The National Health Service (NHS) is grappling with a persistent issue known as the 'revolving door,' where senior executives who have departed from their positions under a cloud of controversy or questionable payouts often secure new, high-paying roles within the health service. This phenomenon has drawn criticism from patient advocates and prompted government initiatives to reform leadership regulations.
Recent cases highlight the challenges. Paula Vasco-Knight, former chief executive of Torbay and South Devon NHS Foundation Trust, was suspended and later resigned following allegations of nepotism. An employment tribunal awarded a whistleblower £230,000 after finding she had bullied staff for complaining about Vasco-Knight's favouritism, including appointing her daughter's boyfriend to a managerial position without a fair selection process. Despite these issues, Vasco-Knight subsequently took on roles as chief operating officer and acting chief executive at St George’s University Hospitals NHS Foundation Trust. Her tenure was further marred by a conviction for fraud for funneling NHS money to her husband’s business; she was later stripped of her CBE.
Another case involves Dr. George Thomson, who left Rotherham NHS Foundation Trust after being suspended over allegations of unprofessional behavior. He then took up a similar position at Northern Devon Healthcare NHS Trust, where a medical advisory committee had expressed concerns about his previous conduct. Dr. Thomson remained off work for nine months at the new trust while continuing to receive his salary before departing with an undisclosed payment.
Katrina Percy resigned as chief executive of Southern Health NHS Foundation Trust amid criticism for failing to investigate hundreds of patient deaths. Instead of leaving the NHS, she moved into a newly created senior role within the same trust, maintaining her previous salary. Similarly, Professor Steven Trenchard resigned from his chief executive post at Derbyshire Healthcare NHS Foundation Trust following a whistleblower-bullying scandal, receiving a substantial payoff. He was later hired by Pennine Care NHS Foundation Trust as a part-time consultant project director.
Perhaps the most prominent case cited is that of Sir David Nicholson, who was held responsible by MPs and patient groups for inaction regarding the Mid-Staffordshire hospital scandal, where numerous patient deaths were linked to neglect and poor care. After taking early retirement with a significant pension, he returned to the NHS in a part-time chairman role at Worcestershire NHS Trust, and later took on chairmanships at several other trusts.
The practice has been repeatedly criticized by expert reviews over the past two decades. A 2015 review by former Marks & Spencer chief executive Stuart Rose noted that failing senior managers were often moved to new, well-paid roles. A 2019 independent review led by Tom Kark KC found that existing regulations, known as Fit and Proper Person Regulations (FPPR), were failing and recommended stronger disciplinary measures.
In response to these ongoing issues, the government last year announced plans to formally regulate senior NHS managers. These plans include introducing a statutory 'barring system' to prevent individuals who commit serious misconduct from taking up other senior positions within the health service. The Health and Care Professions Council (HCPC) is expected to be given the power to bar such managers.
However, the implementation of this barring system is expected to take years, with initial work not set to begin until early 2027. Critics have raised concerns about the potential effectiveness of the proposed system, with some arguing that it may be too narrowly applied or that existing regulatory bodies are already overburdened. The Professional Standards Authority has warned that the HCPC’s existing processes for resolving fitness to practice cases are slow. Some experts suggest the creation of a new, independent regulator with a robust investigatory and tribunal service might be necessary.
Despite these concerns, the proposed barring system is seen as a welcome, albeit long-overdue, step. The Department of Health and Social Care stated that NHS patients deserve to be led by competent individuals, not by those who have been removed due to past failings.