NHS hospital boards and their bureaucracy is costing taxpayers up to £500million a year, Oxford University researchers have claimed.
Professors Carl Heneghan and Tom Jefferson estimate England’s 161 acute NHS trusts are spending around £386million a year running their boards and teams that support them.
But they say including mental health, community and ambulance trusts in the calculation could push the total above half a billion pounds a year.
By comparison, supermarket giant Tesco, which employs more than 330,000 people and operates thousands of stores, reported total pay for all its company directors of £18.6million last year.
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The findings come as the NHS is under pressure to cut bureaucracy and get more money into frontline care.
Prof Heneghan and Dr Jefferson, from the University of Oxford’s Centre for Evidence-Based Medicine, examined the cost of hospital boards as part of their Substack – Trust the Evidence (TTE) – investigation into where NHS money goes.
Prof Heneghan said: “Why does the NHS need so many separate boards to run hospitals in England?”
He added: “How much do these boards cost, and why does one national health service need so many separate management teams?”
Every NHS trust has its own board, typically including a chair, chief executive, other executive directors and non-executive directors.
The pay can be substantial.
NHS England’s framework puts basic pay for non-executive directors at £13,000 a year, while chairs of the largest organisations can receive more than £60,000.
Executive directors can earn considerably more, often earning six-figure salaries.
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Prof Heneghan and Dr Jefferson estimate the combined pay of the members of a representative acute hospital board could reach £1.5million to £1.9million a year.
But the cost does not only include the people sitting on the board.
Trusts also employ staff to support their work, including secretaries, administrators, governance staff and executive assistants.
There can also be costs for recruitment, training, meetings, outside reviews and professional advice.
Taking those expenses into account, Prof Heneghan and Dr Jefferson estimate the total cost could reach around £2.4million for each acute trust.
Applied across the 161 acute trusts they examined, that produces the figure of around £386million a year.
Some NHS boards are considerably larger than the typical example used in their calculation.
They cite Manchester University NHS Foundation Trust, which reported 26 directors in office during the year, while Newcastle upon Tyne Hospitals reported a highest-paid director receiving £377,500.
And the £386million estimate covers only acute trusts.
Official NHS England accounts show there were 205 NHS trusts and foundation trusts in England at the end of March 2025, once organisations including mental health, community and ambulance trusts are included.
Prof Heneghan and Dr Jefferson estimate that including the wider network could push the total NHS-wide cost above half a billion pounds a year.
Prof Heneghan and Dr Jefferson used Tesco as a comparison to illustrate the radically different structure of the NHS.
Britain’s largest supermarket chain has hundreds of thousands of workers and thousands of stores but does not have a separate corporate board for each major geographical group of shops.
Tesco’s latest annual report records total aggregate remuneration for all its directors of £18.6million in 2025/26.
The researchers acknowledge the comparison is not like-for-like because NHS trusts are separate statutory organisations with responsibility for patient safety, staffing, finances and the delivery of healthcare.
But the academics argue it raises the question of whether all the separate NHS boards are necessary.
They wrote: “Do we need all these boards and costs to run the show?”
Prof Heneghan and Dr Jefferson argue the number of separate boards – and the cost of running them – deserves greater scrutiny at a time when the NHS is trying to find savings.
They warned that the sums identified in their analysis may represent only a fraction of the wider administrative bill.
They wrote: “The figures reported here for the NHS are a vast underestimate of the bureaucratic superstructure taxpayers carry.”
The NHS is currently trying to cut costs by reducing running expenses, merging some organisations and tackling what it describes as unnecessary bureaucracy.
It says savings should be redirected into frontline services.
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