Nepotism, questionable payouts and a revolving door of jobs for disgraced fat cats: Inside story of the NHS’s ‘revolving door’ of bosses

Paula Vasco-Knight was chief executive at Torbay and South Devon NHS Foundation Trust and had previously enjoyed the prestige of being appointed NHS England’s national lead for equality – and, two years later, was awarded a CBE for her work on equality and diversity.

But later that year, things seemed to unravel, after an employment tribunal awarded whistleblower Clare Sardari, a former nurse at Torbay Hospital, £230,000 after she was bullied and intimidated for complaining about Vasco-Knight’s ‘nepotism and favouritism’.

The NHS boss had appointed her daughter’s boyfriend as the hospital’s equality and diversity manager without a fair selection process.

The allegations led to Vasco-Knight’s suspension from her job. She subsequently resigned. In a statement announcing her departure, the trust said she was relocating to the North West for family reasons.

It said that ‘considerable success’ was achieved during Vasco-Knight’s tenure and that it was ‘unfortunate her achievements had been overshadowed by the tribunal judgment’.

Yet instead of being barred from any other leadership position, she landed further high-paying NHS roles.

First, Vasco-Knight was appointed as chief operating officer at St George’s University Hospitals NHS Foundation Trust in south London, then she was promoted to being its acting chief executive.

Shortly after, however, Vasco-Knight was arrested and convicted of fraud for funnelling NHS money to her husband’s business while at the Torbay and South Devon NHS Foundation Trust. She had authorised payment of £11,072 to his graphic design business for work which was never carried out.

The couple later produced a document to justify the invoice. But investigators found it could not have been created in the year they claimed as it contained ‘text copied straight from a document that wasn’t published until November [the following year]’.

Vasco-Knight was given a 16-month suspended prison sentence. Her husband Stephen received a two-year suspended sentence after pleading guilty to fraud.

The couple said they didn’t have enough money to pay back the £11,072. However, a few months later, Exeter Crown Court ordered them to pay back the amount after the NHS Counter Fraud Authority found they had undeclared assets. Vasco-Knight was stripped of her CBE in 2017.

In 2018, the Parliamentary and Health Service Ombudsman said the Vasco-Knight case represented a failing by the hospitals regulator, the Care Quality Commission, to administer Fit and Proper Person Regulations (FPPR), which ensure those appointed to director-level across the NHS are fit for the role.

Vasco-Knight’s story started in 2014, but it is not an isolated case.

Sadly, it is an all too familiar situation: known as the NHS revolving door – where highly paid senior hospital bosses who have moved on from their posts under a cloud end up in other roles within the health service.

Stopping it is something successive governments have promised repeatedly. Now, finally, ministers are formulating a legal process to ensure it no longer happens.

But it may take years before this process comes into force – and, even then, critics warn that it may prove weak, putting patients and staff at risk.

Another example is that of Dr George Thomson, an endocrinologist who, in 2012, joined Rotherham NHS Foundation Trust as medical director on £185,000 a year.

In 2014, he was suspended on full pay for six months while being investigated over accusations of ‘unprofessional behaviour’.

A report by Deloitte found that the trust’s board, which included Dr Thomson, was ‘dysfunctional and ineffective’ – although the section of the report which addressed problems with individual directors’ behaviour was redacted.

A Rotherham NHS spokeswoman said at the time they would not disclose the reason for Dr Thomson’s absence because it ‘would not be appropriate’.

Dr Thomson left the trust in November 2014, taking up the same position at Northern Devon Healthcare NHS Trust the following year. At the time the trust’s medical advisory committee wrote to the chairman and chief executive, highlighting ‘serious concerns’ over the move.

In a letter released to the media, they expressed worry about allegations of ‘unprofessional behaviour’ by Dr Thomson at Rotherham.

In January 2018, the medical advisory committee passed a vote of no confidence in Dr Thomson, citing allegations of ‘intimidating and bullying behaviour towards senior clinicians’ at Devon as well as ‘a lack of clinical leadership’.

