According to an Incomes Data Services report, nurses were not being paid well when compared to the top managers in England's NHS trusts. These managers in 2008-09 received pay rises of nearly seven per cent whereas it was just three per cent for nurses.

The rise was as much as seven times more than nurses for the NHS chiefs.

Top managers were needed to sail them through financial challenges, the NHS Confederation said.

Seniors managers when questioned about why bosses have had above-inflation rises when ordinary workers have had much lower rises said that it was not easy to run NHS trusts as they have budgets of many millions of pounds.

The report compiled on about 380 NHS trusts in England stated that in 2008-09 chief executives received an almost seven per cent average pay increase.

The report said that with £270,000, the highest-paid chief executive was at Guy's and St Thomas' in London.

A spokesman for Guy's and St Thomas' said, "The pay of our chief executive, Ron Kerr, reflects the experience, expertise and responsibility that the role demands, and we are delighted to have a chief executive of his caliber to lead the organisation.

Report author Steve Tatton said, “Our annual survey of NHS boardroom remuneration will not make comfortable reading for those wishing to see those at the top of the service leading from the front on wage restraint.”