Leading questions

by Emma Knowles

20 July 2018

Worrying vacancy rates among NHS directors need to be addressed

A new report this week puts the worrying high levels of senior vacancies across NHS providers back in the spotlight. The problem is across all disciplines including finance. There have been attempts to address these concerns in recent years. But the new figures suggest there is still some distance to go in addressing this key problem.

The report from The King’s Fund and NHS Providers finds that 8% of executive director posts were vacant or filled by an interim at the end of 2017. This is based on a survey of nearly two-thirds of trusts and when the work was last undertaken four years ago, the highest level of vacancies was for finance directors (9% of posts vacant). But finance directors are now below the average level of vacancies at 7%, with operations and strategy directors having the highest vacancy rates (9.4%). This is broadly in line with the vacancy rate for finance staff in general in NHS providers (see the HFMA’s report on The NHS finance function in 2017).

The small improvement for finance director vacancies is good to see, but the overall level of executive vacancies is too high at a time when strong and stable leadership is so important. The report also raises concerns about the short tenure of many senior executives – and it is finance and operations directors who are most likely to have been appointed within the past three years. Nearly one in five of directors of all disciplines were appointed last year.

This is an issue that the HFMA has been highlighting and looking to address for several years and I was interviewed as part of this latest research. Some 10 years ago, the association raised concerns about the relatively small number of deputy finance directors that wanted to pursue the most senior finance roles. And it is an issue that Future-Focused Finance, in conjunction with the HFMA and the Skills Development Network, has taken forward in recent years with its senior talent management programme.

This has seen two cohorts of aspiring finance directors join a national talent pool – with a number of programme ‘graduates’ subsequently being appointed to their first director roles. And, more recently, the programme has launched two networks for future leaders (band 7 and above) and finance leaders (band 8c and above) giving participants access to learning and development opportunities.

There are also plans to develop a support programme for newly appointed finance directors and chief finance officers.

This hopefully addresses one of the key supply issues, maximising the number of would-be finance directors with the skills and confidence to take leadership roles in high-profile complex organisations in a challenging environment. Increasingly, the skills needed are also changing with system working and the ability to drive transformation as important as perhaps more traditional, organisation-focused skillsets. (The HFMA is also working with CIPFA to look at the skills needed for finance directors holding both NHS and local government positions.)

The King’s Fund report acknowledges the value of many of these specific development programmes, alongside other aspiring finance leader programmes for chief executives and chief operating officers. But it also calls for a better approach to supporting executives in post when they encounter difficult periods. It raises particular concerns about the tendency for senior managers to be removed too quickly for underperformance, when performance challenges are widespread across the NHS and can often be outside the executive’s direct control. 

This is not only often unfair on individuals, but it damages the work being done to attract future leaders to these demanding roles. There is also a specific issue in organisations with the most severe challenges. If taking these roles is seen as career-threatening, how will we ever attract the best leaders to where they are most needed?

NHS finance offers a fabulous career. Our staff attitudes survey reveals relatively good levels of job satisfaction, albeit with a number of comments about working under great pressure. And it also shows that job satisfaction is highest among the most senior staff. However, finance managers have consistently voiced concerns, through the attitudes survey, about how valued they feel by government health departments.

This is surely the place to start. Establishing more collaborative relationships between government, system leaders and executives out in local health economies is likely to provide a better deal for patients and also help address vacancy rates among the service’s executive leadership.