NHS managers voice worries over ‘Stalinist’ SHA tactics

The zero tolerance culture for failure has made some chief executives fear for their jobs as a “Stalinist” culture is draining the NHS of experienced chief executives and making trusts insular and risk averse, senior leaders have told the Health Service Journal.

The concerns were prompted by the departure of two London hospital chief executives from trusts facing serious performance challenges. The sudden resignations of Tara Donnelly, from West Middlesex University Hospital trust, and Julian Nettel, from Barts and the London trust, have left managers across the capital fearing for their jobs.

“If someone asked me for views as to whether they should apply for a chief executive’s post, I’d say I wouldn’t touch it with a barge pole”.

Many also feel the shake-up will discourage people from applying for top jobs at a time when vacant posts often attract just one candidate.

Making mistakes

University College London Hospitals foundation trust chair Sir Peter Dixon told HSJ: “It raises all sorts of questions about the way we treat our senior managers. I think there’s a Stalinist culture among SHAs that isn’t helpful. You need to be able to make a mistake.”

He added: “There’s not a mass of people waiting on the sidelines who want to take these jobs on.”

Barts and West Middlesex face deep rooted problems and have been named as trusts that will fail to secure foundation status.

But many trusts in London are performing badly against targets – and the region has the highest number of trusts that will fail to become foundation trusts. Managers fear NHS London is looking for scalps in response to Department of Health pressure.

Performance anxiety

A London acute trust chief executive said: “It feels as though there’s a new intolerance in London and that some excellent, talented leaders are being forced out or put under so much pressure they leave.

“A lot of chief execs are thinking ‘there but for the grace of God’.”

A London insider said: “If someone asked me for views as to whether they should apply for a chief executive’s post, I’d say I wouldn’t touch it with a barge pole.”

The insider added: “These are difficult jobs and this makes people adopt risk averse behaviours.”

Ms Donnelly stood down after her trust failed to alert NHS London that eight patients had waited more than 12 hours in accident and emergency. The SHA said this meant nearby trusts were unable to help.

But a chief executive at a neighbouring hospital said: “We wouldn’t have been in a position to help out, however much we’d have wanted to.

“I think [the resignation] is very hard on a first offence and whether that’s really in the best interests of the organisation is very debatable.”

Official protocol

HSJ understands West Middlesex had established informally that other hospitals were unable to help but did not follow official protocol.

NHS London has taken a hard line on trusts it feels should be able to deliver on key targets. HSJ understands this was not the first time there had been a difference of opinion between the trust and the SHA.

One London hospital chief executive said the departure of Malcolm Stamp, NHS London’s provider agency chief executive, last December had deprived leaders of someone at the SHA with whom to have informal discussions.

The “high level of anxiety” resulting from recent resignations made trusts potentially reluctant to help other organisations if it meant they would miss targets, the chief said.

Performance management

Managers in Partnership has seen an increase in casework involving senior managers in London in recent months, mainly disciplinaries, grievances and capability procedures related to performance management. Chief executive Jon Restell said it was understandable that SHAs wanted to hold top managers accountable but said putting people under “unreasonable amounts of pressure” would not help.

However, King’s College Hospital foundation trust chief executive Tim Smart was unsympathetic. He said: “Personally I don’t subscribe to the view that there is a climate of fear. I think targets are targets and you have to deal with them.”

The SHA denies any suggestion that it bullies managers. Deputy chief executive Anne Rainsberry said the SHA simply wanted to improve performance and there would always be a turnover of chief executives.


Health Direct has seen this increasing trend in intolerant centralist health bosses for a while.

On Wed, Feb 11, 2009 we posted London acute trusts face shake up as bosses resign
London’s hospital trusts face a massive management shake up after the resignations of five chief executives over failures in their trusts.

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