From pillar to post

Wanted: exceptional candidate to run health authority with long-standing problems.

Job includes clearing£5m debt and implementing controversial programme of savings while handing over much power to primary care trusts.

Income per capita low (but population healthy) and expenditure kept high by bed-blocking. Vocal locals include former health secretary Virginia Bottomley.

The job description for the chief executive of West Surrey health authority may not actually say this but most health service managers will know that it is not an easy post.

The fact that it is not even more difficult is largely due to Jenny Griffiths, who is quitting the chief executive's role after three years.

She joined at a time when the HA had an overdraft of£18m and a damning auditors' report had criticised the lack of financial information and control.

'I am very proud of what I have achieved here. The worst is now behind us, we have more or less cracked it, ' she says.

The deficit has been reduced to£5m and a programme drawn up which should save£4m a year for the next three years - provided it is implemented.

But dealing with the authority's long-standing financial problems has not been easy.

Proposals to cut services, including beds in community hospitals, led to stormy public meetings and have had to be substantially modified.

A 'care in the home' strategy is now being implemented, but over a longer period and with strict evaluation.

Bed-blocking has proved difficult to sort out as care homes closed. Long waits for operations are relatively common and trusts find the high house prices make it difficult to attract nurses.

Last year, junior health minister Gisela Stuart ordered the authority to accept an independent review panel which called for a 'radical rethink of management and accountability issues', while praising the savings the authority had made under its 'Sustainable NHS' programme.

But Ms Griffiths is adamant that she is not leaving the NHS because of the difficulties of the job.

'Basically It is about getting a life, ' she says. 'I have worked for 60 or 70 hours a week for many years.'

Her plans for the future include voluntary work, possibly returning to studying, spending more time with elderly members of her family, and travel - and simply catching up on all the books she has not had a chance to read in her 25 years in the NHS.

'I just do not want to get to 60 and say I have not done these things, ' she adds. 'I want to go while I still have a good chunk of life ahead of me.'

Local MP Virginia Bottomley is scathing about the task Ms Griffiths has had to face. 'Jenny has been wonderful, deeply committed and working night and day, ' she says.

'She was put in an intolerable situation and was put under tremendous pressure from the centre. She did the job with great courage and dignity.

'Regrettably there will be others who look at her experience and think: 'What is the future for me in NHS management?' Losing Jenny is an enormous loss to the NHS, and if you think how many talented NHS managers are beginning to look elsewhere then there is cause for concern.'

Ms Griffiths admits that the West Surrey job was tough in parts and says the strong working partnerships formed there, along with support from the wider NHS community, have sustained her.

'I have done tough jobs before so I have had to develop a thick skin, ' she says - she led the Hertfordshire health agency through difficult times, and has also been chief executive of Oxfordshire family health services authority and worked in the NHS Executive.

The task for Ms Griffiths' successor - she will leave in June this year - will be to ensure the planned savings are realised.

'I would say, focus on the system and processes of implementation, ' says Ms Griffiths. 'Our emergent primary care trusts will be key to that - the partnership with them is vital.'

But Nick Buchanan, the chief officer of West Surrey and North East Hants community health council, believes that may be a tough job.

'I do not think the HA faces an easy agenda, ' he says. 'It would be premature to say it faces a certain future. I think things will continue to be difficult.'

He points to the effect of implementing national standards for heart disease and cancer, funding for elderly care, and the reluctance of the local community to accept that cuts in services are needed at a time when the NHS is being given generous funding as factors which will make the HA's job more difficult.

So was there anything structural or personal which would have persuaded Ms Griffiths - who is only in her late 40s - to stay in the NHS?

Apparently not: 'If I had been 10 years younger I would have gone for a primary care trust. I think that is where all the energy and drive will come from, ' says Ms Griffiths. 'But given where I am in my life the answer has to be no.'