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Revealed: 60pc of trusts have a ‘first-time’ CEO

Published on: 29 Aug 2023

Nearly two-thirds of trusts have a ‘first-time’ chief executive, while one-third of the sector’s CEOs have been in their current post for 18 months or less, following a period of remarkable turnover since the covid crisis.

HSJ analysis found:

  • Of the total 201 acute, mental health, community and combined trusts, 121 (60 per cent) have a CEO for whom it is their first trust CEO role. Of these, 40 (20 per cent of all trusts) have also taken up their first role since February 2022, meaning they have been in post for 18 months or less; and
  • Sixty-two trusts (31 per cent) overall have a CEO who has started in the post since February 2022. A further eight have announced they are planning to leave, meaning 35 per cent of trusts either have CEOs who have changed in the past 18 months, or will change in the near future.

It follows rapid churn in trust top leadership since early 2022, in the wake of the most intense phases of the covid pandemic, and has been acknowledged by NHS England chief executive Amanda Pritchard.

The trend is if anything more marked among the largest and most influential trusts. 

Of the 22 trusts which had more than £1bn turnover in 2021-22, 12 (more than half) have CEOs who have taken up the post since February 2022 – meaning they have been in post for less than 18 months. Another (Dame Jackie Daniel at Newcastle Hospitals) will leave later this year. Seven of them are in their first CEO role and five of them have also been in post for less than 18 months (Royal Free, Leeds Teaching Hospitals, University Hospitals Birmingham, Nottingham University Hospitals, and Oxford University Hospitals).

Among the ‘Shelford Group’ of 10 large, academic teaching hospital trusts, half of them have first-time chief executives, and two of those (Birmingham and Oxford) have been in the post for 18 months or less.

It should be noted that some ‘first time’ CEOs are also very experienced in their role. Those who have been in post for more than 16 years include Glen Burley at South Warwickshire FT, who is group CEO of three other trusts; and Claire Murdoch at Central and North West London FT and Matthew Winn at Cambridgeshire Community Services Trust — both of whom have in additional held national director roles.

South East has most new CEOs

The wave of new CEO leadership since covid appears to be most marked among mental health trusts and MH-combined trusts. Among these, three-quarters have first-time CEOs, and 23 per cent of the total have been in post for 18 months or less.

Of acute and acute-combined providers, 48 per cent have first-time CEOs, and a fifth have been in post since February 2022. At dedicated community trusts, all but three of the 14 trusts are first-time CEOs, but only three took up the role in the past 18 months.

Among the 16 specialist trusts, all have a first-time CEO, except Alder Hey Children’s Foundation Trust with Louise Shepherd, but only three of them (19 per cent) have been in post for 18 months or less.

Regionally, the South East has the largest share of ‘first-time’ CEOs by some margin (74 per cent), and has the lowest mean time in post (39 months) while the North West has the longest mean tenure at 60 months (see bar chart right and below). 

Recovery phase

NHSE chief executive Amanda Pritchard, who led Guy’s and St Thomas’ FT until 2019, recognised last month that there had been “very little turnover of hospital chief executives during the peak of the pandemic”, but “since we’ve now hit the recovery phase, which is extremely hard work, we’ve seen much more movement”.

Meanwhile, the new Leeds Teaching Hospitals CEO, Phil Wood, who was previously its medical director, said this month that CEO turnover reflected “the size and scale of the challenge that the NHS now faces in terms of the number of people waiting for some type of intervention, the workforce situation that we find ourselves in, and the financial constraints that we find ourselves in. [It is] quite a perfect storm of challenges that perhaps we didn’t anticipate coming out of the pandemic.”

But he also called an overemphasis on the importance of trust CEOs in the NHS – over their wider team and system – “outdated”.

NHSE is experimenting with new ways to support the expanded number of ‘first-time’ and relatively new CEOs.

An NHSE spokeswoman said: “Through successful initiatives like the aspiring chief executives’ programme, which helps staff with strong potential to prepare to become CEOs, and buddying new chief executives up with more established leaders to provide mentoring and support, the NHS is continually looking at ways to best support our staff.

“As part of the NHS long-term workforce plan, the NHS will continue to improve the culture and leadership across organisations, ensuring that we keep more of the staff we have within the health service by better supporting them throughout their careers, including progression to senior leadership roles.”

Dips and spikes

Analysis of CEO time-in-post (see bar chart left and below) shows a spike in new appointees between August 2021 and August 2022 and a dip between August 2019 and August 2020.

Of the 22 current CEOs who were appointed between August 2020 and August 2021 – while the pandemic was still in an intense phase – a very high proportion (17, more than three quarters) are ‘first-time’ CEOs.

A flurry of very experienced and successful CEOs have retired or left their trust in recent years, including Dame Alwen Williams at Barts Health; Dame Jackie in Newcastle; Sir Julian Hartley at Leeds Teaching Hospitals; and Sir Mike Deegan at Manchester University FT.