The Scalpel's Blog


From a bright idea to a successful programme

Chris Hopson, chief executive of NHS Providers, on the impressive benefits and extremely high success rates of a brand new programme designed to prepare NHS staff for the challenging and complex role of becoming a CEO.

The task of leading an NHS trust has never been more difficult or demanding. It takes a special kind of person with an abundance of talent, commitment and resilience to survive and thrive in such a difficult and complex role. This is reflected in the fact that the average tenure for a provider chief executive is now just 18 months.

Three years ago, it was becoming increasingly clear to me and senior colleagues at NHS central bodies that we had to address the NHS provider chief executive pipeline.

The challenges were threefold. Firstly, the pipeline was beginning to narrow, with fewer and fewer credible candidates willing to put themselves forward for provider CEO roles. There were far too many provider chief executive appointment processes with only one appointable candidate, occasionally not even that.

Secondly, as the pressure on the NHS was mounting, it was obvious that the provider chief executive role was going to get more difficult and challenging and that we needed to provide a greater level of development support for new, first-time chief executives. 

Thirdly, we agreed that it was simply wrong and unacceptable, post dissolution of Strategic Health Authorities, for the NHS not to have a structured development programme for one of its most important senior leadership positions. After all, the 233 trust chief executives are formally accountable for £70bn of public expenditure, over 750,000 staff and a million patient interactions every 36 hours.

The idea of the ‘Aspiring chief executive programme’ was therefore born. A programme that identifies potential future provider chief executives, uses a rigorous process to select those with the greatest potential, and then enables them to benefit from a well-designed and thoughtful development programme.

The programme design has been particularly impressive, thanks to the team at the NHS Leadership Academy. We’re all used to those rather dull, ‘show and tell’, sheep dip you in the content, development programmes. They feel very ‘day before yesterday’ to me. This programme, as the blogs from the programme participants show, is very different. 

A strong emphasis on group learning. A deliberate and challenging focus on getting participants to reflect on what would personally make them an effective top leader of a complex organisation. Having the patient and staff perspectives right at the heart of the programme by ensuring each participant has a staff and patient buddy, with frequent interaction. And getting the right balance between how to lead an individual provider institution and how to play the increasingly important wider, system leadership, role.

Has the programme been successful? We’re doing a proper piece of evaluation so the full, evidence-based, objective judgement must wait. But from where I sit, the programme has significantly exceeded my expectations.

We’ve had two cohorts of 14-28 participants in total. Cohort one graduated in February 2017 and cohort two graduated in November this year. Of the 28, 10 (36%) have already been appointed to lead trusts. That’s an extremely high success rate, and that’s within just a year of graduation. Many schemes of this type would expect to see a slower, say three-year, chief executive appointment return.

A significant number of other participants, particularly from cohort one as you’d expect, have also been through chief executive appointment processes where they have been judged clearly appointable but have been pipped at the post. That’s a success in itself – we now have a bigger pool of credible provider chief executive candidates, giving provider boards a wider choice of candidates than before. 

The participant blogs also point to another crucial benefit – that all the participants feel they are significantly better equipped for the chief executive role as a result of the programme. I particularly like the consistently expressed view that, to paraphrase, “I thought I was ready to be a chief executive, but the programme has taught me I wasn’t. Thank goodness I did it.”

Another benefit which I can particularly see, as someone who has spent time with the programme participants, is the power of the group that has been created. It’s great to see a group of senior leaders providing such strong support to each other in what will inevitably be difficult and challenging roles. But also a group who have a clear view of how they believe the NHS should be led and will be seeking to promote that view. 

It is very encouraging that the NHS now has a high-quality, top leadership scheme in place to help create and support the next generation of provider chief executives. We often talk about the importance of system leaders acting as system stewards – this feels like acting as a good NHS steward.


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