The trust launched an investigation and Dr Thomson stayed off work for nine months, while continuing to receive his £300,000 salary. The trust did not disclose its findings, but Dr Thomson left in December 2018, taking an undisclosed payment ‘in lieu of notice’.

A Good Health investigation has now discovered that Dr Thomson is working as a consultant physician at the Royal Cornwall Hospitals NHS Trust.

We asked the trust to put questions about the situation to Dr Thomson. A spokeswoman said: ‘As with all staff who work at the hospital, he is appraised annually. He is well regarded by patients and colleagues. There have been no complaints about the care he provides.’

NHS head Katrina Percy also resigned under a cloud, only to reappear in another highly paid post. She was chief executive at Southern Health NHS Foundation Trust but quit in August 2016 after the organisation faced intense criticism over failings to investigate the deaths of hundreds of mental health and learning disability patients between 2011 and 2015.

One patient, 18-year-old Connor Sparrowhawk, drowned in a bath at Slade House in Oxford, a facility for people with learning disabilities and mental health needs in July 2013. The trust later admitted its neglect caused his death.

Ms Percy resigned in August 2016, but rather than leaving the NHS, she moved into a newly created ‘strategic’ role within the same trust, receiving the same £180,000 salary as her previous chief executive job.

Connor’s mother Sara Ryan said at the time: ‘It is a scandal… it doesn’t happen in the real world. She failed as a chief executive. How could she possibly keep the same salary?’

Gail Hanrahan, from the Oxfordshire Family Support Network (for carers of people with learning disabilities), said: ‘It’s typical NHS culture… There seems to be no consequences for her after years of documented failure.’

Ms Percy left the trust a few weeks later, in October 2016. She is now the joint chief executive officer of the National Association of Primary Care (NAPC), a membership body for primary care professionals.

The NAPC’s website says: ‘Katrina was an NHS CEO for almost ten years. [She] is known for leading transformational and innovative change through the creation of integrated primary and community care teams.’

(Despite numerous efforts to speak to Katrina Percy, Good Health has received no response.)

Then there’s the case of Professor Steven Trenchard, a mental health nurse by background. He resigned from his £150,000-a-year post as chief executive of Derbyshire Healthcare NHS Foundation Trust after a whistleblower-bullying scandal.

An employment tribunal in 2015 heard that the scandal began when the trust’s human resources director Helen Marks accused the then-chairman Alan Baines of sexual harassment. Professor Trenchard colluded with Mr Baines ‘in an attempt to dismiss the claimant or alternatively obtain her resignation’, it was claimed.

Mrs Marks was awarded £800,000 and received an apology from the trust. Professor Trenchard was then suspended for seven months, earning £90,000 while not at work.

In February 2016, he resigned with a £75,000 pay-off.

Five months later, he was hired by Pennine Care NHS Foundation Trust, which covers Greater Manchester, as part-time consultant project director.

His appointment was criticised by Mrs Marks and by the then-Derbyshire MP Pauline Latham, who said: ‘Do they really want someone working there who has such a stain on his character?’.

Professor Trenchard is now a lecturer in mental health nursing at Keele University. (Despite attempts to contact Professor Trenchard and the university, we received no response.)

But perhaps the highest-profile NHS revolving door case involves Sir David Nicholson. He was held responsible by MPs and patient campaigners for not taking action over the Mid-Staffordshire hospital scandal where up to 1,400 patients may have died due to neglect and poor care – while he was head of the West Midlands Strategic Health Authority.

Sir David, who earned £290,000-a-year in the role, was dubbed the ‘man with no shame’ by protesters after reportedly ignoring warnings that patients were dying. (He was also criticised over a £50,000-a-year expenses bill which included first-class travel.)

Sir David took early retirement from the NHS in 2014 and left with a £2million pension pot. Initially, he spent his time advising private sector companies.

However, four years after quitting under a cloud, he returned to a health service job – as part-time chairman of Worcestershire NHS Trust, earning £40,000 a year.

