Worryingly high numbers of vacancies on NHS boards may affect the quality of patient care, report finds

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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.

Notes to editors

1) The report, Leadership vacancies in the NHS: what can be done about them? was produced by The King’s Fund in partnership with the HSJ Future of NHS Leadership inquiry.

For any queries, please contact the press office on 020 7307 2603 or mediaoffice@kingsfund.org.uk

The research is based on in-depth interviews and a Freedom of Information request. The FOI request was sent to all acute, mental health, community and specialist acute providers in England. Responses were received from 134 acute trusts (94.4 per cent), 56 mental health trusts (100 per cent), 19 community trusts (100 per cent) and 18 specialist acute trusts (100 per cent). Alongside the FOI request, The King’s Fund carried out in-depth interviews with voting executive board roles.

2) The HSJ Future of NHS Leadership inquiry was launched earlier this year and will report in 2015. Its members are: Sir Robert Naylor, chief executive of University College London Hospitals NHS Foundation Trust (chair); Stephen Dorrell, MP for Charnwood and former chair of the House of Commons Health Select Committee; Dr Sam Everington, practising GP and chair of Tower Hamlets CCG; Richard Lewis, partner and health leader, EY; Dame Gill Morgan, chair, Foundation Trust Network; Professor Laura Serrant, professor of community and public health nursing and director of research and enterprise in the Faculty of Education, Health and Wellbeing at the University of Wolverhampton; and Dr Emma Stanton, chief executive, Beacon UK and psychiatrist, South London and Maudsley NHS Foundation Trust. The inquiry is investigating what leadership the NHS requires to thrive now and into the future. Its website, from which responses to its public call for evidence can be made, is www.hsj.co.uk/future-leaderships

3) The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.