The calibre of applicants for top NHS posts is getting worse, many healthcare leaders believe.

Four in 10 respondents to a survey by the NHS Leadership Academy said the quality of chief executive talent had dropped, while only 7 per cent of the 142 respondents said the standard of applicants had improved.

Some 38 per cent said the quality of chief operating officers had got worse, compared with 13 per cent who reported an improvement.

Perceptions of applicants for directors of finance, nursing and medical lead roles were marginally more positive, according to the survey that garnered responses from some 110 trusts.

Just under one in three respondents said applicants for directorships in finance and nursing had worsened while almost one in five said talent in the field of medical directors had declined.

According to the study, between one-fifth and one-quarter of respondents rated the quality of candidate pools as “quite poor” or “very poor” for each position.

Fewer than 10 per cent rated the quality and calibre of applicants as “very good” for any of the five key roles.

The survey of provider chairs, chief executives and HR directors also exposed a reluctance of candidates to step up to senior roles in the NHS following increased scrutiny of trust leadership, following the Francis report and care failings at Mid Staffordshire Foundation Trust.

One non-foundation trust chair told the researchers: “The quality of candidates for executive posts is not as high as it was five, 10 years ago.

“To put it bluntly, the finance director, the operations director and the chief executive who I’ve recently appointed, I suspect five years ago I would have made better appointments in all three of those posts.”

The chief executive of a foundation trust with a turnover of between £100m and £300m said: “The other candidates, all of whom were senior deputies or existing workforce directors in other NHS organisations, were unappointable.

“Luckily, I had a highly appointable candidate who in my view has been here a year and is extremely effective, very focused. But the others… were below the line.”

Respondents said well qualified candidates were unwilling to “take the risk” of moving from the “safety” and “comfort” of their role to a board position.

Such reticence was due to a “blame culture” and the combination of long working hours, a stressful environment and relatively low financial rewards.

Jan Sobieraj, managing director of the academy, said: “Talent development is not just an NHS problem; it is a global issue and healthcare systems across the world are struggling to recruit leaders with the right level of skills and capabilities.

“With this in mind, we are currently working to ensure the talent management processes we have in the NHS are much more effective and the development of talented individuals becomes a core part of our business.”