One of the most highly regarded chief executives in the NHS has announced he is stepping down.

  • Sir Robert Naylor to leave University College London Hospitals next March
  • He has led highly regarded FT for 15 years
  • Tariff “not fit for purpose” and ACOs should replace FTs, says outgoing FT leader

Sir Robert Naylor will leave University College London Hospitals Foundation Trust next March, after 15 years at the helm.

Sir Robert Naylor

Sir Robert called for accountable care organisations to replace foundation trusts

In an exclusive interview with HSJ, Sir Robert said the national pricing tariff was “not fit for purpose” and called for accountable care organisations to replace FTs.

He said: “If you look to the future it’s about collaboration not competition… We’re undoubtedly moving towards capitated budgets and accountable care organisations, so I think we’re going to see them sprouting up all over the place. In fact, we’re interested in developing an ACO here in north London.”

He added that the development of ACOs “will fundamentally change commissioning and will raise the whole question of whether commissioning is needed at all”.

ACOs would require “stronger regulation”, he said.

He added: “You need to maintain and maybe even strengthen the functions and role of the Care Quality Commission and the new NHS Improvement body.”

He said:  “If I was leading an ACO my whole strategy and raison d’etre would be to look after the health of the population I’m responsible for.

“That would mean that we would think much more about investing in prevention - primary care, community services, social service. Rather than as I’ve done over the last fifteen years which is think about how I can spend another £150m on proton beam therapy.

“I seriously question whether that’s the right type of investment… when that same amount of money would probably buy you six or seven primary care centres with 20 GPs in it.”

Sir Robert helped develop the FT model as part of Labour health secretary Alan Milburn’s strategy team. He said that in order to develop ACOs across the country “the first thing we would have to do would be to disband the FT model”.

He added: “You have to create a new statutory entity of the ACO and you can’t assume that any of the existing people have the skills to be able to run an ACO because it’s a different set of skills. You need much more cooperative and collaborative skills.”

Chief executive role ‘far more difficult today’

The long-serving chief executive said the role is “far more difficult” now than it used to be.

The role of chief executive has been made more difficult because of “successive reorganisations”, Sir Robert said.

He added: “The system has built layer upon layer of bureaucracy and it’s become so labyrinthine that you have to be an expert guide to find your way around the system. Often it’s who you know and who your contacts are. I always encourage new chief executives to invest in networking because sooner or later you’re going to need your supporters.”

Sir Robert said the tariff is “not fit for purpose” and questioned whether there is any incentive for trusts to deliver a surplus.

“The whole tariff situation is no longer fit for purpose, and that’s been compounded by the fact you’ve got all these hospitals making a deficit and they’ve been given handouts,” he said. “It’s hardly surprising that trusts now are aiming to make a deficit because if you make a surplus, then what would happen? They’d take the money away from us, so what’s the point?”

He said it was the right time to leave the trust because “I completed what I came here to do some time ago but if I were to stay to see the next phase of developments through I’d need to stay another five years, which would take me way beyond where I intended to”.

Sir Robert said he had not yet decided what he would do next, but that it might well be “largely health related but probably on an international platform”.

He said the role of acute trust chief executive was the “best job in the health service”.

He added: “People like me never wanted to go into the bureaucratic jobs of the health authorities, commissioning or the Department of Health or anything like that.”

Commissioning has “become too complex” and is an “industry of its own”, Sir Robert said.

He added: “I’ve argued that we need much bigger, far fewer, more professional commissioning bodies. There needs to be stability in commissioning arrangements. You can’t change your commissioning structure every time you have a new government or a new secretary of state.”

Sir Robert said he had the “strongest working relationship” with Labour health secretary Alan Milburn.

He added that current health secretary Jeremy Hunt is a “charming, intelligent, capable guy”.

“He clearly has some big challenges because the economic situation is not as good as it was when Milburn was secretary of state, for example, when Blair announced he was going to radically increase funding to the NHS. We’re in a totally different fiscal environment now,” he added.

This story was updated at 10.35am to include more detail from the interview.

Future of NHS Leadership inquiry

Sir Robert chaired Future of NHS Leadership inquiry, which published its final report in June.

He said the NHS had “failed” to encourage clinicians to take up leadership positions, and professional bodies “have not supported clinicians going into leadership as much as they should have done”.

The inquiry also said there should be fewer NHS organisations to avoid management talent being spread too thin.

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