Wigan's outgoing NHS chief gives final interview before his retirement
And Andrew Foster spoke openly about the highs and lows of 13 years in the top job at Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust as well as his concerns over the future of the health service.
He told of the huge task he took on in the borough, first as chair of the Trust and then as chief executive, turning around a struggling organisation with morale at rock bottom.
He also spoke of last year’s lengthy industrial dispute over the creation of wholly-owned subsidiary company WWL Solutions, which saw his leadership put under an intense spotlight.
However, he saved some of his frankest and harshest criticism for authorities in the region, slamming them over centralisation plans which he fears will see Manchester hospitals gain while the rest of the region loses out.
Mr Foster, who was born in the hospital he has been running (but had all traces of his Wigan accent removed by elocution lessons at a young age), said he will be vacating the top desk in the Trust Headquarters at Wigan Infirmary with great regret on his final day of work, scheduled for October 18.
Mr Foster, 64, said: “I’m very sad to be leaving, it’s 23 years since I first came here.
“Most chief executives are in their 30s and 40s and I’m among the top 10 oldest chief execs in the NHS. It’s really hard work and I think after 13 years it’s time to let somebody younger have a go at it.
“The saddest bit of leaving will be saying goodbye to the staff. One of the things I really enjoy is just walking round the hospital.
“I’ve made it my habit to just drop in without announcing myself in advance. After all these years I’m not treated with suspicion, as though I’m coming to find fault!
“I know most of the staff at least by sight and a lot by name and I shall miss that. Wigan is a good place and that is because the staff here are so fantastic.”
Mr Foster arrived in the NHS in 1991 and had stints at Wrightington and Ormskirk following a complete change of career from his previous jobs in property development and confectionary marketing.
The latter role saw him work as a brand manager for Smarties, Jelly Tots and Tutti Fruttis, saying his proudest achievement there was the introduction of the blue Smartie. He came to Wigan as chair in 1996 and found the hospital Trust in a terrible position.
He said: “The place was in a bit of a mess. Ian McCartney, the local MP, had labelled it the worst Trust in the country. He had lots of reasons for doing that and lots of them were quite true.
“The Trust was at loggerheads with almost everybody: MPs, the local authority. Internally it was doctors versus managers. It was a very unharmonious arrangement. I went to see Ian and said I wanted to build partnership working at every internal and external level and would like his support. He said that if I would stick to my word he wouldn’t criticise. He became one of our strongest supporters.
“The first year was very difficult. The main thing I did was bring in two really good chief executives. They did a really good job in tackling all these problems and should take all the credit. I just set the tone.”
Mr Foster spoke proudly of chairing from Wigan the negotiations which would lead to the Agenda for Change, which he described as “the biggest pay reform the world has ever seen, with more than one million people moving from a system dating back to the First World War to something much more modern”.
He then headed to Whitehall for five years during what he described as “the time of NHS plenty” before the borough called once again in 2007 when the chief executive post at WWL became vacant.
He said the two biggest achievements of his time at the top in the NHS were overseeing quality improvement and staff engagement.
He said: “The thing that inspired me most in the national job was quality and harm reduction. We started in 2007 with a project called Halve The Harm and in that year about 600 incidents of harm, such as infections, pneumonia, falls, pressure ulcers and so on, happened in healthcare institutions.
“In the end the reduction was by 90 per cent. That was supported by about 400 quality champions who have worked in 200 projects, from dramatic things like saving people’s lives to just improving patients’ experiences in hospital.
“At the most serious end, things like death rates after heart attacks or kidney injuries have been reduced by projects done by staff.
“Staff engagement is the other big feature of my time here. If you want to improve something you don’t send a manager to tell people how to improve, you ask the staff working in that service and they come up with the ideas.
“That’s been our modus operandi for years now and I think it’s why we perform so much better than other organisations.”
The statistics and silverware cabinet at Trust HQ bears out the confidence.
For the past two months WWL has been placed third in the monthly league tables of all 136 acute Trusts in the NHS covering performance quality and the satisfaction of employees and those being treated. The highlight of Mr Foster’s time at WWL, though, came in 2014 when the Trust received the prestigious accolade of hospital of the year given out by the Health Service Journal.
The ups, though, have also come along with the downs, and Mr Foster’s staff-centred approach came under most scrutiny last year when furious employees working in key roles such as catering, cleaning and portering downed tools over plans to move them to WWL Solutions.
Weeks of strikes saw the temperature raised considerably and Mr Foster facing intense pressure over his handling of the situation as staff, MPs, trade unions and other voices all joined the chorus of criticism while backing those on the picket line. Mr Foster says he has developed a thick skin, telling how he also became doctors’ “public enemy number one” in one of his national roles for a time, but it is clear the damaging row left a lasting impression.
