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Ministers took over a year to approve NHS leader’s appointment

Published on: 22 Aug 2023

Ministers took more than 300 working days to sign off a senior NHS leader’s appointment, HSJ can reveal, as new data exposes the huge delays trusts face when trying to secure government approval for very senior managers.

HSJ submitted a Freedom of Information request to the Department of Health and Social Care following government pay advisers’ warning in July that delays were having a “direct operational impact” on trusts.

The single longest delay to answer a very senior manager pay case, defined as when the salary is over £150,000, in the last five years was 315 working days in 2022-23, the data shows.

Factoring in weekends and public holidays, this meant the total delay for the role to be signed off was well over a year.

Managers in Partnership chief executive Jon Restell said: “Whether they have a fearful eye on the Daily Mail or whether they simply don’t care about filling board vacancies, ministers drag their feet when making these decisions.”

The figures also show eight cases from 2022-23 are still being processed. The fastest response took just three days, while the average time taken for that year was nearly 50 working days.

Performance in 2023-24 to date appears to have improved, with cases answered in an average of 22 days.

Earlier this year the Care Quality Commission reported ministers to the National Audit Office over months-long delays to board appointments. Other arms-length bodies, including NHS Blood and Transplant and the UK Health Security Agency, were reported to be facing similar challenges.

The issue was flagged by the independent pay review body that considers senior salaries in the public sector in July. It said: “The length of time it is taking to confirm salaries for some appointments is a further hindrance to NHS leadership. Senior posts remain vacant for an unnecessarily long time, which is having a direct operational impact. We think the current system needs urgent reform.”

*8 further cases still being processed.**30 further cases still being processed.

The figures cover trusts and foundation trusts. Ministers are unable to formally block pay cases in FTs, though they can set out “letters of disappointment”.

The figures released by the DHSC also revealed that just one of more than 400 requests was not approved.

The requirement for ministerial approval was introduced by former health and social care secretary Jeremy Hunt in June 2015, when the threshold was first set at £142,500. It was increased to its current level in January 2018.

Mr Restell said: “Approval delays have rightly been raised by the Senior Salary Review Body as adding to already difficult recruitment exercises. The government’s approach also runs counter to the spirit of its own Messenger review, which recommended using pay to attract leaders to the most challenged NHS trusts.”

“The figures obtained by the HSJ also show that ministers approved all bar one of the requests from trusts and FTs. So it is fair to ask whether the process leads to better decisions or just adds a pointless delay to recruiting to one of a small but critical number of executive jobs.

“It would be much better to have a robust and open national pay framework within which trusts and FTs could make quicker decisions.”

The DHSC said: “It is right that decisions on salaries for very senior managers are subject to close oversight to ensure value for money to the taxpayer. However, the government has been working to expedite the clearance process so that senior leaders can begin their role without unnecessary delay.

“As a result of these actions, so far this financial year the mean number of working days taken across all cases has fallen to 22.”