New hospitals chief has his work cut out

Graham Smith has joined the Trust at the most difficult time imaginable. The Commission for Health Improvement recently published a critical review of the Trust's standards of care, shortly after auditors attacked managers for allowing the organisation to fall so far into debt.

Consultants, GPs and nurses have also criticised the management, and the Trust needs to find ways of paying off debts of almost £7m.

However, the 53-year-old father-of-four from Lincoln is well-equipped to deal with the situation. He has worked in the NHS for more than 30 years, and now specialises in temporary assignments.

He is sent to new posts by the Directorate of Health and Social Care, and has just finished helping a new chief executive to settle in at a trust in Harlow.

Mr Smith said working with new hospitals was similar to watching The Archers.

"You can miss a few episodes and tune in later on, and you soon pick up the whole plot again," he said.

"There are certain things you expect to find in contemporary hospitals."

Although he does not feel the CHI report was particularly bad for a large and complex Trust, Mr Smith told the Evening News that much needed to be done to address the problems it faced.

Problems blamed on predecessor

A TOP Worcestershire consultant has called for the county's new health chief to repair the damage done by his predecessor.

Consultant orthopaedic surgeon Noor Ahmed said he hoped Worcestershire Acute Hospitals Trust's acting chief executive, Graham Smith, would "turn things around" at the troubled Trust.

Mr Ahmed, chairman of Worcestershire's medical staff committee, blamed former chief executive Ruth Harrison for the current situation.

"Consultants' morale is very low because of the problems we've had locally with the management," he said.

"Now the old chief executive has gone, we will have to reassess things. There were a series of problems, including the appointment of managers which consultants were unhappy about."

The British Medical Association recently revealed a quarter of the NHS consultant workforce in England was ready to resign or retire because of problems in negotiating a new contract.

The contract has been rejected by consultants, because many fear it would lead to excessive management control.

Mr Ahmed said this was particularly true in Worcestershire, where consultants have delivered two votes of no confidence in management staff.

"It would give unfettered power to managers. That worries people the most. We would have to do far more work without adequate remuneration. Consultants work over and above their contracted hours anyway, but they don't want managers to control their time contractually.

"They would rather keep the informal arrangement. The proposed contract is not family-friendly."

This is what Worcestershire's new acting hospitals chief had to say when the Evening News quizzed him about himself and his plans

What attracted you to this job?

I was sent here! The Directorate of Health and Social Care determine what assignments I take on. My assignment was coming to an end in Harlow, and it was suggested I come to Worcestershire. It's a big Trust, and there's lots to be done. It was important there was as little discontinuity as possible, and they needed someone who could hit the ground running. Some people have said I'm a troubleshooter, and some of the circumstances I have been in have required some troubleshooting.

Which of your past achievements are you most proud of?

I like bringing about change and being involved in change. In the early 90s, the whole of the mental health service in Nottingham was being remodelled. It was good to be involved in bringing about change of that order.

What are your main concerns about the Trust?

We do need to offer speedier access to many of our services and we need to look at the way in which emergency patients come to hospital and the way they are waiting for beds.

We also need to balance the books. If we charge too much for what we do, the Primary Care Trusts won't have the money to pay us. There's the patient choice issue, which is being developed in London, where patients who have been waiting too long at one hospital can choose to go to a different one.

We could be facing a situation where our costs are too high and our services are too slow. Unless we change that, patients could choose to go elsewhere.

GPs and consultants have complained about a lack of communication with the Trust. How will you improve that?

With the consultants, we don't seem to be very visible. On a personal level, I will be getting out and about, and I'm encouraging my executive colleagues to visit more wards. I've not spoken to GPs yet.

Are you concerned about the capacity of hospitals in Worcestershire?

I can't win with this question! The health service is changing very rapidly. It all depends on how many people are unwell at one time, and how unwell they are. If you get fixated on the number of beds, it blocks thoughts about the way of giving patients care. We can use the present beds better, and look at admissions, discharges and length of stay. That's more productive. Unless we've got procedures as slick as possible, we won't know if we've got enough beds.

What do you think about the Trust's escalation policy, with its yellow one and yellow two alerts?

The point at which someone needs a hospital bed reflects the services that are available in the community.

Most health economies have an escalation policy, and they come in different colours and different levels. The best systems involve GPs and other health representatives. But when someone needs to come into hospital, they come in - end of story.

What do you think will be the main challenges facing the Trust in the future?

It's about hitting the National Plan targets, which represent what each patient is entitled to. It's not just managers being obsessed with targets, it's managers being obsessed with targets for the benefit of patients.