The Mid Staffs families were appalled. ‘[This man] left the NHS because of the shocking state it was in and now they are bringing him back,’ said Julie Bailey, whose mother died at Stafford Hospital.

Sir David stood down as chairman in August 2022. But he then became chairman at the Dudley Group NHS Trust, having also been appointed chairman of Sandwell and West Birmingham Hospitals NHS Trust in 2021. He also took on the chairmanship of the Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust in 2023.

In 2024, the Royal Wolverhampton trust announced that Sir David would continue in his role as chairman of these four Black Country trusts until 2027.

A spokeswoman told Good Health: ‘Sir David Nicholson was subject to the appropriate Fit and Proper Person Regulations (FPPR) checks as part of his appointment, with the required checks undertaken in line with NHS requirements. The FPPR checks are also undertaken annually.’

The case made for retaining these senior people in the NHS is that the wealth of experience and expertise they hold would otherwise be lost to the service.

But, over the past 20 years, a number of expert reports have called for an end to the revolving door for discredited NHS managers.

A review on NHS leadership, conducted by former Marks & Spencer chief executive Stuart Rose in 2015, reported that failing senior NHS managers were frequently moved on, only to resurface in new, well-paid leadership roles at different trusts.

In 2019, an independent review – led by Tom Kark KC and set up in the wake of scandals such as Mid Staffs amid fears that poor top managers were being allowed to ‘fail up’ into other powerful jobs – declared that FPPR were failing.

Tom Kark recommended stronger disciplinary measures and broader definitions for what constitutes management misconduct.

However, it wasn’t until last year that the Government set out plans to formally regulate senior NHS managers, including preventing those who commit serious misconduct from taking up other senior health service jobs.

It said that a new statutory ‘barring system’ would be introduced for NHS board-level directors and the managers who report to them directly. The Health and Care Professions Council (HCPC), which regulates 15 other health and care professions, would also be given the power to bar NHS managers who had committed serious misconduct from taking up other senior NHS roles.

Bernie O’Reilly, chief executive of the HCPC, told Good Health: ‘If a senior leader is found to have committed serious misconduct, they should not be able to continue to lead in the NHS.’

However, he added that initial work on this will not start until early 2027. ‘The exact mechanism and scope of the barring system is still to be developed, consulted on and decided,’ he says.

But just before the announcement of the new plans, the Professional Standards Authority for health and social care warned that the HCPC itself takes too long to resolve professional fitness to practise cases and that its pile of older unresolved cases had grown in 2024.

As Dr Tom Kane, chairman of the professional regulation committee at the British Medical Association, told Good Health: ‘A disbarring system run by an already overburdened, existing regulator won’t be enough to crack down on poor management.

‘We need to see the creation of a new regulator with a robust investigatory and tribunal service and a statutory register for managers.’

Matthew Tuff, joint vice president of the campaign group the Association of Personal Injury Lawyers, concurs: ‘A barring system is long overdue, but the current laudable proposals would only apply to board-level directors and the people who report to them directly.

‘The system should apply to all senior managerial roles that have significant responsibility and impact on patient safety.’

The barring system is also only cautiously welcomed by Managers in Partnership, the union for managers and other senior staff in health and care services.

Its chief executive Jon Restell told Good Health: ‘The proposals are bedevilled by technical problems, including the fact that many managers are also clinically registered as doctors and are already covered by a different regulator [raising confusion over who has jurisdiction].’

But Tom Kark says that although the new system may not turn out to be perfect, it is ‘very welcome and long overdue’.

He adds: ‘The power to disbar rogue NHS senior managers was first proposed by a report in 2002, then again in 2012 and by my report in 2019. We did recommend that it should be put in the hands of a new independent regulator, but it would take much longer and cost more to do this.’

A Department of Health and Social Care spokesman told Good Health: ‘NHS patients need to know that the best people are in charge… rather than individuals who have already had to be removed for their failings elsewhere.’