Ken Jarrold on looking after chief executives

The topic was management below district level and I argued strongly that hospital management was to be valued as much as any other level. It was a reaction to the disastrous reorganisation of 1974, which had sucked authority and responsibility up to district, area and region.

As the senior administrator of Nottingham General and University Hospitals my responsibility was confined to the general office, switchboard and porters, and a bit of external relations and complaints. But similar points were made by the British Medical Association and others.

The Royal Commission and the government took note. In 1982 unit administrators were given more scope as the structure above them was simplified. In 1985-86 the unit general managers came along as part of the Griffiths reforms and the chief executive at hospital level began to emerge. NHS trusts were the next big change and the chief executive role became a reality. From then on the position of chief executive at local level was secure and, rightly, the chief's role was seen as a career pinnacle.

The next big move forward came with the foundation trusts. No one would doubt that foundation chief executives are among the most powerful managers in the NHS and of at least equal standing with the same role at strategic health authority level.

The issue now is what chief executives will do with their status and power and what the NHS should do for them. I hope with all my heart that chiefs will focus on the business of the NHS. Their priorities should be patient and staff experience, nursing as the essence of care, science as the essence of diagnosis and treatment, supporting team leaders, and healing the divide between senior management and the people of the NHS.

It is very important the role of chief executive in trusts and primary care trusts should be attractive to our brightest and best. If the best people do not want to be chiefs then we are in real trouble.

Chief executives need two things from the NHS. First, to be treated as we expect them to treat others. They should not be bullied. They should be treated as human beings with hopes, fears, strengths and weaknesses. Their work should be judged fairly and changing the chief executive should not be a means of avoiding the real issues. Chief executives need to be valued, cherished and healed as well as rewarded and given balanced feedback.

Second, the centre needs to set them free. The national agenda needs to be implemented and the regulators, SHAs and PCTs need to be treated with respect. But it will not serve their interests if chiefs are separated from the business they are running and are seen as mere agents of the centre. Chief executives need the space to be local leaders.