Career Path: leading change in the NHS

I graduated in plant biology from Oxford University in 1979 and there is a link to how I came into the NHS, although it is rather tenuous. My first job was in a nature reserve doing research work. We used to have parties of school children come round and I found I was more interested in working with people than plants.

So I did a social work qualification and worked in a centre for people with learning disabilities, in the garden. This was in the shadow of a Hartlepool factory, so unfortunately all the plants died! Despite this, I enjoyed the work and moved into social services, ending up as an area manager.

It was a chance encounter with a colleague that brought me to the health service. She said there was a job as director of planning and information in Rotherham Priority Health, the community mental health and learning disabilities service.

Acute transition

I got the job, rose quickly through the ranks and in 1995 I moved to the acute sector as chief executive of Derby City Hospital, overseeing the merger of two hospitals to form a trust. I did not get the merged job, all for the best as it turned out because the job of chief executive of Lewisham in south east London turned up.

I could not have put Lewisham on the map at the time, but I really came to love the place. It was a real community hospital with a dedicated bunch of staff. You did not work there unless you were committed to the place.

This was the time that star ratings were being introduced and I was very pleased when we got three stars. We hit all our major targets, including financial balance. There was a Commission for Health Improvement report that I still have because it talked about the high morale and the positive atmosphere.

In 2001, I went to the Modernisation Agency, initially as director of service improvement and then in 2004 as director. It was a logical step. Lewisham had pioneered quite a few of the programmes that became the agency. Long before Choose and Book, we were doing electronic booking and we had a forerunner of the accident and emergency collaborative.

I chaired the national A&E taskforce. At the time, people really did not believe it was possible to hit the four-hour target. The NHS demonstrated that it was and the A&E experience has been radically transformed as a result.

As director, I was in charge of winding down the Modernisation Agency, which closed in 2005. Of course, it was not the happiest of times, but I wanted to do the best possible job for people moving on. We achieved an organised retreat and people were looked after.

Huge challenges

The job I have just left was as regional director at the Audit Commission, where I was responsible for the audit and inspection services of all public services in a quarter of England.

I also developed the commission's national foundation trust practice. FTs can choose their own auditor, and initially none of them chose the commission. Since we set up the specialist division, we have won 30 per cent of the market and are the largest single provider. I am quite proud of that.

Throughout my career, I have tried to be at the leading edge. I have also made sure I took every opportunity to develop my leadership skills through courses and by being an active member of organisations such as the NHS Confederation. My belief is that leadership is about enabling frontline staff to deliver - a belief I have always striven to put into practice.

Now I am moving to Westminster primary care trust as chief executive. I wanted to come back to London and I wanted to come back to the NHS. PCTs are where it's at right now. The organisation is in excellent shape, but the challenge of becoming a world class commissioner and addressing health inequalities is huge. We are on that journey.