North Wales health board chief was Wales’ highest-paid NHS manager, while 39 Hywel Dda clinicians earned more than its highest-paid director

THE CHIEF executive of Wales’ largest health board received a salary of more than £260,000 last year, according to new research examining senior NHS pay alongside waiting-time performance.

The TaxPayers’ Alliance says 574 senior NHS managers covered by its latest “NHS Rich List” received salaries greater than the Prime Minister’s £172,153 entitlement during 2024-25.

Across the organisations examined, the campaign group identified 1,758 senior managers receiving at least £100,000 in total remuneration, including 292 whose reported remuneration reached £300,000 or more.

However, the headline totals require careful interpretation. In NHS annual accounts, “total remuneration” can include accounting calculations showing changes in future pension benefits. These figures do not necessarily represent money paid to an executive during that financial year.

North Wales chief had highest Welsh salary

Carol Shillabeer, chief executive of Betsi Cadwaladr University Health Board, was identified as the highest-salaried senior NHS manager in Wales.

The health board’s accounts place her salary in the £260,000 to £265,000 band for 2024-25. The TaxPayers’ Alliance recorded the midpoint as £262,500.

Her accounts also show a total remuneration figure of between £440,000 and £445,000. This included a £180,000 pension benefit calculation, rather than £180,000 being paid directly to her during the year.

The research ranked Betsi Cadwaladr sixth out of Wales’ seven health boards for referral-to-treatment performance and last for accident and emergency waiting times.

Betsi Cadwaladr’s own annual report shows that 57.2% of patients attending its major and minor emergency departments during March 2025 completed their visit within four hours, placing the health board seventh out of seven in Wales.

It also recorded 3,763 patients spending 12 hours or longer in emergency departments during that month, again placing it last among the Welsh health boards.

The health board remains in special measures after being placed under the highest level of Welsh Government intervention in February 2023.

Cardiff executive’s reported total included pension calculation

The TaxPayers’ Alliance also highlighted Cardiff and Vale University Health Board, which it ranked last in Wales for referral-to-treatment waiting times and fifth for A&E performance.

Its report stated that Emma Cooke, executive director of therapies and health science, had total remuneration of £367,500 during 2024-25.

Official accounts show that Ms Cooke’s actual salary during the year was in the £130,000 to £135,000 band. Her full-year equivalent salary was between £140,000 and £145,000.

The total remuneration figure of between £365,000 and £370,000 included £236,000 attributed to pension benefits and £10,000 in benefits in kind. No bonus payment was recorded.

Cardiff and Vale states clearly in its accounts that the pension benefit “is not an amount which has been paid to an individual by the UHB during the year”. It is an accounting calculation that can be affected by salary changes, additional contributions and wider pension valuation factors.

Thirty-nine Hywel Dda staff earned more than chief executive

The accounts also reveal a significant West Wales dimension to the debate.

At Hywel Dda University Health Board, which provides services across Pembrokeshire, Carmarthenshire and Ceredigion, the highest-paid director received remuneration in the £225,000 to £230,000 band during 2024-25.

That was just over seven times the organisation’s median employee remuneration of £32,002.

However, 39 Hywel Dda employees received more than its highest-paid director, an increase from 35 the previous year.

The health board said all 39 were medical or dental staff who had accepted responsibilities beyond their standard job plans, including additional clinical duties and, in some cases, medical management roles.

Remuneration across the Hywel Dda workforce ranged from £23,970 to £353,573 during the year.

Unlike some of the larger figures recorded elsewhere, Hywel Dda’s fair-pay calculation excludes employer pension contributions and the cash-equivalent transfer value of pensions. It includes salary, benefits in kind and any non-consolidated performance-related pay.

The accounts show that the remuneration of Hywel Dda’s highest-paid director increased by 2%, while average remuneration across the organisation’s employees increased by 11%.

Campaigners call for performance-linked pay

Across the NHS organisations examined, the TaxPayers’ Alliance said 1,603 senior managers had salary entitlements of at least £100,000.

This included 1,267 receiving between £100,000 and £200,000, 319 receiving between £200,000 and £300,000 and 17 whose salaries exceeded £300,000.

The number receiving salaries above that of the Prime Minister reportedly rose from 512 in 2023-24 to 574 in 2024-25, an increase of 12%.

Anne Strickland, a researcher at the TaxPayers’ Alliance, said: “Taxpayers will be appalled that NHS executive pay is soaring while patients are still left waiting for care.

“Ministers must keep their promise to link performance to pay, so that failing NHS bosses are held accountable and money goes into patients’ care, not managers’ pockets.”

Senior NHS leaders oversee organisations employing thousands of staff and controlling budgets worth billions of pounds. Health boards are also responsible for complex hospital, community, mental health and primary-care services.

Nevertheless, the publication of the figures is likely to intensify scrutiny of executive pay at a time when patients across Wales continue to experience lengthy waits for emergency treatment, operations and specialist appointments.

