Naylor: The NHS has failed clinical leaders

Sir Robert Naylor, chief executive of University College London Hospital Foundation Trust and chair of the Future of NHS Leadership inquiry, said clinicians had not been incentivised, partly because professional bodies “have not supported clinicians going into leadership as much as they should have done”.

He added that the rewards for clinicians to go into leadership were not “sufficiently great” and the “downsides of failure are greater than the upsides of success”.

Sir Robert told HSJ that the efficiency savings required over the next five years will only be realised by having leaders “in every part of a more simplified organisation of the NHS”.

He added: “If we’re serious about the NHS becoming more efficient and more productive then we need to make these top jobs more manageable, simpler, with greater autonomy to get on, and make the changes that are necessary.”

Sir Robert said the financial challenges faced by the NHS require “big changes” that are made more difficult by bureaucratic processes.

He added: “It’s so difficult to make changes that leaders who are responsible for making these changes are disincentivised because of the sheer complexity of the processes they have to go through.”

Sir Robert said the regulatory burden on trusts is “extreme” and has increased over the years.

He said: “I know from my own experience and having been in the first wave of foundation trusts in 2005, for quite a long period of time there was a dramatic reduction in the bureaucratic burden because we were given autonomy and freedom.

“What’s happened over [recent years] is the extent of external intervention has gradually increased to a level that is now as bad, if not worse, than it was before we became a foundation trust. Everyone is asking us for information about the most excruciating detail in order to comply with the regulatory responsibilities that they’ve been given.”