He said: “I don’t want to get into the rights and wrongs of it but it was a dreadful period for everybody in this organisation.
“I issued a statement to staff just this week saying if I knew then what I know now I wouldn’t have done it. It’s the biggest blot on my record here. It’s part of the job of any chief executive to be criticised all the time but a significant part of my working life has been about building relationships with staff and this was completely counter to everything I really stand for.”
Mr Foster said his primary aim was to improve the Trust’s financial situation and he speaks starkly about the funding issues the NHS has faced for some time and continues to have to confront, not helped by the current political turmoil.
He said: “In my 13 years as chief executive there have been nine years of austerity, of having to make big savings every year. Dealing with more patients with fewer resources has been a very tough environment to work in and it still is.
“Austerity has led to workforce shortages. We now have significant vacancy rates across all our clinical staff which puts pressure on the ones still here. Nurse training places were cut and although these decisions have now been reversed the effect won’t come good for another three or four years. Recruitment from Europe has dried up and they’ve almost all gone back now, which is hardly surprising because no-one’s guaranteeing them anything after October 31.
“Nurses can also retire with a full pension at 55 and lots of them are reaching that age too.”
However, Mr Foster says the biggest difficulty his successor will face concerns the reconfiguration of the NHS across Greater Manchester, about which he was scathing.
This recently reared its head again with the suggestion a number of services, including that treating breast cancer, could move away from Wigan. He said: “There was a consultation in 2014 which in my opinion was conducted in a completely dishonest way.
“There was a claim it would save 3,000 lives, based on the lowest surgical mortality rate in the country compared to Greater Manchester. However, the lowest rate was in Chelsea and Westminster which has an utterly different population to Wigan, so the idea we could save lives in Manchester by turning us all into Chelsea and Westminster was dishonest. It also forced all the hospitals into fighting with each other.
“We told them it wasn’t possible because it needed more staff and the whole project has been waiting for £100m of investment.
“The Government has just announced £14bn of investment but it did not include Healthier Together, but it still hangs there like a threat. It has been difficult to recruit in surgery for several years because of this.
“We’ve got the best breast services in Manchester, the only one peer reviewed as outstanding, yet somebody somewhere decided it would be a good idea to shift all our service to Bolton.
“There are suggestions of building a new unit for £285,000, when in the NHS you can’t build a shed for that. It is a fake figure used to give Bolton an advantage. What worries me for the future of the hospital in Wigan is decisions like this will continue to be made pinching a sliver out of this hospital. Eventually this won’t be a great place to work.
“We’ve always had fantastic cardiologists but slowly surgery is being stripped away from this Trust. There’s a threat to take away children’s services, that’s under review. These reviews are run by clinicians in big Trusts in the middle of Manchester who think it would be better if everything was there.
“Then, if you don’t have a children’s service, can you really run a maternity service? That’s the risk.
“Rochdale is now a cottage hospital when it used to be a full district general hospital, Bury used to be a complete district general hospital but is now a partial A&E with no surgery service at all. Wigan is the biggest community in Greater Manchester and really has to have its district general hospital.
“Fortunately we’ve got strong support from the council and the Clinical Commissioning Group. That’s important because the people in Greater Manchester driving these reconfigurations have always ignored counter-arguments and just put their heads down and get on with it.”
Mr Foster says cancer hospital The Christie running a service in Wigan so patients do not have to go into Manchester for chemotherapy is an example of the way he would like to see health organisations working together. However, with tongue in cheek he says that sometimes he feels drastic measures are needed. He said: “I think Wigan gets very little out of being part of Greater Manchester’s health systems. In my more fanciful moments I occasionally wonder about telling them to go away and getting Wigan to join Lancashire. It could be called Wexit.”
Mr Foster is not stepping away from work completely, but will be helping NHS Improvements launch a People Plan and taking on a role for a couple of days a month as a non-executive director of Health Education England.
That will keep him involved with WWL as he will continue working in international recruitment, which he describes as “a baby of mine”, having launched a scheme to bring staff from oversees from Wigan which out-performed the national set-up.
It is clear, though, that after more than two decades’ involvement he remains equally passionate about the NHS itself. He said: “Although the top issue on everybody’s minds at the moment is Brexit the second is the NHS. It’s the most treasured institution in the country. We see that locally, we get so much positive feedback from patients and careers about the service they get here.
“All politicians know how loved the NHS is, but after 10 years of austerity it needs looking after.”