The picture revealed is complex – being a chief executive in the NHS is very rewarding, bringing high levels of achievement and fulfilment, but is also very challenging.

A number of those interviewed highlighted the burden of regulation and some behaviours that can be described as bullying. There was a high personal cost for these individuals and arguably an even greater cost for the NHS.

We are concerned that the pressures of the role and difficult environment in which chief executives are operating is deterring the next generation from putting themselves forward for the role. Our report underlines the need to foster a positive culture in which NHS leaders are supported, talent is nurtured and innovation is encouraged.

Is there less support for people on the way up than when I started? Yes, undoubtedly…

If you are fortunate enough you might get a good mentor and the right sort of support, but lots of talented people lose their way and get frustrated. Sir Robert Naylor

Commenting on the report, chief executive Chris Hopson said:

Chris Hopson, chief executive of NHS Providers, said: “The job of a chief executive of a hospital or other NHS trust should be one of the most sought-after roles in the public sector. But these reflections from some of the NHS’ most experienced leaders show first hand how all-consuming the job of running an NHS trust is these days. They are being squeezed by regulation, inspection, targets and form filling – all in the context of the longest running financial squeeze in the NHS’ history. This is a much more hostile environment and, if we are not careful, we risk the CEO role becoming the impossible job that very few people either want or are able to succeed at.

“We know that more and more trusts are struggling to recruit to their top roles, and many are increasingly relying on interims to fill CEO positions. The average tenure of a CEO has fallen to under three years, and anecdotally we hear of an increasing reluctance among executive directors to aspire to the top position. We are in danger of putting off a generation of people from wanting to become CEOs in future. This cannot be good for patients or taxpayers. We need much greater support for those running our hospital, mental health, community and ambulance trusts.”

The response to the current financial situation has been additional regulation requirements and performance reporting. At one level this is understandable. But if you want creative solutions, if you want transformative solutions, a very different approach is required. Angela Pedder

To coincide with the launch of the report, Chris has written a blog on the leadership challenge the provider sector faces.

We have already started doing some work in this area. Last year, in response to feedback from boards about lack of investment in future leaders, we developed an aspiring chief executives’ programme with the NHS Leadership Academy and NHS Improvement. We have just taken applications for the second cohort of 14 participants on the programme.

The report is available on the King’s Fund website.