# Transcript

Narrator
This film is about the lessons learned by an academic and senior leader, Anita Rogers, who has experienced two very different kinds of leadership. Firstly, as an insider within the NHS, and secondly, as an outsider opposing a particular aspect of NHS policy.
Anita Rogers
I gained a number of insights about power and leadership from both experiences, as chair of a formal designated leadership role in an NHS trust, and a very informal role as a participant in a community action group.
Narrator
Anita is a Canadian who settled in Mid Wales. Today, she’s a member of the Save Aber Group, defending the services of the local general hospital. But previously, she was a senior manager in the NHS, working on an organisational change which she eventually opposed.
Anita Rogers
What I discovered, at least in my experience, was that a formal role doesn’t necessarily give you an immense amount of power. Whereas, in this informal role, as part of a community action group to save the local hospital, I feel a lot more of a sense of power.
Narrator
Between 2006 and 2008, Anita served as chair of the Ceredigion and Mid Wales NHS trust.
Anita Rogers
My job was to lead the board of directors. In essence, it meant speaking to the press, speaking to the public, representing the views of the organisation. My job was also to chair the board meetings.
Narrator
The trust was one of 22 designed to manage hospitals across Wales. But in recent years, the Welsh Assembly has made moves to centralise clinical expertise and save costs by merging trusts.
Anita Rogers
During the time that I was chair, the plan was to merge administratively with two neighbouring trusts in the south of the country – Carmarthenshire NHS Trust and Pembrokeshire NHS Trust. The plans seemed like a good idea at the time because the promise was that we would run more smoothly, that we would have more access to trade of services, if you will.
Narrator
But in the rural Aberystwyth catchment of the Mid Wales Trust, there was deep suspicion. Locals feared the services of their only general hospital, Bronglais, would be downgraded if there were an administrative merger.
Interviewer
And when you were chair, which side were you on?
Anita Rogers
When I was chair, I initially believed the promises that an administrative merger was appropriate and that it would ultimately result in better services – that it would knock down the organisational barriers whereby doctors could go back and forth amongst the three hospitals that were going to merge. I really did think it was a good idea.
As time went on, staff were increasingly uncomfortable. They had actually been in a similar situation many years before. They had a long memory. And I began to see that, in fact, the promises were hollow promises. That there was going to be a danger of services being eroded here.
I should also say there wasn’t really a choice. This merger was mandated by the Welsh Assembly Government. And whether I had objected or not, it would have gone through.
Narrator
The potential problem for patients was that if services at Bronglais were downgraded, they faced an 80 mile trip to the nearest hospital.
Anita Rogers
For many of the health care treatments that they need, they will have to drive an hour and a half or two hours. And in Wales, the drive is on curvy narrow roads, so these are very difficult distances. In addition, there is the issue of the golden hour. If somebody is in very serious health difficulties, they have the best chance of surviving if they’re are treated within the hour – the golden hour.
Narrator
Despite her increasing concerns, Anita hung on to her role as chair, trying to exert influence from within.
Anita Rogers
There is very little evidence anywhere that mergers accomplish what they set out to accomplish – cost effectiveness, better services. They just don’t do it. There’s no evidence base they do. And I spoke out in the Wales community about my concerns.
The regional director paid a visit to me spontaneously. He just happened to be in the area, is the way I remember it and the way I remember him telling me how he happened to be there without an appointment. But he said, if I don’t toe the line, they could pull me out of there tomorrow. What was shocking, though, being in the role myself was that feeling of not having any power at all. And to this day, I’m still haunted by it.
Narrator
After the merger, the local trust and Anita’s role within it ceased to exist and a new centralised health board took over.
Anita Rogers
The fears of the local population and the staff at Bronglais hospital in Aberystwyth have come to pass. The hospital services have been eroded. There has been consistent removal of services from Bronglais and those services have been relocated in the south of the country, in one of the two hospitals with whom we originally merged. So there has been a centralization and a consolidation of services so that now the local district general hospital is actually in danger of not being able to survive.
Narrator
After her frustrating experience, Anita tried to join a local pressure group, which had long been fighting to save Bronglais as a fully functioning district hospital. At first, the so-called Save Aber group was cautious about her approach.
Anita Rogers
Joining the group was a really interesting process because I had been the chair, I’d actually met with this group, and at the time, I was on the side, really, of the health board. So I was seen, really, at the very least, as untrustworthy, or the enemy at worst. So it wasn’t easy to break in. It took several months to establish a level of trust.
Narrator
The voluntary group is made up of practising and retired health professionals, GPs, hospital consultants, nurses, and local politicians, and is informally chaired by retired hospital consultant, Peter Gartner. But although there’s no official hierarchy, some members are more influential than others.
