Standout trends in this year’s rankings include the prevalence of the multi-trust leader, the influence of outstanding CQC ratings and the rise of women chief executives

HSJ Top Trust Chief Executives 2017

Three significant trends emerge from this year’s HSJ ranking of the NHS’s top 50 chief executives: how the top leaders are increasingly running more than one organisation; how influential Care Quality Commission ratings have become; and how women may soon come to dominate the top ranks of the provider sector.

HSJ’s annual analysis of the NHS’s top trust chief executives, held in association with Korn Ferry, was judged by some of the service’s leading figures. They included CQC chief inspector of hospitals Sir Mike Richards, NHS England medical director Sir Bruce Keogh and NHS Improvement director of nursing Ruth May. The chief executives were judged on three main criteria: the performance of their trust; their contribution to the wider health economy or the NHS; and their personal example (see judging criteria below).

The top 50 is split into two; the top 15, which are ranked, and the remaining 35. The full list can be seen here.

The most striking factor in the 2017 ranking of chief executives was the trend for the best to be leading more than one organisation. Seven of the top eight have either successfully taken on a second trust, are doing so or about to do so – Basildon’s Claire Panniker is in charge of three and at least one other among the leading pack expects to be leading a group of four or more in the near future.

This widespread experiment in extended leadership could come to a sticky end – indeed such is the range of different approaches being adopted that some are bound not to succeed.

Ipswich’s Nick Hulme and South Warwickshire’s Glen Burley both find themselves jumping into the top 50 on the back of successes which has seen them given a second trust to steward.

Of course, this widespread experiment in extended leadership could come to a sticky end – indeed such is the range of different approaches being adopted that some are bound not to succeed. But for the present, the best leaders in the system are having to learn how to manage groups rather than just single organisations.

The influence of CQC ratings

Jeremy Hunt told HSJ in September 2015 that CQC ratings had replaced foundation trust status as the “definition of success” for NHS trusts. Despite the brickbats regularly thrown at the commission this appears to have come to pass.

Five of the 10 trusts awarded an outstanding rating now see their chief executive among the top 15, with three within the top five (Clatterbridge’s outstanding rating was announced after the judging was complete).

The most astonishing leap of the year comes from Marianne Griffiths of Western Sussex Hospitals Foundation Trust – who jumps straight into the top 50 at number three. The fact that she matched acknowledged masters in Sir Andrew Morris and Sir David Dalton in achieving an outstanding rating for an acute trust was the most important factor in her placing (though being named HSJ’s chief executive of the year cannot have hurt).

Northumberland’s John Lawlor also went straight into the top 15, while his close counterpart from Northumbria David Evans and East London’s Navina Evans, who also scooped the HSJ trust of the year award in November, were new entries into the top 50.

When it came to head-to-head battle between the Christie’s Roger Spencer and Cally Palmer from the Marsden for a place in the top 15, it was the former’s outstanding rating which swung it for the North West chief.

The only chief executives of outstanding trusts not to make the top 50 were the Walton Centre’s Chris Harrop and, controversially, the giant of the North East, Newcastle’s Sir Leonard Fenwick.

However, it is also worth pointing out that the performance of Morecambe Bay’s Jackie Daniel is equally as impressive given her top 10 ranking was awarded by judges when her trust was still rated “requires improvement”

If you exclude the ratings of those second (or third) trusts taken on by the leading chief executives; nine of the top 50 run “outstanding” organisations, while 28 lead those rated “good”. Birmingham Children’s Hospital Foundation Trust, led by Sarah-Jane Marsh, has not been rated – but it is expected to do very well when its rating is announced later this month.

In this context, one of the 12 remaining chief executives stands out. Alwen Williams, leader of Barts, is the only chief executive of a trust rated “inadequate” to make the top 50: a reflection that she is making a pretty good fist of an impossible job.

However, it is also worth pointing out that the performance of Morecambe Bay’s Jackie Daniel is equally as impressive given her top 10 ranking was awarded by judges when her trust was still rated “requires improvement”. Her bravery in tackling the problems at the troubled teaching trust was praised by all the judges.

The rise of female chief executives

A bright future was predicted for Ms Daniel and she is representative of a new breed of chief executive, most of them female.

The last 12 months has seen the retirement of Peter Homa, Sir Robert Naylor and, perhaps, Sir Leonard – all leading lights of the past two decades or more.

In their place come figures such as Ms Griffiths, Ms Daniel, Ms Panniker, Ms Marsh, Luton’s Pauline Philip and Guy and St Thomas’ Amanda Pritchard, as well as less well known women leaders such as Paula Clarke, now taking on the challenge of University Hospitals of North Midlands, and Southampton’s Fiona Dalton.

There are 22 women in the top 50, the same as last year. However, the number of female chief executives in the top 15 has risen from six to eight and those in the top 10 from four to five.

It is reasonable – given the ages of veteran leaders like Sir Andrews Morris and Cash and Sir David Sloman and the fact that many of the female chief executives have climbed to the top when relatively young to foresee a situation within a few years in which women occupy a significant majority of the positions in the top 50.

It is lazy to suggest leaders of the same gender all work in the same way – compare, for example, the divergent styles of Birmingham trio Sarah-Jane Marsh, Dame Julie Moore and Tracy Taylor (who again hovered on the edge of the top 15). But it may be the rise of female leaders is associated with the weight given by the judges to the importance of working co-operatively across organisations and localities.

Again it is important to avoid stereotype – Jackie Daniel has been a “heroic leader” in the best sense while driving change at Morecambe Bay. But, as Mr Homa acknowledged last week in HSJ, the model of the grand leader of the equally grand teaching trust as the exemplar chief executive appears to be now fast receding.

Indeed, Sir Andrew Morris and Sir David Sloman received the most praise from judges for their commitment to mentoring fellow chief executives and others rather than for the success in running great hospitals or being system leaders.

Finally, it is worth noting Julian Hartley’s jump up the rankings. Turning round the sleeping giant of the NHS that is Leeds Teaching Hospitals Trust has defeated many high profile leaders. Mr Hartley appears to be succeeding where they failed.

A sector split reveals the best showing for leaders of specialist trusts, perhaps reflecting the fact that they have a higher proportion of good or outstanding CQC ratings. Acute trust chiefs come next, followed by ambulance and mental health leaders. Birmingham’s Ms Taylor is the only chief executive of a standalone community trust to make the top 50.

Regionally, the North is best represented, with 19 chief executives in the top 50. The Midlands and East region comes a close second with 15. The London and Southern regions trail a long way behind with eight each (see map).



Revealed: The NHS’s top trust chief executives in 2017