first person

Published: 10/01/2001, Volume 112, No. 5787 Page 27

As Chris Stevens leaves the NHS after more than 20 years'service, what memories does he take with him - apart from the severed limbs in his office and threatening ambulance staff?

I've had enough. After 22 years in NHS management, at the age of 46, I am off to south-west France to escape the rat race.

Starting as a student psychiatric nurse, I worked my way up through junior administration jobs in acute/general hospitals and, with the introduction of trusts, became a chief executive in West Suffolk and most recently in East Norfolk, supporting the creation of primary care trusts.

Certain experiences stand out:

Mary, 40 years old and on a respirator following childhood polio, who fought against the NHS and social services to be discharged from hospital to her own bungalow. She died six months later, but on her own terms and in her own home.

The parents of John, a 40-year-old man with learning disabilities, crying in my office in the hospital that had been John's home for 15 years, asking why he hadn't been discharged years before into the supported housing where he was now living a great life.

The lack of support offered to my family when my father committed suicide after 15 years of manic depression - and having to step over decorators' ladders and paint cans in the corridor outside the chapel in the local district general hospital when I took Mum to see his body.

The nursing assistant who dissolved into tears when praised for her work on a self-study course - it was the first time in 20 years of NHS working that she had been praised.

The domestic assistant who 'blew the whistle' on a charge nurse who was assaulting people with learning disabilities - and the qualified nurses who had kept quiet.

My pleasure the first time my boss acknowledged the fact I was gay, inviting my partner to a trust board social function, even though he chose not to go - much to everyone's relief, I suspect.

Senior managers who thought they knew the answers and couldn't cope with others challenging the status quo, and the colleagues who came up to me after I had spoken out to say: 'Well done, you said what everyone else was thinking' - but who kept quiet themselves.

The health authority appeal panel that reinstated an ambulanceman (because of his 'previous good record') who had returned to a house to threaten to beat up a distressed relative whose partner had just died.

The disappointment in the lost opportunities of a Labour government who replaced principled leadership with increasing mountains of targets and paperwork - and knowing that less and less of what I did was improving anything for patients or staff.

My experiences as a ward clerk and student nurse and what I learnt, and hopefully never forgot, about the ways that staff, as well as patients, were oppressed and kept in their place by managers and their systems.

Seeing personal assistants and secretaries in tears as a result of abusive phone calls from patients and relatives, and realising it was they (not me) who were really on the front line of NHS management.

The evidence of institutionalised racism and sexism in the NHS: looking round chief executive meetings and never seeing a black person there, and often seeing the few women there patronised or put down by male 'colleagues'.

As an on-call administrator in accident and emergency at 3am, seeing the pressure on junior doctors and nurses - and learning that the only way I would find out how many empty beds we really had was to walk the wards and count them.

Having amputated limbs, wrapped in bin liners, propped against the filing cabinet in my office (in a hospital long since closed) waiting for the next internal post run to take them to the neighbouring hospital (the one that had a working incinerator).

But the joy of working with so many wonderful people far outweighs the rest.And the lessons?

Managers need the humility to really listen to people, whether staff, patients or relatives: they generally know the problems and the solutions.

And managers need to be drawn from a much more diverse range of backgrounds and life experiences - we need to value and use those differences.Also, politicians (and some managers) need to read a few decent books on the management of change and motivation, and learn that micro-management from the centre, threatening and bullying may look and sound good sometimes, but are not very effective in improving patient care. Bon chance!

Chris Stevens was, until March last year, chief executive of Norwich Community Health trust.