CEO ‘exodus’ threatens NHS, ministers told
The NHS could face an “exodus” of chief executives within the next two years due to a retirement bulge and intense operational pressure, government pay advisers have warned.
The senior salaries review body’s latest report, published last night, said senior NHS leaders’ turnover was high, emphasising that one-third of executive directors had been appointed within the past 20 months (as of August last year).
The SSRB said this particularly affected “challenged” trusts, pointing out organisations rated “inadequate” by the Care Quality Commission tended to have vacancy rates and proportions of first-time executives that are “several times higher than those of ‘outstanding’ trusts”.
The board makes recommendations for NHS “very senior managers” and national “executive senior managers”.
Its report said: “Some do not see promotion to senior leadership as attractive, given the increased responsibility and loss of entitlements such as payments for overtime and being on-call.
“Those at the top of Agenda for Change, the pay scale below the [executive senior manager and very senior manager] scales, are paid more than the lowest-paid [ESMs and VSMs]. Up to 9 per cent of VSMs have basic pay below the top of AfC.
“Around 46 per cent of CEOs are eligible to retire and many more will be in the next 12 to 24 months. Given the challenges outlined here, the risk of an exodus of CEOs is especially concerning.”
HSJ research last summer found nearly two-thirds of trusts had a “first-time” CEO, while one-third of the sector’s CEOs had only been in their post for 18 months or less, following a period of remarkable turnover since the covid crisis. The SSRB cited similar findings.
Its report acknowledged government had taken steps to address leadership pressures, including implementing recommendations from the Messenger Review, and the introduction of a new VSM pay framework.
However, the report said the pay framework, which is “expected shortly”, has taken “much too long to be introduced” amid concerns some of the impact of its changes might be diluted.
And it said that, while “insufficient remuneration… was not a key theme” in evidence to it on VSMs: “The intensity of the operating context was consistently [given as] evidence as the main source of pressure on these leaders, and on their recruitment, retention, and morale. Stable and high-quality leadership is essential to deliver key health outcomes.
“We heard about the importance, in this strained operating environment, of a pay uplift through which senior stakeholders recognise and reward ESMs and VSMs, given the current pressures on health leaders.”
Sign off delays
Further in its report, the SSRB expressed frustration again at very long waiting times for ministers to approve individual NHS salaries above £150,000.
Pay advisers described the delays as “extraordinary” and repeated their recommendation from last year for timelines to be expedited.
Health and social care secretary Wes Streeting last night on this: “The government is still considering its approach to the recommendation to have a four-week turnaround on pay cases for VSMs and ESMs and so cannot confirm acceptance at this time.”
HSJ has reported examples of ministers taking more than a year to sign off senior appointments; and that they had rejected nearly 50 senior manager pay deals worth more than £150,000 in the past three years, but could only block four of them.