One in four top NHS jobs is vacant - and the gaps at the 'top table' of management mirror recruitment concerns at trusts across the country, HSJ sources have warned.

The posts of directors of human resources, finance, the modernisation agency, the leadership programme and heads of London and South East regional offices are currently being advertised.

The Department of Health described the vacancies as 'an opportunity for six new recruits to be part of the 24 most senior posts in the NHS'. When the posts are filled, only Hugh Taylor - who will move from HR to become director of corporate and external affairs - will remain of NHS Executive board members appointed under the previous government.

One HSJ source said that the need for a 'top table' recruitment drive could be linked to just a few factors, including a clear-out where those directors who worked under previous chief executive Sir Alan Langlands became aware of their own 'sell-by date'.

But many sources are more concerned about the state of recruitment at trust level, where large trusts in particular are reporting difficulties recruiting chief executives willing and able to cope with 'an increasingly difficult role'.

One source said: 'Who'd be a trust chief exec? It is a really tough job, and getting harder. The government is placing more and more personal responsibility on them to meet a massive range of targets.

'Health authorities have a much lower profile, but then the future is uncertain: the smart money is on primary care trusts.'

A senior manager said: 'Now people are being held to account for very demonstrable targets. It is a different world to 10 years ago.'

Andrew Foster, NHS Confederation human resources policy director, recognised a 'legitimate worry' about the pressures with chief executives increasingly 'directly held to account on such a wide range of issues'.

'It is a very hot seat to sit in right now. The rewards are high - but so are the risks.'

NHS Confederation policy director Nigel Edwards agreed:

'We are hoping the leadership programme will get going quickly and pay particular attention to the training needs of middle and toplevel management.'

Paul Castle, chair of Birmingham Heartlands and Solihull trust, where the chief executive post is vacant, said the NHS was 'fishing in a relatively small pond' to find candidates with the track record and talent to deal with the modernisation agenda (see story, right).