Pritchard must decide

But HSJ was wrong – the outcome has been even worse.

Our predictions were accurate, but what we did not contemplate was the role would be taken up on a temporary basis – creating greater uncertainty when the service is crying out for stability; and throwing even more shade over the actions of those involved.

Before we explain why the events of the last few months are such a cause for concern, let us be clear that Amanda Pritchard is a fine trust chief executive with a strong, values-based reputation.

It is worth briefly recapping the events which have led up to her appointment. In early March, NHS Improvement chief executive Ian Dalton and NHS England number two Matthew Swindells were told that their posts were being made redundant and offered packages in return for not challenging the decision.

As highlighted in our April editorial, Ms Pritchard very quickly emerged as the preferred choice of NHSI chair Dido Harding and her NHSE counterpart David Prior (indeed much of the last two months has smacked of a decision looking for an argument to support it).

The only problem with Baroness Harding and Lord Prior’s choice was that Ms Pritchard was very, very reluctant to take up the role. She was profoundly nervous about the way Mr Dalton and Mr Swindells had been treated, was ultra-loyal to Guy’s and St Thomas’ (which she knew was about to enter one of the most important periods in its history), and realised that every other credible candidate had turned the job down (as was the case when Mr Dalton was appointed).

She was asked once, twice, three times (at least) before she finally gave in.

But she agreed to move only on one condition – that she would take up the post on secondment for “up to two years”.

This fact was omitted from all public announcements and indeed many NHSE/I staff – some relatively senior – were unaware of it until HSJ published an update last night. Meanwhile, Ms Pritchard sent a note to thousands of GSTT staff explicitly saying she “expected to return”.

When this note was drawn to the attention of NHSE/I, it was suggested that the decision to second Ms Pritchard was all about the need to move quickly and that, anyway, she would probably take up the job substantively eventually.

These two positions do not sit comfortably together. They create a misleading picture at best. Others may choose a stronger word to describe one or both of them.

GSTT chair Sir Hugh Taylor fought tooth and nail to keep Ms Pritchard but, once she had decided to go, argued for a clean break so that he could get on and appoint a new chief executive. ‘No dice’ said Ms Pritchard and so yet another big London trust enters a period of leadership uncertainty.

Meanwhile, for staff at NHSE/I and in the wider NHS leadership community, Ms Pritchard’s position is already undermined. It is reasonable to expect anyone to take six months or so to get their feet under the table in such a big job. Given the last six months of any secondment is naturally taken up with tying up loose ends and preparing for return, that means that Ms Pritchard will be fully engaged in the role for just a year.

As any observer will know such ‘here today, gone tomorrow’ appointments have a poor record of achievement – just look at Sir Jim Mackey’s tenure at NHSI, another fine trust chief executive whose own secondment meant his loyalties were always divided and did not give him time to implement many of the changes he wanted to see.

Ms Pritchard has, rightly so, many influential and knowledgeable fans and HSJ has been careful to give them a listen.

Their argument is that the GSTT leader is such an outstanding candidate that her secondment, and the uncertainty and disruption it brings, is a “price worth paying” to get her to do the job.

As we have stressed, Ms Pritchard is a good chief executive, but she is not head and shoulders above any other credible alternatives. HSJ is confident that this argument would also make her uncomfortable and nervous – the weight of expectation will be great enough without the suggestion that she is some kind of ‘special one’.

Ms Pritchard’s fans also claim that the charm offensive from NHSE/I leaders (and others) will continue in an attempt to make her commit full-time to the role. They are sincere, but they are also the same people who claimed Sir Jim could be persuaded to change his mind (and then said his return to the North East was inevitable).

Ms Pritchard would be wise to learn the lessons of Sir Jim’s tenure. If she wants to maintain her hard won and justified reputation and reduce damaging uncertainty at GSTT and in the wider NHS, she must declare now that she intends to take up the post permanently, and accept the risk that goes with that, or withdraw from the role.

As for the selection process and those responsible for it, HSJ hopes that it will receive the scrutiny it deserves and that the appropriate consequences will follow.