High numbers of vacancies exist on NHS boards, survey shows

BMJ 2014; 349 doi: (Published 11 December 2014) Cite this as: BMJ 2014;349:g7563
  1. Jacqui Wise
  1. 1London

A third of NHS providers in England have at least one board level position that is not permanently filled, and the worst performing trusts having the most difficulty recruiting executives, research by the King’s Fund has shown.

The report, Leadership Vacancies in the NHS, said that these high numbers of vacancies can negatively affect organisations—damaging staff morale, causing strategic instability, wasting financial resources, and affecting patient care.1

The survey found that 31% of acute trusts, 38% of mental health trusts, 22% of specialist acute trusts, and 36% of community trusts reported having at least one vacancy or interim executive board member. It also found that 17% of trusts in special measures because of concerns about the quality of their care were without a permanent chief executive in post, compared with an average of 7% across all trusts.

Nine per cent of vacancies were for finance director positions, a role that the report described as vital when the NHS is facing an unprecedented financial squeeze. The hardest positions to recruit for seemed to be nursing director positions, which were vacant for an average of nine months and one of which was unfilled for 28 months.

The report said that part of the problem was a perceived “blame culture,” where executives feel exposed if anything goes wrong, even in a situation where they have little control. Other factors were unrealistic expectations of how quickly change can be achieved and excessive regulation.

The research was carried out as part of the Health Service Journal’s Future of NHS Leadership inquiry, which will produce a final report next year. After a freedom of information request, responses were received from 134 acute trusts (94.4% of such trusts), 56 mental health trusts (100%), 19 community trusts (100%) and 18 specialist acute trusts (100%) in England. Alongside this, the King’s Fund carried out in-depth interviews with executive board members.

The report recommended that every NHS organisation should have a leadership strategy and leadership development plan that includes talent management and investing in developing future leaders.

Nicola Hartley, director of leadership development at the King’s Fund, said, “While part of the reason for these high levels of vacancies is the wider health environment, the responsibility for developing future leaders ultimately sits with the trusts themselves. It is important that trusts are investing in developing staff to take on these very challenging roles.”


Cite this as: BMJ 2014;349:g7563


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