NHS trusts face worryingly high levels of senior vacancies

A near-toxic mix of pressures facing NHS organisations, plus a culture of blaming individual leaders for failures has led to NHS trusts facing significant difficulties in recruiting and retaining senior leaders, according to a new report from The King’s Fund and NHS Providers.

Key findings of a new survey data of 145 trusts include:
• 8 per cent of executive director posts are vacant
• Over a third (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
• Half (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
• Short tenure was a concern for all executive director roles, but a particular problem for chief operating officer roles
• Trusts rated ‘inadequate’ by the CQC experience higher vacancies and turnover – these trusts had 14 per cent of posts vacant and 72 per cent of their executives had been appointed in 2017.

Research shows that high levels of turnover has a significant negative impact on the culture and performance of trusts. Leaders interviewed for the report suggested it results in short-term decision-making at a time when they should be moving forward.

The report highlights an ‘inverse leadership law’, where high vacancies and turnover disproportionally affect the organisations with the most significant performance challenges. In trusts rated as ‘outstanding’ only 3% of posts were vacant and 20% of executives had been appointed within the last year (2017), whilst trusts rated ‘inadequate’ had 14% of posts vacant and 72% of executives had been appointed in 2017.

NHS leaders interviewed for the report highlighted an increased risk of regulatory ‘decapitation’, suggesting that consequences of failure are increasingly ‘personalised’ and laid at the door of individual leaders. This can lead to unwillingness to take on these challenging roles and discourage bold leadership once in a role.

The report calls on the national bodies to take action to address leadership vacancies and cultures that deter experienced staff from taking on these roles.

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. 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.’

Saffron Cordery, Director of Policy and Strategy and Deputy Chief Executive at NHS Providers said: ‘We know that high turnover among board-level roles has a negative impact on the culture and performance of NHS trusts. We need a new approach to supporting challenged trusts and systems to develop their leaders rather than a revolving door approach. A solutions is to bring through a new generation of more diverse leaders. We need to create an environment where NHS organisations take on less experienced candidates with confidence. Nurturing talent and embracing diversity must go hand in hand.’