Trusts struggling to fill senior leader posts

NHS Providers and the King’s Fund looked into leadership vacancies, analysing NHS Improvement data, holding a roundtable and interviewing frontline leaders and national stakeholders.

They found that 8% of executive director posts are vacant, with at least one post vacant in 37% of trusts.

In contrast to the groups’ previous study in 2014, finance director posts were among those least likely to be vacant (an average of 7% were vacant) – previously they had the highest vacancy rates. Deteriorating finances had made it less tenable to have finance director posts vacant or filled on an interim basis.

However, tenures were short – finance/commercial and operations directors were most likely to have been appointed in the last three years. Almost 59% of finance directors had been appointed in the last three years, second only to operations directors (64%). The average length of tenure for a finance director was 3.6 years.

One national stakeholder said: ‘In the last 18 months to two years, the acute chief operating officer has been the toughest post to fill. It vies for top spot with finance directors. This isn’t surprising as finance and operations are the areas of greatest angst and pressure in the system.’

Half of all executives had been appointed in the last three years and three years is the median tenure for a chief executive. Perhaps unsurprisingly, trusts rated inadequate by the Care Quality Commission experience higher vacancies and turnover. Churn in senior roles affected trusts’ performance and culture. NHS leaders suggested it led to short-term decision-making.

Senior vacancies averaged 3% in trusts rated outstanding by the CQC, while it was 14% in those rated inadequate.

NHS leaders said there was a perception that blame for poor performance was becoming increasingly laid at the door of individuals by national bodies, politicians and the media. This was leading to a greater reluctance to take on senior roles or discourage bold leadership from those in post.

Saffron Cordery (pictured above), deputy chief executive of NHS Providers, said: ‘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.’

The report also warned that trusts’ leadership lacks diversity and does not reflect the workforce or local community – only 7% of senior managers were from a black and minority ethnic background. Though there were some signs of progress, the difficult climate made employers more risk averse and less likely to employ candidates with less experience.

King’s Fund director of leadership and organisational development Suzie Bailey (pictured) said the upcoming NHS 10-year plan should seek to support the next generation of leaders.

'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,’ she added.

‘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 NHS is 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.’

NHS Confederation chief executive Niall Dickson said a pipeline of effective leaders will be needed in the next decade. ‘There is a lot of nonsense talked about senior NHS managers - these are among the most demanding jobs in the public or private sectors and the pressures at the top are greater than ever.

“We need to start valuing these dedicated men and women who are daily coping with immense challenges running highly complex and often very large organisations. High turnover is in nobody’s interest – it not only affects the services for which they are responsible, it disrupts the relationships that are so important for local organisations to work effectively together.’