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Mind the Gap. The difficulties of stepping up to a Director of Finance role in the NHS

There has been much publicity in the last few years surrounding the number of vacancies at Director of Finance level within the NHS. Last year, the King’s Fund and Health Service Journal noted that nearly one in ten NHS Trusts lacked a permanent Director of Finance (DoF).  This figure did not surprise me, as from my own analysis, the number of vacancies has remained relatively constant for the last few years.

However, what does often surprise me when speaking to DoFs or Deputy DoFs, is that the NHS appears to be making little headway to address the issue. Back in August 2010 the Healthcare Finance Management Association published “Developing Future Leaders” which argued that there was a lack of emphasis on succession planning for NHS Finance Director roles.  The HFMA recommended more mentoring/coaching, increasing the opportunity for board level exposure for deputies, developing talent programmes, re-evaluating the use of Agenda for Change Band 9.  All good suggestions in my view, but five years on, what has been the impact of these?  Given the number of vacancies, have these recommendations made a difference?

Specialising in finance within healthcare, it doesn’t take long to understand that whilst the finance director role in the NHS can be incredibly rewarding and intellectually stimulating, the significant political context and regulation can be a frustration for many. A read of the  HFMA’s quarterly Financial Temperature check, a glance of Monitor’s ‘S’ curve or assessment of the financial performance of NHS Trusts  regulated by the Trust Development Authority paints an equally bleak picture for financial performance.

I remember speaking to an exceptionally talented and well respected Deputy DoF last year who told me there was “no way” they would step up to the DoF post in their current Trust due to the perceived risk involved  for  their career. Thinking about that organisation, I can’t say I would have done either. The view that a DoF role is “not worth the hassle” has been echoed to me many times. On a cold January morning I went for a coffee with a highly experienced and respected interim NHS DoF, who agreed with me that the NHS does not necessarily help themselves, for there are many finance professionals keen to work within the NHS, but often, when in most need, the NHS does look inwards to the “tried and tested.” Given the immense challenges that some NHS organisations face and the necessity to “hit the ground running”, appointing an experienced NHS DoF or deputy of course does make sense. However, I would argue, there are occasions where the NHS could be more flexible in identifying future talent.

So what’s to be done? Increase salary levels further (For DoFs, they have increased significantly in the last few years)? Create talent development pools and financially compensate professionals to relocate? Aggressively partner experienced finance professionals from outside the NHS with NHS organisations (I recall that was attempted previously)?

This year, Interim Partners will launch a detailed study and survey into the length of tenure at board level and the difficulties of stepping up into NHS board level roles. I am very interested to hear your comments surrounding the challenges, frustrations or recommendations of how to more effectively mind the gap and improve succession planning within NHS organisations.

David Rason is the Consultant of Healthcare at Interim Partners. 

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