The chief executive's tale

Views from the front line of the NHS
Comments: 5
There is a widespread perception that there is a ‘crisis of leadership’ within the NHS, illustrated in part by difficulties in recruiting and retaining chief executives in the NHS.

This report, published in partnership with NHS Providers, draws on the views and experiences of 12 departed or departing chief executives, or those changing jobs within health care. It aims to illuminate the realities of leadership in today’s NHS. The interviews illustrate both the positives of the job and its current difficulties. The difficulties need to be addressed if we are, first, to hold on to experienced leaders who are able to transform the NHS in an innovative way, and, second, recruit the next generation.

The chief executive's tale

Print copy: £10.00 | Buy

No. of pages: 84

ISBN: 978 1 909029 62 0

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Key findings

The job of an NHS chief executive can be the ‘best of times’, offering the opportunity to improve health care for large numbers of patients. However, it can also be the ‘worst of times’ – it is tough and can be a lonely, isolated job in a hostile environment. The interviewees raised concerns about:

  • financial constraints
  • increased regulation and a loss of both autonomy and support
  • the greater public exposure they face.

A complete paradigm shift is needed in the way the NHS is run – one that enables competent, innovative leaders to take risks, in a responsible, responsive and supportive environment.

Policy implications

  • The purpose of regulation needs to be reviewed, along with consideration of where it is exceeding its remit.
  • More needs to be done to support and nurture talent.
  • National bodies should aim to support and work in partnership with chief executives to promote a positive leadership culture.

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Comments

#547602 Lynne Bowers
Consultant
Lynne Bowers

A complete paradigm shift is needed indeed - how?

#547603 Pearl Baker
Independent Mental Health Advocate and Advisor/Carer/ Trust Governor
Independent

To be a successful CEO you must think outside the 'box' and communicate with others who have something important to say, or been successful in their chosen area of work, and that includes Carers.

I am sure as a regular 'tweeter' and communicator by email. I am a Carer and Independent Mental Health Advocate and probably seen as a nuisance. I never 'tweet' without good cause. I never email without trying to make those recipients understand that the contents of my email are accurate in content.

'fit for work' example: if you are subject to a COP Order/ Section 117 aftercare i.e. Health and Social Care there is absolutely no way the DWP can interview you for 'fit for work'. The Ministerial response was exactly that (in writing), but who is listening!

Section 117 patients placed in 'supported unregulated accommodation' as part of their 'Care Plan' are not responsible for their rent. The Care Act confirms this: who is listening?

The LA have a responsibility to inspect the above under their Care Quality Framework, but are they doing this/ NO.

Transparency; is ignored by some LA, they will not disclose their Inspection Reports to the Public?

Independent Advocate are a right, but are the LA applying the rules? NO.

Patient choice of 'health and social care provider' this is NOT happening.

Under the United Nations Convention all patients subject to an Appointee of the DWP are supposed to be interviewed/along with their clients, to see if they still qualify (as unfit mentally) to mange their own finances: this does NOT happen.

Individuals attending Health/Social Care appointments that require travel/escort in receipt of Income Support are entitled to these cost being paid? NOT happening.

Carers taking those they support or care for are entitled to a Carers Cinema Discount Card. LA Deputy's /Appointees, disagree, make life difficult.

The most recent 'find' is regarding Housing Association 'housing benefit charges'. some illegal: this alone is costing 'millions' in charges to Housing Benefit. 'Supported unregulated accommodation' is the PRIME TARGET, unlimited charging, this applies to a certain group who are already funded by the LA.

The above practice is illegal on two counts, firstly if they are subject to a 'Care Plan' placed into this accommodation as part of their Care Plan, subject to Section 117. The LA pay, secondly if the LA have a Contract with a Provider for Care and Support, the Housing Association are NOT Supposed to charge 'intensive housing service delivery', by using the same LA Provider? who has already been Paid by the LA. This is ILLEGAL.

I now come to the Court of Protection: for those subject to a 'Property and Finance' order? LA Deputy's are NOT kept up to date with relevant Statutory and Legal information, this has led to illegal charging (from clients account) Office of the Public Guardian have requested I write a Report, as they are aware their current procedures are inadequate. DONE.

Success to date:
Carers cinema Card was obtained via another route.

'fit for work' no interview took place with my client, the other client died!

Travel/escort expenses are about to be paid, after five months? CCG will be paying,(made life very difficult) by saying NOT us.

'Supported unregulated accommodation' has been my concerns for sometime, they are NOT regulated by the CQC. the Senior Social Worker who contacted me from the Midlands regarding 'safeguarding' issues, has been appointed Chief Social Worker Inspector of these property's and will inspect complaints, this is great news. this LA were aware of his contact with me, well known for my work regarding 'Supported unregulated accommodation'.

Patient 'health' choice has been successful, with the help of an Independent Advocate they were bale to access their chosen consultant.

My letter to the Head of Legal regarding the LA Deputy exceeding their 'powers' under a 'Property and Finance' order has given them second thoughts, and my concerns, are now being looked into.

