NHS CEO role ‘at risk of becoming impossible’

The difficult environment faced by NHS chief executives could deter future leaders from putting themselves forward, a report has warned.

The joint report, The chief executive’s tale, by trade association NHS Providers and The King’s Fund, an independent charity for healthcare improvement, draws on the experiences of 12 former and current long-standing NHS chief executives.

It found that regulatory and financial constraints, a loss of autonomy and support, and greater public exposure are among the issues creating a challenging environment for NHS leaders.

Angela Pedder, outgoing chief executive at the Royal Devon and Exeter NHS Trust, whose comments are featured in the report, said: “The response to the current financial situation has been additional regulation requirements and performance reporting. At one level this is understandable. But if you want creative solutions, if you want transformative solutions, a very different approach is required.”

Sir Robert Naylor, former chief executive of University College London Hospitals, said: “Is there less support for people on the way up than when I started? Yes, undoubtedly… If you are fortunate enough you might get a good mentor and the right sort of support, but lots of talented people lose their way and get frustrated.”

NHS Providers said the report highlights the need to foster a positive culture in which NHS leaders are supported, talent is nurtured and innovation is encouraged. “The job of a chief executive of a hospital or other NHS trust should be one of the most sought-after roles in the public sector,” said Chris Hopson, chief executive of NHS Providers. “But these reflections from some of the NHS’s most experienced leaders show first-hand how all-consuming the job of running an NHS trust is these days.

“They are being squeezed by regulation, inspection, targets and form filling – all in the context of the longest-running financial squeeze in the NHS’s history. This is a much more hostile environment and, if we are not careful, we risk the CEO role becoming the impossible job that very few people either want or are able to succeed at.”

Hopson added that many trusts were now struggling to recruit, with many relying on interims to fill CEO positions. “The average tenure of a CEO has fallen to under three years, and anecdotally we hear of an increasing reluctance among executive directors to aspire to the top position. We need much greater support for those running our hospital, mental health, community and ambulance trusts,” he said.

“This compelling report reflects what NHS Confederation members tell us, which is that these roles can be highly rewarding but are also beset with pressures that aren’t always reasonable,” said Stephen Dalton, acting chief executive of the NHS Confederation. “It would help the NHS to deliver care if support for these leaders was galvanised. They need explicit public backing from politicians and national bodies, sensible resourcing and the headspace to focus on the huge task of transforming the NHS as part of an evolving health and social care system.”

Matthew Walker, healthcare expert at PA Consulting Group, agreed that being a chief executive in the NHS was a particularly challenging job. “They are leading enormous organisations that would be FTSE 100 companies if they were in the private sector. They get a lot of stick for pay levels that are above the level of the prime minister, but they are way below that of the chief executive of a FTSE 100 company.

“One of the difficulties is the blame culture that goes with the job when things going wrong. That is not to say people should not be held to account, but there is a lot to be said in other industries where it is unacceptable not to call out error, as opposed to a system where if an error is found then [the person at the top] is punished.”

The report highlighted three areas where improvements could be made. It said the purpose and extent of regulation should be reviewed; more should be done to support and nurture talent; and national bodies should aim to support and work in partnership with chief executives to promote a positive leadership culture.

In response to feedback from boards about the lack of investment in future leaders, NHS Providers launched a training programme last year aimed at developing future chief executives. It said it has just taken applications for the second cohort of 14 participants.

Story via – http://www.cipd.co.uk/pm/peoplemanagement/b/weblog/archive/2016/05/12/nhs-ceo-role-at-risk-of-becoming-impossible.aspx

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