One of the longest serving acute trust chief executives has said high turnover of senior staff is usually down to individuals not being good enough, rather than unfair treatment.

Heather Lawrence will have been in post at Chelsea and Westminster Foundation Trust for 10 years next month.

You’ve got to be brave. You are not here to be popular

She told HSJ that such longevity required good ability to manage relationships, particularly with chairs and consultants. Another common mistake among non-financial chiefs was to think they could leave finance to others, she said.

“It is about being financially competent, having strategic savvy and clear communication with people,” said Ms Lawrence.

“They [staff] should see you being really hardnosed about money but also about care. You’ve got to be brave. You are not here to be popular, you are here to be respected.”

NHS chief executive Sir David Nicholson has voiced concern about chief executives’ short tenure, and estimated the average time in post as 700 days. He said there was often just one strong candidate for appointments.

Ms Lawrence said structural changes had resulted in some people taking posts without sufficient experience, particularly in commissioning.

However, she described the job of chief executive at some organisations as “undoable”.

“If you are a new chief executive taking on a difficult job, my advice is to negotiate your contract very carefully,” she said.