24 hours: The working life of Paul Jennings
The chief executive of Walsall Teaching Primary Care Trust talks to Amy Raphael about the challenges of working for a service frequently criticised by the media, what he’s achieved and his plans for the future.
I'm usually in the office by 8.30am and try to leave by 6.30pm, but I’ve always got my BlackBerry with me, even on holiday. My job falls roughly into two parts. First, I’m responsible for the healthcare of the 256,000 people who live in Walsall. As a Primary Care Trust (PCT),we have a budget of £385m to purchase services from healthcare organisations. That works out at around £1m a day, or £40,000 for each hour of the day. The figures may sound daunting but a considerable part of the money is pre-spent.
Second, we run a provider service. We provide all the community care services in Walsall, from district nurses to health visitors. We also provide the learning disabilities service, in partnership with the local authority, and we’re responsible for the mental health service.
For the last ten years, the NHS has had record additional funding – about 10% growth year on year. In real terms, the expenditure of the NHS has risen by over a third, which is pretty impressive. A large part of what we’ve done, particularly around waiting times and targets, has been bought with that development money.
Considering such a rise in expenditure, it’s frustrating when the press concentrate on the things that go wrong in the health service. People always call cheap shots: you could have done this better, you should have spent the money on a hip operation. We did a really brilliant thing last year by becoming the first PCT to sponsor a stand at a football club. The Txt 64446 health stand at Walsall FC costs £20,000 for a season ticket, and those who register receive health messages. We have a target audience of more than a million people because there’s a market at the ground on a Sunday; anyone in advertising would confirm it’s a pretty good hit. Yet a local TV station did a really unpleasant piece, showing a picture of 20 defibrillating machines and suggesting that we could have spent the money on those instead.
There’s always a lag between what we’re trying to do and people’s understanding of it. Part of that lag is due to the way in which the media manages health stories. Hospital closures, for example, are always presented as bad news, despite the fact that a lot of them actually deserve to be closed.
I’ve got a saying by Liam Donaldson, Chief Medical Officer, pinned to my wall: “Every chief executive officer of a public sector body believes that somewhere out there is a bullet with their name on it. They think it’s only a matter of when, not whether, it will start to move towards them.”
Sometimes it’s a matter of finding ways to help people understand our role: we’re the third largest employer in the borough and as such we need to create a separation between provider and commissioner.
Implementing change
Over the next 12 months, we’re looking to find a new organisational home for services so that the trust will be simply and solely a commissioning organisation. However, no-one will lose their job because this is not an exercise in cost cutting, although we will be changing the jobs that people do.
In terms of mental health, we are undergoing a three-year exercise to create a new organisation by joining Walsall up with the neighbouring borough of Dudley. In terms of community services, I have to say that I don’t know the answer yet. We will only make a move when we find a safe organisational home for the services.
Alongside commissioning, the focus will be on issues of planning and pathways of care. We’ve always had a responsibility to engage with patients and the public and I think we’ve done that reasonably well. But nothing like well enough. In general terms, we’ll be broadening the range of people with whom we have contact and particularly aim to communicate with black and ethnic minority groups who, at the moment, are not well represented.
As part of the NHS, we are also guilty of not giving procurement enough attention. When it comes to buying services, we tend to do what we did last year: expect the provider to do a bit more for a better price. And then we fill in the gaps. There will increasingly be issues of procurement as more choices appear in the system. The scenario used to be simple – you had a family doctor and a local hospital and nothing more – whereas now there’s a whole range of possibilities in terms of service provision, including the private and voluntary sector.
Other countries illustrate that plurality of provision can work in terms of bringing in services through competition, but people generally believe that you need reserve capacity in the system to make it work. Which is where sustainability becomes an issue: ultimately those services end up having to be more expensive and I don’t particularly want to pay a premium on what I pay now just to have some reserve capacity in the system.
Sustainability is also about the work force; it takes a number of years to change the skills of workers. The NHS is an immense organ with a financial turnover this year equivalent to the GNP of Portugal, so change can only be made incrementally or by fine-tuning. Huge shifts would simply prove unsustainable.
Bright future for PCTs
I’ve had senior management roles within healthcare for more than 15 years. I find it tremendously rewarding to be away from my desk. Later on today, I’m going to the Birmingham Children’s Hospital to talk about their paediatric and intensive care services. Then I’ll spend an hour or so on our psychiatric intensive care unit.
I also chair the Service Improvements Board and one of our biggest tasks is the 18-week target, which means that a patient has to be treated by a hospital within 18 weeks of a GP referral. It’s a huge shift in the way we’re doing all sorts of things. I feel incredibly optimistic about the future of our PCTs.
PERSONAL FILE
Name Paul Jennings, 52
Position Chief executive of Walsall Teaching Primary Care Trust
Biggest challenge To get the proper focus on commissioning that we need in order to improve health across the board at Walsall.
Defining moment Becoming a chief executive and realising that I really was where the buck stopped. I was asked to come here and turn things around and I’ve been here since 2004. There were performance issues when I arrived but recently we were highly commended in the Health Service Journal Awards – although we weren’t the best PCT, we were the most improved.
What does the future hold? A much greater focus on productivity, effectiveness, patient safety and our place in the system.
