A third of NHS providers have at least one board-level position not permanently filled, research by The King’s Fund and HSJ Future of NHS Leadership inquiry has found. The research highlights the difficulty NHS organisations face in recruiting and retaining people for executive positions. This potential leadership vacuum could create strategic instability, waste financial resources, reduce staff morale and affect quality of patient care.
Difficulty in recruiting executives was most pronounced in the worst performing trusts, ie, those most in need of effective leadership. Trusts in special measures because of concerns about the quality of their care were much less likely to have a permanent chief executive in post (17 per cent of trusts in special measures were without substantive CEOs, compared to an average of 7 per cent across all trusts).
Key factors that might dissuade leaders from taking up a board-level position include a perceived blame culture in the NHS where executives feel exposed if anything goes wrong (even for things outside their control), excessive regulation and unrealistic expectations of what can be achieved in short timeframes.
Almost one in 10 (9 per cent) of trusts have vacancies for finance director positions, an important role when the NHS is facing an unprecedented financial squeeze. Nursing director positions were vacant for the longest time – an average of nine months with one post open for 28 months – indicating that they are the hardest positions to recruit to.
The report recommends that every NHS organisation should have a leadership strategy and leadership development plan, which includes talent management, succession planning and investing in developing future leaders. National bodies have a key role in creating an environment conducive to recruiting and retaining board-level leaders, including removing excessive regulation and modelling the kinds of leadership behaviours needed for the future.
Nicola Hartley, Director of Leadership Development at The King’s Fund said: ‘This report reveals a worryingly high number of board-level vacancies. Long-term vacancies or high staff turnover can have negative impacts on NHS organisations including on their quality of patient care.
‘Talent management is key to ensuring that NHS trusts are well led. While part of the reason for this high level of vacancies is the wider health environment, the responsibility for developing future leaders ultimately sits with the trusts themselves. It is important that trusts invest in developing staff to take on these very challenging roles.’
The research is meant to inform the HSJ Future of NHS Leadership inquiry, which is investigating the leadership needed for the NHS to thrive now and into the future.
Sir Robert Naylor, Chair of the inquiry and chief executive of University College London Hospitals NHS Foundation Trust said: ‘The HSJ Future of NHS Leadership inquiry has heard evidence from a range of individuals and organisations but no matter their background one theme has always quickly emerged: the problem the NHS has in retaining leaders.
’What is crystal clear is that we cannot continue with this continuous ‘churn’ of leadership. Equally clear is that we need to encourage the abundant talent we have in the NHS to take up senior level roles – particularly our clinicians.’
The inquiry members intend to address this and other current issues with NHS leadership when they report next year.