Dr Gareth Goodier of Cambridge's NHS Foundation Trust
"..managing healthcare is three times more complex than managing manufacturing.."
Backgrounder The Cambridge University Hospitals NHS Foundation Trust’s humble beginnings stretch back over 240 years to a 20 bed hospital with 11 patients. Today it has an income of £455m, some 500,000 patients and 1,170 beds at the two main hospitals that make up the Trust, Addenbrooke’s and the Rosie Maternity. At its helm is Dr Gareth Goodier, chief executive of Cambridge University Hospitals NHS Foundation Trust. Under his leadership, the Trust has consistently been rated as one of the UK’s best hospitals for both patient care and research. After qualifying as a doctor in 1975 and working in England, Gareth spent many years in Australia as chief executive of a number of major hospitals and health systems. He returned to London in 2003 to work as an NHS chief executive before moving to his current role in 2006. More information about the trust can be found at its website: www.cuh.org.uk 1) How would you compare running a Trust employing 6,800 staff to a private business of a similar size? It’s much more complicated. There is an American study which indicates that, at the base grade, managing healthcare is three times more complex than managing manufacturing – and at the level of a ward sister and above, it’s five to six times more complex. All the literature indicates that running a hospital is significantly more involved than an equivalent size of business enterprise. 2) What kind of business would you most compare the Trust to and why? It’s like a 1,100-bed hotel – one where all the customers have serious problems and need your help. We’re providing a service, but where a conventional business has a limited number of product lines, we have thousands of patients, each of whom is different – and each of them needs different treatment from a team of specialists. For me, the consultant staff, nurses and allied health professionals are almost equivalent to artisans, because every patient is unique. 3) It is common to see excellent academics fall short as business leaders, do you think doctors are best suited to running organisations the size of Cambridge Hospitals Trust? You don’t need to be a doctor to run a major hospital, but it’s certainly an advantage. On top of my medical training, I have formal management qualifications that include an MBA and eight years’ professional management studies. I’ve been a chief executive for 19 years and have several years experience as a management consultant. Having worked as a doctor helps you understand the hospital language and the environment as well as identifying with the ethos of clinical care. 4) There’s a large amount of innovation inherent at the Trust regarding treatments and medical approaches; how much of a priority is this? It’s a big priority. Our mission is to deliver innovation and excellence in health and care. We have many advantages on this campus, not least our close links with Cambridge University, the Medical Research Council, GSK, Cancer Research UK, and the Wellcome Trust. I believe that we have a duty to be innovative in the way we provide health services – and ultimately, I want patients to benefit. 5) What efforts are undertaken to commercialise these if any? Most of them are routed through Cambridge University and the Medical Research Council, who do a great job of picking up the commercialisation of intellectual property. As well as clinical innovation, we believe that we are one of the leading NHS hospitals for the development of new management ideas like business intelligence systems. We’re currently exploring joint ventures with companies in this area. 6) Cambridge Hospitals Trust benefits from not having the intense competition of its London rivals and in Papworth and Addenbrooke’s, two hospitals of international repute. What are the pros and cons of such a situation? Our peers in the UK are Oxford and the top London teaching hospitals – but we aim to compete against the best in the world as well as the best in this country. Remember that NHS patients now have a choice of where they are treated – so we’re competing with all other healthcare providers in the UK for the services we provide. Activity is up 13 per cent this year, so as we’re having to manage increased demand as our reputation attracts more patients to Cambridge. 7) The Trust has huge short, medium and long term capital spending planned including almost £100m over the next three years, yet last financial year, planned spending increased by 35 per cent over 12 months. How difficult is it to keep such massive capital budgets under control, particularly in the longer term? Our planned capital spending is £600m over the next 10-15 years. Everybody understands that major capital works are very complicated and demanding, but by and large we stick to the timetable. As a Foundation Trust, we’re expected to make a surplus, which we can invest in new buildings like the £84m Addenbrooke’s Treatment Centre, which opened on time last year. It gives us bigger and better facilities for patients, and it brings together hospital care and research: the building is designed to help take advances in medical science from the laboratory to the bedside. 8) How do you expect the economic downturn to impact on the Trust? All businesses will have to tighten their belts to pay off the finance industry’s debts, but there’s a political dimension to the provision of health services. Few governments would want to risk reducing the quality of healthcare or cutting back on services. Patients are increasingly aware that the NHS is significantly behind its European peers for cancer and heart disease outcomes – and those disparities reflect the fact that the NHS has been underfunded by a significant amount for the last 50 years when compared with our main competitors within the OECD. In Cambridge, we will keep improving our productivity and efficiency to ensure that we continue to deliver excellence in clinical services, education, and research. 9) What would you highlight as your biggest achievements at the Trust so far? Delivering a Healthcare Commission rating of ‘excellent’ for both quality of services and use of resources for the last two years in a row. This is the key national assessment that measures what really matters to patients – and it puts us right at the front of the pack. I’m also very proud of the huge improvements in infection control here over the last two years. For example, we’ve seen a 66 per cent reduction in MRSA bloodstream infections, which are down from 123 cases in 2004/05 to 41 in 2007/08. This year we’re aiming for no more than 33. 10) What are your biggest challenges going forward? Maintaining excellence in patient services, research, and education – despite the economic downturn. We’ll be investing several hundred million pounds to ensure that we keep our position as an international leader within the health industry.