Daily Insight: Will you be staying long?

We published some detailed work this morning looking at the turnover of chief executives and exec directors at nearly all general hospital trusts (apologies to other trusts which we haven’t been able to analyse yet).

Senior management instability can be a barometer of wider cultural and performance issues, and is part of the Care Quality Commission’s leadership reviews.

Our analysis reveals what while some trusts have more than half their executive directors intact from five years ago, others have none at all.

While 23 trusts have had a single CEO for five years or longer, there are 31 which had at least three CEOs between April 2017 and now, and four which had at least four. Southport and Ormskirk led the way with five CEOs – but its latest recruit is Ann Marr, who has led the well-regarded St Helen’s and Knowsley trust for nearly 20 years, making her perhaps the longest serving. Last autumn she took on Southport and Ormskirk as well.

Knee-jerk sackings may be increasingly appealing as performance bites over the winter, the general election approaches and politicians get nervous. NHS Providers and the NHS Confed say the analysis underlines the importance of supporting senior leaders and understanding their structural challenges.

But turnover is clearly not always A Bad Thing. A lot of the best performing trusts – Homerton, Newcastle, and Chelsea and Westminster for example – are ‘mid table’ on turnover. Sometimes it’s time for a clearout. But that only works if replaced by good & credible management, supported by the centre, which can then bring a period of stability and recovery.

Where the big problems come – and what is highlighted by our analysis in a few cases – is when hospitals with big problems get stuck in a cycle of instability and further failure. Bosses are pushed out, sometimes at the behest of politicians wanting heads on spikes, without any plan or ability to attract and put in place good, long-term replacements.

Only way is up…

It is the trust with the worst accident and emergency performance in England, where just a third of patients are admitted, transferred or discharged within four hours.

But Barking Havering and Redbridge University Hospital Trust has now told HSJ it is within its gift to make “sustainable” improvements within the next year.

Despite the trust suffering system-wide issues such as lack of social care capacity, similar to many other places across the country, Matthew Trainer, chief executive of the trust, said there are improvements being planned by the trust on its own performance.

Those being planned by the trust include speeding up ward admissions and more timely discharges of patients.

Mr Trainer has said he will take “a long hard look at myself” if the A&E position has not improved relative to other London providers in a year’s time.