Struggle to recruit managers will add to cycle of failure The pressure on chief executives and the risk of failure are so great that few candidates are coming forward.
The NHS management body count is mounting. In the year since Robert Francis QC unveiled his final report following the Mid-Staffordshire scandal, 10 chief executives have resigned over performance issues.
Is this a sign of a commitment to the highest standards of leadership, or a system where senior managers are being set up to fail?
Seven chief executives have quit from foundation trusts, and three from trusts. At least three more are in difficulties.
A trawl through Health Service Journal's coverage of the departures reveals a catalogue of failure. Treatment delays, understaffing, weak leadership, bullying, data irregularities, missed targets, deteriorating finances, unsafe care, A&E mismanagement and poor governance litter the charge sheets.
Chairs, non-executive directors and the occasional director add to the casualty list. Departures were inevitable in the wake of the turning of the regulatory screw, as the government battled to restore confidence in its management of the NHS after a series of scandals. Sir Bruce Keogh's forensic analysis of 14 trusts with persistently high mortality rates inevitably led to further resignations.
Finding someone to blame is enjoyable and easy for the media – and convenient for politicians and regulators too. It creates a story of accountability for failure, while cauterising the wound by demonstrating that the fault lies with the individual, not the system of which they are part. Complex problems are reduced to a simple narrative of personal culpability.
But such a high failure rate deserves deeper investigation. Should these chief executives never have been appointed? If they were credible candidates, why did the expectation of success morph into failure – sometimes remarkably quickly?
The seven foundation trust departures warrant particularly searching questions. These organisations are supposed to be the health service elite, rigorously tested before admittance to the club and replete with strong governance, accountable to local people.
If these boards do not go back over what happened, they will repeat mistakes. Some of those who fell will have been the right leaders for more plentiful times but ended up being broken on the wheel of the funding cuts. If others should not have been appointed at all, boards need to understand how the process failed. This should not be an excuse for another round of the blame game, but a route to moving forward with more confidence.
Perhaps a more uncomfortable question is whether chief executives are being left to fail in the face of a constellation of circumstances which would crush most private sector leaders. There is a sense of helplessness around some of these failures, when people who thought they were in charge suddenly find themselves simultaneously unable to manage finances, clinical quality and demand. This pattern is likely to accelerate as greater numbers of trusts head into deficit.
The pressure on chief executives and the risk of failure are now seen as so severe that few candidates are coming forward. According to the Foundation Trust Network, it is repeatedly proving a struggle to find even one appointable candidate. If the choice is thin, the cycle of failure will continue.
The government has finally realised that repeated management failure is becoming a dangerous problem. Salford Royal foundation trust chief executive Sir David Dalton has been appointed to examine grouping trusts into chains, exploiting the public sector calculus which says that if you link a good organisation with a bad one you will surely end up with two good ones. Health secretary Jeremy Hunt has also accepted that senior managers need to be paid well.
Somehow, the rot has to be stopped. The alternative – with 2015 predicted to be the year when numerous trusts risk falling off a financial and quality cliff – is an accelerating pattern of firing, hiring and more firing as a distraction from the real issues. Guardian Professional.
The NHS management body count is mounting. In the year since Robert Francis QC unveiled his final report following the Mid-Staffordshire scandal, 10 chief executives have resigned over performance issues.
Is this a sign of a commitment to the highest standards of leadership, or a system where senior managers are being set up to fail?
Seven chief executives have quit from foundation trusts, and three from trusts. At least three more are in difficulties.
A trawl through Health Service Journal's coverage of the departures reveals a catalogue of failure. Treatment delays, understaffing, weak leadership, bullying, data irregularities, missed targets, deteriorating finances, unsafe care, A&E mismanagement and poor governance litter the charge sheets.
Chairs, non-executive directors and the occasional director add to the casualty list. Departures were inevitable in the wake of the turning of the regulatory screw, as the government battled to restore confidence in its management of the NHS after a series of scandals. Sir Bruce Keogh's forensic analysis of 14 trusts with persistently high mortality rates inevitably led to further resignations.
Finding someone to blame is enjoyable and easy for the media – and convenient for politicians and regulators too. It creates a story of accountability for failure, while cauterising the wound by demonstrating that the fault lies with the individual, not the system of which they are part. Complex problems are reduced to a simple narrative of personal culpability.
But such a high failure rate deserves deeper investigation. Should these chief executives never have been appointed? If they were credible candidates, why did the expectation of success morph into failure – sometimes remarkably quickly?
The seven foundation trust departures warrant particularly searching questions. These organisations are supposed to be the health service elite, rigorously tested before admittance to the club and replete with strong governance, accountable to local people.
If these boards do not go back over what happened, they will repeat mistakes. Some of those who fell will have been the right leaders for more plentiful times but ended up being broken on the wheel of the funding cuts. If others should not have been appointed at all, boards need to understand how the process failed. This should not be an excuse for another round of the blame game, but a route to moving forward with more confidence.
Perhaps a more uncomfortable question is whether chief executives are being left to fail in the face of a constellation of circumstances which would crush most private sector leaders. There is a sense of helplessness around some of these failures, when people who thought they were in charge suddenly find themselves simultaneously unable to manage finances, clinical quality and demand. This pattern is likely to accelerate as greater numbers of trusts head into deficit.
The pressure on chief executives and the risk of failure are now seen as so severe that few candidates are coming forward. According to the Foundation Trust Network, it is repeatedly proving a struggle to find even one appointable candidate. If the choice is thin, the cycle of failure will continue.
The government has finally realised that repeated management failure is becoming a dangerous problem. Salford Royal foundation trust chief executive Sir David Dalton has been appointed to examine grouping trusts into chains, exploiting the public sector calculus which says that if you link a good organisation with a bad one you will surely end up with two good ones. Health secretary Jeremy Hunt has also accepted that senior managers need to be paid well.
Somehow, the rot has to be stopped. The alternative – with 2015 predicted to be the year when numerous trusts risk falling off a financial and quality cliff – is an accelerating pattern of firing, hiring and more firing as a distraction from the real issues. Guardian Professional.
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