Every year some NHS chief executives have their contracts terminated suddenly and some are even asked to clear their desks immediately. These forced exits sometimes follow a lifetime's service to the NHS.
This has been criticised as a waste of talent and a sign of a sick organisation.
But what does it feel like to be dumped, how long does the hurt last and what effect does it have on the rest of that person's life and career? Many former chief executives HSJ contacted felt unable to discuss the experience even though their sacking took place several years ago. Most seem to suffer an enduring sense of loss.
John Beecher
Former role: chief executive, Mid-Glamorgan Ambulance Service
Date left: 1998
Reason for leaving: merger
Current role: consultancy
'I was interviewed for the job heading the new trust, but I was unsuccessful. Then I was called in and told I could either go off and do some project work somewhere or I could clear my desk by five o'clock.
I replied that they were putting me in a terrible position and I asked if the matter could be talked through with my representative. But the decision had been made and there was no room for negotiation.
It came as a bombshell. I was 49, with 26 years' service behind me. The next thing I knew I was out of the door and, shortly after that, at the dole office. One year later and they would have had to pay me a pension. Initially a redundancy package was agreed for me , but as soon as I received it an injunction was taken out and the money was frozen for the next 12 months.
It was all one hell of a shock, I can tell you. At first I didn't feel as if I was still on the same planet. My wife and I just managed - we had to, really. The First Division Association was helpful and our family supported us while the lawyers were wrangling. It went as far as the High Court, but the day before the case was due to be heard they settled and I got£200,000, including legal fees. The whole episode leaves a very nasty taste. When you serve an organisation for that length of time it's just not a very dignified way to end your career.
It was a case of: 'This is what we are doing and this is how we are doing it.'
People were on a real power kick. What really got me was that my record was second to none. I introduced paramedics into Wales, I set up some of the first research projects looking into clinical effectiveness. My service exceeded all the set standards and was advising other services. Over the years I believe I achieved a great deal - but it counted for nothing.
My colleagues were made redundant or given early retirement - one was put on gardening leave. It was just a case of, 'let's get these people out', never mind that they had given 20 years' service. And we're talking about good people here. The way they were treated was appalling.
At one time you gave no thought to your contract of employment, but after my experience my advice to anyone is make sure your contract has been checked by a legal representative.
I've gone into consultancy now and it's going well. I'm still dealing with the ambulance service and I run training courses. But I'm very concerned at what's happening in the health service - they are throwing out expertise despite the severe skills shortage.
What sort of example is this setting to those managers coming up through the service? It's creating a culture where people accept that a macho and authoritarian approach is the way to do things. Once these people get into top jobs it seems they can do as they like.
Reorganisations are being used for settling old scores.
There is very little real accountability.
You're supposed to all pull together, but when jobs come under fire and the whole thing becomes fragmented a 'look after yourself 'mentality starts to take hold.
Staff are feeling vulnerable, which is not surprising, given the numbers being told to clear their desks. And I think it's stifling dynamism. You need people who will innovate, but you'll end up with people who'll just keep their heads down.
This is an issue close to my heart, and I have arranged a meeting with the director of human resources for the NHS in Wales and written to the Welsh Assembly to highlight the totally inappropriate way the service is managing its staff.
Meanwhile, our ambulance service is in a pretty poor state. And with just one provider who is going to do the monitoring?
I still feel angry about what happened to me - two or three years isn't long enough to get over something like that. It wasn't a job, it was a way of life for me. So I've stayed in the field rather than go into something new because the ambulance service gets into your blood. I couldn't leave it behind altogether.
Tony Blee
Former role: general manager, Isle of Wight health authority
Date left: 1992
Reason for leaving: reorganisation
Current role: volunteer
'It came completely out of the blue. I'd been heading the authority for 10 years and I was getting good grades in my performance reviews, so it's not as if people could say: 'You're a complete failure - go away.'
They announced a reorganisation and I suppose I shouldn't have assumed it, but I thought I was OK. I'd built up a really good relationship with the GPs, I knew the island and I felt I was the person to move things forward.
The new job was called health commission chief executive, but it was essentially what I had been doing.
Then I was called up to see the regional general manager, and he said I couldn't be interviewed. It was meant to be kind - not making me jump through hoops when they had no intention of appointing me.
But it still came as a horrible shock. I remember feeling how unfair it was and wondering what on earth I'd done wrong.
As far as I could find out it was because the regional manager felt it was time for a change.
I still think getting rid of me was a strange decision, but it was handled as well as it could be. I was 54 and I felt I still had a lot to offer. They found me a job at the regional health authority as value-for-money manager. It was quite interesting but it didn't really stretch me. It was a case of, 'What on earth are we going to do with Blee - oh, he can do this.'
Anyway, I stayed until 1995 when the region moved to Bristol, and then I was 57, so I retired. It was a waste of my talents really - I think at 54 I had a good 10 years left in me for something. I remember when general management came in they told us we wouldn't want to do the job forever, but that they'd find us something. That just hasn't happened, which is a waste for the service.
