The Scalpel's Blog


Supporting chief executives to build a better NHS

We can spend years nurturing and supporting leaders to develop and progress into a chief executive role, yet a report by the King’s Fund found that the average tenure is just 18 months. What’s making people think about moving on so soon? And how can we get better at keeping them? Deepy Kang, senior programme lead at the NHS Leadership Academy, questions the short tenure of NHS CEOs and looks at what leadership support they may need.

‘Top jobs’ are highly pressured in any environment. But try combining this with the need to provide safe and high-quality services for patients with complex needs. Then add increasing public and media scrutiny in a fragmented system – often with conflicting views about what needs to be done and how to do it – and the leadership pressure gauge rockets off the scale.

We’re all being asked to do more within our own organisations in a tough financial climate while trying to think more about the importance of broader systems leadership. The NHS needs strong, stable leaders who are able to strategically plan and look ahead while taking the immediate needs of their staff and patients into account. This makes the role of a CEO more important than ever before. So why is the NHS losing talented people after such short periods of time?

Ideally the CEO would stay in post for at least five years to give an organisation – and the system – the stability it needs. But people move on for different reasons. Those in their first official CEO role may want to move into a bigger organisation with more complex challenges, or they may feel as though they’ve done what they can, especially if they’re leading a trust which is in a strong performing position. Some might feel they need to ‘jump before they’re pushed.’ For others, the role might present its own set of challenges which they feel ill-equipped to lead.

We need to get to a point where CEOs across the health system feel supported, cared for and developed to reach their full potential as a leader. We need to build a system which has tolerance for some mistakes to be made in the spirit of learning. We know chief executive roles are extremely challenging, so providing the correct support to help people perform at an optimum level is critical.

Planning for the future

Trying to remain part of a sustainable system is a huge challenge facing CEOs. How do you sustain services in your trust while trying to reconfigure services for the future? How do you cope with the prospect of sacrificing something which impacts the organisation for the benefit of the system? As well as leading their organisation, CEOs also have a key responsibility for motivating staff, ensuring their voices are heard and that they feel truly valued. This is happening against a backdrop of unprecedented change.

The role of a CEO within the NHS is incredibly challenging, which means appetite for it can be low. In 2014 the King’s Fund found that 16% of community trusts had no substantive chief executives. Perhaps this is linked to the high risk to reward ratio of the role. When you’re leading a risky organisation in the private sector, you may face the prospect of losing your job and not being employed for a long period of time, but you’re also more likely to be rewarded financially with a handsome remuneration package agreed at the outside which mitigates against this personal risk. In the NHS it’s completely different; we’re asking people to take on these demanding roles which could make or break their careers, often with a lack of support. No wonder some colleagues feel that it’s a better prospect to remain at one below chief executive level at the executive level. Surely it’s the job of the system to take care of these talented individuals for the future of our NHS?

Good leadership across the NHS must be about empowering staff to deliver quality services to patients, so each and every person involved feels accountable for the part they play. Effective leadership development taps into the NHS’s diverse pool of initiative, innovation and commitment –  fostering a culture of leadership based on the values of the NHS we all so passionately believe in. This is vital if we’re to achieve the radical, transformational shift needed to deliver a sustainable NHS across our local communities.

What we’re doing to help

Any developmental intervention, no matter how insightful, transformational, and useful it may be to future leaders, also needs genuine involvement and engagement with leaders in the wider NHS system. By doing so, they will be able to provide the much-needed support that future leaders so desperately need.

The Academy has been working in partnership with NHS Providers and NHS Improvement for the past year and a half on our Aspiring chief executive programme. It gives upcoming CEOs the opportunity to develop their skills and capability and to network and connect with other likeminded individuals to build up a peer support network to draw on when things do get tough.

Experienced CEOs across the health service have also hosted sessions with participants, giving them the chance to ask questions and learn more about the career they’re about to embark on. To date more than 50% of participants who have completed the programme on Cohort 1 have been appointed in their first chief executive role.

We’re also hearing lots of positive feedback from participants who have told us that their learning has been invaluable in helping them to prepare for this role. The key to this has been involving stakeholders in the NHS and central organisations in the design and delivery of the programme so they back and champion the participants and help them be the best chief executive they can be. This is really promising and exactly what we need to continue doing.

Despite the challenges they face, many CEOs within the NHS still believe it’s a huge honour and a privilege to be in this role and thrive on the increased sphere of influence to benefit patients and services. Their role is vital to ensure services remain fit for purpose, staff are valued and high-quality care is being delivered to those who need it the most. Providing the right leadership support for these individuals will be key to ensure they have the right skills, attitudes and behaviours to build a better NHS.


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