Sarah-Jane Marsh, Chief Executive of Birmingham Children’s Hospital NHS Foundation Trust

The year 2015 is a challenging time to be an NHS chief executive. The expectations of patients, families and staff are rightly high; the money available, and financial and regulatory flexibility to implement change, is low. Coupled with this, we cannot recruit or retain the workforce we need for the present, let alone the future – and there is organisation after organisation  those reason for existence is to hold up a scorecard to tell us how we are getting on.

So, what do we need from the chief executive of NHS Improvement to help us deliver even better services for our populations against these challenges?

We need to move away from the rigid organisational forms that are constraining us. Is the foundation trust model the right one for 2015? Can we instead be allowed to re-shape and re-form at pace?

First, we need to be inspired: inspired by someone who cares about patients, families and staff, but also who cares about us as chief executives, and wants to support us to do a better job. Just like everyone else, we work better when we feel valued. This has been starkly absent over recent years.

Second, we need a plan for the money. We all know there is little additional cash – and pretending this is not the case represents a highway to nowhere. What will the tariff/funding arrangements look like going forward? How will existing debt be restructured in a sustainable way? How will we access much-needed capital? ‘There is no money’ is not a responsible answer.

Third, we need to move away from the rigid organisational forms that are constraining us. Is the foundation trust model the right one for 2015? Can we instead be allowed to re-shape and reform at pace, by a process that supports rather than overwhelms us, especially when it is clearly the right thing to do?

Fourth, the regulatory frameworks should be aligned. We need one definition of what ‘good’ looks like, and to be held to account for that. At the moment, no chief executive really knows the ‘rules of the game’.

Fifth, and most important of all, we need someone who believes in the NHS, and who we believe can lead us out of the most difficult position in our history. Someone with vision, passion and drive, but also the ability to turn plans into actions, and surround themselves with deliverers who can make things happen at speed.

The year 2015 is also an amazing time to be an NHS chief executive. Patients and families are more willing than ever to participate in their own care and ensure they keep fit and well. Our staff are some of the best in the world and they never give up or in. Every day is a ‘going the extra mile’ day. Whoever gains the privilege of becoming chief executive of NHS Improvement needs to recognise that we are an organisation of 1.3 million people – not a series of systems and processes – and, when all is said and done, there is more to cherish and maintain than there is that needs to change.