Annette Doherty has resigned as Chair of East Kent Hospitals University NHS Foundation Trust, just over a year after taking up the post, following an attempt to suspend the trust's Chief Executive that was subsequently found to have exceeded her authority.

Doherty, who was appointed in early 2023 with a mandate to oversee the trust's recovery from years of poor performance and clinical failures, moved to suspend Chief Executive Tracey Fletcher without securing the support of the board's non-executive directors or following established NHS governance protocols. The action was overturned, Fletcher returned to her post, and Doherty's position became untenable.

The precise circumstances that prompted Doherty to act unilaterally have not been disclosed publicly. What is clear is that the decision was taken without the board consensus required under NHS governance frameworks, and that when challenged, it did not stand. The Chair's resignation followed.

East Kent is no ordinary trust to lead. It has sat at the highest level of NHS England intervention, National Oversight Framework 4, for a sustained period, and remains in the process of implementing recommendations from the 2022 Kirkup report. That inquiry, led by Dr Bill Kirkup, found that the deaths of dozens of babies and mothers in the trust's maternity services were, in large part, avoidable. Its findings were damning not only about clinical practice but about a culture that failed to listen to families and failed to learn from mistakes. The trust has been attempting to rebuild ever since.

Against that backdrop, the governance breakdown at board level carries particular weight. A trust under this degree of national scrutiny depends on stable, functional leadership to make credible progress. The relationship between a chair and a chief executive is the central axis of NHS board governance. When it fractures publicly, and in a manner that requires external adjudication, the institution's ability to project confidence to staff, regulators and patients is compromised.

NHS England is expected to conduct a further review of board governance at the trust to establish how the dispute arose and why established processes were not followed before the suspension was attempted. That review will need to examine not only the specific incident but the broader dynamics within the boardroom over recent months.

In the immediate term, the trust requires an interim chair. That appointment will be made against a backdrop of significant workforce and public anxiety. Staff at East Kent have lived through years of regulatory intervention, public inquiry and reputational damage. Patients and families, particularly those with direct experience of the maternity services failures, have had reason to watch the trust's leadership closely. Another departure at the top does little to reassure either group.

This is the fourth chair the trust will have sought in five years, a figure that illustrates the scale of the leadership instability it has endured. Each transition carries a cost: in institutional memory, in relationships with regulators and commissioners, and in the time it takes a new appointee to understand the specific pressures of an organisation in special measures.

Turning around a trust at this level of intervention is genuinely difficult. The board is expected to drive rapid change while an executive team manages the day-to-day reality of running a large acute hospital under resource pressure. Those two imperatives do not always align neatly, and the tension they generate can become acute. That tension does not excuse a departure from governance process, but it does help explain why leadership relationships at trusts in this position are so frequently strained.

What East Kent needs now is a chair with the experience to hold that tension without it becoming destructive, and the credibility to reassure NHS England that the board can function as it should. Whether such a figure can be found quickly, and whether they will stay, are questions the trust has had cause to ask before.