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Worrying ‘level of churn’ identified among NHS leaders

NHS Providers and The King’s Fund have published a report on leadership vacancies in the NHS that, the organisations say, has important findings nationally, regionally and locally.


‘Leadership in today’s NHS: Delivering the Impossible’ presents an analysis of data from a recent NHS Providers’ survey of leadership vacancies in Trusts, and the results of qualitative interviews and a roundtable that The King’s Fund conducted with frontline leaders and national stakeholders.

The analysis focuses on executive directors within the provider sector. Encouragingly, compared to the last time The King’s Fund conducted a similar analysis in 2014, the average length of tenure for a chief executive has increased from two and a half years to three years. But this is still short and the level of churn in all the executive director posts examined remains worrying. The ability to recruit high calibre chief operating officers is of particular concern with growing demands on services.


The report finds that 8% of executive director posts are vacant or filled by an interim and 37% of Trusts have at least one vacant executive director role. There are many reasons for this, perhaps most significantly, the pressure that NHS Trusts are facing and the challenges that its leaders face on a daily basis as well as the culture of blaming individual leaders for failure.


One of the most noticeable differences in the four years since the 2014 analysis is that in 2018 leaders of NHS Trusts are increasingly being expected to look beyond the four walls of their own organisation to work as part of local health and care systems in the transformation of how services are delivered. Although this change has been welcomed by leaders, it means different leadership skills and approaches are required.

NHS Providers says the data and insights highlighted in this report really matter – high vacancies and turnover have a significant impact on culture, staff engagement and performance and disproportionately affect the most challenged organisations in our system.


The report also touches on the relatively new, but growing role of the managing director within the NHS and calls for more clarity over what this role entails and therefore the skills the ideal candidate must possess.


Click here to download the full report.