2012-10-08



Just like for Fernando Torres, moving to Chelsea has been a big step forward – but also full of challenges

Following in the footsteps of one Fernando Torres, I have moved from Liverpool to Chelsea to take up my new job as the chief executive of Chelsea and Westminster Hospital on 3 September.

Like many people who start their career in clinical practice in the NHS, my clinical career has been in nursing. I never set out to be a chief executive. But having previously worked as the chief executive at Alder Hey Hospital and the Royal Liverpool University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust is my third tour of duty.

Looking back over my first month here at Chelsea and Westminster, I can honestly say that the experience has both surprised and delighted in many respects. The positive staff attitude, the commitment of the consultant staff and the vibe of walking into a hospital with one of the most creative designs in the UK combine to offer a real sense of excitement and enterprise.

This was reinforced by the trust's annual members' meeting on 16 September, where the public turned out in strength and the council of governors representing 15,000 members of thetrust gave testimony to the high regard and affection in which this hospital is held.

This is all a great tribute to the leadership and stewardship of the trust at a time of repeated criticism of public services.

But – and there is always a but – how do we maintain that level of success and support in the face of the biggest structural change the NHS has seen since its inception in 1948 and the unprecedented enduring economic climate?

I have spent much of this first month in meetings with colleagues, getting up to speed with what's going on locally, how that fits with national policy and what the implications are for how we run our services and continue to improve the patient experience.

Attending the public consultation meetings on NHS North West London's services strategy, Shaping a healthier future, the support for the NHS is overwhelming. Yet the anxiety over access to high quality services is palpable as both health service professionals and the public as taxpayers and patients face very difficult questions about a sustainable model of healthcare and the changes we need to make.

The NHS is inextricably linked to higher education, through the two sectors' mutual concern for delivering the best possible research and teaching environments. Much of our discussion between the NHS and universities focuses on strengthening partnerships, sharing resources where possible and collaborating, to reduce costs and improve the quality of what we do.

But it is not just these two sectors that have to deliver more in a different way. Chelsea and Westminster runs the biggest sexual health and HIV service in Europe and very shortly the commissioning budget for the sexual health part of this service will transfer to local authorities, as part of their wider responsibilities for public health under the Health and Social Care Act.

I could go on but I won't. The picture is clear – managing change in this complex and multifaceted environment is a big part of being a health service manager today.

Of course, what matters is to ensure that all that change does not overwhelm our day job of getting things right today and this week for our patients and their families. That means taking time to get out in the hospital and its community-based services to understand the services we deliver and what our staff and patients think about them.

One of our biggest challenges as managers and leaders in this time-poor world is to be sufficiently visible and accessible to our most important resource – our staff. Being omnipresent is almost an essential requirement of the job and the weekly reflection of "did I get the balance right?" is often a frustrating experience.

Nevertheless, it has always been thus and anyone who has been around long enough will testify to the relentless expectation we have of our healthcare system and the overwhelming demand that faces us. Collaboration will be the touchstone for success if we are to stand any chance at all of meeting that demand – there will be no room for unnecessary duplication of services and that will challenge our thinking and our political will at a local level.

I am very aware from my discussions with colleagues and observations across the NHS that this is not simply a local issue. There isn't anywhere that I know of in the UK that isn't having these discussions and grappling with the choices that have to be made. It's a manifestation of our success in medicine, technology and science. We live longer and hopefully more active lives but consequently we have become a much higher-maintenance population to serve.

The challenge of that is how to manage the changes we need to make while continuously improving what we do. It's here that we have the opportunity to do our best work through innovation and enterprise. It's the promise of what we might create and the good that we might do that gets us out of bed every morning, whether we are a doctor, a nurse or a manager.

So it's the end of another week and time to reflect – I've met some great people again, spent time with our superb hospital charity at their Arts for Health launch, and got to take a close-up look at some of our services.

I've absolutely no doubt that people haven't seen me around enough and I've spent too much time in meetings. But I also have a sense through my conversations with colleagues that all of our organisations are experiencing the same in every respect. It's a time of tremendous uncertainty and personal responsibility for us all. It's daunting, it's challenging, it's rewarding – and we call it the NHS.

Tony Bell is the chief executive of Chelsea and Westminster Hospital NHS Foundation Trust. He blogs fortnightly about his job.

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