Changing of the guard: lessons for the new NHS from departing health leaders

Just prior to the new NHS structures going live in April 2013, we interviewed some of the most experienced NHS leaders to gather their lessons for the new generation of leaders.


Published: 28/03/2013

ISBN: 978-1-905030-63-7

Download the Viewpoint [PDF 1.2MB]

Nicholas Timmins, Senior Associate, Nuffield Trust discusses the key themes that emerged from the interviews conducted for this viewpoint.

These frank reflections from 12 former or soon-to-depart hospital, primary care trust (PCT) and strategic health authority (SHA) chief executives, along with health regulators, offer insights into the challenges they faced during the last decade or more in the NHS.

Gathered and edited by Nicholas Timmins, Senior Associate at the Nuffield Trust, the interviews included in: Changing of the guard: lessons for the new NHS from departing health leaders provide insightful commentary on the complexity of health management and the size of the task that these leaders were dealing with – both through the unprecedented funding increases of the Blair and Brown years and the current period of austerity.

Ranging from lessons for successors and career advice, to discussion on policy, structure, culture and the health care environment, the interviews are wide-ranging and insightful. Scattered across these interviews are many insights and lessons for future chief executives, including: the central reliance on clinicians, data and evidence to drive change.

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 Nicholas Timmins, Senior Associate, Nuffield Trust and Editor, Viewpoint

Concern for patient care was at the top of every interviewee’s agenda, and their highest priority whilst leading their respective organisations – particularly relevant in the wake of the Francis Inquiry Report.

There is also the acknowledgement that it is the engagement of clinicians that is key to almost all advances in health care: “the opposite of the commonly perceived culture – and perhaps of the too frequent practice – of managers trying to order doctors around”.

As might be expected, repeated re-organisations came out as every leader’s biggest ‘bugbear’.

Something very significant is happening to the leadership of the NHS, and the Nuffield Trust is to be applauded for recognising it Alastair McLellan, Editor, Health Service Journal

Featuring interviews with the likes of Dame Ruth CarnallAndy McKeon, Sir Michael Rawlins and acute sector chief executives such as Dr Chris Gordon and Dr Lucy Moore, this latest offering from the Nuffield Trust suggests there is a need for NHS management to rediscover itself as a profession at a crucial time in the reform of the service.

This paper is the latest in the Nuffield Trust’s series of Viewpoint publications, which provide a platform for international health leaders to share expertise and contribute to discussion and debate on NHS reform.

We are grateful to the Health Service Journal for being our media partner on this publication. In-depth coverage of the paper was included in the HSJ edition of Thursday 28 March 2013. Visit the HSJ website for further analysis of the interviews from the publication.

At the Nuffield Trust we are producing a number of resources to prepare for the new structures of the NHS in England going live on 1 April 2013. This publication is the first. To be the first to receive upcoming outputs, sign up to to our updates on NHS reform.

Suggested citation

Timmins N (2013) Changing of the guard: lessons for the new NHS from departing health leaders. Viewpoint. Nuffield Trust.