Anita Rogers
In the Aber group, yes, it’s a collection of equals. But the leadership actually resides, to most extent, I think, in William Roberts, who is the one who coordinates, who has the vision, who has mobilised people, who has the political networks and uses them. So it’s not a positional leadership. Ostensibly, he is just another one of us volunteers, but in fact he has taken leadership.
William Roberts
If we’re asked about do we want cardiology or cardiac surgery in Bronglais, the answer has to be no. But if we want general surgery, it’s pretty clear to me that we want to say that.
Narrator
But William Roberts doesn’t set all the agendas. Despite the common aim of saving Bronglais, there are considerable disagreements over the details.
Anita Rogers
It’s one of the reasons why I’m a bit tentative to jump in, intervene, try to focus it. One, I’m not the chair, but two, I’m aware of the factions and the tensions and the kind of slots that people, I think, have.
Narrator
One long running tension is about how complex or simple the group’s public message should be.
Jack Evershed
My message is a very simple one. It’s always the simple moral one, that we have an equity, that there needs to be equity of access to services to the people in Mid Wales. And especially when it comes to emergency, we deserve the same right to life as anyone living anywhere else. That is a message that’s not hard to sell.
William Roberts
There are two plans. There’s your plan, Jack, which is quite different to the plan that the consultants came up with and which they prepared for Elin. And therein starts lying a problem.
Jack Evershed
Yeah. Well I still haven’t seen that particular document.
William Roberts
Well, I’ll pass it on to you.
Narrator
Another complexity is differences in the vested interests of the professionals in the group and their attitudes towards the new centralised health board, [INAUDIBLE].
Elin Jones
But I think the issue of consultation and now pushing the health board to accept that they have to get out there and talk to people otherwise they’re going to lose the argument and it’s going to be political mess, really.
Diane Richards
Unfortunately, it’s not just about talking to people, it’s listening to people.
Speaker One
What’s the feeling about other consultants in the hospital about this?
David Jackson
Certainly some of them, they’ve got their wives, their family, or they have to protect themselves in a way. And I think the health board would be unremitting in its treatment of various consultants who broke ranks.
David Lewis
I think that it’s only fair that we don’t lay all of the blame on [INAUDIBLE]. A lot of the change in practice has been imposed from Royal Colleges and other colleagues in the disciplines that we work in.
David Jackson
You cannot have half a hospital. You cannot suck away services that are totally independent.
David Lewis
I couldn’t agree with you more. I wasn’t implicating the status quo I think it –
David Jackson
– a lot more combative.
David Lewis
All I’m saying is that I’m trying to apportion how these unfortunate decisions have been made. And often by our fellow professionals.
Diane Richards
Also, going back to what you said about consultants are worried because they’ve got their families here. They don’t want to rock the boat. Consultants come from away. Nurses and all of the other therapies tend to be from here. And so they’re going to be defending their community to a far greater extent because it’s our family, our neighbours, and our friends.
Anita Rogers
I think the free-flowing style can be a little bit problematic because it gets a little unfocused from time to time. What we saw in the meeting last night was a paradox in that we had a group of, individually, very strong leaders who came together voluntarily to be in this meeting. Paradoxically, what we lacked was strong leadership of the meeting itself.
Narrator
Despite the lack of agreement on details, the campaign still flourishes because the broad aim of saving Bronglais unifies the group. And most of the work takes place in between the bi-monthly general meetings.
Anita Rogers
Most of what’s happening is going on behind the scenes. There’s a lot of networking that goes on – meetings with various public people, groups. But it’s very emergent, because opportunities come up. And I think that’s really a significant part of leadership – to actually be able to spot the opportunities as they come up and to take advantage of them. It’s important not to be defeated by what looks like formal authority and formal power. That there’s a tremendous amount of power available in local and emergent leadership.
Narrator
During the filming with Anita, we encountered another example of the significance of emerged leadership within the health and social care sector. There was a demonstration outside the hospital as part of the National Day of Action on Pensions. Just as with the Save Aber group, it shows that people can, individually and collectively, take a stand against the forces of strong organisations. They could also use their conscience, guided by moral vision of some kind, to lead in a variety of ways, both inside and outside of formal institutions.
Anita Rogers
One of the things I have learned about leadership over the years is that it’s a constant negotiation process. And there’s an ebb and a flow. There are constraints, there are budgetary concerns and worries – there are many different kinds of constraints that are real and that we have to live with. But for a leader or a manager in which, perhaps, decisions are being taken that they may not agree with, I think it’s very important for a person to weigh up in a vigilant way. To be vigilant, not morally blind, and continually examine the central purpose of why they’re there, which is care of patients. These are not easy issues. Ethical dilemmas are not easily resolved. Sometimes they’re not resolved at all.