Some acute trusts have kept more than half of their executive directors over a five-year period – whereas others have seen all of them change, according to HSJ analysis of top-level managerial stability.
We looked at the number of executive directors who had been in place between April 2017 and April 2022, by examining annual reports and board papers.
One trust – Southport and Ormskirk – had five CEOs during the five year period, and three other trusts had four.
The national average was more than two different CEOs at each trust across the five years. Thirty-one trusts (out of 108 listed) had three or more different CEOs during the period, and just 23 trusts had one (see tables left and right).
Cornwall Hospitals had three CEOs, including one interim, in the year to April 2022.
Stability and performance
A number of the trusts with very high turnover have had severe performance problems — such as Nottingham Hospitals, Medway, Barking, Havering and Redbridge, and Shrewsbury and Telford.
Failures often cause the CEO and directors to leave or be force out, sometimes multiple times over, and it can be hard to recruit strong, long-term replacements. The trusts struggle to recover — leaving them in a cycle of poor performance and unstable management.
The best performing trusts typically have a lot more stability (see scatter chart below). Some argue the pattern proves that stable leadership underpins good performance and improvement.
Joe Harrison has for nearly 10 years been CEO of Milton Keynes University Hospital, an organisation which has kept three execs for five years, and nine over the past year He said: “Having a relatively stable team allows for longer term planning, and the delivery of those plans over time.
“In addition, trust and confidence in the executive grows across the hospital as people become more familiar with the consistency of style and approach. This however cannot be at the expense of new ideas and challenge being brought into the team.”
NHS Providers interim chief executive Saffron Cordery said: “This analysis underlines the value of long-term investment in NHS trust leadership. It highlights too the danger of chopping and changing leaders amid longstanding financial, capacity, workforce and other structural pressures on the health system.
“It is vital to invest in people alongside operational priorities. More must be done to guarantee a robust and diverse pipeline of leaders, equipped to take on crucial roles.”
NHS Confederation chief executive Matthew Taylor said: “This important analysis shows the fallacy of removing chief executives from their posts too quickly when they are often dealing with systemic challenges that can take years to address and turn round.
“Under pressure from governments and regulators, the simple answer has too often been to bring in new leadership without having a more fundamental assessment and understanding of the underlying issues. These can sometimes have very little to do with the approach of leaders, though strong and effective leadership undoubtedly helps.
”The operating environment for chief executives and other senior NHS leaders has become much more hostile… This is having an impact on the number of people applying for chief executive roles – we know that some NHS organisations have found it more difficult to recruit to these roles and they often have to rely on interims… More than 60 chief executives have been on our support programme for first-time CEOs, and many of them consistently tell us that the support mechanisms they have in place are few and far between.”
Outliers and hospital groups
There are some outliers, such as Southport and Ormskirk and Epsom and St Helier trusts, whose current NHS England oversight rating is two, the second best of four levels, but there has been a lot of executive change.
As with a number of other trusts, this is because group arrangements have been put in place with nearby trusts, involving replacing/combining their executive top team.
Epsom and St Helier stressed that many of the trust’s directors from before it formed a group with nearby St George’s last year, have remained in director roles, just not as part of the group’s shared top-level executive team. Yeovil, which has combined leadership ahead of merging with Somerset Foundation Trust, also said many of its former directors had remained in other senior roles in the organisation or health system.
Ann Marr has been CEO of St Helens and Knowsley hospitals since 2003, and last autumn agreed to in addition become CEO of Southport and Ormskirk — marking five CEOs in five years for the latter. She said in a statement that the two trusts ”are now working in partnership, providing stable leadership and shared development opportunities across both trusts. Working together provides the opportunity to deliver high quality and sustainable services to all of the people we serve.”
At the other end, University Hospitals Plymouth has the lowest NHSE oversight rating, “four”, as it grapples with several major performance problems, but has kept a single CEO and relatively large numbers of exec directors over the past one and five years.
Regional averages suggest turnover has been greatest in the South, North West and London, and least in East of England and the North East and Yorkshire (see chart right).
We included only general acute trusts, and some were excluded as no historic information was available.