• Trust chief with nearly 20 years experience says provider CEOs are treated too inconsistently 
  • Retiring Paula Clark says good CEOs who “have their heads down doing the job” are often overlooked
  • University Hospitals of North Midlands chief believes integrated care systems will be the solution to its finance woes

A long-standing chief executive has argued NHS trust leaders are treated too inconsistently, as those who “have their heads down doing the job” sometimes don’t get enough recognition.

Paula Clark, the soon to retire chief executive of University Hospitals of North Midlands Trust, argued “the system needs to be more consistent” in its treatment of provider CEOs.

Ms Clark, who has had nearly 20 years’ experience as a trust chief executive, said: “What I’ve observed over time is the way chief executives are treated is variable… there are some fantastic CEOs who just have their heads down doing the job, who don’t get the recognition, and there are some people who get recognition when maybe they’re not doing the job quite as well.

“It is about consistency of the way people are treated because that would encourage people to work differently.”

Ms Clark, who was previously chief of the Dudley Group Foundation Trust, joined UHNM in October 2016, just as the trust’s finances were collapsing.

In an interview with HSJ, she said: “One of the things I had observed is sometimes the [new leadership team], the people who have gone in to try and fix a trust are treated almost as harshly, in terms of the regime, [as] the people that got it into trouble in the first place.

“When an organisation hits rock bottom and [has] imploded, the team that go in to and try [to] turn things round are subject to that same regulatory regime, than other teams who maybe have run [their trust] into trouble.”

UHNM was placed into financial special measures in May 2017, and at the time faced a deficit of £120m. This year the trust has reduced its deficit to around £57m.

Regarding special measures, Ms Clark said: “I think having the financial special measures regime run from the centre, from Wellington House, means there is a distance and a remoteness. They can’t possibly understand the workings of this organisation and this system from that distance… I think the financial special measures regime needs to be locally focussed, system focussed.

“One of the things I said from the outset when we [UHNM] went into special measures is that I would have preferred the ‘success regime’ structure, which runs the whole system.

“Not only were we in financial trouble but so were other providers and the clinical commissioning groups. Therefore you needed that system approach. I think focussing on us to the exclusion of the system was a mistake and it would’ve been better regionally.”

She believes the new joint regulatory regime between NHS England and NHS Improvement, led by beefed up regional directorates, should help address this issue.

Ms Clark also suggested the trust’s financial outlook was beginning to turn around, adding: “One of my only regrets upon going is that I’m leaving two years too early because I really believe integrated care systems are the answer to Staffordshire.

“I think there is a real will both by [our] local authorities and NHS organisations to break the cycle and make sure we can actually make this work.”

Ms Clark told HSJ one of her key successes at the trust has been an increase to its bed base, and her departure comes just after the opening of 64 new beds.

In addition to UHNM and Dudley Group FT, Ms Clark was also chief executive at Burton Hospitals FT and Erewash Primary Care Trust.