Why so many vacancies? Time to stop the NHS talent drain
A range of problems and events all broadly linked to the quality and, particularly, availability of leadership are rapidly converging.
If they remain unresolved, 2013 may see the NHS significantly under-prepared to maintain, let alone improve, service quality while delivering the redesign which will keep the system affordable.
The first problem is the sheer scale of senior posts which are unfilled or occupied by an interim. An incomplete list of acute and mental health trusts without permanent chief executives takes in: Avon and Wiltshire Partnership; Berkshire healthcare; Brighton and Sussex; Cambridge University; Countess of Chester; Croydon; Great Ormond Street; Ipswich; Isle of Wight; University Hospitals of Leicester; Milton Keynes; Morecambe Bay; North Bristol; North Middlesex; Peterborough and Stamford; Plymouth; Royal Liverpool and Broadgreen; South London and Maudsley; South Tees; and Weston Area Health.
This list does not include the currently leaderless South London Healthcare. It is one of 16 trusts which this week received an “escalation letter” from the Department of Health signalling heightened monitoring of their progress through the foundation trust pipeline. Further vacancies will appear as a result of this scrutiny.
Of course, top-level vacancies mean gaps appear further down the leadership hierarchy as people act up and management is de-layered in efficiency drives.
There is a similar struggle within the organisations being created to run the new system. Last week, NHS Commissioning Board director of commissioning development Dame Barbara Hakin complained of the difficulty in filling top jobs at commissioning support services. The board is also having to sell its own local area director jobs as “ambassadors” to give the positions a sense of importance that many potential candidates believe they lack.
At the same time as the NHS battles to fill these key positions it is experiencing a talent drain which is shocking even experienced observers. The fact the NHS will lose the skills and experience of strategic health authority chief executives Sir Ian Carruthers, Sir Neil McKay and Dame Ruth Carnall at the same time is just the tip of a spectacularly large iceberg.
The loss of talent is largely a result of the government’s restructuring. The exit terms rightly offered to these senior people after lengthy service are hugely attractive. HSJ spoke to a leader (not one of those mentioned above) who desperately wants to stay in his post, which will survive the reorganisation, but could never look his family in the eye again if he turned down the money on offer.
He, of course, is already being courted by management consultants.
The NHS is papering over the widening cracks in its leadership base - often by using a growing band of interim executives. This jerry-rigging will not hold forever as the financial and reconfiguration gales pick up force. But look out across these choppy waters and it is possible to see a real storm on the horizon. The Francis inquiry into care failings at Mid Staffordshire Foundation Trust may prove to be the final straw.
HSJ has spoken to one NHS leader who says they will resign on principle if they are criticised. But, more significantly, many fear the wave of opprobrium the inquiry - and more particularly its media coverage - could unleash on NHS leaders and the surge of increased regulation it might inspire.
There is no neat solution to the growing gap in leadership capacity and, no doubt, new leaders will rise to the challenge. But in the meantime the Department of Health, commissioning board and Trust Development Authority should pay serious attention to persuading some of those eyeing the sun lounger to stay around long enough to give the new generation a chance to build the necessary knowledge and experience.
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Readers' comments (18)
Anonymous | 4-Jul-2012 8:04 am
A very well written piece on a really concerning issue. It is really quite hard to motivate junior managers to aspire to greater things in the face of growing public animosity stoked by the media. Worse still, despite valiant attempts by Sir David his regional teams and Secretary of State seem to have been wooed by the private sector into under-valuing the NHS ethos.
....and you didnt even mention pensions!
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Anonymous | 4-Jul-2012 12:17 pm
With increasing pressure on clinical standards and financial performance, public scrutiny, and 'change fatigue' its no surprise many senior leaders are looking to pastures new, or to enjoy their retirement. These are challenging times for the NHS, and perhaps its not such a bad thing that many have moved on?
The NHS are now desperately in need of commercial/private sector skill sets to navigate these uncertain times. New leadership from outside the NHS may well be the answer for many (not all) Commissioning bodies and Providers, with an injection of new ideas, new thinking and new approaches. The NHS needs to embrace the opportunity to bring something new to the table, to do things differently. Someone with 30 years service to the NHS will have made a fantastic contribution, but are they the leaders the NHS needs for the future anyway?
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Anonymous | 4-Jul-2012 3:27 pm
Perhaps a culture of more open advertising of NHS positions would help. Isn't the prevailing approach rather introspective, covert, and favouring the ones you know? Many good NHS and external candidates never hear of the best senior roles...
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Anonymous | 4-Jul-2012 4:42 pm
Could someone please tell me how anyone from the commercial wolrd would be attracted to run multi-million businesses with the salaries and terms and conditions the NHS can offer? Its not that what we can offer is derisory, its just that they dont compare.
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Patrick Newman | 4-Jul-2012 7:31 pm
Not to mention the inconvenience of interims costing up to twice as much as an established post holder. The pressure to rush into FT status will surely produce casualties and FT themselves with the emphasis on 'enterprise' level responsibility must have their own pressures and stresses. Surely there must be more to CE roles in the NHS than the person who is sacked when there is a controversial failing in the trust.
