Two of the highest-profile chief executives in the NHS are leaving the health service.
Tim Matthews, who has led Guy's and St Thomas' Hospital trust in London since 1993, has been appointed chief executive of the Highways Agency, which is responsible for the UK's main roads and motorways.
Mike Fry, who was the youngest trust chief executive in the country when Manchester's Christie Hospital became a first-wave trust in 1991, is leaving to run a barristers'group practice.
Mr Matthews, who drives a 'modest' Peugot 306, told HSJ that, like others of his era, such as NHS chief executive Sir Alan Langlands and director of planning Alasdair Liddell, the time had come to move out of the NHS to further his career.
'I have worked in the NHS for 16 years and loved every - well, almost every - minute of it.I feel very positive about the NHS.I just felt I needed a new challenge, ' he said.
Mr Fry said: 'It's been an intriguing place to work. There's a bit of hassle and pressure, but it's an exciting place to work with money to spend at the moment.
'There's no other job in the health service that particularly appeals. I fancied something completely different.
'In a way, I'm leaving before I get old, embittered, twisted and cynical.'
Manchester South community health council chief officer Janet Finucane said it had always enjoyed 'cordial relations' with Mr Fry, although there had been questions about waiting times for chemotherapy in recent months.
Private contractor Baxter Healthcare provides a chemotherapy compounding service, making up individual treatments.
Ms Finucane said the CHC had received complaints about 'serious delays' in providing these and raised the issue with Mr Fry and the purchasing authority. But the problem was at its height in November.
A Baxter Healthcare spokesperson said both it and the trust had 'had problems dealing with the volume of work' but were changing the way services were provided 'to make it easier to cope'.
At the Highways Agency, Mr Matthews will be heading a debate on whether road charging should be introduced, along with issues concerning routine road maintenance and building.
'It was a job that interested me, ' he said. 'The more I investigated it and talked to people, the more interested I became.
'But I think it shows NHS managers have the right kind of background and skills to go into other areas of management.'
He will have a far larger budget -£1.6bn, compared to£320m - and a national profile, but the salary is not much more than the£120,000 he earns at Guy's and St Thomas'.Mr Fry said: 'My standard of living will not be dropping.'
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