Understanding Band 9 NHS Salary
Band 9 NHS salary represents the highest Agenda for Change pay band, reserved for Chief Executives, Managing Directors, and Trust CEOs with ultimate organizational authority and Board Chair accountability. The Band 9 pay scale recognizes 18-25+ years of exceptional executive leadership, proven CEO track record, and the ability to provide ultimate strategic direction, manage entire NHS organizations with budgets exceeding £500M+, and deliver system-wide healthcare transformation. Band 9 salary reflects the ultimate expertise required to serve as Chief Executive with final accountability to Board Chairs, NHS England, regulators, and the communities served by major NHS trusts and Integrated Care Systems.
Band 9 Pay Scale 2025/26
Current Band 9 NHS salary rates across all UK regions
| Years | Type | England | Wales | Scotland | Northern Ireland |
|---|---|---|---|---|---|
| 0–2 | per year | £109,179 | £110,818 | £122,736 | £105,385 |
| 0–2 | per hour | £55.99 | £56.83 | £63.62 | £54.04 |
| 2–5 | per year | £115,763 | £117,499 | £128,051 | £111,740 |
| 2–5 | per hour | £59.37 | £60.26 | £66.37 | £57.30 |
| 5+ | per year | £125,637 | £127,463 | £137,058 | £121,248 |
| 5+ | per hour | £64.42 | £65.35 | £70.96 | £62.18 |
Important Note: These Band 9 pay rates represent the BASE Agenda for Change scale effective from April 2025. Many CEOs of larger NHS trusts, teaching hospitals, or Integrated Care Systems earn significantly more (£150,000-£300,000+) through trust-specific supplements, market rate adjustments, and performance bonuses that reflect organizational size, complexity, and local market conditions.
Typical Roles in NHS Band 9
Band 9 NHS salary and Band 9 pay positions are for Chief Executives with ultimate organizational authority, extensive executive leadership experience at the highest levels, and Board Chair accountability. These roles require exceptional strategic vision, advanced qualifications, and a proven track record of leading complex healthcare organizations. They represent the pinnacle of NHS leadership:
Career Progression from Band 9
Band 9 pay represents the pinnacle of NHS Agenda for Change careers, but many pathways for further progression exist:
Excel as Chief Executive (3-7+ years at Band 9)
Demonstrate organizational excellence, system transformation, and outstanding regulatory performance while earning competitive Band 9 salary with annual increments to £125,637+ (plus supplements).
Progress to Larger Trust CEO (£150,000-£250,000+)
Move to CEO of major acute trusts, teaching hospitals, or large Integrated Care Systems with budgets exceeding £1B+ and ultimate accountability for regional healthcare transformation.
Advance to Major Teaching Hospital CEO (£200,000-£300,000+)
Become CEO of major academic health centers, large ICS systems, or multi-trust organizations with ultimate accountability for research, education, and complex tertiary care delivery.
National / International Leadership
Progress to NHS England executive leadership, regulatory body CEO (CQC, NHSE), Cabinet-level government appointments, WHO leadership, or international healthcare CEO roles earning £250,000-£500,000+.
NHS Band 9 Benefits & Perks
Exceptional NHS Pension
13.5% employee contribution with significant employer contributions
CEO Leave Package
30-35 days annual leave plus 8 bank holidays plus executive discretionary leave
Ultimate Authority
CEO-level authority, Board Chair relationships, organizational leadership
Premium Executive Car
High-end executive car allowance or fully-expensed premium lease
National Leadership Development
Access to national CEO forums, NHS Providers, executive DBA/PhD funding
Substantial Performance Bonuses
Major performance-related pay based on organizational achievement and CQC ratings
Compare with Other NHS Pay Bands
What is Agenda for Change?
Agenda for Change (AfC) is the NHS's comprehensive pay system that determines the Band 9 NHS salary and compensation structure for over one million NHS staff. Introduced in 2004, it provides transparent frameworks for CEO-level career progression, with Band 9 pay representing the highest Agenda for Change grade—Chief Executive positions with ultimate organizational authority and Board Chair accountability.
The system covers all NHS staff from entry-level support workers to chief executives, with Band 9 positioned as the highest grade within the nine-band structure (Bands 1-9). The Band 9 salary recognizes 18-25+ years of exceptional executive leadership, proven CEO track record, and the ability to serve as Chief Executive with ultimate accountability for organizational performance, Board Chair relationships, regulatory compliance, and strategic healthcare delivery at system and national levels.
The Knowledge and Skills Framework (KSF) underpins Agenda for Change, ensuring that Band 9 pay earners demonstrate the highest competencies in CEO-level leadership, organizational governance, and system transformation. Annual pay progression within Band 9 occurs through successful Board Chair reviews, rewarding organizational excellence, financial sustainability, outstanding CQC ratings, and CEO-level strategic leadership.
Band 9 NHS salary levels represent the BASE AfC scale for Chief Executives. Many CEOs of larger trusts earn significantly more (£150,000-£300,000+) through trust-specific supplements that reflect organizational size, complexity, and market conditions. This makes Band 9 salary the foundation for exceptional CEO-level compensation packages that reward Chief Executives leading major NHS organizations serving millions of patients.
NHS Pay Rise 2025/26
3.6% Pay Increase for 2025/26 | Backdated to April 1, 2025
In May 2025, the UK government announced a 3.6% pay increase for all Agenda for Change staff for the 2025/26 financial year, backdated to April 1, 2025. This has positively impacted Band 9 NHS salary rates, with the starting point rising to £109,179 and the top point reaching £125,637 in England. These above-inflation awards recognize the CEO-level leadership, ultimate organizational accountability, and strategic system transformation delivered by Chief Executives earning Band 9 salary compensation.
The Band 9 NHS salary improvements reflect consecutive years of above-inflation awards (3.6% in 2025/26 following 5.5% in 2024/25), ensuring that Chief Executives receive fair compensation for their ultimate strategic accountability and organizational leadership. This represents a cumulative increase of over £17,000 for Band 9 positions since 2022/23, significantly enhancing Band 9 pay competitiveness for experienced Chief Executives and Trust CEOs.
Recent NHS Pay Awards Timeline:
These pay increases apply uniformly across all Agenda for Change bands, ensuring that Band 9 pay earners receive the same percentage uplift as colleagues in other bands. The government continues to work with NHS Employers and trade unions to negotiate settlements that reward CEO-level professionals appropriately, maintaining the attractiveness of the Band 9 salary structure for Chief Executives, Managing Directors, and Trust CEOs leading major NHS organizations across the UK.