Encouraging and supporting more leaders with clinical expertise onto NHS boards will strengthen NHS leadership and help it to better reflect the diversity of its workforce, according to a new report from NHS Providers and The Leadership Academy.

Clinician to Chief Executive: Supporting leaders of the future says only a third of NHS trust chief executives have a clinical background, a smaller number than other national healthcare systems.

The report highlights the fact that trust chief executive positions are becoming increasingly difficult to fill, as the role becomes ever more challenging and complex.

The report sets out the value that a clinical background can bring to both the leader and the NHS as a whole whilst recognising that successful chief executives can come from a wide variety of backgrounds.

   

In a series of case studies, trust leaders urge the service to build up a pipeline of future leaders, including clinicians who should be encouraged to consider going into management earlier in their career.  

The report sets out the value that a clinical background can bring to both the leader and the NHS as a whole whilst recognising that successful chief executives can come from a wide variety of backgrounds. The advantages a chief executive with a clinical background can bring include an understanding of what matters most to patients, their loved ones and staff – helping their trust to hold “the line” on quality.

Angela McNab, the chief executive of Camden and Islington NHS Foundation Trust, said: “I think my experience as a clinician means I more easily see things from all angles – staff, patients, carers and managers and I remember the frustrations as a clinician which disengaged me and I try hard in this role to ensure we prevent those frustrations or at least acknowledge them and share solutions.”

Sonia Swart, the chief executive of Northampton General Hospitals NHS Trust, added: “The lessons of medicine are often also lessons for life and for understanding how staff feel about the care they give at the most difficult of times.”

The lessons of medicine are often also lessons for life and for understanding how staff feel about the care they give at the most difficult of times.

Sonia Swart    Northampton General Hospitals NHS Trust

The report also includes a survey of trust chief executives which found that: 

• Almost 80% of chief executives with a clinical background no longer practise in a clinical capacity due to time constraints in their leadership role.

• Almost 50% of chief executives with a clinical background have kept their registration, retaining the option of working alongside frontline colleagues or returning to clinical practice when their tenure as chief executive ends.

• Respondents commented that the NHS needed to do more to tackle the barriers to clinicians entering senior management roles.

Nick Broughton, the chief executive of Southern Health NHS Foundation Trust, said: “A lack of time is the greatest challenge. I was able to continue with clinical work on a limited basis for the first 18 months I was a chief executive. The increased need to work at a system level has placed considerable demands on my diary.”

Every month I dedicate one shift or a whole day, to practice of some sort. It keeps me connected to the reason we are all here and truly shapes and informs my thinking.

Helen Greatorex    Kent and Medway NHS and Social Care Partnership Trust

A number of chief executives have kept their professional registration open in order to schedule front line shifts alongside their duties as CEOs and allowing them to shadow clinical staff and visit wards. These chief executives were able to get exposure to and keep open a direct line of engagement with patients, their families and staff.

Helen Greatorex, chief executive of Kent and Medway NHS and Social Care Partnership Trust, said: “I work shifts on the wards sometimes, these days I do it as a healthcare assistant. Every month I dedicate one shift or a whole day, to practice of some sort. It keeps me connected to the reason we are all here and truly shapes and informs my thinking.”

The chief executive of NHS Providers, Chris Hopson, said:

“It is common knowledge that being a chief executive of an NHS trust is one of the most difficult and complex roles out there.

“Despite this, and as this research shows, the role of a provider chief executive is one that offers a great deal of personal satisfaction. This comes from the responsibility of improving care for patients and their families. We desperately need to ensure that clinical talent within the service is nurtured right the way up to the chief executive role and that the clinical route to the chief executive role becomes part of a strong pipeline of future leaders.

We desperately need to ensure that clinical talent within the service is nurtured right the way up to the chief executive role.

Chris Hopson    NHS Providers

“Whilst successful chief executives can come from a range of different backgrounds, the clinical chief executives in our report argue that bringing their clinical experiences into leadership roles can support better decision making and improve the quality and safety of care. 

“We hope this work will inspire more clinicians from a range of professional backgrounds to see leadership roles as a worthwhile and immensely rewarding career choice.”

The chair of the Leadership Academy, Peter Homa CBE, said:

“Many colleagues view the provider chief executive role as an enormous privilege; after all, there are few roles with a greater potential for impact on the health and wellbeing of the local population. But having done the role myself, solid and reliable support for those willing and able to take on this level of responsibility is more critical than ever.

Many colleagues view the provider chief executive role as an enormous privilege; after all, there are few roles with a greater potential for impact on the health and wellbeing of the local population.

Peter Homa CBE    The Leadership Academy

“The NHS Leadership Academy is focused on ensuring that we’re able to support the development needs of aspiring and existing chief executives, whether recently appointed or well-established. That support ensures they feel supported to make a positive difference to communities for as long as possible, bringing stability to staff and in turn, high quality care to patients and their families.

“Providing such support is part of our work towards an NHS with the culture, systems and processes in place to identify, develop, deploy and support leaders at all levels into roles that best suit their development, and the service’s needs. Underpinning all of this is the need to ensure that equality and diversity remains a golden thread in everything we do, in line with our core NHS values.”

The report is made up of a series of personal accounts from trust chief executives with clinical backgrounds about their journey into leadership roles within the NHS. These offer insights and advice for clinicians considering a future career in leadership.

Read an accompanying article written by Cassandra Cameron and published by the BMJ. 

About the survey:

Clinician to Chief Executive: Supporting leaders of the future is based on a survey of NHS trust chief executives, carried out in June 2018 by NHS Providers. There were 81 respondents to the survey, representing 36% of trusts in England.

Desktop research was also undertaken looking at the biographies of those CEOs who did not respond to the survey so we could ascertain a complete picture of the CEOs in England.

Of the respondents, 98% of survey respondents identified themselves as CEOs, and 2% had previously been an interim CEO but had since returned back to their substantive post.