Sue James, Chief Executive of the Derby Hospitals NHS Foundation Trust
PUBLISHED: 10:52 22 May 2013 | UPDATED: 10:52 22 May 2013
Pat Ashworth meets Sue James of Royal Derby Hospital
If you are an adrenalin junkie, a hospital is a wonderful place to work, Sue James observes. She reflects, ‘It’s like living a soap opera in that you are touching the whole range of human emotions every day in terms of patients and staff. Living in a big village and trying to keep everybody focused and working to the same goals is a real challenge sometimes.’
There’s another analogy Sue uses about what it’s like to step into the role of chief executive for the first time, as she did when she took charge of Barnsley District General Hospital in 1996 at the age of 39. ‘It’s a bit like the Tour de France, where they all slipstream and take turns being at the front,’ she suggests. ‘If you’re a director, you can keep up with the chief executive and think, “I know what they’re doing, so of course I can do the job”. But actually taking that headwind and being at the front and staying there and protecting everyone else; making sense of the world and navigating your organisation, with that constant sense of responsibility, is a feeling that it’s very hard to put into words. But I love it.’
You can tell she loves it: it shines out of her and she is energised by it. It would all have been very different if she had pursued the career that first attracted her. Born in Hertfordshire, the eldest of three children, she took herself off to a summer school in America half way through her A level course, and on the back of it, gained a place at the Bristol Old Vic drama school. But a wise mother encouraged her to finish her exams and to do a secretarial course so that she would “always have something to fall back on”, and watching a friend who had won the annual RADA award for the Most Promising Actress but who had failed to get a single job, made her think again.
Purely by accident, her first secretarial job was in the health service. She loved it, found it spoke to her basic values and set out to gain the professional qualifications she needed to move to an administrative role. That happened in the late 1970s. ‘All the industrial action was going on and everyone talked about whether we’d cross a picket line,’ she recalls. ‘And I thought, if I crossed a picket line, nobody would notice because my job was such a tiny one. I wanted to make a difference.’
She wanted to work in a hospital, applied to the Middlesex in London and started there in 1979. That ‘winter of discontent’ gave her what she cheerfully describes as ‘a brilliant Cook’s tour of the health service’ in which she found herself on the wards and even running kitchen portering. In the six-and-a-half years that followed, she gained her qualifications, married, had two babies, studied for her Master’s and ended up teaching management at the South Bank University. A decision to move out of London took the family to York, where Sue’s husband worked for the railways, and to a job at St James’s Hospital (‘Jimmy’s’) in Leeds.
There, she was astonished how differently women in the workplace were viewed. ‘Women were decorative or useful and if you were lucky, they were both, but they certainly weren’t in powerful positions,’ she remembers. ‘I was very fortunate to be able to get a job there.’ A move to Leeds General Infirmary (LGI) found her in one of the very first general management jobs in the hospital service. ‘I was managing surgeons,’ she remembers with a smile. ‘They couldn’t understand how I could have any impact at all as a general manager: their world didn’t involve managers. And I was the only woman outside nursing in a management job in the whole hospital. It was an interesting place to be.’
She was 33 at the time, and describes the four years at the LGI as ‘the furnace that really created my management skills.’ She honed them with a job at board level in Bradford before moving to Barnsley, and with the exception of a period leading the NHS Modernisation agenda for the Trent region in 2000, has been a chief executive for the last 17 years. Her heart remains in hospitals rather than in the policy world of the NHS. ‘It’s like flight,’ she says. ‘Staff at the front line are on the ground, feeling the ground as it is. I’m at 10,000 feet and see the detail and the shapes and can be on the ground if I want to. The strategic health authorities are at 30,000 feet, so they can see overall shapes and interlinking.’ And the Department of Health? ‘Probably at 50,000 feet and above the cloud level. They just see the clouds and think it’s reality!’
The Derby Hospitals NHS Foundation Trust has an annual budget of £442 million. It is one of the largest employers in the region, with 8,500 staff (80% of whom are women). The state of the art Royal Derby Hospital has 35 modern operating theatres and 1,100 beds, many of these single rooms. Seventeen babies are born every day in its maternity unit. But what’s more likely to impress the 644,000 patients whom the hospital sees each year is that it’s one of the cleanest and safest hospitals in the country.
It also has a reputation as a progressive organisation, a place where people want to go and work. Sue can’t emphasise enough that having a really good team of first-class professionals is crucial to everything. ‘I have a fantastic team. My job is to knit it all together and make it into something that people looking into the organisation can see as a whole rather than as a series of individual bits’ she says.
