I was taken aback when my local paper, the express and star ran a story about a banker style bonus for Dr Anthony Marsh.
The story was also picked up by a number of national newspapers.
In what I thought amounted to a rebuke to the express and star, the spin doctors at the West Midlands Ambulance Trust issues a statement on their web site claiming Dr Marsh was saving the two trusts money by doing the job of two chief executives:
“For the combined work his salary has been increased by £50,000, saving the taxpayer approximately £130,000 on the cost of having a substantive chief executive in each ambulance trust.”
When I read the hubristic rebuttal from the trust I raised an eye brow but thought the matter closed, even though my curiosity was aroused by the Conservative MP Therese Coffey, who on Twitter, displayed great admiration for Dr Marsh.
Then, this week, I received a number of phone calls to my office making specific allegations about operations at the ambulance trust. I am duty bound to follow them up in slower time.
Later in the week, a copy of a letter arrived in my office, sent anonymously.
Unless I am the victim of a very elaborate hoax, it seems to suggest that there was extreme concern voiced by members of the Trust board back in 2013, when Dr Marsh was appointed. I say “appointed” but if this letter is right, it seems to suggest that someone in authority (I assume Dr Flory CBE) felt that Dr Marsh was the only human being on planet earth suitable to take on the onerous task of running an ambulance service. In so doing, Dr Marsh got the job, and the £50K pay rise.
What does this all mean? I don’t yet know. But I will find out.
Immediate questions spring to mind:
1. What minister authorised this and where is the paper trail?
2. Why were the concerns of Dr Geoffrey Harris OBE that the manner of the appointment was “wholly unacceptable, undermining behaviour that is entirely inconsistent with what we would consider normal business practice, courtesy and respect for others.” ignored?
3. Who, exactly, approved the £50K uplift and what do the Treasury say about it?
4. What does Jeremy Hunt say about it for that matter?
5. Dr Marsh seems to have appointed a deputy/assistant at the East of England Trust, presumably to help cover when he is on his two days a week in the West Midlands. Have I got this right and if so, how much is the person paid?
6. How was Dr Marsh’s deputy/assistant appointed and were references taken up?
These questions will do for now. There will be more.
Here’s the text of the letter that arrived at my Westminster office. It certainly looks genuine but as I say, it might not be. If I’m the victim of a hoax then I sincerely apologise for leading people on a wild goose chase. I’ve talked to several people with inside knowledge of the Trust though, my team have talked to others as well. Given the information we have received, I don’t think it unreasonable to publish.
28th November 2013
Mr D Flory CBE
NHS Trust Development Authority
At our meeting on Monday afternoon, 25th November, you made it clear to me that the East of England Ambulance Service (EEAST) should not proceed with its planned recruitment of a CEO on the basis of open competition and, further, that the TDA would like the Trust to consider the appointment of CEO from another ambulance Trust on a shared basis.
The reason, you said, was that the TDA, based on our previous campaign plus experience with the East Midlands Ambulance Trust and the North West, was not confident that any campaign would identify a candidate of the right calibre. In your view, there were simply very few, if any, suitable candidates available. Moreover, a joint appointment would optimise the value of an experienced leader who would have the confidence of politicians and the wider NHS.
As agreed, I discussed this proposed approach with my Non-Executive Directors prior to our Board meeting yesterday, 27th November. I also made a low-key statement at the Board in public, on the lines we agreed, that the recruitment process had need paused to allow further options to be developed and considered. I needed to make this statement as my written report to the Board, drafted and published before our meeting on Monday afternoon, recorded that the recruitment process was moving ahead with an indication of the timetable.
I have to report that my Non-Executive colleagues were both dismayed and extremely disappointed. Your approach, they feel, does nothing to address the key factors that the Trust needs in place to succeed. Furthermore, and most important, your approach appears to take no account of the risk to service delivery and to patients that it would entail, especially as we move into winter and the period of greatest demand on the Trust and greatest risk to patients.
Rather the reverse: leadership capacity has consistently been identified as a key need for the Trust. I and my colleagues cannot see how a severe reduction in senior management capacity would do anything other than re-open and worsen this leadership deficit and risk seriously destabilising the organisation. Specifically, we cannot see how any CEO, no matter how competent and experienced, working on a part-time basis could commit sufficient time and focus to EEAST to address the organisation’s leadership, management and developmental needs comprehensively and effectively. This deficiency is, we believe, substantially amplified by the widespread and diverse geography of both this and neighbouring ambulance Trusts and the absence of any natural synergies in terms of patient flows, resource utilisation or proximate geography.
