Sheffield hospital bosses have defended a management shake-up which could see two extra positions being created.
An internal memo seen by The Star outlines plans to recruit a new strategy and planning director and a new organisational development director.
Health union Unison, said it was 'disappointed' by yet 'another management shake-up' and added members were only entitled to a one per cent pay rise.
The top level shake-up also sees current director of strategy and operations Kirsten Major take on the role of deputy chief executive.
Top boss, Sir Andrew Cash, is understood to working more closely on the Sustainability & Transformation Plan - a five year plan every hospital trust has been ordered to carry out on the future of health and care services.
One staff member who works at the hospital trust said: "Whilst it is natural to expect some staff at management level, it just sits uncomfortably in the current economic climate that management positions still seem able to be given priority over clinical procedures and nursing staff.
"Possibly several nurses or doctors could probably have been employed for the sum of the director level salaries which previously the Trust has presumably managed without, as they appear to be new appointments.
"Interestingly, 1.3 million NHS staff including nurses will receive just a minimal pay rise still capped by the government at one per cent for 2017.
"The implementation of STP’s would appear to be actually generating more management positions which will then actually use up more of the funding, this seems questionable."
Hospital chiefs defended the move and said they increased frontline staffing levels by around 600.
But John Campbell, Unison rep on behalf of staff at Sheffield Teaching Hospitals said: "This seems to be another case of organisational change by the Trust. It's disappointing.
"Only last week, Sir Andrew Cash reported that the Trust had 260 nursing vacancies that needed to be filled. We know from concerns raised by our members that there are some areas where they don’t have the full complement of staff.
"This adds additional pressures to those who are working and any extra money the Trust are finding to pay for these additional executive posts would surely be prioritised for the recruitment of more front line staff, nurses, cleaners, catering, admin and clerical. These are the frontline staff who are bearing the brunt of the increased activity.
"It’s interesting that the Trust don’t talk about the number of staff who have left or the impact not being able to fill vacancies is having on sickness absence which we are told Sheffield Teaching Hospitals is the highest in the region."
Sir Andrew Cash, chief executive at Sheffield Teaching Hospitals said: "Most other NHS Trusts, including neighbouring ones, have deputy chief executives so this is not unusual. To support the work we need to do to ensure we continue to develop and attract the best possible staff for the future we are going to appoint an organisational development director but this is not a board director.
"We have one of the smallest executive director teams in the NHS and our overall management costs are equally low given that we are responsible for delivering care to two million patients, employ 16,500 staff and have a billion pound turnover.
"There are just six Executive Directors overseeing all of the five hospitals and community services and the changes proposed will not impact on the recruitment of front line staff. Indeed in the last 12 months we have increased the number of staff we employ by almost 600.
"We have also recruited almost 400 qualified nurses and over 370 Clinical Support workers since last April into new and existing posts."
Sheffield Teaching Hospitals NHS Foundation Trust run the Hallamshire, Northern General, Weston Park cancer hospital, Jessop Maternity Wing and the Charles Clifford Dental Hospital.