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Third of NHS trusts have at least one vacant director role due to ‘near-toxic’ pressures

Just over one-third of trusts have at least one vacant executive director role due to “near-toxic” pressures facing NHS providers, startling new research has shown.

In a new report released by NHS Providers and the King’s Fund, several “financial and austerity and performance” pressures facing management, alongside a blame culture of staff leadership, has left trusts struggling to recruit and retain senior leaders.

The pressured climate has led to high turnover in the nation’s health service boards: more than half—54%— of substantive executive directors were appointed in the past three years, with 18% employed in the last year alone.

The report also highlighted the ‘inverse leadership law’ as a particular area of concern. The King’s Fund and NHS Providers found that the law— where trusts experiencing the most challenging levels of performance were also experiencing high vacancy rates and shortest leadership tenures— was “still very much in force,” with those who conducted the report calling on a new approach to address the issue.

In trusts rated as ‘outstanding’ a tiny 3% of posts were vacant, and 20% of executives had been recruited in the last year— whereas trusts rated ‘inadequate’ by CQC inspectors had 14% of posts vacant and a massive 72% of executives had been appointed in 2017.

The survey, which received data for 1,035 executive director posts, also noted there was a lack of diversity in leadership of trusts and did not reflect the wider NHS workforce or local communities.

“The combination of prolonged austerity, increasing demand for services and growing shortages of clinical staff has created a near-toxic cocktail of pressures for senior NHS leaders,” the report said. “This is starting to take a toll both on those currently in leadership positions and on future leaders aspiring to these positions.”

Trust managers also spoke of there being a disconnect between NHS England and NHS Improvement (NHSI) at the national level as well.

One NHS trust director said: “We need to role model better leadership at the top of the NHS. NHSI and NHS England say: ‘We are not one organisation. It is difficult legislatively to be one organisation.’ And then they tell us in STPs that we need to play nicely even though we are all separate organisations.

“You go from one meeting with NHS England to another with NHSI and it’s clear that regional teams have told their staff to stick it to the other national body when you get the chance… there is no consistent leadership message coming through the system.”

Responding to these findings, Niall Dickson, chief executive of the NHS Confederation, said: “We need to start valuing these dedicated men and women who are daily coping with immense challenges running highly complex and often very large organisations. High turnover is in nobody’s interest— it not only affects the services for which they are responsible, it disrupts the relationships that are so important for local organisations to work effectively together.

“The challenges facing the health service in the coming decade are enormous— we need a good pipeline of strong, effective leaders who feel confident about themselves and will inspire and empower their staff.”

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Image credit: ijeab, iStock images


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