The Big Interview: Matthew Kershaw

QUESTION: You’ve been in the job for two weeks – how is it going?

ANSWER: I’m really enjoying it. It’s a great trust to work for, a great city to be working in, there’s a lot of enthusiasm and it’s a vibrant place.

There are some really good things going on in the hospital. There are also some challenges, which you always have running a big public sector organisation.

The thing about Brighton is there are some great opportunities and fantastic people to be working with.

You get the benefit when you’re coming in new to look at things in a different way.

I am doing a lot of going out and meeting and greeting staff to learn about the organisation, finding out what people are doing, how they’re seeing the work and the job that they have.

I have been impressed by the commitment that people have, by the care that is given to patients and their relatives.

As chief executive it’s a great place to start from. What I need to do is support those staff and help them to use that enthusiasm, care, commitment and ideas to make things even better for patients.

I am also impressed with the ideas that they have got. There is an internal initiative developed by fairly junior members of staff to try and get good ideas into improving how they can run the hospital on a day to day basis, because sometimes the people who are doing the jobs every day have a good insight into how things could be done better.

I have been hearing about how small changes have made a big difference. It has all really enthused me about how we can build on that and take on some of the more challenging issues, which of course exist, as they do in every hospital in the country.

Q: What are your aims and visions for the hospital?

A: This is a really interesting trust because it’s providing different sorts of services. My aim is to build on the fantastic stuff that’s going on at the moment in a number of different areas.

So firstly that we’re providing the best possible care to our local population, the people in Brighton and Hove and Haywards Heath and surrounds, for what would be standard district general hospital services – people having their babies, people having minor and in some cases major operations.

People who’ve had an accident who need themselves fixed, that basic level of service which is for the vast majority of patients what they come to us for, I want to make sure that is as good as it possibly can be.

This organisation has other functions as well. We’re providing a service to the broader population of Sussex, Surrey and Kent for some of our major tertiary services – cardiac care, vascular care, major trauma – on behalf of a massive population.

It is a different sort of service to the more standard services that a lot of hospitals provide, so we have got to get the balance in providing both.

The third thing is we have a real responsibility as a teaching hospital to help in the development and education of our junior doctors and nurses in training and other staff, to help not just this hospital, but also others to produce the future people who are going to provide care to patients.

That’s a really big responsibility for this organisation and one that I’m really looking forward to being involved in.

Whilst people in Brighton might think the research unit is a long way away from what matters to them, actually it makes a big difference to their lives because they get access to some treatments that they wouldn’t do if we weren’t doing that research and those trials.

Q: What issues at the hospital need addressing?

A: Obviously at the moment we’ve had some difficulties and challenges with access on the emergency basis, so that’s a priority for us at the moment.

Again parts of what we do works fantastically. I’ve been speaking to patients over the last couple of weeks and many of them have been extremely positive about their experiences, despite what they might have heard.

There are times patients wait too long and there are times not everything has worked as well as we would want it to.

The hospital and our partners in primary care – GPs, social services, community services, ambulance trusts – need to work harder to improve the way patients flow through the system and that means before hospital, whilst they’re in hospital and when they need to be going home from hospital.

Q: How are you going to make improvements to accident and emergency?

A: A little bit of it is going back to basic principles. We have got some people who’ve come in and helped us who have got experience of looking at how they can improve in emergency systems within the NHS. We have to go back to basic principles about streaming patients – so patients who are more minor come in and go out very quickly.

People who are in for three days require something different. Frail elderly patients who have a longer length of stay might need a different type of care.

It’s about organising the hospital to make sure we can look after each of those patients in the particular way they need to be looked after.

It’s not the care each person is getting, because I have been really impressed by the quality of care, but it’s about the system that works to organise that care.

So is everything done at exactly the right time? Are all the services joined up to make sure everything happens as efficiently and effectively as it can and is what we do in the hospital linked to outside as well as it should be?

It’s about looking at those processes step by step for all types of patients and making those improvements to every little bit so overall the whole system becomes better.

There’s not one problem with one solution, because these things are more complicated than that. Lots of times it works fantastically, sometimes there’s some real pressure in the department and as a result some people have waited too long and we need to get that better, working with our partners. These things are complicated and take time to sort, and we need to sort it in a way which is sustainable.