A LA withdrew ALL Bus Passes for the Mentally Ill, this is Discrimination.
A rehabilitation unit has the added expense of paying for Bus travel for their clients, this has been challenged by me.

All those suffering from a Mental Illness who will not qualify for a Driving Licence on Health grounds are able to KEEP their Bus Pass. Medical evidence to that effect.

The work I do effects Carers and patients, this is what they are interested in, it makes a difference to their lives.

Carer recent consultation with their GP took two weeks to achieve, required minor 'op' by GP. Receptionist said she had no appointments? without this treatment it could turn cancerous.

I am a CEO of myself, with many friends, some in the Profession, others not, but All needed help at some point, which is where I 'fit into' a system that has lost direction.

The latest idea, that the current practice of making an appointment to see your GP, will be replaced with you meeting with a multidisciplinary team (and not always the same people) is actually humiliating for the individual. A Carer has said this is NOT the way forward for those suffering from a learning disability/autism.

#547610 Ram Jassi

This report does not solicit the views of the CEOs in respect of equality, diversity and inclusion and could not find any reference to equality in this report. If the NHS is lacking BME leaders and there are many CEO/Leadership vacancies then why are BMEs not being considered, nurtured and given the patronage to succeed in these roles? It amazes me we have only one recently appointed CEO in the NHS system. What's going on? It this not a leadership failing?
Ram Jassi, views are my own.

#548042 kEVIN RILEY
Solicitor - specialising in supporting front line staff in the NHS.
N/a

THE NHS IS (ALLEGEDLY - SEE BELOW!!) SHORT OF FUNDS FOR TWO REASONS - FIRSTLY BECAUSE THE GOVERNMENT WISHES IT TO BE SO - SECONDLY BECAUSE FAR TOO MUCH MONEY (CIRCA 60%) OF TAXPAYERS MONEY IS PAID ON EMPLOYING ON CHIEF EXECUTIVES (OVER 165 OF THEM) AND OTHER "MANAGEMENT" PERSONNEL THAN IS SPENT ON FRONT LINE SERVICE DELIVERY STAFF.

THE REPRESENTATIVE OF THE KINGS FUND STATED ON THE NEWSNIGHT THAT ONE RESULT OF BREXIT WAS THE REQUIREMENT TO MAKE FURTHER SO CALLED "SAVINGS" TO THE AMOUNT THE GOVERNMENT IS PREPARED TO ALLOCATE TO THE NHS.
NO ONLY IS THE ABOVE WRONG IN FACT BUT IT IS ALSO LEGALLY INCORRECT AS IT IS OPEN TO THE GOVERNMENT TO ALLOCATE AS MUCH AS IT LIKES EACH YEAR TO THE NHS OUT OF THE OVERALL AMOUNT IT RECEIVES IN TAXES EACH YEAR.
THE REALITY IS THAT THE UK IS RANKED ONE FROM THE BOTTOM IN THE AMOUNT IT SPENDS EACH YEAR ON THE NHS AS COMPARED TO THE OTHER 15 ORIGINAL MEMBERS OF THE EU.
So far as the level of spending on the NHS in the UK is concerned (given the differences in the way countries fund their health care) it is usual to compare total spending (public plus private) expressed as a proportion of countries’ GDP.
On this basis, data from the OECD shows that in 2013 (the latest year for which figures have been published) the UK spent 8.5 per cent of its GDP on public and private health care. (This excludes capital spending equivalent to 0.3 per cent of GDP to make figures comparable with other countries’.)
•AS ALREADY MENTIONED This places the UK 13th out of the original 15 countries of the EU on the amount it spends on the NHS
THE ABOVE ALSO CONCLUSIVELY ESTABLISHES THE FACT THAT JEREMY HUNT IS "NOT TELLING THE TRUTH" ABOUT HIS AND THE GOVERNMENTS BEHAVIOUR TOWARDS THE NHS.
THE ABOVE INCLUDING HIS MISREPRESENTATION ABOUT HIS ABILITY TO GUARANTEE ANY IMPROVEMENTS IN THE NHS.
SINCE THE HEALTH AND SOCIAL CARE ACT 2012 NEITHER HE, THE GOVERNMENT, THE DEPT OF HEALTH NOR NHS ENGLAND HAS ANY POWER TO CONTROL HOW THE NOW LEGALLY INDEPENDENT NHS FOUNDATION TRUSTS BEHAVE.
HE AND THEY CAN ONLY "ADVISE OR RECOMMEND" BUT CAN DO NOTHING IF THE CHIEF EXS OF THESE TRUSTS CHOOSE TO IGNORE THAT ADVICE OR RECOMMENDATION.

