People always surprise you. When I started interviewing retiring NHS chief executives to support a project with the King’s Fund, I had several preconceptions that were quickly disproved. The first preconception was that my four interviewees would be tempted by the traditional exit interview traps of score settling or self-authored hagiography. Instead what I found was a group of people who were contemplative and willing to look as hard at their failures as their successes.
Like picking out a good performance in a movie it was often the small and almost inconsequential moments that stuck with me from the interviews, rather than the bold declarative statements or soundbites. To pick out just two of these smaller moments:
Tim Smart, the former CEO of King’s College Hospital who came into the job with a long private sector background from British Telecom, is not the first person I would have labelled as a patient champion. I expected our conversation to focus on how commercial the NHS is (or isn’t), the strength of public sector boardrooms compared with the private sector, and so on. Instead we started by talking about how he tried to put the patient at the centre of everything the trust did.
Again, beware hagiography, but I was immediately taken with Tim’s anecdote about awarding the contract for the shop in the lobby of King’s. Although he was only shadowing the board at the time, when he was asked for his view Tim said, “What are the potential operators prepared to do on committing to penalty and reward payments based on patient feedback. Look, I told you we are going to make every decision at King’s with the patient at the centre and the shop is important to patients, their visitors, and staff, so what are the bidders going to do on this?” The contract went to a different bidder than originally planned.
With Ed Colgan, former CEO at Somerset Partnership NHS Foundation Trust, it was his gentility and humanity that immediately leapt out. When I asked him what kept him up at night as a chief executive he did mention serious untoward incidents and the prospect of never events, but he also said the smaller personnel issues mattered—”Did I say something that has upset someone or make a remark that could be interpreted in the wrong way? Could I have handled something better, or did my intervention make a difficult situation worse?”
King’s is a billion pound trust, turnover at Somerset is £150 million per annum, and I’m pulling out the shop in the lobby story and smaller personnel issues. But that is what matters to me. Of course, I want the CEOs of NHS organisations to do the vision, mission, and strategy bit; forge new relationships with partners in the local health economy; and cut tough deals when they need to be made. But I also want leaders who have clarity of purpose, consistency of approach, and support a culture that says I care about you and you matter—and that has to be demonstrated across the piece from the big stuff to the small stuff if it is going to be authentic.
My final two reflections are about the process and approach of this publication rather than the content. Firstly, it is clear that while there is considerable diversity in the backgrounds of the interviewed CEOs, with commissioning, clinical, non-NHS, and managerial experience represented, there is not much gender or ethnic diversity in who was available for interview. I suspect that in 10 years’ time the photos of retiring CEOs will look broadly the same, but I hope I am proved wrong.
Secondly, a friend of mine said he is getting sick of policy reports that get worthies together, write some worthy things (it should be like this, why isn’t it like this, Finland does it like this), ask for money or a structural change, and then state the obvious knowing the reports have time limited relevance and will simply be put on the shelf with all the others. I agree and for a few years now I have been increasingly drawn to the Nick Timmins school of oral history instead—and I am very grateful Nick was able to include a few of our interviews in his publication for the King’s Fund.
The beauty of hearing the story in a chief executive’s own words is that this document can be taken back down from the shelf and re-read to learn how others tackled the pressures of juggling competing demands, bringing on talented staff, and innovating; to see how senior leaders are impacted on a personal level by national policy; and to assess over time how things have improved or in some cases never changed. So I hope you will read this publication and take it back down off the shelf from time to time because the wisdom of the crowd, the wisdom of the experienced, and the wisdom of retiring public servants in the NHS is not time limited.
Siva Anandaciva is the head of analysis at NHS Providers, leading a team focusing on NHS provider finances, workforce, and informatics. Prior to joining NHS Providers, Siva was an analyst on the graduate management scheme at the Department of Health. Since October 2014 Siva has been a governor of the Homerton University Hospitals NHS Foundation Trust.
Competing interests: I have read and understood BMJ policy on declaration of interests and I have no competing interests to declare.