Trusts struggling to recruit directors due to ‘workload and pressure’, says outgoing CEO

Trusts are getting fewer applications for CEO and director roles due to “pressures” including a lack of resources, poor “work life balance”, and central scrunity, an outgoing acute chief has said.

Tracy Bullock is retiring this month after five years as chief at University Hospital of North Midlands Trust, and a 40-year NHS career, and has said she is doing so earlier than she had hoped, due to ill health.

In an outgoing interview with HSJ, she said: “The number of people applying for executive and chief executive roles has declined… A few years ago, you would put out an advert and you would get a good number of applications. You’d spend a couple of hours going through applications.

“Now for exec directors, you’re holding your breath and hoping you get one or two [applications].” 

She had found the “calibre” of candidates remained good but questioned whether many eligible candidates no longer “want to put themselves forward”.

Ms Bullock – a former nurse – said: “The work-life balance for CEOs and directors isn’t great… You can see why people might not want to put their hat in the ring.”

She cited ”workload and pressure” as the main barriers, saying frontline staff “have not always got the resources they need”, which contributed to pressure on directors as well as those staff; as well as “pressure to do better” both from regulators.

Ms Bullock said they were “serious jobs” so “some kind of pressure” and targets were appropriate but added: ”I don’t need regulators to apply pressure to me to want to resolve those things. I’m my own worst critic. So I want to resolve those things for patients… my motivator is myself and my team. I don’t need every regulator or an inspector to tell me that I need to improve.”

She said her experience with regulators over her career as a chief executive had been “variable”, from running one of the best performing trusts in the country (Mid Cheshire Hospitals Foundation Trust) to UHNM, where there are big financial and operational challenges.

There was some positive support from being in NHSE’s highest “tier one” for performance problems, Ms Bullock said, explaining: “That’s not just throwing money at us, but physical resource, like the national GIRFT team came to work alongside us.”

But she warned the higher intervention tiers were “easy to get in but very hard to get out of”.

UHNM remains in the highest “tier one” for planned care, and in tier two for urgent care, she said, but “our urgent care performance has improved significantly; ambulance waits are down”. 

‘Corridor care’ not forever

Some of its improvement in emergency care, in common with many other trusts in the past 18 months, is due to moving more patients to corridors, and squeezing more into already full wards. 

UHNM declared in early 2023 it had made a reluctant decision to reintroduce “corridor care”, and what it calls “Your Next Patient” (when patients are moved to spaces in already full wards to wait for a bed to become free).

But Ms Bullock said they “are not a permanent feature” and will come and go as pressures decline and increase.

“I don’t like either [YNP or corridor care],” Ms Bullock said. “What I would say is we introduced them, not because we felt they were the right thing to do. They were the least worst. We recognised that the risks to patients in our community [waiting for ambulances] were far greater than the risks to patients in the corridor.”

Cheap not best

She also cautioned against expecting all trusts to cut non-clinical costs due to financial deficits, saying: ”We have the cheapest HR function in the country, we have the third cheapest IT function in the country. Cheap isn’t always good.

“One of the things that we have been looking at over the last five years is how we improve our services in those areas. And that’s very difficult for us to do at this moment in time with the scrutiny that’s on corporate [services] and backoffice.”

More transparent than ever

Ms Bullock said major improvements during her time in the NHS included medical and scientific advances, but also governance and management processes. Waiting lists were previously “kept in consultant diaries”, while A&E waits of several days went unnoticed; whereas now these are measured, managed and reported publicly, she said.

“Nobody batted an eyelid around these things, and it was wrong,” she said. “We’ve [become] far more sighted on lists [and] we can make sure patients are being seen in priority order.”

There was also, she said, now “a lot more transparency in relation to things that go wrong”, resulting in “so much negativity around the NHS”, and added: “While I know a lot of people might not agree, I do believe the NHS now is more transparent than it’s ever been.

“Is some of [the negativity] warranted? Possibly, yes. But I think some of it’s an easy target as well… I don’t think there are more things going wrong. I just think, quite rightly, we are more transparent about it.”