This report, published in partnership with NHS Providers, draws on the views and experiences of twelve departed or departing chief executives, or those changing jobs within health care. It aims to illuminate the realities of leadership in today’s NHS. The interviews illustrate both the positives of the job and its current difficulties. It concludes that the difficulties need to be addressed if we are, first, to hold on to experienced leaders who are able to transform the NHS in an innovative way, and, second, recruit the next generation.