Whether leading from the front or prompting from the side, Edna Robinson's goal has always been joined-up thinking, she tells Stuart Shepherd
Edna Robinson is making some adjustments. Until recently, as chief executive of Salford primary care trust and even more recently of Trafford Healthcare trust, she gave the orders. Now, as a part-time policy adviser to communities and local government secretary Hazel Blears, Edna realises people do not have to listen to her if they do not want to.
"It's a different mindset, not being the boss, and it's very exciting" she says. "Working for Hazel Blears and alongside her colleagues in the Cabinet Office and Prime Minister's Delivery Unit, I am helping to look at how targets from one department impact on another and how we can facilitate more joined-up government decision making."
Not that Edna has said goodbye to health. She still heads NHS Networks, which gets around 30,000 hits a day and "punches hugely above its weight". She believes it owes its success to being a brand without a brand, not taking itself too seriously and offering continuity in an era of change.
Sometimes change is suddenly thrust upon NHS organisations. Other occasions might at least allow an organisation a little time in which to seek to reposition or reinvent itself, as was the case when Edna took the helm at Trafford in 2005.
Park Hospital, as the trust's main site was known in 1948, acquired a special place in the history of the NHS, being the venue from which Aneurin Bevan chose officially to launch the new healthcare system.
"That was not a talisman for the future, however," says Edna, reflecting on her time in charge. "While there [was] still a range of goods and services well worth having, the trust no longer hosted an international teaching hospital. It was clear to the workforce that this was no time for dinosaur mode: we needed to raise the quality of our performance and become as efficient as possible."
Then, as now, Edna was after some joined-up thinking, this time to assure what she saw as the trust's vital place in the care continuum. She explains: "People characterise and separate primary and secondary care too quickly. I believe passionately there is a need for local 24-hour services, to meet the challenge of a cohort of illnesses that cannot be characterised as being delivered either in a polyclinic or an international teaching hospital, where opinions and diagnoses can be formed and where complex healing and recovery can take place."
Making an analogy with the high street decimated by large out-of-town supermarkets, Edna recognised the opportunity to create a healthcare campus. This would provide its own local and idiosyncratic services on several sites, with specialties delivered by visiting clinicians, and would act as landlord to primary care and GP tenants accessing its diagnostics.
"We needed to become an organisation that faced both ways, on the one hand creating strategic partnerships with acute trusts where some of my workforce could gain experience, and with primary care on the other to develop the work on the integrated pathways," says Edna.
The other important feature of this delicate manoeuvring was to avoid putting Trafford in a vulnerable position where it might be thought of as a brand or overflow unit to one of its larger neighbours. This was about securing its place in the new market, instilling a climate in which an energetic new executive team could maintain the trust's identity.
While partnerships with nearby trusts were formed to strengthen Trafford's position, hanging on to and stabilising Trafford General Hospital's accident and emergency department was, in Edna's view, crucial to the organisation's sense of itself. It did this by developing a consultant's duty rota with one of its teaching hospital neighbours.
"The clinicians' buy-in and ownership of the vision for the future was very important and one of my biggest achievements was bringing in a new group of clinical leaders alongside the executive team," says Edna.
Not that the trust was short of good practice. In the year before Edna arrived, Trafford had put in a medical unit that was very good at getting people home within 48 hours. Good for the patients, but, as she points out, not so good for the balance sheets.
"We lost£2m by not keeping those patients in an extra day," notes Edna. "For a financially challenged organisation, that wasn't an incentive to use best practice.
"The business systems that underpin the NHS are becoming as important as its institutions," she says. "If we are to have clinical pathway organisations, you don't want harsh financial regulations that fail to mirror what's going on in service redesign. The incentives need to be in place for people to work across the system and for the money to flow into 24-hour care and rehabilitation - where the patient is, to put it straightforwardly."
The joined-up thinking of which Edna is in favour supports junior health minister Lord Darzi's vision of primary care driving much of long-term care management and diagnostics. It also calls for a system that allows organisations like Trafford to be able to craft enduring, cost-reducing local initiatives as opposed to overly simplistic solutions.
"Locally based healthcare such as we were developing at Trafford has the potential to become a bright, vibrant and flourishing campus-based facility, meeting the needs of a swathe of people who have a complex range of conditions - things wrong with them that still need time to be identified - or [who] sometimes want to be able to choose services on their doorstep," explains Edna.
"I don't want there to be a drop-off between the large international teaching hospital and the polyclinic, with the public not knowing what's in the middle."