NHS England and NHS Improvement made six-figure exit payments to five directors as the two organisations merged, accounts show. They spent £30.8m on compulsory redundancies during the two years of the restructure, in which nearly all senior NHSE and NHSI teams were combined, including their top-level leadership. Annual accounts show the bodies paid a combined £8.7m for compulsory redundancies in 2018-19 (covering 130 redundancies) and £22m (for 359) in 2019-20. Departures resulting from the effective merger spanned both financial years. In the previous financial year, 2017-18, the total for compulsory redundancies appears to be just £1.4m. Tough gig Heading up the long-troubled Norfolk and Suffolk Foundation Trust is at present among the toughest jobs in NHS management.