Since my appointment, the Trust has made substantial progress in diagnosing the underlying problems affecting performance which have built up over a number of years. We now have a clear understanding of the way forward and of what is required to deliver a sustainable, high performing organisation. The Trust has not received a warning notice from the CQC, nor is the Trust in serious financial difficulty. This make it even more difficult to understand the rationale for the TDA’s proposed approach.
I and my Non-Executive Directors are clear that the transformation the Trust needs cannot be successfully led by a CEO working on a part-time basis, potentially applying traditional ambulance service solutions. We believe that other ambulance services in England, to a varying degree, will be facing similar performance challenges based on the current ambulance delivery model. Moreover, we believe that the level of engagement, whether externally with politicians, the public and our commissioners or internally with our staff, requires the attention and energy of a full-time CEO and an effective, committed Board.
I am disappointed that, however unwittingly, the approach the TDA has taken to develop this proposal, through discussion with the CEOs of other organisations, has resurrect historic issues which relate to the management of the legacy Trusts which preceded EEAST. We are anecdotally informed that senior staff within the Trust who were linked to these legacy bodies, appear to have been aware that these discussions were taking place in advance of out meeting last Monday. It is also unfortunate that the existing ambulance CEOs you have approached all have historic connections with those legacy services. In addition, the Trust Board has been made aware that some of our senior staff have already had discussions with your candidates in the context of those pre-existing relationships. You will understand that I and my colleagues find this approach by others to staff wholly unacceptable, undermining behaviour that is entirely inconsistent with what we would consider normal business practice, courtesy and respect for others.
You will be aware that a key challenge for this Trust has need the negative impact of a cultural divide remaining from the pre-merger services. This has manifested itself in cronyism and a resistance to collaborative behaviour, often amongst senior managers. It has also set the scene for a general lack of transparency around pay and promotions resulting in some over graded senior jobs and promotions linked to favouritism rather than ability. The Trust Board is working hard to rectify this.
With your assistance, we have made significant strides in appointing what I consider to be a group of Non-Executive Directors of high calibre who are already having a positive impact on the Trust. Following what I considered a wholly constructive meeting with Dale Bywater, I had agreed a clear plan for recruiting to all of our executive leadership positions, in order to complete the reconstitution of the Board. However, I would stress that our current executive directors are working effectively as a cohesive team, complementing the non-executives. It is important to build upon this, not undermine it.
There is still much work to do in transforming this Trust. However, during my tenure, we are beginning to see improvements which include:
• A reduction of back up delays
• A reduction in handover delays at hospitals
• A reduction in long waits
• Sustained improvement in achieving our green targets
• A reductions in complaint and corresponding increase in confidence
• A reduction in sickness absence
• Three months of positive financial monthly run-rate with a year-end surplus forecast
• A reinvestment plan approved by the board, yesterday
That said, I and my Non-Executive Directors fully recognise the critical importance of consolidating the progress the Trust has made over recent months and of nor losing the positive momentum now in place.
I am aware that the TDA is concerned about the Trust’s performance and wishes to be instrumental in its transformation. However, I and my Non-Executives believe that the TDA can best do this is by continuing strong support for the Board and the executive team to deliver the transformation required. Support for the implementation of the Clinical Capacity Review received by the Trust Board yesterday would be particularly valuable. The TDA may be well-placed to facilitate the necessary financial support, including transitional relief for one-off transformation costs, to kick-start the change programme.
In addition, the TDA could help the Trust to improve the confidence of our stakeholders by being seen to be actively supporting the Trust Board. It is an unfortunate reality that negative media coverage has had a material impact on our ability to attract the quality of CEO that we need. This has also been one of the primary reasons why we have lost paramedic applicants.
I now believe that I have a strong team of non-executives coming into place and a Trust Board that, with time and resources, will be able to lead the Trust to the futures that we all desire, delivering a safe, high quality and sustainable service to patients.
To this end, I and my non-executive colleagues would welcome the opportunity for a constructive dialogue with the TDA on how best we can continue, together, to put in place the key factors that the Trust needs to succeed.
Dr Geoffrey Harris OBE JP
Interim Chair of Trust