• Chief operating officers are under “unprecedented pressure” resulted in short tenure and limited candidates 
  • Pressures on NHS leaders could affect frontline staff too
  • The tenure of a chief executive has increased slightly
  • National leadership programmes need to expand to include other board roles

More than a third of NHS trusts had at least one board level vacancy last year with more than half of directors in post for less than three years, according to new research.

A new analysis by the King’s Fund and NHS Providers shared with the HSJ found almost 20 per cent of board level directors were appointed within the past 12 months with recruitment problems blamed on pressures due to “financial austerity and performances challenges” facing the health service.

The findings, based on a survey by NHS Providers last year and analysed by the King’s Fund, revealed 8 per cent of NHS trust executive director posts were vacant with leadership roles in the NHS seen as “less attractive”.

The data revealed that the highest vacancy rates were for directors of operations and for executives performing strategy, planning and transformation functions, whereas chief executive and finance director posts were least likely to be vacant.

Suzie Bailey, director of leadership and organisational development at the King’s Fund, told HSJ that there was “unprecedented pressure” on chief operating officers, who feel the pressure “acutely”.

“Whilst people who hold these roles thrive on the adrenaline, there is also burnout,” Ms Bailey said. “The relentless nature of acute trusts and community services [means] the pressure does get to people.”

The former NHS Improvement leadership director added that this could impact on frontline staff, as pressure could result in a less compassionate leader.

Ms Bailey said that directors of finance also reported difficulties in getting deputy staff to step up.

The NHS Provider survey, which made up the quantitative part of the analysis, found that leadership vacancies were “widespread” with 37 per cent of trusts having at least one vacant post for a board led executive. Trusts providing community services have the most vacant posts, whereas mental health and learning difficulty have the least.

More than half, or 54 per cent, of executive directors were appointed in the past three years, with 18 per cent appointed last year.

The median tenure for a substantive chief executive was found to be three years, which the King’s Fund said was “slightly longer” than previous estimates of NHS chief executive tenure.

The King’s Fund found that NHS organisations with the most significant performance challenges experience high levels of leadership churn and added that national bodies are not tackling this effectively.

The research also found that leadership in NHS trusts is “not diverse” and “does not reflect the wider NHS workforce or local communities – of the 224 trusts reporting ethnicity data, 98 had no black and minority ethnic board members. However, the King’s Fund stressed that trusts are starting to have a “stronger focus” on this issue.

Ms Bailey told HSJ that there is now a “greater awareness” that there are more “systemic problems” than those that come down to single individuals.

“There is now a more nuanced understanding that the role of leaders is really important but we need to see what we can do to support leaders in the first instance,” she said.

She added that a case where a leader is continuing to fail after a period of support, there comes a time when “they do need to be moved on”.

Ms Bailey also said the “bullying behaviour” from national organisations “has to be tackled” and ways need to be found for local leaders to call it out.

She said national organisations should consider how “do-able” the senior leadership jobs are.

“The complexity of leading healthcare is widely acknowledged and, therefore, we need to think about whether these jobs are almost impossible,” she said.

The think tank recommended leadership development programmes “expand their focus” to include roles experiencing particular recruitment challenges.

However, it said that although high turnover needs to be addressed, longer tenure itself is not the goal, but can be an “enabler” of more effective boards.

Saffron Cordery, deputy chief executive of NHS Providers said: “One of the solutions to our leadership challenge is to bring through a new generation of leaders that is more diverse and reflective of the communities the NHS serves.”

“We need to create an environment in which NHS organisations are able to take on less experienced candidates with confidence,” Ms Cordery said. “Nurturing talent and embracing diversity must go hand in hand.”