The definitions of success and the things we value in chief executives in the NHS need to be rethought, writes Sarah-Jane Marsh

22 August 2019. Is that date engraved in your mind? Chances are, if it is, you have a child, grandchild, nephew or niece who got their GCSE results that day. I hope they got what they wished for, but, most of all, that they felt content and proud in themselves, regardless of their grades.

Making the grade

I do worry about how we define success for children and young people these days. Whether that be teachers or parents applying too much pressure over exam results, or young people themselves feeling they have to achieve unattainable body images and seeking validation through social media.

This is something on which I reflect a lot, both personally, as a parent of two young children, and professionally, in my role as chief executive of Birmingham Women’s and Children’s and chair of the National Children and Young People Transformation Programme. Modern society should not place more value on these measures than on supporting young people to grow up happy, healthy, fulfilled and making a difference to society.

With more than a decade behind me as a hospital CEO, I believe the definitions of success and the things we value in chief executives in the NHS also need to be rethought.

When it comes to support, success has many parents, but any sniff of “failure” and you become an orphan

I became CEO of Birmingham Children’s Hospital in 2009. With 34 specialities including 10 national centres, it was then, and is now, an enormous honour and privilege to lead such a highly skilled and compassionate group of people doing such wonderful things for children, young people and families every day. I am proud and humbled by everything we have done together to take the organisation from strength to strength, with the limitations of austerity and a Victorian building designed for adults.

This is where I honed my leadership style; visiting, learning, being visible on wards and in clinics talking to patients, families and of course our amazing teams. I believe it has served me well over the years.

In 2015, whilst pregnant with my second child, I was asked whether I would take on the role as CEO of Birmingham Women’s Hospital too, the same year we had stepped outside our comfort zone to create Forward Thinking Birmingham, an integrated mental health system for 0-25’s made up of NHS, private and voluntary sector partners. The Women’s houses the largest single site maternity service in the UK, together with a Fertility Centre and supra-regional Genetics Hub but had suffered from a series of prolonged corporate governance and financial challenges. FTB was built on big ambitions in the youngest city in Europe, with a complex contracting model and limited resources.

As a board, we thought long and hard about whether to branch out in this way. The days were already numbered of bumper tariff payments and expansion for the sake of scale. In the commercial world, no successful company would have made the economic case for such transactions. But markets and economics were never a good ally for universal healthcare and our motivation was to do the right thing.

The truth is that to take on the Women’s whilst creating FTB was to put on the line the hard-earned and long-held reputation of the Children’s hospital, and indeed my own reputation as a CEO. We never wanted thanks or plaudits, but we did want people to understand. Instead our performance as an organisation, and mine as CEO is continually compared to when we were an organisation of half the size, scale and complexity. When it comes to support, success has many parents, but any sniff of “failure” and you become an orphan.

Why on earth would we do it then? Well, it comes down to what we value as NHS leaders. We saw the opportunity to bring together mothers’ health and birth experiences with the best start in life for children; to combine physical and mental health for children and young people because they rarely have one without the other; and to support the dedicated staff who were looking for leadership and who just wanted to do the best for their patients and families.

To pursue these goals we chose as a board to accept the risks to our reputation, rather than protecting the splendid isolation of a smaller, high-performing trust. I also sacrificed many of the things that are personally important to me, as you simply cannot lead a multi-site organisation in the same way.

I am so pleased and proud that we have been able to move all parts of our recently expanded family forward in the last few years. We may not always have achieved straight A’s across the board, but what we have created together is special, unique and making a difference. We know there is so much more to do and we will never stop aiming higher, with ambition, bravery and compassion in our hearts.