New research has revealed a serious NHS leadership training gap, with just one in five senior managers receiving professional development over the past five years. At the same time, hospital trusts spent heavily on management consultants, raising concerns about the long-term sustainability of the health service’s leadership.
Data obtained by the UCL Global Business School for Health through freedom of information (FOI) requests shows that, on average, just £106 per year was spent on training for each senior NHS manager across 74 representative hospital trusts in England.
Millions Spent on Consultants Instead of Training
While training budgets remained minimal, trusts spent an average of £600,000 annually on management consultants during the same period, although this figure has been declining.
Professor Nora Colton, director of the business school, warned that Health Secretary Wes Streeting’s reform agenda could be undermined if NHS leaders are not adequately trained. “If a major company invested so little in staff development, it would be regarded as laughable,” she said.
High Vacancy Rates in Senior NHS Roles
The research also highlights a recruitment crisis. On average, each trust had 79 senior management vacancies annually between 2020 and 2025 — equivalent to one in seven posts across the NHS.
The shortage is most severe in London, where eight major trusts reported that 34% of senior management positions were vacant over the period. Experts say international recruitment challenges since Brexit and competition from higher-paying private sector roles have intensified the issue, especially for staff with digital expertise.
Regulatory Pressure and Fewer Training Opportunities
The government is pressing ahead with plans to regulate NHS managers, banning those guilty of serious misconduct from holding senior roles. But rather than boosting training, funding pressures are leading to a slowdown in leadership development.
Suzie Bailey from the King’s Fund think tank said: “Some of the senior jobs can look impossible, which is why many staff remain at deputy level rather than stepping into top posts.”
NHS England defended its record, pointing to a “range of free leadership development programmes” already available, and said its 10-Year Health Plan will expand national and regional talent management systems.
