The job of an NHS chief executive is a political job – so too is the departure from that job. Andy Cowper on the exit of two high profile NHS managers 

Don’t let the door hit you on your way out” (traditional)

Two NHS managers’ three decade spanning careers came to very public ends in a contrast of polar opposites last week: it was like knight and day. Sir Andrew Morris announced his plan to step down as chief executive of Frimley Health next February, while Newcastle Upon Tyne Foundation Trust announced that its chief executive Sir Leonard Fenwick had been dismissed for gross misconduct, following an internal investigation and an appeal.

Decades long careers

The sheer longevity of both careers alone should give us pause for thought. In a time when the average tenure of NHS chief executives is measured in months more than years, for both men to have run consistently high performing and well regarded NHS trusts over such a timescale is a remarkable achievement.

Sir Leonard’s career is one that might be described as anecdote rich: one would not describe Sir Andrew in the same way

Gross misconduct is extraordinarily rare reason for an NHS executive of any kind (let alone a chief executive) to be fired and Sir Leonard told the BBC that his dismissal was the consequence of a “witch hunt”.

The bar is rightly set high for “gross misconduct”, and the trust’s statement that two investigations both concluded that “allegations relating to inappropriate behaviour, use of resources and a range of governance issues were proven” will not have been made lightly. It may prove telling that some of these allegations have been referred to the counter fraud body NHS Protect.

Sir Leonard’s career is one that might be described as anecdote rich: one would not describe Sir Andrew in the same way (his recent sexist remark at a King’s Fund event being striking for its sheer unexpectedness).

Both in the Newcastle health economy and across the north east more broadly, Sir Leonard has been “a big character” for decades. He became Newcastle’s chief executive at a very young age.

An obvious point of difference between the two men is Sir Andrew’s turnaround of the long troubled Heatherwood and Wexham Park Hospitals, which his home trust of Frimley subsequently acquired. It is understood that Sir Andrew was not initially thrilled at being asked to take on the turnaround of a troubled trust. Sir Leonard was rarely reluctant to increase the size and reach of his trust’s influence.

As well as Sir Andrew’s gradual involvement in system wide issues, he remains leader of the Frimley Sustainability and Transformation Partnership, following gentle cajoling by system managers. This contrasts with Sir Leonard’s energetic perusal of a wider remint, sometimes in the face of nervousness from central bodies.

Does a “big character” NHS manager write the potential script of their own destruction? Mmmm. To generalise from the particular may be a favourite approach for columnists, but it’s not always enlightening. There is certainly a point of reflection for the Newcastle board about whether its executives, non-executives, and crucially as an FT, its membership can feel proud of the level of challenge and scrutiny of Sir Leonard’s leadership.

The Care Quality Commission may likewise want to reflect on what its consistent findings that Newcastle was “well-led” tell the system.

Then there is the extraordinary fact that Sir Leonard was trying to become Newcastle’s chair once he stepped down as chief executive. This is almost universally regarded in all fields of management as a bad idea, and would unquestionably make the role of chief executive vastly less attractive to potential candidates.

Managing talent

Talent management of chief executives has not been an evident strength of the NHS system over recent years, as HSJ research indicated back in 2015. Things have not much improved for the leadership community since then.

Enoch Powell’s infamous line says “all political lives, unless they are cut off in midstream at a happy juncture, end in failure, because that is the nature of politics and of human affairs”

This begs the question of how Sir Andrew’s experience could be used to support NHS organisations and leaders – and how Sir Leonard’s may now be lost (for good or ill).

The number of trusts with interim chief executives or those planning to depart implies that the NHS does not seem to be growing or bringing through enough chief executives. Boards, regulators and system leaders want to be confident in appointing a new leader to the growing number of troubled providers, and at present do not seem to be.

This may be a wise hesitation: too many such trusts have been “revolving doors”, with relatively inexperienced chief executives not left in post long enough to get under the organisational skin, diagnose the real problems and bring in the required resources, support (or heavy artillery and/or surgical strikes) to fix the root cause of the problem.

The pressure on the provider sector is real. The workforce crisis and Brexit aren’t making things easier, as this column considered previously. There are also very real problems with NHS culture.

Leading an NHS trust in such times as these, with an ageing, growing population (numerically and bariatrically) and low resource growth, remains a huge task. The pressure this is putting on leaders’ basic values is hard for a commentator to imagine.

It is too simple to conclude that Sir Andrew got his exit strategy right and Sir Leonard did not. Former health minister and famous racist Enoch Powell’s infamous line that “all political lives, unless they are cut off in midstream at a happy juncture, end in failure, because that is the nature of politics and of human affairs” glares balefully at us down the years.

The job of an NHS chief executive is a political job. So too is the departure from that job. The end never justifies the means.