Worryingly high levels of senior vacancies in NHS

NHS Providers and The King’s Fund have warned that, amid a climate of extreme pressure, NHS trusts are facing significant difficulties in recruiting and retaining senior leaders.

Leadership in today’s NHS: Delivering the impossible is the bi-product of a survey of 145 trusts across England. The report finds that executive director vacancies in NHS providers are widespread, with eight per cent of posts currently unfilled. Furthermore, 37 per cent of trusts have at least one vacant executive director role, with director of operations, finance and strategy roles having particularly high vacancy rates or low tenures.

Highlighting a culture of ‘blaming individual leaders for failures beyond their control’, the report also finds that 54 per cent of directors had been appointed in the past three years and the median tenure of a chief executive is just three years. The two bodies warn that high levels of churn in these roles has a significantly negative impact on the culture and performance of trusts, often resulting in short-term decision-making, which can paralyse organisations at a time when they should be moving forward to develop new ways of delivering care.

Additionally, trusts rated 'inadequate' by the Care Quality Commission have tended to experience higher vacancies and turnover, representing an ‘inverse leadership law’. Such trusts had 14 per cent of posts vacant and 72 per cent of their executives had been appointed in 2017. Conversely, in trusts rated as 'outstanding' by the CQC, only three per cent of posts were vacant and 20 per cent of executives had been appointed within the last year.

The report urges national bodies to take action to address leadership vacancies and cultures that deter experienced staff from taking on these roles, suggesting that rebuilding the regional talent management functions previously performed by strategic health authorities should be a priority for the new joint NHS England and NHS Improvement regional teams. National leadership development programmes should also expand their focus to include those board roles that are particularly difficult to recruit to.

Suzie Bailey, director of leadership and organisational development at The King's Fund, said: “Leaders in today’s NHS operate in a climate of extreme pressure: staffing vacancies are rife, there are widespread challenges in meeting financial and performance targets and demands on services continue to increase.

"The leadership task facing leaders of NHS trusts has also changed, with greater emphasis placed on working collaboratively as part of more integrated health and care systems. Leaders tell us the job of being a leader in the NHSis still rewarding but is not getting any easier or any less complex, and at present there is not enough support or respect for the people in these incredibly difficult roles. Responsibility for NHS leadership is everyone's business - attracting and supporting the right kind of future NHS leaders should be central to the NHS10 year plan and the work of the national bodies."

Saffron Cordery, NHS Providers deputy chief executive, added: "We need a new approach to supporting the most challenged trusts and systems to develop their leaders rather than continuing with a revolving door approach. This includes finding ways of enticing high-performing leaders into struggling trusts but that isn’t easy to do when a culture of blaming individuals for perceived failures exists.

"These are complex roles in complex organisations and we need to recognise and appreciate the significant leadership challenges involved. One of the solutions to our leadership challenge is to bring through a new generation of leaders that is more diverse and reflective of the communities the NHS serves. While there has been some progress in recent years, there is still a huge amount to do on this front.

"The data we now publish on leadership diversity within trusts is having a positive impact, but these are small steps and we need to create an environment in which NHS organisations are able to take on less experienced candidates with confidence. Nurturing talent and embracing diversity must go hand in hand."

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