Something very significant is happening to the leadership of the NHS.

An entire generation of senior leaders are taking the opportunity of attractive redundancy packages or pension arrangements and leaving the service.

‘The NHS management training scheme remains one of the most over-subscribed in the country − we are not short of talent’

They should not be criticised for this − they have done their time − but it presents the service with a wicked problem. Across the country around one in 10 senior leadership posts lies vacant, the NHS is suffering a major loss of “corporate knowledge” at a dangerous time of change and there appear to be few volunteers to step into the breach.

This is not surprising − the job of an NHS chief executive is a punishing one. True, the rewards are good − but the job security is not. The pressure is unrelenting and the criticism, very often, non-stop and impossible to avoid.

Collected wisdom

No wonder many potential chief executives − especially clinicians − opt for less high-profile jobs which, over the course of a career, can deliver even higher rewards with a tenth of the stress.

The collected wisdom winnowed out from departing leaders with trademark precision by Nick Timmins offers many clues as to how leading NHS organisations can be made more attractive and sustainable. It also, of course, contains myriad dire warnings about what can happen if the denigration of NHS management continues.

The NHS management training scheme remains one of the most over-subscribed executive training courses in the country − so we are not short of talent.

But as these interviews demonstrate, if that talent is to flower much has got to change.

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