When I had to leave my role as a senior NHS manager, I discovered that the health service has a well-used but little-known system for easing people out of top jobs. And I learned that it doesn’t work well for anyone: trusts, our healthcare system, managers, patients or the taxpayer.
It’s quite common for senior leaders to have to step down, even when there are no performance issues and their actions haven’t risked patient safety. Sometimes, as in any sector, people simply end up in jobs that aren’t right for them. And just as often, managers, keen to support NHS bodies through difficult change projects, take on tasks that prove impossible to accomplish.
My case is typical. Individual hospitals are being pushed to group together in larger organisations, centralising specialist care and closing some common services with overlapping coverage. And the timetables for these ambitious reforms are sometimes built around political cycles, rather than good medical care or change management. I ended up overseeing a major change programme – but the deadline was unrealistic, and staff shortages were so acute that we couldn’t recruit enough experienced medics. After a period we got things under control; but senior management made clear that they wanted a change of leadership, believing that it would draw a line in the sand and signal a fresh start.
In the private sector, I’d have been given a fat pay-off and sent on my way. But in UK public healthcare it’s not acceptable to spend taxpayers’ money that way, and departing managers have nowhere else to go: the NHS is the only game in town. So I was summoned to a meeting, and offered a sideways move into a national role at NHS Improvement: the agency responsible for improving practice across the health service.
I soon learned that most such roles at NHS Improvement are one-year contracts, where people do useful work that is rarely followed through into delivery. Working there, some people apply for other NHS jobs and eventually move into senior roles elsewhere in the system. But many, wounded by their treatment and unsure of their chances in the job market, instead use the role as a springboard into interim work; and the NHS is desperately short of skilled, experienced leaders, so it ends up paying them £1,000 a day to plug gaps in its management structures.
Many people offered a one-year job at NHS Improvement would instead be willing to take a less senior job with their current employer, if it meant a permanent job and the chance to stay in the locality. But few are offered this option, and there’s a stigma attached to dropping grades. It’s seen as a sign of personal failure, and there’s an expectation that careers only ever go upwards – which, in these days of long careers and merging organisations, isn’t realistic.
Political leaders and senior management need to recognise that, while not all appointments work out, these people still have skills the NHS needs. And they should understand that failing in an impossible job is a verdict on the job, not the person. After all, those jobs only become impossible because managers are trying to both keep their staff happy, and push through the systemic changes required by national policymakers. The NHS needs to reform, and ministers have a democratic mandate to reshape the system; but currently, the best way to protect your career is to keep your head down, build support among your staff, and resist risky reforms.
With budgets in decline, demand rising, a growing recruitment crisis, and an endless series of new policies and organisational changes, it’s easy for organisations to become over-stretched and leaders to fall out of favour. If the NHS wants people to be ambitious in these very difficult jobs, it shouldn’t push those who run into trouble into temporary non-jobs – and then into an interims market where the NHS must rent their skills back at exorbitant cost.
National leaders need to be more open about the difficulty of succeeding in these hugely challenging jobs, and do everything they can to retain good managers who’ve taken a step back – offering them permanent employment in less high-profile roles. Then people would be more willing to take on the most difficult jobs in NHS management, and there would be less gaps in management grades. That, in turn, would cut the interims bill and improve continuity in organisations that can ill afford excessive staff costs and unstable leadership.
The current system evolved to help protect NHS staff while facilitating necessary leadership changes, but it’s a huge waste of talent as well as money. Politicians and the Department of Health need to be more open, both about the flaws in redeployment processes, and about the pressures that brought us to this point. That would take courage; but if they’re ready to have that conversation, the benefits will be felt by patients and taxpayers as well as NHS managers and policymakers.
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In NHS management being fired means you continue working for more money
