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“The trust now needs wholesale transformation”

The following is an extract from Mark Newbold’s blog – the former doctor has recently stepped down as CEO of an NHS trust:

A couple of weeks ago I contributed to a workshop looking at how Medical Directors might be supported to become CEO’s.

I concentrated on the personal challenges – the emotional impact of such an exposed role with huge responsibility, and the resilience needed to stay strong without becoming dispassionate. As I was speaking, recent events were going through my mind, and I felt this would not be an authentic diary if I failed to reflect on these.

My trust – Heart of England Foundation Trust – has some performance challenges, and recently a Section 111 has been imposed by Monitor, which escalates the enforcement and allows the regulator to take actions at Board level if and when it is considered appropriate.

This was uncomfortable, of course, and it was meant to be, though not as great as my own discomfort that we had yet to get on top of our major challenge, the congestion in our emergency areas.

Monitor issues a press release to accompany new enforcement actions, and on that Wednesday we saw it just as we were leaving for the Staff Recognition Awards. It was hard hitting – words can be so powerful and seeing it in black and white was very stark. You can read it here.

Such language is undermining to leaders, and I wondered if this was the intention. I do not question the action taken, but by utilising a critical style of communication, which implies the leadership might only do the right thing if forced to do so, we risk framing the inability to achieve targets as a behavioural issue.

I left and drove over to the staff awards with a range of thoughts buzzing around my head, including thoughts about my own future. Our awards night takes up a whole theatre, and it is a glitzy, heart warming and emotional occasion, full of celebration, appreciation and praise for the great care that is delivered by our staff.

The evening was fantastic, perhaps the best in recent times. We heard from many patients and staff about some exceptional work that individuals and teams have delivered throughout the year. I toured the theatre afterwards, speaking to staff as they waited for their photos to be taken. They were proud, as they should be, and pleased to be appreciated. We had heard numerous instances of great care, delivered with compassion, by staff who regularly go the extra mile.

As I drove home, I wondered how we could have two such differing perspectives on a single organisation? Were the many testimonies and stories we heard not typical?Could they really be representative of an organisation that is failing on all fronts, and deserving of not just enforcement action but public criticism too?

Following the HSJ headline ‘West Midlands Trust could be forced to change leadership’,  I received many messages of support. Our NHS is full of individuals at all levels who are kind, compassionate and supportive, yet the broader culture remains harsh and blame-based? Addressing deep-rooted and complex challenges takes time, despite the best efforts of managers and clinical staff, and I do wonder whether a more understanding and supportive approach would achieve quicker improvements for patients?

So now, two weeks later, I feel it is time for me to step down. I will no doubt reflect on events more deeply in the future but, for now, here is the message that went out to all staff:

Dear Les,

I write to give notice of resignation from my post as Chief Executive Officer. When we discussed my desire to leave the trust in August you expressed a wish for me to stay on to ensure the work in response to the Enforcement Undertaking was underway and progressing.

We agreed that, should the situation change, we would discuss and review.

I have thought long and hard about my position again, prompted by the recent imposition of a section 111 Notice by Monitor. I believe the time is right for me to move on now, both for the organisation and for myself.

I have very much enjoyed my time at Heart of England. I have been totally committed to the role for over 4 years now, and I am proud that we have brought about many changes. I am particularly pleased with the progress we have made on openness and a transparent way of operating.

Our engagement with partners in the system and with the public has steadily improved, and our ‘informal’ complaints process and use of Patient Opinion is well received and innovative. In Solihull we brought the Community Services into the trust and now we are well set to develop an accountable care system for the borough – a truly exciting development.

I am proud too of commissioning the Kennedy Review and starting to tackle some of the difficult legacy issues in an honest way.

HEFT has now changed considerably, but it is clear there is much more to do. Whilst we are now doing so, I wish I had focussed earlier on staff engagement – it was a mistake to believe that tackling the constant congestion in the hospital would, of itself, be the solution to this. The trust now needs wholesale transformation if it is to deliver the best standards of care on a consistent basis in the future, and I know the new Board is ready to lead this.

The plans we have in place are the right ones, our strategy is forward looking and in keeping with expected healthcare trends, and our new structure brings Board and front line much closer together. All of these will bring improvement in time, but current performance remains challenging, and I think the timescale for improvement will be longer than the regulators wish to see.

Overcrowding is the singular problem that HEFT has, and I regret that I have not managed to solve this on a sustained basis. It is, as you are aware, responsible either directly or indirectly for most of the main missed targets, and indeed our mortality rates and poor staff morale.

If I had managed to solve the overcrowding, I do not think I would be writing this letter. However, a Chief Executive has to know when the time is right to pass the baton on, and I believe that time is now. The teams and the staff in HEFT are excellent and committed, and I have no doubt that they will come through.

We agreed some time ago that, when the time came, we would manage the transition well, and in the best interests of the organisation. Accordingly, I will take my lead from you on next steps, and I look forward to meeting and agreeing how we best do this.

I wish you well in your time as Chair, and I thank you sincerely for your personal support.


Dr Mark Newbold

Chief Executive

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