Almost one in 10 trust boards does not have a permanent finance director amid one of the biggest ever NHS funding squeezes, HSJ analysis has revealed.

A near comprehensive study of executive board posts by HSJ found that 9 per cent of provider trusts had a vacancy or the critical post was filled by an interim staff member.

This fresh evidence of weaknesses in providers’ leadership structures has sparked concern among healthcare commentators. The figures will feed into HSJ’s ongoing Future of NHS Leadership inquiry and inform a report on leadership by the King’s Fund, which is due to published this December.

The largest number of vacancies and interim appointments were among finance directors and chief operating officers (see charts, below).

Ten of the 12 acute trusts without a permanent finance director expect to record large deficits at the end of 2014-15, including University Hospitals of Leicester Trust, and Heatherwood and Wexham Park Hospitals and Medway foundation trusts.

The finding comes as official figures show providers suffered “unprecedented” financial problems in the first months of 2014-15, while HSJ revealed last month that the acute sector was expecting to record an overall deficit of at least £750m at the end of the year. Other findings from our analysis, based on information provided by 227 of the total 236 provider trusts in England, include:

  • More than a third of trust boards have one or more executive director posts vacant or filled by interim staff.
  • The median average time in post of a chief executive is two and a half years. Community trusts have the shortest median time in post, with acute trusts marginally better.
  • More than one in five trusts have chief executives who have been in post for less than a year. However, one in 10 chief executives have been in post for more than a decade.

The King’s Fund’s director of leadership development, Nicola Hartley, said the lack of permanent finance directors could be due to them leaving the NHS for other sectors, and it could get even harder to retain them.

She said: “Financial director positions in the health service have always been tough to fill - their skillset is transferable to other sectors.

“This may get harder as the wider economy begins to recover but NHS finance directors face the relentless pressure to reduce cost and deliver efficiency savings.”


She described HSJ’s findings as a “wake-up call to the NHS to redouble efforts to strengthen talent management and develop future leaders in finance and other disciplines”.

Nuffield Trust chief executive Nigel Edwards said the risk of becoming an NHS finance director may be dissuading people from applying.

He said: “The incentives for people to decide to do these jobs may not be very great. You’re going to spend the next three years making extremely difficult decisions, some of which will be quite painful, which doesn’t sound like a great offer.


“A few years ago people were saying, ‘I don’t want to be a chief executive because it’s too risky.’ Now they are saying, ‘I don’t want to be a director because that looks too risky as well.’”

Healthcare Financial Management Association policy director Paul Briddock said the rate of vacancies was “likely to be a reflection of the very difficult financial climate facing directors of finance in the NHS at the minute”.

Richard Lewis, partner and leader at consultancy EY’s healthcare advisory practice and a member of HSJ’s Future of NHS Leadership inquiry, said: “It must be a concern if NHS boards are facing persistent gaps in their leadership teams and a lack of continuity at the top.

“Of course, in any organisation, there will always be staff turnover… The question for the NHS is whether this turnover has increased beyond the expected level and signals something far more worrying.”

NHS Employers director of employment relations and reward Gill Bellord said that while “constant change can be unsettling for staff and organisations”, turnover can also “bring new ways of working to an organisation which should be encouraged”.

The information was provided to HSJ by trusts during July, August and early this month.

Naylor calls for long term view

The chair of HSJ’s inquiry into the future of NHS leadership has called for a new leadership strategy and development programme for the service covering at least a decade.

University College London Hospitals Foundation Trust chief executive Sir Robert Naylor said the findings reflected an “absence of talented leaders to fill the thousands of executive posts in the NHS”, which is “clearly not sustainable”.

“We’re looking for far too many executives and executive directors and the talent pool isn’t there.”

Sir Robert, an NHS chief executive of 26 years who has been at his current trust since 2000, said: “We seem to have a new strategy for leadership development every five years or so and we need to have a sustainable development programme that is regionally based.

“We need a vision for the strategic development of leadership, not just for this parliament but the next one and the one beyond that.”

He added: “We haven’t invested anywhere near enough in our clinical leaders.

“That’s likely to be a key feature of the Future of Leadership inquiry - how do we get our clinicians more interested in leadership at an early age? How do we get the royal colleges and other parts of the medical establishment to understand its importance?”