The UK's National Health Service (NHS) is grappling with a persistent issue known as the "revolving door," where senior executives who depart under a cloud of scandal or mismanagement frequently secure new, high-paying positions within the health service. In response, the government is formulating a legal process to prevent this pattern, although its effectiveness remains a subject of debate.
The issue came to prominence with the case of Paula Vasco-Knight, who was chief executive of Torbay and South Devon NHS Foundation Trust. Following allegations of nepotism, which led to an employment tribunal awarding a whistleblower £230,000, Vasco-Knight resigned. Despite these circumstances, she later held chief operating officer and acting chief executive roles at St George's University Hospitals NHS Foundation Trust. Her tenure was further complicated by a fraud conviction for funneling NHS funds to her husband's business, resulting in a suspended prison sentence and the eventual stripping of her CBE. The Parliamentary and Health Service Ombudsman later highlighted that the case exposed a failing by the Care Quality Commission to adequately administer Fit and Proper Person Regulations (FPPR).
Dr. George Thomson, an endocrinologist, also exemplifies the revolving door phenomenon. After being suspended from his £185,000-a-year role as medical director at Rotherham NHS Foundation Trust due to allegations of unprofessional behavior and a finding that the board was dysfunctional, he moved to the Northern Devon Healthcare NHS Trust in a similar position. Concerns were raised by the trust's medical advisory committee regarding his past conduct, and a vote of no confidence was passed due to allegations of bullying and a lack of clinical leadership. He remained off work for nine months, receiving his salary, before leaving with an undisclosed payment.
Katrina Percy, former chief executive of Southern Health NHS Foundation Trust, resigned amid criticism for the organization's failure to investigate hundreds of patient deaths. Despite her departure, she transitioned into a newly created strategic role within the same trust, retaining her £180,000 salary. Critics, including the mother of a patient whose death was attributed to the trust's neglect, condemned the move, calling it a scandal and highlighting a perceived lack of consequences for failure.
Professor Steven Trenchard, who resigned as chief executive of Derbyshire Healthcare NHS Foundation Trust following a whistleblower-bullying scandal, received a £75,000 pay-off. Five months later, he was hired by Pennine Care NHS Foundation Trust as a part-time consultant project director. His appointment was met with criticism from a whistleblower and a Member of Parliament.
Perhaps one of the most high-profile cases involved Sir David Nicholson, who faced responsibility for patient neglect and poor care during the Mid-Staffordshire hospital scandal. After taking early retirement in 2014 with a substantial pension, he later returned to the NHS as a part-time chairman of Worcestershire NHS Trust. He subsequently held chair positions at several other NHS trusts, with appointments extending until 2027.
These cases have led to repeated calls for reform. A 2015 review by Stuart Rose highlighted the pattern of failing senior managers resurfacing in new roles. In 2019, a review led by Tom Kark KC concluded that FPPR were failing and recommended stronger disciplinary measures. Last year, the government announced plans to introduce a statutory "barring system" for NHS board-level directors and their direct reports, empowering the Health and Care Professions Council (HCPC) to prevent individuals who commit serious misconduct from holding senior NHS positions.
However, the proposed system faces potential challenges. The HCPC has been warned about delays in resolving professional fitness to practice cases. Critics, including Dr. Tom Kane of the British Medical Association, suggest that an overburdened existing regulator might not be sufficient and advocate for a new regulator with a robust investigatory service. Matthew Tuff of the Association of Personal Injury Lawyers argues the system should encompass all senior managerial roles impacting patient safety, not just board-level positions.
Jon Restell of Managers in Partnership notes that the proposals may be complicated by situations where managers are clinically registered and fall under different regulatory bodies. Despite these concerns, Tom Kark acknowledges that the new system, while not perfect, is "very welcome and long overdue," noting that the power to bar rogue managers was first proposed in 2002.
A Department of Health and Social Care spokesperson stated that patients need assurance that "the best people are in charge... rather than individuals who have already had to be removed for their failings elsewhere."