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Published: 10/04/2003, Volume II3, No. 5850 Page 14 15

Job insecurity is an occupational hazard for football managers, but why are NHS leaders in Thames Valley suffering the same fate? Mark Gould reports

When Terry Venables was ousted from Leeds United last month after just eight months in charge even NHS managers with little interest in the fortunes of the Premier League may have felt his pain.

Why? At times, the lot of a senior manager in the health service and that of a football manager have much in common. Both are in charge of multi-million pound budgets and a talented team of top professionals. More importantly, both are prone to lose their jobs at a moment's notice.

Trusts in Berkshire, Buckinghamshire and Oxfordshire are the latest to witness a round of chief executive departures over the past year.

Thames Valley strategic health authority chief executive Nick Relph told a recent board meeting that he was concerned about staff turnover and difficulty appointing to senior posts such as chief executives and finance directors.

He gave the warning in February - before it emerged the SHA was to lose a highly regarded trust chief executive, David Highton, who leaves Oxford Radcliffe Hospitals trust tomorrow.

In the paper to the board, Mr Relph said he was 'concerned about the capacity and capability of our health systems to meet the challenges they face'.

'In particular the recruitment to chief executive, finance director and key operational posts remains problematic.'

The SHA, which is one of the largest in England, covering 29 trusts, has seen the departure of six chief executives this year for a variety of reasons (see box).

The First Division Association, which represents NHS senior managers, feels chief executives face too much pressure, which contributes to a high rate of attrition.

FDA research reveals that NHS chief executives have an average life expectancy of just three years in any one post. This compares with an average five years three months for private sector bosses in the top 350 UK companies, according to the Institute of Directors.

FDA head of health Paul Whiteman says NHS chief executives face national and local political pressures, scrutiny from the NHS and other agencies and now have to compete for their jobs with the franchise-hungry private sector.

'In jobs of this size a chief executive takes up to 18 months to get a grip of the post, so a three-year lifespan doesn't give them any time to address the local situation.

Constant change is not always the solution - sometimes you need a bit of continuity to achieve things.'

Oxford Radcliffe Hospitals trust has been dogged by long waiting lists and by February was facing a£20m deficit on an annual budget of£320m. A leaked report by management consultants PriceWaterhouseCoopers criticised management for failing to take steps to tackle the deficits when they emerged. It is understood to blame 'decision-making in corridors, poor decision-making and lack of expertise' for the financial problems.

The trust will not comment - and Mr Highton was not available - on the specific criticisms, but it admits that much of the overspend was on staff costs, including the use of 'premium agency staff ' to cover nurse vacancies and 45 per cent of purchases bought through non-official suppliers.

But as Mr Highton clears his desk, almost three years to the day since he first arrived, his supporters say he brought continuity and improvement to the trust.

Last week it met the accident and emergency waiting targets, with a leap from 72 per cent to 91 per cent of patients being seen within four hours.And local community health councils paid tribute to Mr Highton's leadership skills - the trust went from zero stars in 2001 to one star last year - and for tackling 'systemic' problems which pre-dated his arrival.

The chief executive embarked on a£200m capital scheme, including a£125m private finance initiative project to replace the ageing Radcliffe Infirmary and relocate services at the John Radcliffe and Churchill hospitals by 2007. He negotiated the sale of the 18th century Radcliffe Infirmary to Oxford University at the end of March for over£40m - some of which will be used to offset the trust's deficit.

Oxford CHC said Mr Highton has been used as a scapegoat.

CHC chief officer Linda Watson has written to health secretary Alan Milburn expressing 'deep regret that Mr Highton has been put in this invidious position'.

'None of the systemic problems of the trust offer quick wins, and the steps that David and his team have taken to turn matters around will take time to come to fruition.

'For the first time in years, the trust had a chief executive in whom the staff had confidence and in our view David achieved a major sea change in working relationships within the trust. This management team has worked hard at being visible and listening to staff at the front line, in marked contrast to former practice.'

Mike Williams, an executive director of Thames Valley SHA, and previous chief executive of Radcliffe Infirmary, has been seconded to replace Mr Highton until a permanent replacement is found.

HSJ asked Mr Relph to expand on his concerns about recruitment and retention but he declined to make any further comment.

A spokesperson for the SHA would only say that with 29 trusts within the SHA, 'one would expect there to be some senior management changes'.

Moving and shaking: turnover in Thames Valley

Ruth Harrison, previously chief executive of Worcestershire Acute Hospitals trust, has been appointed chief executive at the new Buckinghamshire Hospitals trust created by the merger of Stoke Mandeville Hospital trust and South Buckinghamshire trust.Acting chief executive of Stoke Mandeville, Fiona Wise, has been seconded to Bedfordshire and Hertfordshire strategic health authority as director of modernisation.South Buckinghamshire chief executive Roy Darby will work within the SHA on the development of acute services before his retirement later this year.

Suzanne Goodband will become chief executive of Royal Berkshire and Battle Hospitals trust in June, replacing Mark Gritten, who leaves for a 12-month secondment to the Department of Health and Social Care (South) as head of performance.

Bart Johnson, previously deputy chief executive of Sutton and Merton primary care trust, has been appointed chief executive of Chiltern and South Bucks PCT.He replaces Steve Young, who is retiring.

Last month, Keith Neiland, chief executive of Buckinghamshire Mental Health trust, started a one-year secondment working 'within the Buckinghamshire health community on service strategy development'.

During his absence, director of nursing Jill Cox will be acting chief executive.

At North East Oxfordshire PCT, chief executive Geraint Griffiths left in September to become chief executive of Rowley Regis and Tipton PCT in the west Midlands.Director of development Ginny Hope is acting chief executive.