% saying they are not worth what they are paid and 31% saying they are not competent at their jobs.

These negative perceptions persist despite the UK spending considerably less than other comparable countries on the management of its health system and pay levels of NHS managers largely in line with managers in other sectors.¹

Dr Nick Krachler, Senior Lecturer (Associate Professor) in Human Resource Management at King’s Business School, said:

"Our survey shows considerable alignment between public perceptions of NHS pay levels and the claims of trade unions and professional associations that pay levels – which are determined by government after consultation from a Pay Review Body – ​are unsatisfactory for frontline NHS roles. Noteworthy is that these roles constitute the vast majority of the frontline NHS workforce. Of interest to the new Labour government will also be the considerable concern of Labour voters about these issues. This highlights the urgent need to address healthcare workers’ economic wellbeing which I hope the new government will heed".

Gerry McGivern, Professor in Public Services Management & Organisation at King’s Business School, said:

“There are interesting variations in survey respondents’ views. Our findings suggest that the public believe new junior doctors, nurses and health care assistants are paid too little, senior doctors and matrons are paid about right, and NHS CEOs are paid too much. There is also some support for paying trainee NHS managers more, particularly among younger survey respondents, while most people over 45 years say trainee NHS managers are fairly paid, and that there are too many NHS managers in general. This perception of NHS managers may be because the public are less likely to meet NHS managers than doctors, nurses and health care assistants, so are unaware of the work most do behind the scenes. Indeed, research suggests that the NHS spends less on management than comparative health systems, so perhaps the NHS needs to better communicate to the public the important and challenging work its managers do.”

Anna Quigley, Head of Ipsos’ Health and Social Care team, said:

“These findings on pay for NHS staff reflect wider public perceptions that NHS staff are overworked, unhappy, and for some roles underpaid. The public want to see improved working conditions and pay for frontline staff – not only because they think this leads to better care but because they simply want these workers to be more valued. The public are also concerned about inefficiency in the NHS, and this is linked to a belief that there are too many managers – but we also know people overestimate how many managers there actually are in the health service.”

Survey details
Ipsos interviewed a representative sample of 2,252 people aged 16-75 across the UK. Polling was conducted online between 21 and 24 June 2024. Data are weighted to match the profile of the population. All polls are subject to a wide range of potential sources of error.

1. https://www.nhsconfed.org/articles/are-there-too-many-nhs-managers