To my surprise and somewhat consternation I find myself once again chief executive of a hospital 17 years after last running one and five years after stepping down as a chief executive to develop my portfolio business.  


The assignment started simply enough, facilitating the acquisition of a trust that would not secure FT status making it the second acquisition I'm currently dealing with. Interesting stuff but in the case of this second acquisition the chief executive departed and I was asked if I'd  take over as interim. 'You do realise.' I said, 'that I haven't run a hospital for 17 years?' No matter came the reply, because ‘...this is about leadership, delivering the acquisition and preparing the organisation to be acquired.’ 


Never one to resist a challenge I now find myself once again running a hospital – well, at least on a part-time basis for the foreseeable future. So what's it like after all this time being away? Well, I have to say pretty much the same. The local issues remain as they always were: delivering the bottom line, developing effective relationships with clinicians and worrying about key external relationships with patient groups, politicians and others.


Although the national context has changed (self-managed trusts were just starting out when I first ran a hospital) it’s strange to say it feels very distant. Yes, national policies have come (and frequently gone) but the essential skills to manage organisations are no different today than they always were except context is a bit more complicated. And yes, commissioning has developed somewhat since the 1990s but with clusters and emerging clinical commissioning groups it currently feels like a two-tier process. The sooner this settles down with clarity of roles and accountabilities the easier NHS system-wide business relationships will be.


Finally, these assignments tend to be challenging not necessarily because of sorting bottom-line delivery but because of the wider soft relationship issues. NHS acquisition is a two-way process and we forget FTs need to be wooed to develop interest in acquiring trusts seen to have been failing. This is an important lesson that also underscores the lack of incentives for acquisition in the NHS, something that tends to be overlooked by M&A commentators focusing solely on the business dimension of acquisition.