Healthcare leadership, on both sides of the Atlantic

Welcome to issue two. Senior pay breaking the published benchmarks, a week of healthcare leadership across the Atlantic, and the moves worth knowing.

From my desk

Most of my week ran on healthcare, and a lot of it across the Atlantic. I am running senior health searches in Toronto and the Bay Area, and a good part of the week went on sourcing and lining up the right conversations. Recruiting construction leaders across borders is a different discipline to a UK regional search. The technical track record gets someone into the room; in North America, the relationships and the local knowledge are what actually land the job. More than one person told me the same thing this week: out there, business still runs on a handshake and knowing people.

Closer to home, I had a useful call about the first hospital under the New Hospital Programme. The contract is still sat at Stage 0. That tracks with what the rest of the sector is seeing: the programme is moving, but slowly, and the design is not expected to be finalised until the summer at the earliest.

The pattern worth noting is that a stalled programme does not mean stalled hiring. The intent is still there. It just goes quiet until the funding and the design line up.

The week in construction

• Sisk has been picked for the £67.8m London children's cancer centre through the NHS Procure23 framework. P23 keeps proving itself as the route for complex health schemes, and tier-one appetite for framework-led health work is only growing. Source
• Balfour Beatty has won an £83m contract to build the new Forres Academy in Moray. The Scottish public-sector pipeline stays active while parts of the English market wait, and there is steady demand for leaders who can run hub-model delivery.
• BAM, in joint venture with Siemens Energy, has taken its first contract under the ASTI framework for a substation in Aberdeenshire. Grid connection work is where a lot of the next decade of infrastructure hiring sits, and the firms building those teams now will own the talent.
• HS2 has pushed back its £1.03bn interim maintenance contract procurement by more than four months. Another slip, another reset for supply-chain planning. Commercial leaders who can hold a team together through delay are at a premium. Source
• Sizewell C has set out plans to maximise offsite working to manage a looming skills shortage. Offsite and modular delivery is no longer a nice-to-have on mega-projects, and the leadership skill set is shifting towards manufacturing-led construction.

People on the move

Two senior appointments worth knowing, both at tier-one names:

• Kier has appointed Rachel Warren as Group Finance Director, part of a wider reshape of its finance leadership.
• Stephen Knott has returned to Amey Consulting as Chief Operations Director, after leading its Strategic Highways business.

Other areas of interest

The shape of the June market is worth a comment. The picture across the sector is two-speed. Public-sector frameworks, health, schools and grid are still pushing work out, while parts of the private market sit behind a much tighter commercial and regulatory filter. Demand has not gone; the confidence to commit to delivery has thinned.

For anyone leading or hiring, that changes what good looks like. The premium is moving towards leaders who can win framework work, hold margin under scrutiny, and keep a team steady through stop-start programmes. Pure growth operators are worth less in this market than disciplined ones.

One more thing worth sharing, drawn from a run of conversations this week about the North American market. The best leaders out there are paid well and tied in with golden handcuffs, so they rarely move for money alone. The ones genuinely worth approaching are not the unhappy under-performers; they are the well-regarded people who have just been passed over for a promotion. That holds true on both sides of the Atlantic, and it is usually the difference between a list of names and a list of people who will actually take the call.

On senior pay

The big theme of my week, and the subject of a new guide I launched on LinkedIn, is that senior construction pay has broken the published benchmarks. The guides still put a Design Director at £90,000 to £120,000. The live search I am running for design leadership on a billion-pound hospital scheme is paying £160,000. That gap is the whole story of senior pay in 2026.

Pay at director and board level is rising faster in construction than in any other part of the UK economy, and the pipeline is the reason. Sizewell C, the New Hospital Programme, AMP8 and HS2 are all chasing the same small pool of people who have genuinely led delivery at scale. When demand concentrates like that, the published median stops being a useful number.

We have pulled the real figures together in the UK Construction Leadership Salary Guide 2026: ten senior and board-level roles, broken down by tier and sector, blending published benchmarks with our own live executive searches. If you are pricing a leadership hire this year, benchmark before you go to market. It is free to download at lechley.kit.com/salary-guide.

One useful thing

I shared a piece on LinkedIn this week on why the design manager has quietly become one of the most important roles on a hospital scheme, and it prompted a lot of good conversation. The short version: on healthcare work, design is no longer something that happens before the build and then gets handed over. The contractors who win and deliver NHS work are the ones treating design as a live discipline the whole way through, with someone senior who owns it. If you would like the piece, reply and I will send it over.

What I'm working on

Right now a good chunk of my time is on healthcare leadership across North America. I am looking for people with a genuine healthcare construction background who could step up to lead a business unit across both Canada and the United States, working between Toronto and the Bay Area. This is a build-and-lead brief, not a deliver-a-scheme one.

Here in the UK, I am working on a major hospital programme and want to speak to two types of leader. People who pair a design background with commercial strength, and people who have genuinely built mega-projects, schemes north of a billion pounds, from the ground up.

If any of that is your world, in the UK or North America, reply and tell me what you are seeing. And if there is a subject, a company or a person you would like me to cover in a future issue, just say. I would rather write about what is actually useful to you.