Sir Bruce Keogh: six-figure NHS managers deserve the money The Department of Health report warned: "Any increase in pay costs above this level will risk unfeasible reductions in clinical staff which may harm the ability to maintain access to and quality of NHS services to the public." But Sir Bruce said: "Some of those managers will deserve very significant salaries. I've never achieved anything as a doctor in my career without working hand-in-hand with a really good manager. So I think it's important that we focus on ensuring that we have the right managers of the right calibre. Asked whether doctors should enjoy further rises, Sir Bruce said it is a "very legitimate debate" but one for politicians. But he said Jeremy Hunt is right to promise to block excessive pay rises at health quangos. Sir David Nicholson, the chief executive of the NHS, and Paul Baumann, the chief financial officer, will this afternoon be questioned by MPs on the health select committee on managers" salaries. Sir Bruce said pressures on A&E appeared to have grown worse this winter. The service is trying to have more people treated at home or discharged more promptly. "There is a feeling that this year is worse," he said. He added: "We are seeing increasing demand and have been for some years for our accident and emergency departments. We see in our A&Es about 16 million patients a year. That's climbed by two million over the last decade. You could argue that just means an extra four patients a day per A&E but it still represents an inexorable climb. We also are seeing increased demand for our urgent care centres, walk-in centres. They are up at about seven million a year and climbing by 12% a year. We are also seeing seasonal variations, so in the winter although the numbers tend to be down, we see much sicker and older patients.