11.05.16
Trust CEO role at risk of becoming ‘impossible job’ due to unprecedented pressures
Interviews with NHS trust chief executives, published by NHS Providers and the King’s Fund, show many feel the job has never been harder, leading to warnings that it will be hard to recruit the next generation of chief executives.
Worries flagged in the report include financial pressures on the NHS and over-inspection and regulation.
Chris Hopson, chief executive of NHS Providers, said: “These reflections from some of the NHS’ most experienced leaders show first-hand how all-consuming the job of running an NHS trust is these days.
“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.”
He warned that the average tenure of a chief executive is now three years and he had heard anecdotally that trust management staff are increasingly reluctant to take the top job.
Karen Dowman, Black Country Partnership chief executive, said: “Nationally I don’t think there is any acceptance, by any politicians, of just how bad things are. We will have gone from spending at roughly the European average in terms of GDP to what will soon be 6 per cent. And that has happened very rapidly.”
She added that the lack of resources meant there wasn’t “a strong pipeline” of CEOs, finance directors and operations directors.
The interviewees also said that they felt regulation and monitoring of NHS performance was creating an unnecessary drain on time and money, given the other pressures.
Sir Jonathan Michael, former CEO of Oxford University Hospitals, said that he thought regulators failed to understand relative risk, discouraging trusts from trying out innovative approaches out of a fear of the consequences.
He said: “One of the frustrations particularly recently has been the lack of understanding that health care is an inherently risky business but there has been this drive from regulators and politicians to somehow present it as something that ideally ought to be risk free.
“Being alive is risky, particularly when you’re very young or very old, and being treated is inherently risky. But equally, not being treated is inherently risky. We need to understand risk and mitigate and minimise it. But the drive politically and publicly to say the ideal model is risk free is generating a degree of pressure on clinicians, on organisations, and therefore on the chief executive.”
Dowman said: “We are in constrained times financially, and I am sure we could lose 20 posts if it wasn’t for this endless different tweaks of information for different things”.
She added she had received e-mails from six different organisations requesting data on how many doctors were at work during the junior doctors’ strikes and had deleted all of them.
Angela Pedder, chief executive of the Royal Devon and Exeter NHS Foundation Trust, said she had joined the NHS at a time when trainees were encouraged to gain a broad range of management experience.
She has worked in acute, community, learning disabilities and mental health services and even hotel services and human resources. Pedder said that now “even fewer people will move between sectors so the potential to develop whole-system knowledge and skills is very limited”, adding that people often came into senior management having been siloed in one sector throughout their careers.
However, the interviewees said they remained proud of their job and thought that it should be valued.
John Pelly, former CEO of Moorfields Eye Hospital, said: “For all its sleepless nights and everything else that you have to live with, it is a fantastic job. It is a fantastic responsibility you are given. If you feel you’ve got the ability to do it, I would say you should do it.”
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