Alan Randall from Eastbourne Hospitals trust was the only chief executive to speak to HSJ on the record about the demands of his job. He is surprisingly upbeat about working in a role which is both 'knackering and exhilarating'.

'You are always being watched. But It is not just that. It is the number of people watching you - the regional office, the HA, the CHC, the primary care group, not to mention the media and all the formal inspection bodies.'

He expresses concern that those running trusts are being increasingly dogged by 'dozens of single-issue men' from the NHS centre, regional office, and local HAs.

'They are only interested in their own agenda - whether it is finance, or waiting lists, or whatever - and do not look at the whole picture. That is an increasing worry.It feels like there are dozens of people who feel they have the authority to make their own demands.'

But Mr Randall believes the pressure owes more to a double-whammy effect of working simultaneously to meet old and new agendas. For now his job is often 'impossible'. 'That is why on a Friday evening you really enjoy that gin and tonic, 'he laughs.