New £2 million Nofio Ysgol programme will begin in nine council areas this September before expanding across Wales

EVERY child in Wales is to be given the opportunity to learn how to swim and stay safe around water under a new national school swimming programme.

The Welsh Government has announced that its Nofio Ysgol programme will begin in September 2026, providing pupils with a minimum of 20 swimming and water safety lessons, primarily during Years 4 and 5.

The scheme is intended to address major differences in access to school swimming across Wales. Around one in five maintained primary schools currently offers no swimming lessons, while relatively few children take part in swimming activities outside school.

For many pupils, lessons organised through their school are their only opportunity to become confident in the water, learn essential swimming techniques and develop potentially life-saving self-rescue skills.

The first phase of the programme will begin in nine pathfinder local authority areas in September, backed by £2 million of Welsh Government funding.

It will then expand to as many as 16 council areas from September 2027 before being introduced across all 22 Welsh local authorities from September 2028.

The programme will include swimming instruction, water safety education and Swim Safe Cymru sessions, together with classroom resources linked to the Curriculum for Wales.

Additional support will be provided to children and communities facing the greatest barriers to participation, including pupils in rural and deprived areas, Welsh-medium schools, disabled learners and children with Additional Learning Needs or healthcare requirements.

The programme will be funded directly by the Welsh Government and delivered through participating local authorities, with national support from Swim Wales.

Announcing the Nofio Ysgol Implementation Plan for 2026–2029, Cabinet Minister for Culture and Sport Heledd Fychan said swimming was both a life-saving skill and an important foundation for lifelong physical activity.

She said: “Every child in Wales should have the opportunity to learn to swim, understand how to stay safe in and around water, and develop skills that could one day save their life.”

The Welsh Government said the phased introduction would allow councils and schools to test different delivery models, strengthen the swimming-teaching workforce, improve the collection of information and assess the programme’s impact.

The scheme forms part of the Government’s commitment to improving preventative health, physical activity and children’s mental and physical wellbeing.

Ministers said the long-term aim was to ensure that a child’s access to swimming lessons was not determined by where they lived, the school they attended or their family’s ability to pay for private lessons.

Hywel Dda says a dedicated unit would improve patient safety and specialist support, but no final decision has been made

A SPECIALIST facility in Carmarthen has been identified as the preferred future location for adults detained by police while experiencing a mental health crisis in public.

Hywel Dda University Health Board will be asked on Thursday, July 30, to approve public and staff engagement on plans for a dedicated Section 136 Place of Safety unit at Cwm Seren, within the Hafan Derwen mental health site at St David’s Park.

The proposal could see adult provision concentrated at the Carmarthen facility rather than continuing across a number of existing sites within the health board area.

Section 136 of the Mental Health Act gives police officers the power to remove someone from a public place when they appear to be experiencing a serious mental health crisis and take them to a designated place of safety.

The person can then be assessed by mental health professionals and offered appropriate care and support. The health board has a legal responsibility to provide the service.

A review of the existing arrangements found concerns relating to the suitability of some environments and the ability to provide consistent staffing across several locations.

Five potential models were considered during a multi-agency appraisal involving Dyfed-Powys Police, local authorities, West Wales Action for Mental Health and the patient representative body Llais.

The preferred option is a purpose-built Section 136 suite at Cwm Seren.

According to the health board, the Carmarthen facility would provide the safest, most clinically effective and sustainable model of care.

It says the unit would offer immediate access to specialist mental health staff, improve the management of people considered to be at acute risk and provide better access to physical healthcare when required.

However, concentrating the service in Carmarthen could also raise questions about travelling distances for police, patients and families from Pembrokeshire, Ceredigion and more distant parts of Carmarthenshire.

The health board says those potential effects, together with measures that could reduce them, would form part of the proposed engagement process.

Andrew Carruthers, Chief Operating Officer at Hywel Dda University Health Board, said: “People who are detained under Section 136 are often experiencing some of the most difficult moments of their lives, and it is essential that we provide a safe, supportive environment where they can receive timely assessment.

“The work undertaken with our partners has carefully considered a range of options for the future provision of this service.

“The preferred option at Hafan Derwen has been identified because it offers the strongest benefits in terms of patient safety, clinical support and sustainability.”

Mr Carruthers stressed that no final decision had been taken.

He added: “Subject to Board approval, we will want to hear from staff, people with lived experience, carers, partner organisations and members of the public before any final decision is considered.

“Their feedback will be an important part of the process.”

Should the proposal be approved by board members, an eight-week engagement exercise would run from September 2 until October 26, 2026.

Staff, service users, carers, partner organisations and local communities would be asked for their views on the preferred option, its possible effects and any safeguards or mitigation that should be introduced.

The health board will consider the proposal at its meeting on Thursday, July 30. The meeting will be streamed online from 9.30am.