‘I‘m relying on 8,500 staff to give thousands of patients the greatest service they can get. That sense of depending on other people is both a huge joy to me but there’s also the opportunity for someone not to do what they’re supposed to do, or do it badly, or come in and have an off-day, and that affects the service. I’m responsible for that but I’m not culpable for it, and that sense of responsibility without necessarily having all the levers to pull to make it work is quite daunting at times really.’
The NHS affects everyone in the country. It’s not surprising, she reflects, that it’s a newsworthy item and that people are always commenting on it, but she finds it frustrating that articles are generally designed to sell newspapers rather than put a professional critique on the NHS. ‘People get a very distorted view of the service,’ she suggests.
‘Patients say to me, “I was worried about coming into hospital because I read something in the newspaper last week. But I was lucky, because the service I got was wonderful.” And I say, well, actually, they’re not lucky: that is the normal service. It’s the articles that are distorted. I think that sense of constantly being in the public eye has always been there – we just deal with it differently these days. The response of the NHS previously was to pull down the shutters and peer out suspiciously from underneath. Now our approach is to be as open as we can and work to align the world of journalism and the world of health services.’
Her diary is packed, her days are all pretty much spoken for. The 48 hours during which this interview takes place have included meeting with the consultants and senior team of the emergency department, with the full team of divisional directors, medical directors and heads of nursing, with the joint council of the trades unions, with the academic health sciences network... the list is endless and all of it is stimulating and patient-centred. ‘Every single day is different and that’s what keeps me fresh,’ she says. ‘To be a chief executive, you’ve got to be intellectually curious, you’ve got to want to know what’s going on.’
So she spends at least half a day every month in the uniform and role of a healthcare assistant, ‘going about and seeing for myself and feeling what it’s like to be a clinical front line member of staff, and how far away the ideas and processes we are developing at executive level can feel sometimes. My team brace themselves for when I come back and say, “Why can’t we do that?”’ she says with a smile.
She goes by invitation. Her most regular work is bathing and feeding patients and looking after their personal needs but she has spent time on the paediatric wards and in the discharge rooms, on the maternity and labour wards and in the operating theatres. In her previous job as chief executive of Walsall hospital, she worked as an orderly and even as a security guard.
‘Staff like it, because if I walk in dressed in a suit, it’s “Oh, Sue James is here – everyone look busy,”’ she says mischievously. ‘Everyone disappears and leaves some poor senior person to entertain me. It’s a different reaction when I’m in uniform. There’s a double-take from consultants when they see the Sue James face and the healthcare assistant’s uniform, but they are used to me now.’
One of the initiatives resulting from this experience is the ‘Pride of Derby’ awards for staff. ‘A letter from the board saying you’ve done well is a bit like Mr Grace in Are You Being Served. It can seem insincere and general,’ she observes. ‘I introduced a system where if a member of staff, a patient or a manager saw someone going above and beyond what they were expected to do, they could write to me and nominate them. We keep it confidential and nobody knows who’s appreciated them. Typical is a letter praising a senior nurse, relating to care for a patient who had died. The main thing we are seeing is, “because the NHS is having such a pasting, I want you to know what my experience was”,’ Sue says.
The new Royal Derby Hospital School of Nursing, Midwifery and Physiotherapy is to be officially opened on 17th May by the Chief Nurse for England and Wales, Jane Cummings. The occasion is the Nurses and Midwives Conference, to be attended by health professionals from all over Derbyshire, and the following day will see 150 of them process in uniform through the streets of Derby for the Florence Nightingale Commemorative Service at Derby Cathedral. It has been a welcome development having the School of Nursing and the Graduate Entry Medical School now both on the hospital site.
The biggest challenge ahead for everyone in the health service is the proportion of frail elderly patients in the hospital population: the average age of those in hospital is now 66 and Derby has seen a 20 per cent increase this year in the over-90s coming into A&E and a 70 per cent increase in the over-80s. ‘The challenge for all of us is to make sure people have got years of life left with a good quality. That’s what we’re beginning to turn our minds to, because bringing them in just to patch them up and send them out is not good enough. We have to find a different way,’ Sue concludes.
Her biggest tribute is to her family, and especially to her husband, who chose to put his own career on hold and stay at home while the couple’s children were small. ‘This was the mid-Eighties and new men hadn’t been invented, certainly in Yorkshire... He has been such a support to me all the way through my career,’ she says warmly. She is proud of the children: the couple’s son works in community regeneration and their daughter is currently teaching in Australia but home for some precious time at Easter.
Home is in Shropshire and Sue’s days are very long but a cast-iron rule is that she doesn’t work at weekends ‘except for late Sunday night, when I’m just getting my head round the week ahead.’ And what a week it is always bound to be.