The NHS’s longest serving chief executive, who has just marked 50 years in the service, says regulation and unreasonable expectations are making senior leaders’ roles more difficult than at any other point in his career.

  • Sir Leonard Fenwick has been chief executive of Newcastle upon Tyne Hospitals FT and its predecessors for 38 years
  • Says he benefited from national and local support earlier in his career
  • Senior leaders today face “overbearing criticism” and excessive regulation
  • Recent investment means NHS now better placed to cope with severe financial strain

Sir Leonard Fenwick has been chief executive of Newcastle upon Tyne Hospitals Foundation Trust and its predecessor organisations for 38 years, and passed half a century in the health service this month.

He said his success was partly thanks to strong support and guidance earlier in his career. As he climbed through senior management, becoming chief executive of the Freeman Hospital in 1977, Sir Leonard said: “You did tend to be thrown in at the deep end [but] on the other hand there was support, national and local, to get on and break new ground.”

Len Fenwick

Source: Wilde Fry

Sir Leonard has just marked 50 years in the NHS and his 68th birthday

He said regional NHS authorities had been “tolerant and did allow someone like myself to be on a long leash”. “Occasionally when you tumbled there wasn’t this overbearing criticism that you see today,” he added.

Sir Leonard told HSJ the main reason for the shorter tenure of many trust chief executives today was excessive external scrutiny and criticism.

“Expectations are at times unreasonable,” he said. “If you go back to years gone by, the media coverage was not so intrusive or dynamic. Public expectations were not as great.

“The development of the regulation industry in the NHS is exponential; it’s intrusive [and] on occasions unforgiving.

“There’s a plethora of ringside commentators. Bureaucracy in the NHS has become rather overbearing. A blame culture has gained momentum in the last two or three years.”

Sir Leonard said new leaders at trusts who inherited problems were sometimes “just not [being given] the time provided to bring about a range of improvement”.

He said coordination of education and training had also changed substantially, with trusts now less able to secure trainees in roles and professions, and move them around, as needed. “Whether it is a clinician or an accountant, we seem to be much more constrained by overarching bureaucracy,” he said.

Notable achievements during Sir Leonard’s five decades in the NHS include the merger of Newcastle’s three predecessor trusts in 1998 and the closure of Newcastle General Hospital in 2010, having consolidated acute services on two sites. He has grown the trust’s service range and its income broke the £1bn mark for the first time in 2014-15, significantly exceeding the performance of the main acute providers in several larger cities.

‘The development of the regulation industry in the NHS is exponential’

This was achieved because “in the NHS, success breeds success”, he said, while his advice to other leaders is to “take the staff as a whole with you, avoid the rhetoric and empty promises”.

Sir Leonard said the current funding constraint on the NHS was “clearly more challenging” than any it had seen in his time. “But on the other hand, the infrastructure – the capital investment in recent decades – is now there to be utilised… technology is allowing distribution of service delivery to more effective settings,” Sir Leonard added.

The trust chief executive, who also turned 68 this month, said he was in two minds about his future at the FT, amid severe financial and demand pressures in the health and care system. “There’s always so much going on, and now the winds of change are blowing through, do I think, it’s time now to step down, or do I need to be around to make sure that everything we’ve achieved in Newcastle is not unpicked? Because things are tight, there isn’t much latitude.”