You are Helen Ashworth, chair of the board of Pennine Cardiac Institute in Leeds. The director of your largest unit has resigned, the national registry closes in fourteen weeks, and two finalists are waiting. Before the board compares them, you must decide what the post needs above all.
The situation
On Wednesday 4 February 2026 Professor Alan Voss, who has run Pennine Cardiac Institute's (PCI) interventional cardiology unit for nine years, resigned to take a chair abroad. He leaves in twelve weeks. He has written the unit's submission to the national cardiac registry himself every year since 2017, and the registry closes its data window on 15 May. The unit brings in £41 million of the institute's £88 million turnover; the operating surplus is £4.4 million.
What PCI sells to the commissioners who buy its NHS activity, to referring cardiologists and to trials sponsors is the outcomes it publishes in that registry. Two commissioners hold outcome-contingent clauses: a ranking below the top quartile puts £12 million of activity out to re-tender. The board's running read of the submission is 62 out of 100, against 70 for the top quartile. And £6 million of trials funding names a principal investigator of record, a role sponsors accept only from a credentialed cardiologist.
Of the unit's eleven consultants, four have signalled they might follow Voss or move to a rival London centre that has been recruiting PCI's registrars since the autumn. Each replacement costs about £180,000 and takes nine months. The board's index of whether the unit believes its leader understands its work stands at 30 with the post vacant. You have £350,000 approved for the transition.
Two finalists came through a shortlist of nine. Dr Priya Anand, 44, is an interventional cardiologist in London with a top-decile personal outcomes record and no management post behind her. Marcus Reeve, 51, has led two NHS turnarounds, carries a £60 million budget and has no clinical background. Your board has split three ways: some see an operating problem, some a clinical one, some a question of leadership pure and simple. You came to PCI from finance, not medicine.