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The chief executive's tale

Views from the front line of the NHS

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.

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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