Ed Macalister-Smith
NHS Wiltshire and Bath
Interim CEO NHS Wilts and B&NES Cluster
NHS Executive Coach.
Chair of Shadow LETB, also lead of Clinical Networks review and Major Trauma across South Central.
Previously CEO NHS Buckinghamshire, CEO NHS Isle of Wight, and CEO Nuffield Orthopaedic Centre NHS Trust Oxford.
Recent activity
Comments (14)
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Comment on: How to make modern dementia services
Good article Daniel, thanks Ed
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Comment on: David Stout leaves NHS Confederation to run commissioning support organisations
Good luck David, and well done at the Confed.
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Comment on: Trust rips up FT plans and seeks merger
What is it about this round of reorganisation that is putting pressure on some of the most innovative integrated systems, just when we need their pathfinding the most? Come on Kings Fund, we need some reflection on this...
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Comment on: Expand independent sector provision, says 'most powerful' hospital chief
"Shoving millions more into the community without proper business management systems is a recipe for disaster" - well, there's a thoughtful and value-free contribution, from a CEO who has benefited from and has an interest in maintaining the organisational status quo. ...and in the face of what he himself calls a tsunami of impending need which will require fundamental change. Can't really see where the leadership is in that. And if Gareth thinks community and primary care services aren't subject to productivity challenge, he hasn't set foot in the parts of the NHS that I have been occupying for quite a few years now...
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Comment on: Are we expecting too much of the CQC?
The problem is not so much the expectations we have of the CQC itself, but rather the expectations that we (especially politicians) have of the whole concept of organisational regulation. Every time there is a failure, an additional layer of organisational assurance or regulation is added (once again locking the stable door after the particular horse involved in the particular failure has bolted). In my view, we are well past the point where an additional amount of organisational regulation produces an equivalent amount of added value. Of course, it's easy to say, after a failure, "well, we have to do something..." and rightly so, but why another layer of organisational regulation? We set up quasi-autonomous organisations so that they can be accountable, and then we undermine that accountability by adding layers of regulation. If an organisation fails, it needs to be held to account, not cocooned in regulation. And if organisations were able to devote at least some of the resources they currently use to provide external assurance, and apply it to internal quality improvement instead, who knows what level of benefit might be added? But the focus on organisational regulation also diminishes the responsibility of individuals for their actions and for their colleagues actions. The professional regulation function is perhaps where much more attention should be focussed. Getting organisations such as the NMC to operate effectively and to develop a culture of professional accountability is likely to have much greater benefits than more organisational regulation. And by the way, every NHS organisation should already have a NED who acts as the Whisleblowing Champion, the point of last resort for staff with concerns. And any Chief Executive worth their salt will make sure that their staff know that their door is always open to genuine concerns.
