What were the critical factors which led to the major changes which we see happening in the programme?
I think a couple of things happened. One was it became very clear to people in theatre and in one or two other areas that we were genuinely not there to try and cut people out or to cut costs, but we were there in a positive way to try and do what was necessary, to try and do the right thing, and if that involved a bit of recruitment rather than cutting costs, we were up for that.
So that sense that we were positive about getting things to happen and not negative about stopping things, I think that helped hugely. But also there is an old saying, and it’s true, ‘success breeds success’, if people start to see that some things can happen, it’s amazingly encouraging to them to go on and try something else.
Once you break that jam, and I do think you saw that happening in the third programme, that sense that people began to feel things could actually be done, and once you’ve got that underway, I think it becomes self fulfilling really quite quickly.
Having worked on this project, how well managed to you think the NHS is as a whole?
The lesson for me in terms of the whole of the NHS - because I do think the hospital is actually one of the good examples of how a hospital is run, and that gives you a sense of what happens in the rest of the NHS - I just don’t think there is a sense of management.
And I was left with a very frustrated feeling that actually quite small sums of money properly and sensibly spent could have produced very large results in terms of reduced waiting lists, and actually very large sums of money had been thrown at the NHS and produced very little.
What changes would you like to see made to ensure better management in the NHS?
I do believe that whilst there is a great deal one can do in terms of training people who already have a natural aptitude, unless you’re recruiting the very best young people, the very best senior people as a starting point so that they start to recognise those young people and bring them through, until we start taking the management of these complex organisations seriously, in the way that management is taken seriously in commercial organisations, frankly we’re just going to be chipping away at the edges of the problem in the NHS.
What do you think the biggest lesson the NHS can learn from this project?
I think what the NHS needs to learn is that actually you don’t solve problems by throwing money at it, and not every problem actually needs money to solve it. That’s the first lesson. Secondly, to get out of their heads the idea that things have to take three years to do and get into the idea that there is a series of objectives that we need to do now, and that we’ve got months, not years to do it. Those two things, I think, would have the biggest single impact on the way that the Health Service is managed.
What have you personally learned from the project?
The lesson that absolutely leapt out at me was the absolute need for clarity in reporting structures; who reports to whom, and who has the authority at the end of the day to say no we’re going to do it. That was really reinforced for me in a very, very powerful way.
To what extent do you feel the Chief Executive, Brian James, understood what role psychology played in changing management styles?
I think Brian was unquestionably one of the better managers in the NHS. He was doing a good job in terms of managing the books, he’d got the thing into some kind of order, he’d got his trust status sorted out, but he was flummoxed I think by just how much in effect he had by simply being out on the shop-floor and saying “I’m behind this, I want this to happen, tell me how we’re going to do it”, rather than “it’s all very difficult”, etc. I think he’s bright and intelligent, and he’s a very amiable sort of guy, and I think in many ways a very able sort of guy, so I do think that he will have picked something up from this and learned something from it and will change things more rapidly.
Hospital management involves more than just the Chief Executive, why did you focus so much upon Brian?
Whether you like it or not, if the ship is heading for the rocks, there’s absolutely no point in talking to the boiler man. There’s no point in doing it. You have to get the captain to see that there’s a problem, and then he can move and get people going in the right direction to start to get things changing.
And I think the chief executive is that role, you have to start there, and if you’ve got a chief executive who’s really on the ball, I guarantee within a year at the very, very most you’ll have a group of other people who are on the ball as well because it just happens as night follows day. People start to see what people want, what the managers are asking for, it becomes very clear. People respond to it, they get a sense of enthusiasm. You have to start with Brian.
I see it as the beginning of something really important at Rotherham. I think Brian, if he carries on with that attitude, will see I think huge changes remarkably quickly, and I think if we went back to look at Rotherham in 18 months’ time, I think it will have one of the shortest waiting lists in the country.
Do you have views on ways the NHS is managed or could be managed in the future? Share you suggestions in the comments area.