Managers are not pawns to be sacrificed to save others' reputations There can be few more thankless jobs anywhere than being a chief executive in the NHS. Of course jobs requiring leadership of thousands of staff, with responsibility for the welfare of tens of thousands of people and commanding six-figure salaries, are never going to be easy.
And there are worse large organisations to take charge of - London Underground, for example.
But beside the relentless change that health sector managers have taken for granted all these years, the struggles with meeting targets, the prioritising within tight budgets, the placating of clinicians, unions, patient groups and regional offices, there is now one, far bigger problem. And this time It is personal.
This week we see another exodus of senior managers who've paid the price for not coming up to scratch. Tayside health board and Epsom and St Helier trust will be seeking new chief executives. Bedford Hospital trust needs a new chair to join the newly appointed chief executive.
There is no question that high profile jobs such as these must carry with them an exceptional level of responsibility and accountability. There is no room at the top of NHS organisations for underachievers, ditherers or those who just can't deliver.
And it is entirely right and proper that the buck should stop with the chief executive - and, where appropriate, the chair.
But it is also fair to ask questions about the departure of senior managers when any kind of 'scandal' erupts in the NHS. At times, it seems those at the top are in a no-win situation.
If information is available about part of the service where things are going wrong, and it is not acted on appropriately, then heads must roll. If information is not available then mechanisms for providing it should have been in place - so heads must roll.
The circumstances in each of the three cases highlighted this week are very different - Tayside, nursing a massive deficit about which questions have been asked for years;
Bedford, where fallout from the 'bodies in the chapel' saga continues; and Epsom and St Helier, where an imminent Commission for Health Improvement review is expected to be highly critical.
In each case - regardless of the spin put on it - senior managers have considered their positions and cleared their desks. None of them can claim that the buck does not stop with them. Ensuring financial soundness and that people are treated with dignity are core responsibilities; clinical governance is a statutory duty for a chief executive and it is vital that after months of collecting information about a service, CHI reviews should be acted upon.
But what everyone else needs to be assured of - not least their potential successors - is that none of these managers has been made a scapegoat by regional officials or politicians.
The ending of a career has to be seen to be in the interests of staff and the local community - not in the interests of regions or politicians being seen to do something when things go wrong.
The transparency that is supposed to apply throughout the health service also needs to apply to those at board level. The development of a blame-free culture has to apply at the most senior level, as well as the most junior.
Ultimately, when senior figures depart their posts at difficult times, we need to be sure that it is the only right and proper outcome, for there are inevitably even more difficult times ahead. CHI reviews are only in their infancy, traffic lights are imminent and dozens of health authority chief executives are wondering what sort of future they can expect.
Beleaguered senior managers want to be reassured that the new strategic health authorities, CHI and the NHS executive can offer the promised supportive and enabling approach, as well as showing the door to those who have genuinely failed.