NHS trust leaders are navigating one of the most complex periods the service has seen. NHS England’s Revenue Finance and Contracting guidance [ 1 ] has raised expectations around financial governance, accountability and board ownership of performance. Chief executives, executive teams and non‑executive directors are now expected to demonstrate stronger grip at a time when financial and workforce pressures continue to intensify.
At the same time, trusts must deliver transformation, improve productivity and maintain quality of care. Balancing strategic ambition with operational discipline has become significantly harder, not because leaders lack intent, but because the environment around them has fundamentally shifted.
Recent commentary, including HSJ’s Following the Money, highlights an increasingly tough stance from NHS England: weaknesses in financial governance or requests for cash support are now seen as signs that boards “do not have a grip”. Accountability has clearly widened from finance directors to entire boards.
But this perspective risks oversimplifying the challenge. In many organisations, leaders are being asked to take collective ownership of financial and operational risk without access to coherent, reliable insight. Data remains scattered across systems, inconsistent in quality and difficult to reconcile. Reporting often lags reality. Operational decisions cannot easily be linked to financial impact.
The issue is not unwillingness to lead. It is that leaders cannot control what they cannot see.
The evolving NHS operating model adds another layer of challenge. Leaders must balance local accountability with system priorities, while ensuring financial viability. Yet system‑wide insight into demand, cost and activity is often incomplete. Without a shared evidence base, even the most capable leadership teams struggle to assess risk, challenge assumptions, or intervene early.
A clear strategy and strong relationships remain essential. But neither can replace the need for consistent, connected, real‑time information.
Transformation remains a central expectation, yet the margin for error has narrowed. Trusts are asked to deliver meaningful change while demonstrating value for money and maintaining financial control.
High‑level plans are not enough. Leaders need:
Without these fundamentals, transformation becomes guesswork and grip becomes impossible.
Boards are being asked to engage more deeply with financial and operational information that is increasingly complex. Non‑executive directors must challenge assumptions and provide assurance, but often do so without access to clear, accessible insight.
For boards to take genuine ownership of performance, they need information that is transparent, timely and aligned with organisational reality. Culture and capability matter, but they depend on the quality of the data that underpins decision‑making.
The narrative that CEOs and boards lack grip captures only part of the truth. Yes, expectations are rising. But the barriers are structural, not personal. NHS leaders are being asked to deliver stronger assurance in a system where meaningful, connected insight is still difficult to obtain.
The real challenge is not a deficit of leadership, but a deficit of usable information.
LOGEX works closely with NHS organisations facing these pressures. We see first‑hand how greater transparency, activity‑based insight and scenario planning enable boards to lead with confidence and meet regulatory expectations.
By bringing operational and financial data into a single, coherent view, our tools help leaders:
Grip is not just about accountability. It is about creating conditions that allow leadership to succeed.
[ 1 ] https://www.england.nhs.uk/long-read/revenue-finance-and-contracting-guidance-for-2025-26/