The first series of the West Wing, the peerless US political drama, features an episode entitled Take This Sabbath Day. In it President Bartlett agonises over whether to commute the death sentence on a convicted killer. He is lobbied three times by different religious figures but fails to act in time. The episode ends with the president kneeling at the feet of a priest and declaring: “Bless me, Father, for I have sinned.”
The NHS is about to make its third post-Lansley attempt to appoint a senior figure to oversee the operations of the service at a national level.
The first came in 2015 and resulted in the appointment of Northumbria Healthcare Foundation Trust boss Sir Jim Mackey as NHS Improvement chief executive.
Mr Mackey (as he was then) was keen to contribute at national level, but less enthusiastic about spending time away from his home and family in the north east.
Eventually he and his new employer agreed a two-year secondment. He left in 2017 with a strong case for a knighthood, but few good memories and plenty of bad ones.
Despite NHSI knowing the date of Sir Jim’s departure the efforts to recruit his replacement appeared to start very late. It was almost as if they feared asking the question. Little wonder, for as soon as they did, they were greeted by a blanket “no thanks” from every trust chief executive they approached.
Eventually they had to turn to Ian Dalton, who had taken up the helm at the troubled Imperial Healthcare Trust just four months earlier and, not unreasonably, wanted to keep the large salary he had agreed in north west London.
Incoming NHSI chair Baroness Dido Harding was cautioned not to rush to appoint and to consider the option of placing NHS England number two Matthew Swindells into the role as the two organisations began their merger in all but name.
She continued anyway – loyally following the brief she had been given on her appointment. Those who questioned the decision were told legislation required a separate NHSI chief executive who did not report to NHS England boss Simon Stevens.
Then last month it suddenly appeared as if that was not a problem any more. A furious and shocked Mr Dalton was given his marching orders.
But, just as surprisingly, Mr Swindells was not slotted in to the vacant post, now relabelled as a joint chief operating officer holding the NHSI chief exec role as a formality. Instead Mr Swindells’ position was put at risk and HSJ understands he is under significant pressure to “take the package and go”.
So now, once again, the calls to trust chief executives have begun and, guess what the answer to the question ”would you like to be the COO” has been? Julian Hartley of Leeds Hospitals has said “no”, Stephen Dunn at West Suffolk has said “no”. And so have many of their peers.
A few others like Guy’s and St Thomas’ Amanda Prichard have expressed their unhappiness about such a move, but have been the subject of a concerted effort to change their minds.
This is little surprise when you consider the treatment of Mr Dalton and Mr Swindells.
If the recruitment process continues as it currently is, the service will reach one of two conclusions about the new joint NHSE/I chief operating officer. It will either view them as somebody without the nous to realise how difficult a job it is; or as someone not strong enough to resist having their arms twisted by the powerful.
Neither is a good look for someone whose main job will be to have tough conversations with the seven new regional directors and trust chief executives about the provider sector deficit.
Yes, it would be awkward for this government to have the NHS led by two former Labour party policy advisers in Mr Stevens and Mr Swindells. But then again, Baroness Harding is a Conservative peer as, until he recently resigned the whip, was NHSE chair Lord David Prior.
If Mr Swindells had done a bad job or was not up to the new one, then the attempt to get him to quit would be understandable. But the former trust chief executive has tackled a range of difficult tasks well – including helping the NHS prepare for a no-deal Brexit – as even Baroness Harding admits.
The NHS England deputy chief executive could walk into a very well-paid private sector job (like the one he left to join NHSE). That he wants to stay and continue the job – despite being so badly treated – is to his credit.
With the creation of NHSX set to take some of his technology responsibilities away, he has even got some time on his hands.
Why rip a good chief executive away from a trust that needs them – probably damaging a promising career in the process? Why pay a large redundancy package to someone who can and, even more importantly, wants to do the job?
As recent experience underlines, these roles require aptitude for navigating Whitehall, at least as much as they do provider chief executive experience (though many forget Mr Swindells has worked as a hospital chief).
The NHS has had two chances to find the right operational leader. Mr Swindells may not be the perfect fit, but he is a good bet right now. Here’s hoping the NHS will not be left seeking forgiveness for a third bad call.