NHS needs structural reform - Peter Lachecki

International businessman Peter Lachecki has just retired after five and a half years as Chairman of the Gloucestershire Hospitals NHS Foundation Trust which had a huge financial black hole when he took over.

Ian Mean, Business West Gloucestershire director talked to him about how he steered the Trust back to financial health and how he saw the challenges facing the NHS.

*When you took over, the Trust finances were pretty dire weren’t they? How did you go about sorting that out?

“The surprise deficit was well over £30 million. The first thing we had to do was to really understand what the extent of the problem was and then dig into all of that.

“We then had to be very transparent in what we found across the whole organisation, our partners and the NHS.

“Bit by bit with everybody’s support, it took us nearly three years to get to where we wanted to be.

*Was it the toughest thing you have had to do in your business career?

“Yes, without a doubt partly because some of the previous leadership had pretty much let down the staff, and as a board we stood up in front of the staff and apologised for that”.

*The NHS is the largest employer in Gloucestershire—around 20 000 people. It is a huge business isn’t it?

“Our turnover must be around £1 billion. I think that brings responsibilities for the leadership and we have taken that very seriously, in employment, investment, procurement and the environment to name just a few areas”

*Do you think the NHS is broken as a business model?

“No, it isn’t because the NHS is still providing excellent quality of care to many millions of people across the country. In essence, it is still delivering, however, it’s not doing what people expect and what people working in the NHS would like to deliver.

“I think the model isn’t broken but it needs a structural reform in terms of thinking about the long term-particularly about workforce planning.

“We haven’t got that longer term view linked with the investment needed and without that we just run out of steam.

“And I think society has got to decide what it wants to pay for.

“Longer term workforce planning is key, as is long term care for the elderly and investment in public health. We are going in the wrong way as a country in terms of our general health.

“Fundamentally, it is not broken but it needs longer term investment. Politicians are often not geared up to do that.”

*How are we going to reduce the waiting lists now over 6 million?

“It is going to take a long time.

“Even if you could magic up the money, you can’t magic up the people.

“One of the things that the NHS staff are doing is looking at the priorities for people who are on waiting lists. So it is not just in chronological order.

“There is no magic bullet. The leadership responsibility is to be honest with people and keep people informed what is going on.

“People could be waiting a year and longer for a considerable time to come.”

How long is it going to be before we get to a proper hospital-social care plan for the NHS that works?

“That is a million dollar question. There needs to be proper joined up strategy between social care and health.

“Locally, everybody is doing a great job but essentially the jobs in social care are very poorly paid.

“People have wrongly called them lower skilled but it is criminal to say that. This is a structural issue in social care.

“What does society want? Are we interested in looking after our

elderly and more vulnerable people or are we more interested in potholes. Are we becoming a less compassionate society?”

*If you were the Health Secretary tomorrow what would be your priority?

“I would like to think I would be looking at the longer term issues.

“Workforce planning, how does social care really work, how are we investing in prevention of poor health and health care inequalities.

“All those things in the long run not only improve the health of the nation but it is actually likely to be cheaper for the taxpayer.”