Chapter 9: Succession - What Good Looks Strategic Plannig Looks Like.

Ask most boards about succession and someone will point to a document. It's usually in a folder, written a couple of years ago, with a name or two pencilled in for "emergency cover", maybe even a line on the BCP. Everyone agrees it's important. Nobody has opened it since.

That's not succession planning. It's an emergency drawer, and the trouble with emergency drawers is that you only find out what's missing when you open one in a hurry.

In a good board, succession is a live discipline. It's on the agenda every year and it shapes who gets developed, who gets stretched and who gets recruited. And it covers the boardroom as well as the executive team. Because the departure that catches most independent providers out isn't the CEO's. It's the founder-chair who has quietly been the organisation's memory for fifteen years.

Why it matters more in the independent sector

In a large NHS trust, a departing chief executive leaves behind a deep bench of directors and a well-worn recruitment process. In a private hospital group, a specialist clinic or a family-run provider, the bench is often one or two people deep. Sometimes it's nobody at all.

Knowledge in smaller organisations also tends to live in heads rather than systems. The CEO who knows which consultant needs careful handling, which commissioner relationship is fragile, and why that one policy was rewritten after the incident in 2019. When that person leaves, the knowledge goes too, unless someone has deliberately planned to keep it.

And there's a regulatory dimension. CQC's Regulation 5 requires providers to make sure everyone acting as a director, or in an equivalent role, is fit and proper. That includes interim appointments. A rushed stopgap appointment is precisely when those checks get skipped. Separately, CQC's notification rules mean a registered manager's extended absence or departure is something you have to tell the regulator about, along with how the service is being run in the meantime. Neither of those is a good moment to start working out a plan.

Three horizons, not one plan

The boards that handle succession well tend to think about it on three timescales at once.

1.     Tomorrow morning. If the CEO were unavailable from 9am tomorrow, who steps in, with what authority, and who tells staff, CQC and your major partners? This is the contingency layer. It should be written down, agreed by the board and known to the people named in it.

2.     The next 12 to 24 months. Which internal candidates could be ready, with the right development, for an interim or permanent step up? What experience are they missing, and what is the organisation doing about it?

3.     The longer view. What will the organisation need from its next leader? The CEO who built the business may not be the CEO who scales it, or steers it through a new CQC framework. Succession is also a strategy question.

Most emergency drawers only cover the first horizon, and often not very well.

A word on language while we're here. Succession conversations are full of "what if she was hit by a bus tomorrow?" We'd like to see that phrase retired. It turns a sensible planning question into a grim joke about one person's misfortune. In a healthcare setting, where colleagues really do face sudden illness, bereavement and accidents, it can land badly too. It also frames succession as a rare catastrophe rather than ordinary governance. Leaders leave for all sorts of unremarkable reasons: a promotion elsewhere, a family move, retirement, burnout. Ask the question plainly instead: "If our CEO was unavailable from tomorrow, for any reason, what happens?" It's kinder, and it gets a better answer.

The CEO's exit

Good CEO succession starts long before anyone resigns. In practice it looks like this:

•      The board owns it, not the CEO. The CEO should contribute to talent conversations, but a CEO choosing their own successor is a governance risk, not a plan. The chair, or a nominations committee where you have one, leads.

•      Talent is reviewed by name. At least once a year, the board looks at the people one and two levels below the executive and asks who could do more, sooner.

•      Development is deliberate. Potential successors get real exposure: presenting to the board, leading on an inspection, chairing a governance committee. Nobody becomes board-ready by watching.

•      Knowledge is written down. Key relationships, decisions and their reasons, and the "why we do it this way" that never made it into a policy.

•      The exit itself is managed. Notice periods, handover plans and how the departure is announced to staff, patients, commissioners and CQC are all agreed in advance, not improvised.

The board's own succession

This is the half most boards forget. Directors, and especially non-executives, tend to stay until something makes them leave. Then a board that looked balanced is suddenly missing its only clinician, its only finance specialist or its chair, all at once.

What good looks like here:

•      A skills matrix that's actually used. The board maps what it has against what it needs: clinical, financial, legal, digital, regulatory, lived experience. Then it uses the gaps to drive recruitment, rather than recruiting people the chair already knows.

•      Staggered terms. Directors don't all arrive together, so they don't all leave together. Tenure is reviewed openly, and long service is valued but isn't treated as a job for life.

•      A plan for the chair. Who chairs the board if the chair can't? Who leads the search for the next one? These are questions the board answers together, ideally led by a senior independent director or equivalent.

•      Fit and proper from day one. Every new director, whether permanent or interim, goes through your fit and proper person process before taking up the role. No exceptions for "just covering for a few months".

•      Induction that builds the next generation. New directors are properly inducted into their governance and regulatory responsibilities, so that the board's knowledge isn't held by its longest-serving member alone.

Red flags

If any of these sound familiar, succession has drifted into the emergency drawer:

•      The succession plan hasn't been discussed at board in the last 12 months.

•      The only named successor is the CEO's own choice, and the board has never met them properly.

•      Nobody can say who would chair the next board meeting if the chair resigned tonight.

•      Every non-executive joined within the same year or two.

•      The registered manager and the CEO are the same person, and there's no named cover for either role.

Five questions for your next board meeting

1.     When did we last discuss succession, and what did we change as a result?

2.     If the CEO was unavailable from tomorrow, who would step in, and do they know?

3.     Which internal candidates are we developing, and what are we doing differently for them this year?

4.     What does our skills matrix tell us about the board we'll need in three years' time?

5.     Are our interim arrangements fit and proper-ready, or would we be cutting corners under pressure?

Succession is one of the clearest tests of whether a board is thinking beyond the next quarter. A plan that lives in a drawer protects nobody. A plan that the board talks about, updates and acts on protects patients, staff and the organisation's future, whoever happens to be leading it.

For your free succession planning leadership skills matrix, click here