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The forest was still.
The Californian sun, just starting to slip behind the horizon.
The creatures in forest getting ready for the night…
… but no.
They sensed something was wrong. They sniffed the air. Somewhere, the forest was smouldering. By daybreak a fire had swept through the mountainside. Nothing left but ashes.
A year ago this January, the wildfires in Los Angeles;
- 30 deaths,
- 150,000 evacuations,
- 11,500 homes destroyed.
- Economic losses around $140 billion.
The fires destroyed over 57,000 acres, impacting hundreds of species; salamanders, owls, pollinators. Official counts focus on human lives and property, but…
… studies highlighted the loss of critical nesting sites, the destruction of habitat and long-term population declines.
There is a complex interaction between fire patterns and wildlife. It’s called pyrodiversity.
The thing about forest fires is their terrifying speed. How nigh-impossible they are to contain.
Sniff the air. Can you smell it? There’s a forest fire in the making the NHS and I'm far from sure it will be contained.
Over the last eighteen months the NHS has experienced a level of senior leadership turnover that’s way beyond anecdotal.
It’s worrying.
In management terms, as worrying as any forest fire. Almost impossible to extinguish.
Management theory tells us, warns us… this is exactly what happens during large-scale organisational disruption.
What is striking is how closely the NHS is tracking that evidence.
Michael Porter’s work on mergers and major organisational change suggests that around 18% of top leadership leave during periods of significant restructuring.
Other studies of mergers and acquisitions put senior executive turnover even higher… 20–30% within two to three years… particularly where roles, authority and accountability are reset mid-flight.
So what does that mean for us?
- England has around 215 NHS trusts and
- 42 Integrated Care Boards, plus
- NHS England.
- That’s roughly 260 organisations each led by a chief executive or equivalent, excluding deputies and national directors.
If we apply Porter’s conservative 18% benchmark, we would expect ~45 chief executives to leave during a major system reorganisation.
If we use the higher figures from healthcare and corporate merger studies, the number rises to 60–75 senior leaders.
What do we actually see? Public reporting over the last eighteen months points to exits by:
- NHS England CEO, plus
- a cluster of senior national directors exiting.
- At least 10 ICB chief executives stepping down or being replaced.
- Trust CEO turnover approaching a quarter of posts;
- implying 50 or more trust-level departures, including permanent and unplanned exits.
Taken together, a guesstimate is between 60 and 80 chief executives and equivalent senior leaders have left their roles across the NHS in the last eighteen months.
That is a forest fire sweeping through top NHS management and puts the system squarely within… and arguably above… the range predicted by management research during disruptive change.
Heaven knows what the numbers are in the middle ranks facing redundancy, or those who have just had enough, gone... adding fuel to the fire of losses.
This is not coincidence. Not a failure of resilience or commitment.
It is what happens when leaders recruited to run organisations find themselves instead, managing perpetual transition, blurred accountabilities, moving goalposts, financial retrenchment, political intervention and rising personal exposure with diminishing authority.
Hospital Boards... vassal boards, in name only. The delivery arm… the Amazon for NHSE that is, in turn, the Deliveroo for the DH+. Administrators. Processors.
The risk is not just the loss of talented individuals…. the latest of which is Rob Webster, who, in our recent Podcast sounded to me like he was pleased to be strapped-in for a the rocky-ride ahead? Now, now he is going.
Each departure takes with it institutional memory. What’s been tried, what failed, what nearly worked and why.
New leaders arrive needing time to learn the landscape, rebuild relationships. Re-establish credibility. Strategies pause, rebrand or quietly disappear. Improvement programmes stall.
There’s also a cultural signal.
High turnover at the top tells the rest of the system that leadership is temporary. Risk is unrewarded and survival matters more than stewardship.
Authority is put at question.
That encourages short-term-ism, compliance and caution. Precisely the opposite of what complex service reform needs.
Management studies are clear... successful transformation depends on leadership stability, clarity of purpose and time. The NHS currently offers its leaders ambiguity, turbulence and impatience.
The threat is not chaos tomorrow morning. It’s a slower burn and more dangerous…
… a system that learns to be very good at reorganising itself and steadily worse at delivering lasting improvement.
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Have the best weekend you can...
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