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Exclusive: Grant signals global search for 'fresh' chief to replace David Nicholson

The chair of NHS England has underlined his determination to consider people from outside the UK and with no health service experience as candidates to be the organisation’s chief executive.

In an interview with HSJ, Sir Malcolm Grant also revealed all of NHS England’s current national directors had ruled themselves out of replacing Sir David Nicholson.

He emphasised he was beginning a “genuinely open and global search” and saw the appointment as an “opportunity to break from the past and to consider candidates who may not have had any NHS or health related experience”.

Sir Malcolm said NHS England’s board had drawn up job requirements specifically so it was not “confined to [individuals with] a lifetime in the NHS, or even of significant experience in the NHS”.

Sir Malcolm suggested leaders without NHS experience could be successful if they appointed the right staff: “Great leaders delegate quite a lot, keep their eyes on the big picture [and] trust others to have the immediate grip.”

He said success in the role would be “very much a question of values… and actually the freshness that a new appointment can bring to the role”. He added that he was “entirely open minded” about whether the chief executive should be a clinician.

He emphasised the role was different to that of NHS chief executive, to which Sir David was appointed in 2007.

“What we’re doing is recruiting somebody to lead NHS England, the commissioning side,” he said.

Although “candidates will need to demonstrate their ability to have a grip”, he said, NHS England’s leaders “don’t have a responsibility for the provider side”. The NHS system now includes many “largely autonomous bodies over which our new chief executive will not have control”.

“So the new role, I would say, is one of advocacy, inspiration and leadership,” Sir Malcolm said.

“What we need is someone who can really inspire us in thinking about the new models for the NHS.”

He said this meant NHS England was “very much looking for somebody who has a relationship building capacity rather than somebody who is able to command by force of personality”.

Sir Malcolm said he hoped to shortlist candidates in September or October, and appoint shortly afterwards.

The appointment will be made by NHS England’s non-executive directors but must be approved by the health secretary. Sir Malcolm said the Department of Health would be “briefed [throughout] the process” and indicated ministers would have the opportunity to veto candidates.

He said there would probably be “iterative” discussion with the DH to avoid the health secretary rejecting NHS England’s chosen candidate at a late stage.

Asked about the salary for the new chief executive, Sir Malcolm said the “starting point” would be Sir David’s package. His salary is around £210,000, although he was paid benefits in kind of £56,400 in 2011-12.

When asked whether it should be larger, Sir Malcolm said: “We live in an era of austerity.”

He said there may be “outstanding candidates around the world” who would take a “very significant” pay cut for the role, but that if a “truly exceptional candidate” demanded more, “then I’m sure further discussions could be had”.

Sir Malcolm said all of NHS England’s national directors had decided not to apply.

Interim deputy chief executive Dame Barbara Hakin, medical director Sir Bruce Keogh and policy director Bill McCarthy had been considered possible candidates.

The chair himself is retiring after 10 years as provost and president of University College London in September, after which he said planned to spend more time on his NHS England role.

Readers' comments (28)

  • mmm seem to remember the England (National) Football Team going down this line........swedish management didnt do them much good

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  • Sir Malcolm hasn't shown much urgency as DN said he was leaving months ago. The sooner he goes the better, taking his sycophants with him. The NHS is crying out for new leadership

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  • "all of NHS England’s current national directors had ruled themselves out"

    They're not idiots! The new system is all over the place.

    This story is stating the obvious rather. You'd want to find the best person for the job, and given there aren't many people in the world who manage organisations with £80bn or so turnover in a polarised political climate, you might just have to go outside the 5 or 6 legitimate (ish) candidates in this country.

    I would welcome an outsider with a track record in a different system, or even different sector. There are plenty of experienced old hands in the system already, someone fresh might be good.

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  • Phil Kenmore

    I rather like the part about how NHS England’s leaders “don’t have a responsibility for the provider side”. This on the day that Barbara Hakin is grilled about what NHSE are doing about the A&E pressures. Perhaps if Malcolm keeps saying it often enough someone will believe him (especially some Politicians or media...)?

