A visionary CEO

Martin Turner FCCA joined the National Health Service in 1969 as a finance trainee. Today he is chief executive of one of the largest NHS trusts in the UK. He tells Colette Steckel about his career and the problems he faces as CEO

Gwent Healthcare NHS Trust is one of the largest Trusts in the UK, treating over half a million patients at its three acute hospitals in Newport, Abergavenny and Caerphilly, and through its 20 community hospitals, health centres, mental health and learning disability services. It employs 12,500 staff, among which are 250 consultants, over 1,000 doctors, and 5,500 nurses. And it has one committed chief executive who has his hands full, making sure that the Trust runs smoothly and that its patients have access to good quality care.

'The one thing about being a chief executive in the NHS is that it�s difficult to measure your success,� says Martin Turner, who has been at the helm of the Trust since its inception in 1999. �You�re always trying to balance the financial with the non-financial aspects of the Trust and that can be frustrating. When you look at a profit-making business, a CEO may have a number of targets, some of which are financial. In the NHS, we have hundreds of targets, and that�s a real issue for chief executives.�

Waiting lists are a case in point. Although the Trust has achieved many of its key waiting time targets - for example, an 18-month target for orthopaedic treatments, four months for cataracts and a reduction in waiting times for outpatients - Turner recognises that hospitals generally are under enormous pressure. �The Trust�s hospitals are 92% occupied, which is OK but doesn�t leave us much room to cope with volatility,� he says. �A lot of patients admitted to hospitals are emergency cases. It�s hard to predict how many patients will come in at any one time. It could be 150 one day and 20 the next. And that causes enormous problems.� Turner points out that health service experts recommend an occupancy rate of 85%, which clearly the Trust exceeds, before inefficiencies start creeping in. �What does being inefficient mean in the NHS?� he asks. �It means trolley waits for patients and cancelled operations, and we do quite a lot of that these days.�

Turner attributes the increased pressure on hospitals to what he calls delayed transfers of care, where patients are well enough to leave hospital but remain in hospital beds awaiting places in nursing or residential homes. Over the past two years, the Trust has seen a 63% increase in the numbers of people remaining in hospital but no longer requiring hospital services. In absolute terms, that works out at 257 beds �blocked� on average each month. �It has got to the stage where we have physicians and surgeons running around the hospital to see who can be discharged because there aren�t enough empty beds available for new emergencies or for people on our waiting lists. We didn�t see that sort of pressure, say, 20 years ago,� observes Turner.

Delayed transfers of care is not an easily resolved issue for the Trust because the onus is on local authorities to ensure that care packages are available for patients ready to leave hospital. But Turner is hopeful that working together with the local health boards and the local authorities will bring about a reduction in the number of such patients, which in turn will free up desperately needed beds. �There will always be plenty of business for the Trust and the NHS in general. We are getting older but not necessarily healthier. And an older population puts even more strain on the health service,� he adds.

Despite the pressures, the Trust, which has a £343m budget, met its financial targets including breaking even for the 2002/03 financial year. To maintain financial stability and meet ever-growing demand, it is also working in partnership with local health boards and other groups, to develop a long-term strategy for healthcare in Gwent. Even patients are being consulted about future developments through Public and Patient Involvement initiatives launched last year. Turner has a vision for healthcare in Gwent that centres on a modernisation programme. Such a programme focuses on new ways of delivering services, improving efficiency and eliminating waste. The Trust has already invested in buildings and facilities to meet demand for services in the region, including a coronary care unit in Nevill Hall hospital, a £1m medical assessment unit at Royal Gwent Hospital and a Midwifery-led unit in Caerphilly. Further proposals throughout the region, such as state of the art diagnostic cardiology facilities costing £5m at Royal Gwent Hospital, and a community hospital at Blaenau Gwent, have already been given the green light by the Welsh National Assembly.

�We aren�t talking about minor changes to healthcare in Gwent,� says Turner, adding that he sees a significant difference to the way in which the Trust delivers modern healthcare to the region. He cites Caerphilly, a county in the south-east of Wales, as a focal point for the Trust�s strategy. �Caerphilly has a population of around 170,000 people, some of whom are in very poor health. We are hoping to see big improvements in the health service for that population. The strategy is to bring more services to patients� doorsteps. People are less likely to travel for health services, even if they need them. What the Trust has to do is deliver a service locally so that more people will take it up. The location of services is vital.�

Pursuing a career in the NHS

Turner has spent all his working life in the NHS in south-east Wales. He joined Monmouthshire Hospital Management Committee as a finance trainee in 1969 after seeing an advertisement in the local paper. He studied ACCA in his spare time while climbing the career ladder within the NHS, starting off in payroll before moving onto audit, budgeting and treasury. In 1986, he made the leap from accounting to management when he became unit general manager of Gwent Community Services, providing community, mental health and ambulance services to the region. Turner recalls that it wasn�t difficult to make the move from accountancy although his new position gave him an insight into the NHS from the other side of the fence. �As an accountant, I was used to people asking me questions and respecting my answers because of my experience and expertise but, as a general manager, I suddenly found that everyone knew how to do my job. I received no end of advice. And that felt strange,� he says.

A three-year stint as unit general manager of the South Gwent Health Unit from 1990 saw Turner transfer into acute services. During his time there, he submitted an application for the Unit to convert to trust status and, in 1993, he became chief executive of the newly established Glan Hafren NHS Trust. In 1999, Glan Hafren merged with Gwent Community Health and Nevill Hall and District NHS Trusts to form the Gwent Healthcare NHS Trust, and Turner, who promoted the merger, was appointed chief executive. Shortly after, he travelled to Boston where he spent three months on the Harvard Senior Management Programme, a course from which he says he learnt a lot. �It�s helpful to get a different perspective on the NHS; one from the outside rather from within. Most of the students on the course had never even heard of the NHS.�

Although he points out that his move from the relative comfort of accounting into the heady realms of general management was a memorable point in his career, Turner admits that running a busy and burdened NHS trust isn�t easy. Far from it. He notes that he sometimes feels as if he is �wandering from one problem to another�, particularly as the NHS has been underfunded for years. �The NHS is one of the top preoccupations for the British Government. Health is always a big issue, but rather than increase funding, governments have preferred to reorganise the health service. That said, this current Government has been promising and delivering a lot more money to the NHS but it still feels as if we are treading water. We always need more staff and more facilities. We�re constantly chasing money.�

Despite the financial setbacks, Turner welcomes the challenges posed by the Trust and refers to his work within the NHS as fascinating. �I think most people who join the NHS will tell you that it�s a fascinating industry to work in.� Most of the interest, he notes, lies in the fact that the NHS is a people-oriented institution where the numerous staff at the Trust make a difference to the patients who flood through the doors of the myriad hospitals and health centres. �The people who work in the NHS are extraordinary. They work under enormous pressure but they all show a deep commitment to their jobs,� he says, noting that he meets regularly with staff and unions so that they can air their concerns about the workplace. �I regard that as a major reason for the success of the Trust.