Have things changed much over the last few decades?

Oh, I think it’s the amount of change that is clearly part of the problem with the NHS. We’ve had something like ten major reorganisations now in the last thirty years, which is a reorganisation every three years, and it’s perhaps difficult for people to comprehend how destabilising these reorganisations can be. It can take a few years to settle down and literally, once settled down, it’s all thrown back up in the air again. And I think, as a consequence of that, again it may be somewhat of a surprise to learn that the average career life expectancy of a chief executive of the NHS is now only twenty-two months.

What causes NHS Chief Executives to leave after such a short time?

In the main they either get removed from the organisation, they resign, they retire, or they leave to take up work elsewhere. But that’s how long a career is as a chief executive in the NHS. And as a consequence of that very few people really want to take up the challenge, because it really is very, very high pressure, very, very complex. You’re trying to manage not just the day-to-day delivery of healthcare services on the ground but having to deal with a massive reform programme the Government consistently wants to introduce and changes quite frequently.

Most of the changes affect services on the ground floor, and often many of these changes are proposed and introduced without any testing of whether they will work or not. Over time this breeds an enormous amount of cynicism amongst the clinical staff, in particular, who really suffer from change fatigue. They do feel that they’re always at the end of an experiment.

I’m not suggesting that some of the changes aren’t worthwhile, some of the things that we are doing are making huge improvements in the NHS. But my job, as a chief executive, is to take those new policies that are produced by ministers and translate those into a way that my organisation finds acceptable in terms of adapting to the new way of work. So it’s not about simply imposing these things, it’s about how to make them palatable, how to get people on board, how to incentivise and motivate people to go on a journey which in many instances has no clearly defined endpoint.

What was your perception of the role of chief executive was like before you started in the job itself?

I thought it was just similar to the job as a director of operations, or something like that, and in those roles one is part of a group of executive directors, usually about five or so, of whom the chief executive tends to be first amongst equals, but nevertheless has a defined role to play. But on taking on the Chief Executive role it’s quite clearly a much more important and powerful post than any of the other executives. But I don’t think there’s anything in my experience - and I’m sure I can speak for most executives who move into chief executive positions - there’s nothing that really prepares you for it.

When you first joined the hospital what were your priorities?

When I started in February 2005, my number one priority, and the main reason why the board appointed me, was to become a foundation trust, one of these new semi-independent organisations that were managed at arms-length from Government. And I only had four months in which to do that. So I had to produce a strategy, which I think was quite innovative in what it attempted to do. We were successful in getting approval as a foundation trust and became one on 1st June 2005. And then from about September/October time, 2005, we set about implementing that strategy in earnest.

So when Gerry arrived we were in the middle of quite a major restructuring of the organisation, but it just seemed too good an opportunity for us to learn from Sir Gerry. If we could adapt his ideas and build them into our forward planning, we hoped to be able to achieve our aim of getting below two weeks for an outpatient wait for all our specialities and six weeks for all our admissions by 2008 – a very ambitious set of targets. So we were really looking to learn from the opportunity of bringing Sir Gerry in how we might actually deploy some new ideas and new tactics to get the waiting times driven down.

What was your expectation of the project before you started working with Gerry Robinson?

Well the Trust has been and continues to be a very successful organisation. Before we invited Gerry in to work with us we had some of the lowest waiting times in the country and we had a strong financial position. We’re not in the crisis that many other hospitals are in and we have excellent services which the people of Rotherham can be really proud of.

What we wanted to do was to invite Sir Gerry Robinson in to see if we could learn a new perspective on how to further reduce waiting times and improve the excellent position that we already had. We were already one of the most successful hospitals in the country, we just wanted to know how we could be the best.

We saw this as a great learning opportunity for us; that’s what we really wanted to get out of it. And we thought that the programme would be interesting because in looking at the reasons why it’s so difficult to get waiting times down, we thought that would put a microscope, if you like, on the wider NHS issues that we’re having to face that makes change so difficult.

How did your colleagues feel about letting Gerry and the BBC into the hospital?

We had a debate about it through our hospital management board, of which all our clinical directors sit, but we received quite a lot of assurances from the BBC that this wasn’t about Rotherham per se but looking at the issues. We thought that, on balance, we had more to gain than to lose. Even if some poor publicity came from it, we felt that in overall terms the organisation should gain a lot from having the sort of input that we thought Gerry might be able to bring to us. So we agreed in the end that we would do it, but we did recognise that there would be risks.

What are the management skills you look for as you build your management team?

Something I’ve done in this trust that I know doesn’t happen anywhere else is that I’ve appointed three consultant doctors to executive positions on the board. So half of my executive team, including my chief nurse, are in fact clinicians and that’s something that I’ve introduced because I believe that for the future we’ve got to develop our clinicians as leaders and managers. Clinicians often don’t come with the necessary management skills, so it is also an obligation upon me to develop those individuals.

Clearly good financial advice is also key to effective functioning of the Trust and I have a chief operating officer who actually manages the day-to-day non-clinical services, such as portering, cleaning, catering and so on. Finally I now have somebody called a chief of business development because in the new NHS world that we will enter from 2008, where we’ll be in a competitive market and having to ensure that we become much more customer focussed in what we do, we will need to develop our services in line with the needs of our patients and to those who represent them, in particular, GPs.

Content last updated: 05/01/2007

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