Final Report > Chapter 24: A Health Service which is Well Led > The leadership and management of the NHS > Leadership at the level of the trust

Leadership at the level of the trust

19 The chief executive: We have already indicated that the leadership exercised by central government and, to a degree, at the level of the health authority, conditions what may be done at the level of the trust. Equally, we have argued that it must be the role of the centre to establish an appropriate framework, including certain general principles applicable to all trusts, and then let the chief executive in the respective trusts get on with the job. From the perspective of the patient, the job of the chief executive is to ensure that patients receive care which is safe and of good quality.

20 Since 1999, as we have seen, it has been the duty of each health authority, trust and primary care trust to put and keep in place arrangements for the purpose of monitoring and improving the quality of healthcare which it provides to individuals. [7] We applaud this development, not only because it finally gives proper prominence to the quality of the care provided by the trust, but also because it identifies that responsibility and therefore accountability rest with the organisations which provide healthcare services. The game of `pass the parcel' is no longer an option at local level. This is the way forward and we support it.

21 But there is another side to the coin. If trusts are to have this responsibility, they and their chief executives must be supported in carrying it out. The NHS at the centre must reinforce the duty to secure quality in healthcare and the message which the imposition of such a duty sends, by establishing and maintaining the framework necessary for chief executives to do what is asked of them. In short, they must given the tools for the job. We single out two of these `tools' for special attention; they are:

• appropriate contractual relationships with trust employees
• support for the role of trust chief executive.

We also comment on the role of the trust board and of non-executive directors.

Footnotes

[7] Health Act 1999 s18(1). London: The Stationery Office, 1999