Nearly two-thirds of NHS trusts had a first-time CEO in 2023, and almost a third of current chief executives have been in post less than 18 months. At a time when stability is most needed, NHS leadership is in constant flux.

This churn isn’t random, it reflects a system under impossible strain. New leaders inherit spiralling deficits, rising demand, and the political drive to suppress workforce flexibility while still hitting recovery targets. With average investment in leadership development at just £106 per manager per year, the pipeline is shallow; leaders are often promoted too soon, without the preparation or support to succeed.

On top of this, national performance pressure and blame culture make CEOs expendable. Fail to turn around A&E waits or financial deficits fast enough, and the solution is often another change of leader. The result: a revolving door at the top, shifting priorities, and weakened accountability. Staff lose confidence, reforms stall, and continuity vanishes.

Patients don’t see boardroom changes; they feel the consequences in longer waits, stalled improvements, and services stuck in transition. When leadership churn becomes the norm, resilience breaks down. The NHS doesn’t just need more leaders, it needs conditions where leaders can lead.