David Law, the chief executive of troubled West Hertfordshire Hospitals Trust, has resigned in the wake of its poor annual health check performance.
The trust was one of four that failed to move up from 'weak' ratings in both quality of services and use of resources.
Mr Law was appointed chief executive in July 2004, having previously been director of strategic planning.
In a statement he said: 'My time here has been challenging but I think I leave the trust in a better position than I found it.
'It is only right though that the responsibility for failings identified by the Healthcare Commission falls on the chief executive.'
Deputy chief executive Professor Graham Ramsay, the trust's medical director, is now acting chief executive.
The trust said Mr Law would not be getting severance pay.
'David Law has resigned and as such there is no package attached to his leaving,' said a statement.
The move follows calls for Mr Law's resignation from three local MPs including Labour MP for Watford Claire Ward and Conservative MP for Hemel Hempstead Mike Penning.
Mr Penning told HSJ other senior members of the management team should also step down.
'It's not just David the buck stops with,' he said. 'It all very well to tell David to resign and then say 'we're bringing in someone new but the whole structure is still there.'
He added that takeover by a high-performing trust was not an option.
'There's no one in this part of the world that has the management expertise and track record to come in and turn this around,' he said.
The trust has struggled to implement plans to restructure services at its three hospitals encumbered by massive debts and in the face of high hospital infection rates.
During Mr Law's term it moved from a £26 million debt to a projected £5 million surplus this year.
However, local health campaigner Jean Brett said day-to-day patient care had suffered while Mr Law was 'chasing cuts' and the 'mirage' of a big PFI deal to redevelop WatfordGeneralHospital.
'After last year's Healthcare Commission report the chief executive, chair, board and non-executive board should have been concentrating on what needed to be done to ensure they weren't in a similar situation this year,' she said.
Hertfordshire county councillor Michael Downing, a member of Hertfordshire's health scrutiny committee, told HSJ: 'David Law's resignation may be what protocol demands but it won't actually solve anything.
'Clearly the trust has deep-seated problems, which will still be there.'
He said the departure had come at a difficult time as consultation on reconfiguration of acute services was at a crucial stage.