The good thing is that we have got very dedicated staff who are extremely focused on and passionate about improving the services. I have also spent a lot of the time I have been here trying to make some connections outside the hospital as well, working with the council, with the clinical commissioning groups, with our university colleagues, community trust, the ambulance services, because that is a big part of this hospital. It is really important this hospital is seen as a big part of that system.

Q: Is the research function of the hospital and taking on the extra trauma care putting too much pressure on the hospital?

A: No, absolutely not. The research is in a slightly different place and is a completely different part of our work. The trauma centre is more connected. It’s important for people to know the role we play as a trauma centre is really important.

It involves a very small number of patients – less than 1% of patients who come into the emergency department are in major trauma categories – but if you are one of those patients it is very important you get the best possible care. We provide that service for the whole of Kent, Surrey and Sussex.

That means people can get better services with more staff who are highly trained and better equipped. That’s a good thing for the people of this locality and the wider patch, and if we weren’t doing it we would have had worse outcomes for patients over this period.

So it is absolutely not a distraction or the wrong thing to be doing. It’s what we need to do and that’s not the reason why the emergency department is pressurised. It’s more to do with more general activity, not the tertiary services.

Q: How will the hospital meet its targets of £30 million in savings?

A: £30 million is the efficiencies we need to find this year to meet our financial objectives.

It’s about using our funding in the most efficient and effective way we can and that’s not a bad thing. My job is to do it in a way that also allows us to provide the best quality of care to patients. £30 million was delivered last year too and is the scale of the challenge this year. T

his isn’t something which happened as I arrived, it’s been worked on for six or nine months.

We have an income about £550 million but none the less it’s still a significant challenge. Some of the ways we organise services can also have a financial benefit.

For example, if we improve length of stay, the amount of time patients spend in hospital, so patients come into hospital, have as smooth as possible a journey and then are discharged at the time they need to be.

It’s better for patients because you don’t want to be in hospital longer than you need to be, it’s better for us because we’re only treating people who need to be here.

So you’re improving quality for patients, the system for the hospital and there are financial benefits. We’re not looking for services which we can stop doing. There are absolutely no plans at the moment for redundancies. A lot of the cost in running the hospital is paying the 7,000 staff. That’s not to say there won’t be different ways of organising services that will have some impact on staff.

Q: When your appointment was first announced, the unions branded you the ‘axe-man’ based on your reputation in charge of previous hospitals. What is your reaction to that and does it make it difficult to start a new job being given a label before having a chance to make your own mark?

A: I have been extremely well received by staff here at the trust. Clearly some people outside might have a different perspective but in terms of the staff themselves I have been here a very short time, but I spent a number of days here beforehand to try to meet people.

I have been extremely well received and part of that is because I have been very open about what I want to do here and that I’m genuinely interested in what they do. I have made a real commitment to be here as long as it takes to do the work we need to do, and it’s not a quick job.

Clearly there have been some comments from people about what I’ve done before, but people should make a judgement based on what I’m doing now.

I’m very happy about the work I’ve done in other jobs but they were different sorts of jobs. I’m here to be chief executive of this trust and to work with staff here.

I am very passionate about the health service, I love working for the health service and have done so for 22 years. There are challenges but the NHS is a great thing to work for.

Q: Is the hospital development still going ahead?

A: It’s still progressing but this is a £420 million development. In terms of NHS publicly-funded schemes it’s the biggest in the acute sector – it’s a major scheme, not just for this area but for the country.

It’s quite right that if they’re going to give us £420 million there’s an absolutely clear plan of our clinical and financial processes to make sure we use that money appropriately.

We need to answer some further questions which we will submit to the Treasury in the next few months.

Once we’ve got through this next phase then it will go through to final approval. Assuming that proceeds we will then be into moving.

What has happened in advance of that is what we have done to prepare is underway. The school down the road is being turned into offices to allow the first stage of the decant.

That’s starting to come into fruition for autumn of this year. I’m confident still that we’re on the right track to secure the funding.

The care we provide in these buildings is fantastic but the buildings themselves are not what they need to be for 2013.

The fact the money hasn’t been approved yet isn’t delaying the building at this moment. What it’s not allowing us to do is absolutely finalise all of the plans.

I’m hoping that by the end of this calendar year we’ll be in a position of knowing exactly what money we are expecting.

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