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  • Note it says NHS England... dones't mention Directors of other NHS entities (e.g. Flory @ TDA) ruling themselves out.

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  • Trouble is, at less than £300k you are only going to be able to attract senior middle management from the private sector, not the top leaders. Terry Leahy has been mentioned. He earned £5.2m in 2010 for running Tesco. He has retired with a pension pot worth over £18m. So, why risk his excellent reputation for pocket money?

    Yes, to the publec sector £300k is a big salary, but to the private sector it really is not!

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  • To add to that, Christopher Hyman, the chief exec of Serco, earned just under £2m (according to wikipedia, so don't know if accurate!).

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  • 2:35 - it's ~£300k + pension + virtually guaranteed knighthood.

    Don't underestimate how much the last part is worth to some people. Also, if you've had a good run @ £1m+, you can afford financially to spend a few years on a "low" salary.

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  • The work NHSE is required to do is based on an act of parliament and an order from the government.

    The Chair says the new role is one of advocacy, inspiration and leadership. And a bit of steel to pursue the outcomes the patient needs and the Government is committed to.

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  • I'm sure they can find someone from McKinsey since they are running the NHS anyway.

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  • Why is there always an assumption, often stated but sometimes implied, that private sector leadership and management are somehow superior to those in the public sector? It's a myth wholly unsupported by any convincing evidence. The fact is that life in the private sector is infinitely simpler compared with the public sector which has to juggle multiple and competing objectives and is not driven by profit and shareholder value. Outcomes are more complex and often conflicting. It would make for a more sophisticated, useful and nuanced discussion about what the NHS needs by way of leadership style and skills if comparisons with Tesco, McKinsey, Serco et al were abandoned. They have less to offer than is often suggested. The way would then be clear to have an informed discussion about the nature of the challenges and how they can best be met instead of a discussion too often driven by faith-based prejudices and ideology. Horses for courses springs to mind and horses from the private sector invariably fall at the first hurdle when confronted by the public sector. The NHS can testify to that. This is not to argue in favour of the 'usual suspects' with one exception perhaps. I for one regret that Bruce Keogh is not putting himself forward. He ticks a lot of the boxes in terms of the type of leader Malcolm Grant says he is seeking.

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  • Britnell

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  • I too was struck by the part about how NHS England’s leaders “don’t have a responsibility for the provider side”.
    If commissioners do not need to know anything about what they are commissioning, or who for, or who from, what actually do they need to know?? Surely 'world-class commissioning' demands more of its leader than knowing nothing? Knowing nothing but on a bigger scale perhaps??

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  • Love it: "all of NHS England’s national directors had decided not to apply."

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  • It would be interesting to see the job description.

    To my knowledge, no other country in Europe has a national health system chief executive. They have a system, with elements of political influence, quality/ economic regulators and tariff setters, and providers (public, private and third)

    If the idea of devolving commissioning to CCGs is seen through, all NHS providers become FTs (and pigs fly!) what is the purpose of this role?

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  • Clare Gerada.

    You dont need to look abroad.

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  • Anyone, he just needs to go.

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  • This reminds me of when Gordon Brown was grimly hanging on, even after the election, when most of us were thinking JUST GO NOW. Mind you, look what we ended up with.

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  • The amount of money and benefits that has been paid to DN is absolutely disgusting - for what I may ask has he done to deserve this!! The money could well have been used for a far better cause within the NHS.

    Whoever follows him surely cannot do a worse job or maybe that is fairyland dream.

    How come Barbara Hakin is still employed in her role another pouring of a large amount of money down the drain!

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  • 9.01 No I think a wider view of the needs of the health of our nation is needed. we don't need a clinician we need a top executive who understands customer care and branding putting pride back in the minds of the patients for choosing the NHS. Getting the best out of the workforce by instilling good practice. How about a top exponent of lean driving continuous quality improvement. Lets get the names into Sir Malcolm's ear. Japan and US have some top business people with new ideas to take to NHS

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