IN ACTION EXECUTIVE ENQUIRY


How has your time been so far, have there been any surprises? “I’ve spent time meeting other key stake holders and getting to know the confederation itself and NHS Employers. There haven’t really been any surprises. I insisted on seeing Mike Farrar before I met the trustees to ensure that he and I could get on, with a good working relationship, and we had an immediate rapport.”


Have you had to deal with any other changes of this type of magnitude in your other non-exec roles? “I joined the board of Network Rail around the same time as this role and it’s going through a similar change in that it’s been rescued from the ruins of Railtrack, with a fairly command-and- control style of leadership. Under the current chief executive, David Higgins, it’s going through a stage of empowering people and devolving authority, enabling people to be more creative to make change happen faster. I see a lot of parallels with that and what’s beginning to happen in the NHS, which needs to continue if we’re going to achieve what we need to.”


We’ve been leading up to 1 April for a while, but do you think there’s still a lot of bedding in to be done? “I think there’s an awful lot still be to be done. The change is really about people coming to terms with their new roles, with new powers and developing new networks of influence. I firmly believe that in most modern organisations one doesn’t really exercise authority, no matter how senior one’s position, one exercises influence. You achieve change through networks of influence rather than hierarchy and diktat.”


in London in recent years changes around stroke services have significantly improved outcomes, despite fewer places delivering the service. The people doing it are doing it all the time so their diagnostic abilities are highly-tuned. Discussions are taking place in London about cancer services being concentrated and it seems to me that a lot of the debate around the country is people insisting hospitals must be kept open, but if you actually discuss with them the fact that their relative will have a better chance of a healthy life if they’re operated on by somebody who does this operation all the time, you could change the tenor of the debate. People assume any change is a cut and somehow we need to get to the point where people understand that some changes are about improving services.”


What do you see as your role in this period of transition? “There’s a private role in ensuring that the dialogue between people leading the health service continues and that when people are getting scared they’ve got people to talk to. A lot of what we do with our members is holding regular meetings where they can talk to each other as well as hear from speakers. Giving them an opportunity to chat and reflect upon the challenges they face is important. At a public level, it’s having the courage to continue to make the case for effective change and reconfiguration.”


“You achieve change through networks of influence rather than hierarchy and diktat


What do you see as your main priority? “The process of changing the culture of the service; getting to a situation where people are empowered; they are willing and able to innovate; and feel they will get praise for attempting improvement, rather than blame for it not being perfect. That’s vital if we’re going to get where we want to, post Francis [report]. All of the effort that’s gone into the changes that formally began a week ago will have been wasted if it doesn’t lead to a change in the way that resources are allocated. We must get to a point where resources are available to keep people in the community, where they want to be. I think Mike’s [Farrar] been very clear in his speeches that we have to get away from the assumption that putting resources into hospitals is the way you provide healthcare. The challenge for clinicians, managers and politicians is explaining to people why we need to reconfigure the structure of services.”


How do you see hospitals’ role changing; do you think there will be closures? “There will have to be some closures, there’s no doubt about that. I also think there are important structural changes. For example,


You wanted to work with the Local Government Association on capital spending. Is that important? “Absolutely. When I was chair of the Audit Commission the ‘One Place’ initiative had a lot of work done on it. You looked at the location and the resources going into it from different parts of the public sector to see how you could


pool those to be more effective. I think that’s vital. Mike and I are meeting the chairman of the Local Government Association in the next week or two to discuss how we can achieve this. I think it makes a lot of sense to consider how, in any given area, we can use resources effectively. In my time with the Audit Commission I knew of areas where the director of adult services was also the director of public health. Rather than worrying about legal changes to give people joint budgets, you simply put the same person in charge of both budgets. That involves trust and it would work best in areas where there’s already a strong trust between the health service and local government.”


How do you think the Government can help the service? “Regardless of what you think of the organisational changes, a period of restraint on the part of the Government would be welcomed. Leave the organisation structures unchanged for a while and let people get on with working together. If they then want to propose local organisational changes, let them do it at a pace that suites them. I’ve long believed that strategic integration, with people from different organisations working towards a common objective is much more important than structural reorganisation.”


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