The NHS has spent hundreds of millions of pounds making staff redundant as part of the coalition's controversial health reforms.
Official figures reveal more than £435m, an average of £43,095 per person, went on redundancies with some staff receiving up to £580,000 each.
More than 10,000 full-time workers left because of the Health and Social Care Act, which came into force on April 1 this year.
But of those who left between May 2010 and September 2012, more than a fifth or 2,200 were later taken back by the NHS, sparking claims of a "jobs merry-go-round".
Matthew Sinclair, chief executive of the TaxPayers' Alliance, said: "Health chiefs have wasted a breath-taking amount of taxpayers' money on pay-offs when axing staff.
"The size of the pay-outs, particularly those handed to senior managers, appear to have been allowed to spiral out of control.
"Laying off staff at great expense to taxpayers only to hire them back is unacceptable. This is all too typical of the NHS jobs merry-go-round that needlessly costs taxpayers a fortune."
According to the National Audit Office (NAO), 44 "very senior managers" were made redundant between August 2012 and March 2013.
On average, they were handed pay-offs of £277,273. Individual payments ranged from £33,771 to £578,470.
The Department of Health tried to reduce the risk of staff being paid off by one NHS organisation only to be hired by another but had "limited levers" to stop it, the NAO said.
Redundancy payments can only be reclaimed if the employee rejoined the NHS within four weeks of leaving.
The NAO report said that "further changes" will be needed before the right number of staff with the right skills are in place across the system, including further redundancies.
It states that getting staff in place was the "biggest challenge" for the new organisations and all of them had sufficient employees to start operations on April 1.
The report also revealed that the reforms have already cost £1.1bn to implement and could rise to £1.7bn in total.
The NAO said the transition, which saw 170 organisations closed and more than 240 new bodes created, was "successfully implemented".
However, it noted that some parts of the system were "less ready than others" and that officials were clear "much remains to be done".
It also warned that some clinical commissioning groups, which are taking over from primary care trusts and will be run by doctors, lacked credible financial plans.
Dr Mark Porter, chair of council at the British Medical Association, described this as "extremely worrying" and claimed the radical changes had been a "costly distraction".
"All the evidence is pointing to a worsening financial situation for the NHS and the Government needs to urgently rethink its approach," he said.
NAO boss Amyas Morse hailed the "considerable achievement" already made by NHS staff but warned they face major challenges to finish the job while also making savings.
The DoH said the changes would result in a £5.5bn saving to the taxpayer in this parliament and £1.5bn each year from 2015, which would go back into patient care.
A spokesman insisted the NHS would now be able to work better and deliver higher quality care, with "doctors and nurses in the driving seat".
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