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Leadership vacancies in the NHS

What can be done about them?


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    Ayesha Janjua

There is a growing awareness that NHS provider organisations are experiencing a high number of vacancies at senior levels, are reliant on interims and are experiencing a greater ‘churn’ of senior leaders. This situation could have a negative impact on staff morale and engagement, on costs and on performance.

The King’s Fund, in collaboration with the HSJ Future of NHS Leadership Inquiry, undertook a freedom of information (FOI) request to obtain an accurate picture of board-level vacancies, supplementing the data gathered with in-depth interviews and a literature review. This report details the level of vacancies and their impact and suggests reasons for this.

Key messages

  • A third of NHS providers have at least one board-level position not permanently filled. This is especially true for NHS trusts with poor performance/quality care, like those in special measures. This loss of leadership could be creating strategic instability, wasting financial resources, reducing staff morale and affecting quality of care.

  • Factors contributing to this are 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.

  • Every NHS organisation should have a leadership strategy and leadership development plan. National organisations have a key role in removing excessive regulation and modelling the kinds of leadership behaviours needed for the future.

Policy implications

  • National bodies such as Monitor, the NHS Trust Development Authority and the Care Quality Commission have a key role to play in creating a culture that removes the barriers to recruiting and retaining board-level leaders. This means reducing the regulatory burden on NHS organisations and offering support and time to organisations facing challenges.

  • There is a need to develop individuals who have the requisite skills and experience to lead organisations in difficulty and potentially to lead multiple organisations.

  • Reforming the NHS needs to rely more on change from within organisations and systems and less on performance management and regulation.