Developing NHS trust chief executives – where do chairs fit in?

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The future of the NHS inevitably rests partly on having great leaders. Scarily, the average tenure of NHS trust chief executives is four years, with just over half (51 per cent) in their first role. The job is hugely challenging and, as you will know, if you ask any chief executive what concerns them, you will have a very long conversation. The organisations are immensely complex and the expectations grow by the day.

But what should chief executives expect from their chair? The relationship is such a pivotal one and yet so complex – the chair is boss, challenger, supporter, colleague, arbiter, mentor and coach. The relationship is critical not just for the board, and the whole organisation, but in growing the great leaders we need and that the public pay for and deserve. 

I see wide variation in how these relationships are handled and when developed well these can be hugely positive, but at their worst they can stifle progress of individuals and of an organisation for years. While clearly already a major support in many trusts, I think that chairs can play a greater role in helping to develop these important leaders.

Not that the chair role isn’t challenging enough. It often feels to me like we are goalkeepers, only really recognised when things go wrong and featured for the goals let in. How to manage the balance between being a non-executive with the high level of knowledge expected by regulators, commissioners and inspectors, the accountability for one’s own organisation and the need to drive broad collaboration with other bodies, engagement with the public, governors and politicians and whatever your background, an appreciation of everything technical from EBITDA (Earnings Before Interest, Taxes, Depreciation and Amortization) to SHMI (Summary Hospital-level Mortality Indicator).

Of course, there is much more to the role than that – for me it is about creating an environment for excellence and in Gloucestershire Hospitals we have coined the phrase ‘journey to outstanding’ to guide our progress. None of us can settle for less than excellence in quality of patient care, and that is so dependent on excellence in use of scarce resources. Locked into this latter, is how we, as chairs, enable our colleagues to do the best jobs they possibly can – and that requires tight focus on the leadership of personal development.

My experience has been an incredibly steep learning curve, as I suspect it is for many. I was fortunate to inherit an outstanding chief executive and a very experienced lead governor, but I found little of the support I would have expected to be available from such an immense organisation as the NHS. 

It is true that I faced additional pressures going into a trust in financial special measures but let’s remember that there have been more than 40 trusts in special measures1 and probably many others that aren’t a million miles away. Time and again I looked for documented best practice only to find that none existed. I was very fortunate that those I turned to nationally (eg, NHS Providers) and chairs I met were all very willing to help and I thank them for that.

Throughout my career I have prioritised the development of individuals in my teams as high as achievement of organisation goals. This has served me well and I hope those with whom I have worked would recognise this (maybe not!). I have a professional interest in leadership development and executive coaching but the NHS chair/chief executive relationship was a new one for me. Many of the basics apply but as a relative newcomer to the NHS there are many different considerations too. 

On the basic assumption that there are, and will be, more people like me fortunate enough to be appointed to a chair role, I think we can serve chief executives better. We should ask them what they need and understand what they are getting. Similarly, an in-depth discussion with chairs would help us identify what support and resource could be made available. How can we make better use of the vast experience locked into the chair community – could we use (closed) social media to share concerns, ask each other for advice and talk about great practice that has worked? Is there scope for more formal training and development support for new chairs at the national level?

I think developing such ideas and others would be a powerful investment for future leadership and the success that that could bring. I’m not looking for personal accolades but I’m not just a goalkeeper. I play in many positions and recognition of this for chairs would surely unlock some great potential with relatively little cost.

  • 1. As of September 2018 there are 20 trusts in special measures for financial and/or quality reasons. Since special measures was introduced in July 2013 over 40 trusts have been placed in special measures but many of these have now exited the programme.

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