IN ADDITION TO THE ABOVE, THE SUGGESTIONS MADE AS TO HOW "SAVINGS" COULD BE ACHIEVED AMOUNTED TO THE COMMISSION OF A SERIOUS CRIMINAL OFFENCE BY THE -CHIEF EXECUTIVE OR OTHER SENIOR MANAGER MAKING THAT DECISION
.The already identified (by the Public Accounts Select Committee) dangerous shortage of front line “operational” staff in the NHS is likely to worsen and the appalling existing number of legally “preventable” deaths increase if the criminal law is not enforced as a result of the current perceived (but legally invalid) need to “save” billions of pounds from the already overstretched NHS Budget.
Legally any Government can decide to spend as much of the tax payer’s money that it receives each year as that Government wishes – it is merely a matter of determining priorities.
A perceived need to make “savings” is no defence to the crime of manslaughter caused by a failure to comply with the overriding duty of care that a Chef Executive owes to that deceased individual..
The common factor in virtually all of the negative reports of the Care Quality Commission on individual NHS Foundation Trusts since 2013 has been their identification of the Chief Executives of the now “independent” organisations (although all funded by the tax payer) not employing sufficient front line staff in all “service delivery” areas to enable proper care to be provided.
In many instances this culpable failure has directly led to “preventable” deaths – each of which amounts to the commission of a serious criminal offence by the Chief Executive and/or senior manager “in charge”..
.In every other environment where such preventable deaths occur the Police routinely investigate and the Director of Public Prosecutions prosecute the individual Chief Executive/Senior manager in charge of the organisation where these preventable deaths have occurred
DESPITE WHAT WAS STATED ON NEWSNIGHT BREXIT WILL NOT HAVE ANY EFFECT ON THE AMOUNT OF MONEY AVAILABLE TO THE NHS - UNLESS THE GOVERNMENT ALLOWS IT TO FOR PURELY "POLITICAL" REASONS.
EACH YEAR THE GOVERNMENT DECIDES ON THE AMOUNT OF TAX PAYERS MONEY IT WANTS TO SPEND ON EACH "SERVICE" AND IT CAN EASILY DECIDE TO SPEND MORE MONEY ON THE NHS EITHER BY REDUCING THE AMOUNT ALLOCATED TO ANOTHER SERVICE AREA OR BY INCREASING THE AMOUNT OF TAX IT COLLECTS.
THE REALITY IS THAT THE MAJORITY OF TAX PAYERS WOULD BE PREPARED TO PAY MORE IN INCOME TAX IF THEY WERE ASSURED THAT THE EXTRA MONEY WOULD BE SPENT ON THE FRONT LINE OF SERVICE DELIVERY AND NOT ON EMPLOYING EVEN MORE MANAGERS AND INCREASING EVEN MORE THE ALREADY OBSCENE AMOUNTS OF TAX PAYERS MONEY THESE INDEPENDENT NHS FOUNDATION TRUSTS ALREADY PAY THEIR CHIEF EXECUTIVES AND OTHER MANAGERS..
THE UNFORTUNATE REALITY IS THAT SINCE THE HEALTH AND SOCIAL CARE ACT 2012 (WHICH REMOVED THE NHS FROM DEMOCRATIC CONTROL) NEITHER JEREMY HUNT - ONCE THE GOVERNMENT GIVES TAX PAYERS MONEY TO THE 165 OR SO LEGALLY INDEPENDENT TRUSTS THAT NOW RUN ALL NHS HOSPITAL - NOR THE DEPARTMENT OF HEALTH NOR NHS ENGLAND HAS ANY CONTROL ON HOW THAT MONEY IS SPENT.
THE ABOVE IS A NATIONAL DISGRACE
IN ONE HOSPITAL ALONE (IN RURAL NORFOLK) OVER TEN OF THEIR "MANAGERS" ARE PAID SIGNIFICANTLY MORE THAT THE PRIME MINISTER THE CHIEF EXECUTIVE RECEIVING MORE THAT £250,000.
THE POSITION IS FAR FAR WORSE IN LONDON AND OTHER MAJOR CITIES..
JEREMY HUNT ASKED THESE ORGANISATIONS TO EXERCISE RESTRAINT IN THE AMOUNT OF MONEY THEY WERE PAYING THEIR CHIEF EXECUTIVES AND OTHER SENIOR MANAGERS BUT THEY ALL CHOSE TO IGNORE THAT REQUEST AND THERE WAS NOTHING JEREMY HUNT OR NHS ENGLAND COULD DO ABOUT THAT REFUSAL.

KEVIN S. RILEY SOLICITOR (Ret.).

#548043 David Walker
H & S Mgr (Rtd)
BTHNHSFT

I am but a humble, unpaid, overworked, volunteer Governor in my local NHS Trust. I claim no special knowledge of the mysteries of the financing or the workings of the NHS. I do not, and never have received one pennyworth of financial or medical benefit from my interest of the past 12 years or so in my voluntary work in any sphere.
I just think it's a bit sad that all of the expert contributors above are not in charge of the NHS, because only then would we see the best health service in the world operating at optimum capacity and efficiency. Also, it would be make for much more pleasant reading if those "experts" could contribute a better standard of English without the use of capital letters to make their point, and I always thought of the legal profession as being rather well educated!

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