Preparing for the 'new' NHS: lessons from departing leaders

Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not. 

Partly prompted by Robert Creighton, the former Chief Executive of Ealing PCT, writing a reflection on his time there, this seemed a perfect moment to try to catch some of the collective wisdom of the “dear departing” at a moment when so much experience is walking out of the door.

The result, unlikely though it may sound, is probably the closest the Nuffield Trust, in partnership with the Health Service Journal, has ever got to producing a piece of bedtime reading. 

The dozen conversations recorded in Changing of the guard: lessons for the new NHS from departing health leaders, feature contributions from across the NHS landscape: Dame Ruth Carnall and Candy Morris from the soon-to-be-abolished SHAs; the regulatory perspective from Andy McKeon, Anna Walker and Mike Rawlins; the acute sector view from Dr Chris Gordon, Brian James and Dr Lucy Moore; and the commissioning perspective from Robert Creighton, Sophia Christie, Kathy Doran and Dr Tim Richardson. 

They offer widespread reflections on what it is like to work in the NHS at a senior level, what has been good about the experience, what bad, and what might be done better. You can leaf through them at leisure.

Some of the reflections are personal. Some rather more about the environment, structures and culture of the NHS. Some very different to others in their view about what could be done better, how much can be achieved, in what time scale and at what pace. There is a lot of food for thought here.

And one suspects readers will take rather different messages from the interviews, depending on their own viewpoint. Some may judge some of these senior managers to be rather brow beaten and down trodden, for all their exalted rank. 

Others may see them as heroically delivering a public good almost despite the system in which they work. From all of them comes a commitment to the health service and health care which is rather moving. And there are plenty of nuggets about how to cope.

At a time when, post-Francis, NHS management is both under the microscope and in the public spotlight at a level of magnification that has probably not been seen before, these conversations shine their own light on what it is like to do the job.

All sorts of things emerge. Deep frustration at endless re-organisation. A crystal clear view that the core of the job is enabling clinicians to deliver the best for patients – although enabling also includes a willingness to surround yourself with clinicians brave enough to themselves challenge and sort out poor practice and bad behaviour. 

A worry that the Government needs “to be careful what you wish for” in finally deciding how far to implement the Francis recommendations. 

And a strong view that patients will gain in the long run if NHS organisations were to be far more transparent about their clinical performance and the experience of the patients themselves.

Whether that is really a key to the future, only time will tell. But these views of the world from a bunch of people who were only recently being derided as pen pushers remains, despite the frustrations they record, essentially an uplifting one.

If I ever aspired to be a senior leader in the NHS I would read all of these – for a whole bunch of conflicting insights into the opportunities, the challenges, the difficulties and the sheer exhilaration of what doing a difficult job can bring to the public good.

Nicholas Timmins is a Senior Associate at the Nuffield Trust. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.

The Nuffield Trust has partnered with the Health Service Journal for the publication of Changing of the guard: lessons for the new NHS from departing health leaders. Further analysis of the interviews from the publication are in the HSJ’s edition of 28 March 2013 – visit HSJ’s website to read more.