• Ian Dalton says there is a “slight crisis” in leadership across the health service
  • Says chief executives in difficult jobs should be given more support and time to improve
  • Expresses strong interest in “hospital chains”

NHS Improvement boss Ian Dalton says there is a “slight crisis” in leadership across the health service, and there “needs to be a difference between being a football manager and being a chief executive”.

He also expressed significant enthusiasm for “hospital chains”, which have been seen as an effective way of spreading strong leadership skills across the NHS.

In his first major interview since becoming chief executive of NHSI, Mr Dalton raised concerns about the high turnover of NHS leaders in some areas, citing one trust where there had been 11 chief executives in 14 years.

He said that NHSI will be working harder to support leaders in these difficult roles, and suggested people would be given more time to deliver results.

He said: “There needs to be a difference between being a football manager and being a [trust] chief executive. The fact you might lose a couple of games might lead to a demand for the [football manager’s] head, and that’s not the way you should be running health services.

“My intent as chief executive of NHSI is that people get the time and support they need to deal with often intractable situations.

“You could almost say we have a slight crisis in leadership at the moment really, where our ability to recruit to our more difficult posts is very challenged.”

He referenced work that has started in the Midlands and East to develop a “regional talent board” as a good example of the new approach.

He added: “We’ll be working at national level to support the deployment of management around the system in the next few years, and that’s a big expectation of my chief people officer working with support from the regional directors.”

Asked whether many more trusts are likely to be involved in hospital chains, also known as groups, Mr Dalton said: “I think that’s a possibility. Groups interest me considerably.”

He said work is currently ongoing with the existing chains, such as that between Salford Royal Foundation Trust and Pennine Acute Hospitals Trust, to assess the benefits.

Asked whether there are likely to be fewer standalone organisations delivering services for a particular clinical need, such as community trusts, he said: “That isn’t a pre-determined fact but that’s certainly a possibility.”

Dido Harding, NHSI’s chair, has previously spoken of the NHS’s tendency to “decapitate” senior leaders who take on difficult jobs, when it should be supporting and promoting them.

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