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Published: 21/11/2002, Volume II2, No. 5832 Page 14

As head of the Scottish equivalent of the Modernisation Agency, June Andrews is putting her money where her mouth is. Jennifer Trueland reports

June Andrews is well accustomed to accusations of being poacher turned gamekeeper.

The former Scottish secretary of the Royal College of Nursing raised a few eyebrows when she left the union (taking a significant pay cut) to become director of nursing at Forth Valley Acute Hospitals trust.

Now, three years later, she is risking the jibes again, having left the coal face of the health service to become director of Scotland's first centre for change and innovation.

In her RCN role Ms Andrews had been critical of government health policy, while as an NHS manager she had to implement it (doubtless uncomplainingly) on the ground.

Now, it is fair to say, she is having to put her money where her mouth is - always a problem, when, as she freely admits, she has never been backward about expressing her opinion.

Ms Andrews has a tough job which carries high expectations.

The new centre for change and innovation was heralded in Scotland's NHS plan, Our National Health, which was published two years ago.

Though they probably wouldn't like it to be described as such, it is probably the closest thing the Scottish Executive health department has to England's Modernisation Agency.

The centre combines two previous units, which dealt with service redesign and change and management development. In other words, it brings together work being done to modernise both the structures and the way people work and develop.

Simply bringing these groups together has already had a positive effect, Ms Andrews believes.

Speaking just days into the job, she says: 'People are starting to talk to each other and share ideas about what they've been doing.

For example, the people doing management development have not had access to the same toolbox of techniques that are being used in redesign - for example, to analyse processes. The change process had been artificially divided into people development and service development.'

That is not to say there hasn't been good work going on. Ms Andrews herself is a product of policies to bring on individual managers. For 12 months, she had executive coaching which she says taught her to work more effectively and at less cost to herself.

It is clear that she wants to be seen as part of the team, rather than queen bee. Her workstation is at the heart of the open-plan room, surrounded by colleagues, rather than being tucked away in an office.

And her team has lots to do. In a way, almost everything coming out of St Andrew's House could be construed as change or innovation, so will everything land on her desk?

'I think quite a lot of people would like me to make their particular issue the first thing I work on, ' she says. 'But we have some work to do to look at the major priorities for the NHS and then focus on them.'

In practical terms, the first thrust is likely to be around the stated clinical priorities of cancer, heart disease and mental health.

Waiting times will also be a focus.

'I am still taking soundings to find out what people think. The health plan makes it quite clear what it wanted the centre to do.

Now It is important that we translate policy into practice, ' she says.

Ms Andrews will report directly to Trevor Jones, chief executive of NHS Scotland, and her department's work will be overseen by a health change panel, chaired by chief medical officer Dr Mac Armstrong, and with strong clinician and management input.

Ms Andrews believes this structure sends an important message out about the high priority the Scottish Executive health department is placing in the directorate.

But, while believing it is important that some things are driven nationally, she does not want to be seen as issuing orders from St Andrew's House - a wish echoed by Scottish health minister Malcolm Chisholm, who is particularly sensitive about being seen as centralising.

She wants to encourage change and innovation locally. 'I want to tell people they do not need permission - just bloody do it, ' she laughs.

She brings to the job the invaluable recent experience of being an NHS senior manager and what she hopes will be good continuing relationships with those still working in the service.

Highlights included a 'back to the floor' exercise, reported in HSJ, where she worked as an auxiliary nurse and saw for herself where the problems and successes lay.

She also heard at first hand what went wrong, as she was in charge of complaints at the trust and took part in major consultation exercises about service redesign in Forth Valley.

She smiles as she recalls what one member of the public told her after she had been trying to explain complex service changes to a hostile audience: 'I was told that they didn't agree with what I said, but they admired my courage in coming to say it.'

With a job of this magnitude, Ms Andrews will require every ounce of bravery she can muster.