Being a chief executive of two ambulance trusts – one doing well, the other struggling – gives me a view from both sides when considering organisational change, says Anthony Marsh

Live Q&A with Sir David – 12pm 8 July

The Dalton review into new options for providers is a hugely ambitious piece of work. It also has the potential to be immensely worthwhile.

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‘Managing two trusts presents a unique set of demands, but the solutions we come up with can be useful elsewhere in the NHS’

The broad challenges facing the NHS are the same all over the country. Demand is rising because expectations in our NHS are rising; we are also living longer and have more complex needs, at a time of great economic challenges.

Yet when things are going wrong, we require a more sophisticated approach than always retreating to the same default positions of merger or bust, or buddying up with those next door. Likewise, when things are going well, there may be better choices than eyeing neighbouring trusts as routes for expansion.

Double vision

My experience as chief executive of two ambulance trusts, one performing well, the other struggling, places me in a useful vantage point.

West Midlands Ambulance Service Foundation Trust and East of England Ambulance Service Trust are not next door neighbours. They haven’t been joined together because of expansionism, but out of necessity. As such they could be one of only a few of examples of a non-geographical NHS chain in England.

Managing two trusts presents a unique set of demands, but it is not so unique that the solutions we come up with can’t be useful elsewhere in the NHS. Indeed, we can be something of a live case study.

Here are some of the things that I’ve learned. First, running two geographically separate trusts means my teams and I have to work in a different way. We can’t just do the same thing over more sites; we need to work out how to be separate but united.

Second, being able to make big changes depends on being able to motivate staff and organisations to look forward with a clear vision and a small number of key priorities. I have been using small turnaround teams to review current practice and quickly establish what needs to change.

Best of the rest

However, we must recognise what is good in the current way of working as well as bringing in change. When I first went to West Midlands, we took the best of the four previous organisations and rolled out that level of performance and ways of working, so that patients across the region benefited.

‘The Dalton review can be a big help simply by outlining all the organisational choices currently available’

The joint working arrangements also provide opportunities to better support talent management and leadership succession planning in each organisation.

The Dalton review can be a big help simply by outlining all the organisational choices currently available, and if there are options that simply aren’t possible, by proposing the reform needed to make change happen.

That said, the biggest barrier to change is cultural. Leadership and values are even more important than what is enshrined in black and white. A review that recognises that fact as well as offering practical new steps will be a real winner.

Anthony Marsh is chief executive of West Midlands Ambulance Service Foundation Trust and East of England Ambulance Service Trust

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