Being an NHS chief executive

When I retired in 2014, I planned a memoir about my 13 years as an NHS chief executive. I thought I would finish the book within the year. How little I knew.

Writing it made me re-examine events that had been painful for me, even more so for others, such as when patients hurt themselves or another person. It caused me to reassess some fundamental beliefs about how the NHS works, and whether it is sustainable in its current form.

It made me question my past decisions and find some of them wanting, either because I had been wrong, or because I and those I worked with lacked that amazing instrument first described in the 1950s by Dr Eugene Braunwald, the retrospectoscope. And there were times it laid me low and made me think bleak thoughts.

On top of this, my publisher didn’t like the title. They said it made the book difficult to place. What they meant was that it might not sell. I found another publisher. But they wanted me to turn it into three books, while I was struggling with one. We parted company too.

Cue The Laughton Press, a tiny imprint with one publication to its name. The owner, Steve Marsh, is also my husband. He knows how to hold his only author to deadlines. And he knows his limits, so he brought in a professional editor, Jean Gray, ex-editor in chief of the Nursing Standard, to kick my ramblings into shape.

Illuminating conversations

My experiences at a learning disability hospital back in 1973 shaped me far more than I had realised until I wrote about them. Since the book came out, I have had illuminating conversations with others who have worked in isolated long stay institutions. We have spoken of the guilt we feel for not knowing at the time that locking people away was abusive in itself, never mind the terrible things that could happen in such out of the way places.

My first attempt at whistleblowing wasn’t my finest hour, but I hope recounting it will help people who have never experienced such things to understand why those who knew they were wrong at the time were still powerless to stop them.

There are also some happy stories, such as the positive impact of concentrating on equality and human rights over many years

I explore what happens now in public services when something bad happens. How the attention from regulators, commissioners, the upper echelons of the NHS and the media can get in the way of doing the things that leaders really need to do to ensure patient safety and staff well being. And how those who were there for us in the good times now seem to pass by on the other side.

I used to think that we make our own luck in this world. I would wonder why x or y chief executive had allowed a situation to get so badly out of control. I came to realise that bad things can happen anywhere. It’s what you do about them that matters.

And the book includes my thoughts on the mental health issues that have affected me throughout my career, including October 2013 when I became overly confident, then excitable, and finally irrational and toxic before a crash into severe clinical depression. I was able to come back to work afterwards, but most who have such a breakdown don’t. That should not be so.

There are sections on how to choose a chief executive job, how to stay the course and how (eventually) to leave well – not that I totally nailed that one. I explore the impact of social media and how it can be a power for good as well as ill.

And what to do if you attract an internet stalker – which isn’t just someone who is horrible to you online. How they invade your psychological space, attack your integrity, spread lies, make threats and cause you to fear for your safety and sanity. The book also covers the conflicting demands you find yourself juggling, the sleepless nights, loss of privacy, lack of thinking time and the loneliness of being the accountable officer.

There are also some happy stories, such as the positive impact of concentrating on equality and human rights over many years, still a big part of my life today. The book is not a misery memoir, just an honest one.

Towards the end there is a bit of polemic about the state of mental health services today, and why I deeply regret not having done more to redress this, given my relatively high profile.

If you decide to read it, I’d love to hear what you think.

And as I say in my dedication, thank you to all who choose a life in service of others.