I suppose I could have gone into consultancy, but at that time everyone was rushing into it. I didn't want to set up on my own because it would mean working off the island, which I didn't fancy.
Anyway, it's worked out well for me. There are things in life other than working and I threw myself into volunteering.
Once you get off the treadmill you can try to strike more of a balance in your life. They say the younger you retire the longer you live, so I suppose they did me a favour, really.
Iain Kidson
Former role: chief executive, Whittington Hospital trust, London
Date left: 1996
Reason for leaving: 'unspecified'
Current role: consultancy
'I don't think there's any benefit for me, or for the trust, in raking everything up now. Let's just say I fall into the category of a chief executive who left following a very good appraisal.
I could be bitter, but that's a waste of time and energy. I choose to take a positive view of things and I think if you have any management ethic at all you don't use your personal circumstances to have a go at the organisation.
But that's not to say I don't understand why people are angry. I'm very angry on behalf of those people who I've seen damaged by the absence of a system to deal with people who are dumped.
And it's still going on - the NHS does not seem to be a learning organisation in this respect, and it's very ageist. I was pretty long in the tooth before I became a chief exec.
I'm 53 now, which is no age at all, but how many chief executives are there over 50? What happens to all these people between 50 and 65 with their wealth of experience?
They could be bringing that knowledge to bear and helping the NHS avoid past mistakes. I believe very strongly that there's a natural life cycle for a chief executive lasting between four and six years. After that people find the job an impossible personal burden. They become time-expired and rather than move straight on to the next chief exec job they need some rest and recreation. Ways should be found to tap their experience for use elsewhere in the NHS. But there needs to be a system for dealing with them, and the NHS has manifestly failed to recognise that.
What happens is that a merger is announced and people start positioning themselves. But nobody seems to understand the huge cost to the NHS of all this - it won't be managed to its best advantage while there's all this jockeying around.
Nobody has worked through the personal futures of these senior people or those lower down being treated the same way.
People regularly ring me up and say: 'Hello Iain, I've been dumped. Is there life after being a chief executive?'
From my own point of view there definitely is. Unlike others, I was looked after and received a settlement.
I am a management consultant and I'm also the in-house medical adviser for a medical negligence solicitor. Both these roles draw on my experience as a chief executive and also as a doctor. Chief executives are paid well but they do not receive a sufficient salary to be tossed in and out of employment in the way that seems to be happening.
Simon Strachan
Former role: chief executive, North West Surrey health authority
Date left: 1997
Reason for leaving: 'lack of financial control'
Current role: works for a voluntary Christian organisation involved in Bible translation
'Although my departure was hard, it happened at the right time for the organisation and also the right time for me. I'd been health authority chief executive for 10 years and I wasn't even 50.
There weren't many places to go from there. I don't know if it's possible to find alternative ways to keep people fresh, but there are occasions when, however traumatic, it's time for a change.
I've since discovered there are plenty of people who have experienced being let go. Nobody likes it, but it should be possible to do it without branding people as failures.
Sometimes an organisation needs a change of leadership.
Sometimes an individual needs a fresh challenge. A parting of the ways can benefit both sides and I think that happened in my case.
My problems arose as there were strong financial pressures, it created conflict and we weren't able to carry the community health council with us. The HA was seen as the one who was not fulfilling patients' requirements.
There was a growing sense that 'something had to be done' and the something proved to be a change of leadership. I accept that. If you're the chief executive then you can't take all the plaudits without bearing the ultimate responsibility, too.
Looking back now at my trauma I just feel, 'thank goodness it happened'. And in fact it didn't take me long to feel that way. I moved on to a role where I've been able to put my HA management experience to good use.
I think the real problem is that chief executives are appointed when they are relatively young and then there's nowhere else for them to go. If you get a top job when you're 40 it's very hard to remain at a senior level for 25 years, and the NHS is no different from any other organisation in that respect. There are times when a parting of the ways is best for both sides. But it needs to be handled well and in a blame-free way.
When I left, the HA was very supportive and regional office was understanding, too. But that didn't stop it being a highly traumatic experience. It was not announced until the day before I went, so I'd had a month to get used to the idea and the timing of the announcement was my choice. I just went on holiday and didn't come back - except for my farewell party. I think that's important - it would be awful if they didn't give you a chance to say goodbye to friends and colleagues.
If I have one regret it's that if I'd been around now - when all the money's being handed out - I wouldn't have had the financial pressures that brought everything to a head.
The CHC, the trust and the HA could have just had a big love-in.
But it's a hard world and nobody said it was going to be fair. When I see former health service colleagues, I'm able to say to them that there is a life after - it's just that sometimes you have to go through a lot of pain to get there.
REFERENCE 1 Wall A. Scapegoats in the Wilderness .HSJ 2000; 110 (5694): 26.
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