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Anonymous | 4-Jul-2012 10:14 pm
All you have to do is look at the letters in the FT pipeline article to see why many provider jobs are so unattractive. As an acute trust director I fail to see why anyone would want to be the boss - unless you're being paid a king's ransom as an interim and don't have to achieve either the impossible, or do a 10 year job in 2 years. If the threats are carried through I reckon there will be 80-90 boards sacked in the next 2 years for failing to do just that. The leadership holes are only going to get bigger - and with the NHS's bullying of its leaders and the lack of reward in any sense for taking these jobs on, I can't see the private sector falling over themselves to fill them. And then where will we be ?
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Neil Jessop | 5-Jul-2012 7:08 am
Maybe that is what the service needs now, change fatigue affects more middle management than CXs taking a walk and that drives the developing talent away as well,
The demise of PCTs has no doubt lost many experienced managers even if their were rewarded with reasonable pay offs subject to their length of service and seniority.
What is the life cycle of the new NHS reforms who would bet more than 3 years?
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Anonymous | 5-Jul-2012 9:04 am
Can you blame senior NHS managers from taking their attractive leaving packages and then returning to the NHS as consultants to fill the leadership gap earning more than they did as employees. As a non executive our hands are tied to the agreed terms & conditions that provide the generous packages and we see only too often these senior executives working as consultants to the NHS.
It is absolutely scandalous and executives leaving the NHS should not be allowed to return as consultants for at least 12 months.
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Anonymous | 5-Jul-2012 10:48 am
I'm one of those experienced CEs who walked away from the NHS a year ago - not with a severance payoff but just found a new role elsewhere. I spent 25 years as a CEO or a Director and had led or helped to lead more reorganisations than I care to remember.
I still love the NHS and was very proud of the job I did but felt embarrassed by the crass ineptitude of the reorganisation and by the handling of the people management issues. In the final analysis I did not feel I could stand in front of patients and staff and, with integrity, promote a change a restructuring I felt had nothing to commend it.
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kostamanis1@gmail.com | 5-Jul-2012 11:27 am
The article exposes the acute stress of the NHS administration. Stress leads to anxiety, fear, panic and eventually to "fight or flight."
Alastair's methodical and in depth analysis shows that "flight" is the preferable option. If not reversed, it will be catastrophic for the NHS.
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Anonymous | 5-Jul-2012 12:31 pm
The current situation is a tragi-comedy and so shortsighted. Prepare for an army of hugely expensive interims that will make great Daily Mail copy.
Treat people like sh*t and you get back what you deserve. It's like Pol Pot's purge of the intellectuals and look what the result was there
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Anonymous | 5-Jul-2012 3:16 pm
Anon 10.48. Hear Hear. Many of us have done the same. Left - with or without packages - when we could no longer defend the indefensible. And for some of the above contributors who welcome the exodus of NHS managers in order to make room for people with greater vision from the commercial sector, all I will say is 'be careful what you wish for'. Many of us have worked with the commercial whizz kids brought in to buy the DH out of waiting list problems. I saw hundreds of millions wasted on daft schemes which if targeted at the front line [and only paid on delivery] would have achieved so much more. Why does no-one look at the cost and legacy of the DTC programme - intended to bring commercial intelligence into the NHS to show us all the way. How many of those overpriced and protected new business starts have gone on post initial contract protection?
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Anonymous | 6-Jul-2012 10:05 am
As a senior clinician in an unusual speciality that straddles acute and community services, and nearing retirement, I would agree that CEOs are in a hopeless job, with intolerable pressures. However, the one thing I have consistently seen is the failure for both PCT and Acute CEs to engage with senior clinicians in any meaningful way. It is the clinicians who have all the expertise in how their services should run, and how do do this efficiently and cost-effectively. Unless the CEs listen to the clinicians' advice they will never be able to achieve their objectives, and will end up lost to their organisations and the NHS.
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Anonymous | 6-Jul-2012 12:10 pm
Sorry to spoil the party, but having 20 organisations without permanent CEOs out of 143 FTs and 112 NHS Trusts doesn't sound like much more than usual churn to me.
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Anonymous | 6-Jul-2012 1:19 pm
12:10.
Sounds much more like a combination of the below to me:
1) poor succession planning;
2) not being able to find people willing to take the jobs
3) not *allowing* non-NHS people to apply (how many senior roles to you see where Board level NHS experience is "esential?).
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Anonymous | 6-Jul-2012 4:15 pm
Like Anon 10.48 and 3.16 I too walked away after 30 years from clinican to senior manager, this is not usual churn and the impact is being felt throughout as recent public/patient reports about overall state of NHS reflect.
However what may help is to look to the places within the NHS that are bucking this trend ?
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Anonymous | 9-Jul-2012 10:59 am
I think there is a further problem with the HR system which only seems to appoint or advertise within the system those whose posts are at risk. As someone who was fairly senior and who moved into another area of NHS work there is no chance to even apply for senior posts as they are not advertised outside of the exisiting service. I would willingly re enter the fray with more experience under my belt if I could be given the chance to apply.
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Anonymous | 10-Jul-2012 4:05 pm
Dunno about Neil McKay, but it says a lot when you lionise the likes of Ian Carruthers and Ruth Carnall.
My uncle [now retired] was the chief architect, in the early 1990s for a district general hospital built with public funds. I.e. not a PFI. The build came in on time and in budget. The hospital still stands [minus A&E, paediatrics or maternity] and ironically I went to work in it as a consultant surgeon, never realising the family link. You should ask my uncle what he thinks of NHS management, and how what he saw [admittedly amongst other things] made him leave to go and live in France. After all, despite being a senior clinician for >20 yrs and a clinical director for 4 of those, no-one has the slightest interest in what I think.......
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