The must read stories and talking points in the NHS

Sea change in top CEOs list

Marianne Griffiths is the first woman to take the number one spot in HSJ’s annual assessment of trust chief executives. But the Western Sussex boss was run close by East London’s Dr Navina Evans, while Sarah-Jane Marsh from Birmingham Women and Children’s secured third place.

HSJ’s fifth ranking of all 249 provider trust chief executives is notable not only for women taking the top three places, but also for the rise of mental health chief executives and the relative demise of their teaching trust counterparts.

There are the same number of female chief executives in this year’s Top 50 compared to 2017 (22), but only six among the top 15, the same as in 2016 but two down on last year. However, this will surely be overshadowed by the fact that the top three are all women.

The results are a sharp contrast with the first HSJ Top 50 in 2014. That year, the top 10 were ranked and only one – Dame Julie Moore – was a woman.

Another very significant sign of the times is that the Shelford Group of NHS teaching trusts has only five of its 10 chief executives represented in the top 50.

NHS Improvement’s existential angst

The news that NHS Improvement has hired McKinsey to help clarify its purpose and develop its organisational model has been greeted with predictably little acclaim.

The national body is paying the consultancy giant £500,000 to help with “internal organisational development work”, and to clarify NHSI’s “purpose and operating model”. Work is at an early stage but moving quickly.

As part of the project, NHSI executives were conducting interviews with provider chief executives and chairs on “what’s working well, what they find frustrating, what they think our purpose should be and what activities we should concentrate resources on”.

Trust bosses will probably be only too pleased to tell NHSI what they think.

It’s only two years since the then newly formed NHSI brought in KPMG, at a cost of £630,000, to help define its culture, values and operating model.

Why the constant need for advice? Well, when KPMG came in, NHSI had only just been invented, with no legislative underpinning, by Jeremy Hunt. Chief executive Jim Mackey had only just started yet the clock was already ticking down on his two year tenure. The job was to quickly build a viable organisation out of two (Monitor and the NHS Trust Development Authority) that had different purposes and cultures. Did NHSI have the tools or the muscle internally to do that? Doubtful.

In early 2018, those existential issues are still unresolved, and NHSI still has a long way to go before it feels like a functional organisation. And at least two more major issues are looming: can NHSI make the wider NHS more sustainable – and if it can, does it know how to in the current circumstances? In other words – does it add value overall? Finally: what can be done to stop NHSI and NHS England contradicting each other and making an already fraught environment completely impossible?

We’ll leave judgements about how much central bodies ought to be spending on management consultants to others. But it is worth asking whether there would have been quite so much spent if they had a fixed and clearly defined purpose in the first place.