Mike Farrar’s resignation raises questions about who the next NHS England chief exec might be

The NHS Confederation announced yesterday that its chief executive, Mike Farrar, would be standing down at the end of the month. It was a reasonably abrupt announcement, although Mr Farrar did establish a consultancy business in addition to his duties with the Confederation some months ago, so although his resignation has come somewhat out of the blue, his decision to move into the consultancy world full-time is hardly shocking. In standing down, Mr Farrar has perhaps also taken himself at least somewhat out of firing line ahead of an independent inquiry into the failings at University Hospitals of Morecambe Bay (Mr Farrar headed up the local Strategic Health Authority during the period covered by the enquiry). If the more recent inquiries and reports into standards of NHS care are anything to go by, the plausible scenario is that the inquiry will generate some damning criticisms of the local health service and its leaders.

But Mr Farrar did not just announce that he was standing down from the NHS Confederation. He also revealed that he would not be applying to succeed Sir David Nicholson as NHS Chief Executive when Sir David retires in March.

With this additional revelation, Mr Farrar joined a lengthening list of candidates who have ruled themselves out of the running to take Sir David’s chair. Former NHS England chief operating officer and deputy chief executive Ian Dalton has already ruled himself out (having taken up the position of the President of Global Health at BT Global Services), as have Sir Bruce Keogh (NHS England medical director) and Dame Barbara Hakin, who succeeded Mr Dalton as NHS England deputy chief executive on an interim basis. Indeed, it is now looking unlikely that Sir David’s successor will come from within NHS England – and possibly not even from within the NHS.

There is admittedly still nearly six months until Sir David retires and a number of highly plausible candidates have been mooted as possible successors – including US-expert Professor Don Berwick (author of the high profile review into NHS patient care earlier in the year) and Dr Mark Britnell (formerly a senior figure within the NHS, now global head of health at KPMG). However, Mr Farrar’s withdrawal from consideration will further reduce the options for NHS England Chair Professor Malcolm Grant, and ultimately for Health Secretary Jeremy Hunt. It also underlines the now very public nature of the chief executive role and whoever succeeds Sir David can be expected to face similar levels of scrutiny not only from the specialist healthcare media but from the national press.

The job description for the role of NHS England chief executive has stated that healthcare experience is not essential, but that the successful candidate will have a track record of securing value for money. It now looks increasingly likely that the role may be filled by a candidate from outside the UK as Ministers attempt to create a break from anyone caught in one of the recent health service scandals. But could we see a completely unexpected candidate, from outside not only the NHS but the healthcare sector, come to the fore? Or, as Alastair McLellan of the Health Service Journal has suggested, could we see Sir David still at the helm after March 2014 – albeit in a caretaker role?

Chris Rogers