• Median tenure of inadequate trusts’ chief executives was just eleven months
  • All eight of the trusts that have had four chief executives since April 2014 were rated inadequate or requires improvement by CQC
  • NHS needs to encourage chief executives to take on tough jobs without fear their “career would be damaged”

The chief executives of trusts rated outstanding by the Care Quality Commission have been in post much longer than those rated inadequate – several of whom have stayed less than a year, HSJ analysis confirms.

HSJ looked at the length of tenure of all trusts’ chief executives, and at how many chiefs – either interim or permanent – they had in the past three financial years

Sarah-Jane Marsh

Sarah-Jane Marsh leads Birmingham Women’s and Children’s Foundation Trust, which is rated outstanding

The data confirms a strong connection between leaders’ tenure and the quality of care, as rated by the CQC.

The median tenure of the chief executives of the 13 trusts rated inadequate, measured at the end of 2016-17, was just 11 months.

In contrast, the median tenure of a chief executive at the 14 trusts rated outstanding was just over seven years.

Similarly, the data shows all eight trusts that had four chief executives during the past three financial years were rated inadequate or requires improvement. 

Chief executives are often known to leave trusts because of performance and quality problems, or struggling to address them.

In comparison, just 2 per cent of the 115 NHS trusts that had only one leader over the same period were rated inadequate, with 43 per cent of these trusts given one of the lowest two CQC ratings.

For the 77 trusts that had two chiefs in three years, 48 per cent were rated inadequate or requires improvement. For providers that had three people in the top job, this jumps to 85 per cent.

Ten of the 14 trusts rated outstanding had been run by a single chief executive over the last three years. The four other outstanding trusts had two chief executives since April 2014.

Saffron Cordery, policy director at NHS Providers, said: “It is right that we look to leadership for quality as well as finance and performance… We absolutely need to make sure [chief executives] are being given a decent period of time to demonstrate they can bring that change.”

Adam Sewell-Jones, executive director of improvement at NHS Improvement, said: “A good chief executive accepts that they have to take responsibility but we also know the complexity of the challenges they face.

“Medway Foundation Trust [which is rated requires improvement] had a huge churn in team with constant interims. How do you persuade someone to step up and do that job when the ability [to turn around the trust] very quickly is almost impossible? Genuine transformation takes time [and] we need to encourage chief executives to have a go without fear that if they have one failure their career would be damaged.”

The CQC has recently changed how it inspects leadership. The regulator will now conduct an annual inspection of the leadership of trusts to reflect the 2016 State of Care report, which reported that “strong, visible leadership [is] a major factor in delivering and sustaining high quality services”.

Length of tenure of current chief executives at inadequate trusts

TrustApprox chief executive tenure (up to 31 March 2017)
Brighton and Sussex University Hospitals Trust 2 months
Colchester Hospital University FT 10 months
Kettering General Hospital FT 2 months
Pennine Acute Hospitals Trust 1 year
United Lincolnshire Hospitals Trust 1 year 3 months
Worcestershire Acute Hospitals Trust Less than 1 month
Barts Health Trust 1 year, 10 months
South East Coast Ambulance Service FT Less than one month
The Princess Alexandra Hospital Trust 2 years and 9 months*
St George’s University Hospitals FT 11 months
Northern Lincolnshire and Goole Hospitals FT 1 month
Isle of Wight Trust* 4 years, 9 months
Walsall Healthcare Trust 5 years, 11 months

*Changed subsequent to 31 March

Length of tenure of current chief executives at outstanding trusts

TrustApprox chief executive tenure (to 31 March 2017)
East London FT 7 months
Northumbria Healthcare FT* 1 year, 4 months
The Christie FT 2 years
Frimley Health FT 27 years, 9 months
Liverpool Heart and Chest FT 3 years, 4 months
Northumberland, Tyne and Wear FT 2 years, 9 months
Salford Royal FT 15 years, 8 months
The Clatterbridge Cancer Centre FT 7 years, 5 months
The Newcastle upon Tyne Hospitals FT** About 40 years including predecessor trusts
The Walton Centre FT 3 years
University Hospitals Bristol FT 6 years, 8 months
West Midlands Ambulance Service FT 11 years
Western Sussex Hospitals FT 7 years, 8 months
Birmingham Women’s and Children’s FT 8 years

*Interim, with long serving substantive chief due to return shortly

**Chief executive on long term leave, with interims in place.

Exclusive: Short tenure of 'inadequate' trust chiefs laid bare