“Near-toxic” pressures on NHS organisations and a culture of blaming individual leaders for failures beyond their control are behind worryingly high levels of vacancies at board level, says a new report from The King’s Fund and NHS Providers.

Survey data from 145 trusts found that 8% of board-level posts currently lie unfilled and more than a third of trusts had a least one executive director post vacant. Trust boards also lack experience, the report found, with 54% of directors having spent less than three years in the job and chief executives also serving for an average of less than three years.

Struggling trusts

Struggling NHS organisations are having the most difficulty recruiting and retaining senior staff, the researchers found. Trusts rated inadequate by the Care Quality Commission (CQC) had 14% of executive director posts vacant, with a staggering 72% of board members having been appointed within the last year. This compares to 3% and 20% for the best performing trusts.

The report, Leadership in today’s NHS: delivering the impossible, says many NHS leaders interviewed for the report “highlighted an increased risk of regulatory ‘decapitation’, suggesting that the consequences of poor performance or failure are perceived to be increasingly ‘personalised’ and laid at the door of individual leaders by some national bodies, politicians and the media. This can lead to a greater unwillingness to take on these challenging roles and can discourage bold leadership once in a role.”

Extreme pressure

“Leaders in today’s NHS operate in a climate of extreme pressure: staffing vacancies are rife, there are widespread challenges in meeting financial and performance targets and demands on services continue to increase, said Suzie Bailey, director of leadership and organisational development at The King’s Fund.

“Responsibility for NHS leadership is everyone’s business – attracting and supporting the right kind of future NHS leaders should be central to the NHS 10-year plan and the work of the national bodies,” she added.

New generation of leaders

Saffron Cordery, deputy chief executive of NHS Providers, said trusts needed support to ditch “the revolving door approach” and do more to develop their own leaders.

“This includes finding ways of enticing high-performing leaders into struggling trusts, but that isn’t easy to do when a culture of blaming individuals for perceived failures exists,” she explained.

“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,” she added.

While there has been some progress in recent years, there is still a huge amount to do on this front.”

MiP chief executive Jon Restell praised “great work” by the report’s authors in identifying the causes of the staff shortages at board level. “The NHS is running out of heads to put on the spikes,” he said. “It’s time to nurture this tiny part of the workforce that has such a big impact on staff and patients.”