This report is the Review Body's response to the Government’s request to it to consider whether pay for very senior managers in the NHS in England should be made more market-facing at local level. The Government commissioned this review because it was concerned that national pay bargaining and pay setting might mean the public sector was paying too much for workers in some parts of the country and possibly not enough in others.The report recommends that no additional locality pay measures be added to the new NHS very senior managers’ pay framework. As new and better information becomes available on the new pay framework, the Review Body may wish to re-evaluate this conclusion.