For years, a quiet convention has shaped the careers of NHS executives who presided over institutional failures: move on, and the accountability largely moves on with you. Investigations continue, inquiries publish their findings, and families wait for answers. The executives, meanwhile, take up new posts, start new contracts, and acquire a kind of institutional amnesia that is, in practice, very difficult to challenge through formal process. That convention, if Sir Jim Mackey follows through on his stated intentions, may now be approaching its end.

Speaking at the IPPR conference this week, the NHS England chief executive confirmed that the organisation is examining changes to senior leaders' employment contracts to make it easier to hold them to account for failures that occurred on their watch, even after they have left the relevant post. The statement was brief, as these announcements often are. The implications are anything but.

The immediate backdrop is the Nottingham maternity scandal. The independent inquiry into care failures at Nottingham University Hospitals NHS Trust, which has implicated dozens of babies and mothers in preventable deaths and injuries over more than a decade, has been obstructed in part by the refusal of former senior managers to cooperate with investigators. That obstruction is not, under current arrangements, straightforwardly enforceable. Employment contracts expire with the role. Obligations to cooperate with future investigations are rarely built into them. The result is that accountability, formally speaking, has a convenient off switch.

This is not a new problem and not unique to Nottingham. The pattern has appeared across major inquiries into NHS failures, from Mid Staffordshire to Morecambe Bay to the East Kent maternity report. Senior figures who held operational or strategic responsibility at the time of failure are frequently absent from the accountability process that follows, not through any legal obstruction in the traditional sense, but through the structural gaps in how NHS employment is designed. The system was never built to chase its own leaders.

What Mackey is now signalling is a shift toward individual regulatory liability, rather than collective institutional accountability. The distinction matters. When an NHS trust is found to have failed, the institution absorbs the scrutiny, the regulator intervenes, and the remediation plan is written for the organisation. The individuals who shaped the culture or made the decisions that led to harm often emerge with their professional standing intact, their next appointment unaffected. Contract reform, properly designed, would change that calculus. It would mean that accepting a senior NHS role comes with a durable legal and professional obligation that does not simply expire when the contract does.

The proposed changes also intersect with the broader legislative direction signalled in the government's forthcoming Standards Bill, which is expected to clarify which NHS leaders fall within the definition of regulated healthcare professionals, and what sanctions follow from failure to meet expected standards. That legislative framing matters, because employment contract reform alone cannot enforce cooperation with an inquiry if the legal basis for compelling evidence is absent. The two strands, contractual and legislative, will need to develop in parallel if the ambition is to be meaningful rather than symbolic.

There will be concerns from some quarters about whether tighter accountability provisions could discourage experienced leaders from taking on the most difficult turnaround roles in the NHS. That argument has some surface logic. Trusts in special measures are high-risk environments, where inherited problems are severe and the likelihood of further failure, even under competent leadership, is not negligible. A system that attaches personal liability too bluntly could create perverse incentives, making the hardest jobs the least attractive. Any contract reform will need to distinguish clearly between failures of judgement and failures of governance inherited from predecessors.

But that concern, while legitimate, should not become a reason to preserve the existing gap. The families who lost children or mothers to preventable harm in Nottingham are still waiting for a full account of what happened and why. The executives who could provide that account are, in some cases, drawing NHS salaries elsewhere. Whatever risks come with raising the accountability bar for senior leaders, they are considerably smaller than the institutional cost of a system that continues to treat departure as a form of immunity.