Final Report > Chapter 24: A Health Service which is Well Led > The leadership and management of the NHS > Support for the role of chief executive

Support for the role of chief executive

30 A feature of trusts since their appearance in 1991 has been the difference between the chief executive and many of the healthcare professionals, particularly the senior staff, in relation to their employment. While the latter have what amounts to security of tenure for life, the chief executive (and senior managers) have a far less secure status. Just as we suggest some paring down of the status particularly of consultants, so we see the need to develop a culture in which chief executives (and senior managers) may feel more secure in their employment. Currently, there is a sense in which the NHS is too greatly politicised and too closely managed from the centre. As a participant in one of our Seminars, with experience of life in the public sector, put it: `... the life of a Chief Executive is nasty, brutish and short'. In such a climate, the danger exists of demanding the head of the chief executive (or a senior manager) if some problem affecting a trust attracts sufficient adverse attention. To us, this is no different from the reflex of demanding that some healthcare professional should be `struck off' when something has gone wrong. It is the culture of blame and it is unhelpful, as we have repeatedly asserted. It may satisfy an immediate desire for some punitive action but it rarely addresses the underlying issues. The same is true as regards a chief executive (and senior managers). There is a danger that they can be treated as sacrificial lambs, to achieve some quick political fix. This does nothing to ensure good leadership and management in the NHS; it does the opposite. It deters those who are otherwise capable and committed. For this reason, we are concerned that chief executives (and senior managers) receive appropriate support and enjoy the same degree of security of tenure as other senior professionals in the NHS. They must be allowed to lead and manage, and be supported in this. They must not be at the mercy of the government's anxieties about the headline of the day. The trust's board should be left to make its own decisions on the future of the chief executive, according to clear and agreed criteria.