Pressures facing NHS organisations, coupled with a culture of blaming individual leaders for failures beyond their control, mean NHS trusts are facing significant difficulties in recruiting and retaining senior leaders, according to a new report from The King's Fund and NHS Providers.

"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."

New survey data of 145 trusts analysed for the report finds that executive director vacancies in NHS providers are widespread.

Research shows that high levels of churn in these roles has a significant negative impact on the culture and performance of trusts, it is claimed. Leaders interviewed for the report also suggested it results in short-term decision-making, which can paralyse organisations at a time when they should be moving forward to develop new ways of delivering care.

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' by the Care Quality Commission (CQC), only three percent of posts were vacant and 20 per cent of executives had been appointed within the last year (2017), while trusts rated 'inadequate' had 14 per cent of posts vacant and 72 per cent of executives had been appointed in 2017.

NHS leaders interviewed for the report viewed their jobs as both a vocation and privilege. However, they highlighted an increased risk of regulatory 'decapitation', suggesting that consequences of poor performance or failure are perceived to be increasingly 'personalised' and laid at the door of individual leaders by some national bodies, politicians and the media. This can lead to a greater unwillingness among people to take on these challenging roles and discourage bold leadership once in a role.

The authors also warn that the leadership of NHS trusts is not diverse and does not reflect the wider NHS workforce or local communities, for example only seven per cent of very senior managers in the NHS are from a BAME background.


"Leaders in today’s NHS operate in a climate of extreme pressure," said Suzie Bailey, Director of Leadership and Organisational Development at The King's Fund. 

"Staffing vacancies are rife, there are widespread challenges in meeting financial and performance targets and demands on services continue to increase."

"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."

Saffron Cordery, Director of Policy and Strategy and Deputy Chief Executive at NHS Providers, said: "We know that high turnover among chief executive and other board-level roles has a negative impact on the culture and performance of NHS trusts."

"It is no great surprise that the best performing trusts often have stable leadership in place over many years. It therefore can’t be right that our most challenged organisations continue to experience the biggest difficulties in recruiting and retaining leaders."

"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."