Only the ‘super wealthy’ can afford to be NHS chairs

Chair and non-executive director roles are becoming harder to fill due to inadequate pay and “onerous” time commitments, research by HSJ has discovered.

HSJ’s sources confirmed many potential candidates feel both chair and non-executive director roles demand far more time than is paid for, partly because the introduction of integrated care systems has significantly increased the complexity of how the NHS operates.

One senior recruiter said that, while a pre-covid recruitment process could generate up to 20 applicants for chair roles, some recent posts have seen as few as three or four potential candidates. The job has become a lot less attractive because of the pressure chairs were now under, they added. 

Another recruiter, who had also seen the number of applicants reduce, said there was a growing feeling among candidates that you needed to be “super, super wealthy” to take on an NHS chair role. 

A trust chair, who spoke to HSJ on the condition of anonymity, told HSJ NED roles are becoming “increasingly difficult to recruit to”, with candidates being put off by what they see as an “overly onerous time commitment, plus an increasingly executive role”.

They said: “Increased regulation and tightened central control… mean that the chair now has much less autonomy and is personally accountable for outcomes in the same way their CEOs are, rather than maintaining an independent distance.

“In addition, in many parts of the country, the clustering of trusts into groups or shared board arrangements means that many chairs now do what used to be two or three separate roles simultaneously, becoming effectively a full-time undertaking. The same in these instances applies to shared NEDs.”

The chair said the NHS now has a reputation for requiring “very executive and nearly full-time chairs or NEDs”.

They added: “This puts off a lot of candidates from outside the NHS, which is really not a good thing. Some of the shared or group chair roles are also so large and complex that you really need to have had prior NHS chair experience to do them effectively, further limiting the pool.

The chair concluded: “It’s really hard to become a ‘first-time’ NHS chair these days. We end up defaulting to appointing people who are already inside the system. This cannot be a good thing.”

The chair of an ICS told HSJ: “I’m really not paid enough as a chair for a job that’s three days per week – i.e., 60 per cent of the time – or for the level of responsibility that they expect us to assume.

“NEDs in the NHS never do only two or three days per month. They are expected to do far more than they should, and the level of operational detail that chairs and NEDs are expected to know is inappropriate. As for a pay rise, don’t get me started.

“The role of NEDs is to own strategy and to hold management to account for top-line performance. We [as NEDs] shouldn’t need to know operational minutiae to answer the ‘exam questions’. That’s the role of the execs.”

The chair said they had expressed their concerns to NHSE, but these had “fallen on deaf ears”.

Pay NEDs more, says NHS Providers

NHS Providers has renewed calls for NHSE to support trusts and foundation trusts in raising non-executive directors’ pay. They argue NED pay has remained static for the past five years and that increasing it is now “a matter of priority”. 

While the government has agreed to implement the latest pay award recommendations for executive directors, the remuneration of NEDs falls under a separate framework.

NHS Providers’ chief executive Sir Julian Hartley said trust chairs have an “incredibly tough job given the complexity and size of the services, budgets, and workforce they and their boards oversee”.

He added: “It is worrying, though not surprising then, that when confronted with the scale of the challenge facing the health service, concerns about workload, work-life balance and pay, applicants are thinking twice before applying for chair roles.

“Reviewing non-executive director and chair pay – which has essentially been frozen since 2019 – would be a positive first step towards ensuring we have a pipeline of high-calibre talent willing to lead NHS trusts in the future.”

NHSE deferred HSJ to the Department of Health and Social Care when approached for comment.

A DHSC spokeswoman said: “We recognise the vital role that non-executive directors play in NHS organisations and will continue to work with NHS England to ensure they are well supported in those roles.”