As the new chief executive of NHS Tayside, Gerry Marr bears ultimate responsibility for the health of the region’s 400,000 souls. He comes into the job at a time when the service is being asked to find £25 million in savings.
Last year saw two elderly medicine units, Ward 6 at Royal Victoria Hospital and Ward 31 at Ninewells close, the latter after five patients died from Clostridium difficile. Mr Marr says these were not closed to achieve the £25 million cuts target.
“Everyone seems to measure how good a health service is by the number of beds you have. Every time you close an old hospital people see it as an attack on the health service.
“If I had all the money in the world, I would still have closed those wards. We seem to have this default position that you have to put someone in a hospital bed to treat them. I want to challenge that.
“It’s not about saving money, it’s about providing a better service. The money tied up in those wards was preventing us from investing in very good community healthcare.”
One of Scotland’s greatest and most pervasive health problems is our relationship with alcohol. Unsurprisingly particularly just weeks before an election Mr Marr won’t say whether he supports the SNP’s plan for minimum drink pricing.
“It’s not our job to decide policy, that’s for MSPs to debate. But I think there’s a great deal we can do. We’re funding a programme of screening. When you see your GP about an unrelated issue, they can ask questions about your relationship with alcohol and give advice.”
Once a month Mr Marr meets with the chief executive of Dundee City Council, the Chief Constable of Tayside and Tayside’s chief fire officer to work out ways the organisations can work together more closely.
“NHS Tayside is spending £12 million this year on preventative measures, all based around lifestyle, smoking and obesity. Increasingly, we’ll be focusing on early years.
“All the evidence shows that the best way to avoid an unhealthy lifestyle is to intervene at an early age before bad habits set in.
“If you look at people with drug and alcohol problems, quite often you can trace them back to their early years. You find many of them come from broken homes, are victims of domestic violence from a young age and have poor educational attainment.
“We need to address this but we can’t do it alone. We need the help of other organisations.”
Mr Marr finishes with a pledge that NHS Tayside will become more open and transparent under his tenure and a plea for people to get involved in the running of their healthy service.
“We need to move away from what’s seen as consultation after we’ve already made up our minds, towards genuine consultation with the community involved in the decision making process.”
“The demographics are changing,” explains Sandy Watson, NHS Tayside chairman.
“The proportion of elderly people is getting higher. By 2016 we’ll need another 150 beds and by 2031 we’ll need a new hospital with at least 500 extra beds.”
There’s an unusual absence of jargon and management speak in Mr Marr and this may be because he began his professional life as a nurse, rather than being parachuted in as a consultant.
The 57-year-old started out working in mental health and learning disabilities before moving to America where he worked in trauma and acute care.
He then worked at Glasgow’s Southern General before becoming head of patient services for NHS Greater Glasgow. He was unit general manager for children’s and maternity services, again in Glasgow and took Yorkhill Hospital for children into trust status in the early 90s.
He was director of human resources for the Scottish Executive and then director of performance and planning for the NHS in Scotland. In 2001, he became chief executive of the Tayside University Hospitals NHS Trust. Following the abolition of trusts in Scotland, he was appointed chief operating officer for acute and primary services in Tayside.
He took up his current post in February. One challenge that has affected virtually every hospital in recent years has been infections and Ninewells has been no different. In one month alone last year, the winter vomiting bug caused the closure of no less than nine wards in Ninewells.
“The closures are often associated with the norovirus, or winter vomiting bug, which tends to occur in winter and spreads rapidly,” Mr Marr says.
“It’s a problem but it’s not at the same end of the spectrum as MRSA and C.diff, both of which we’ve reduced dramatically.Pride”We also have signs in wards saying things like ‘300 days since the last infection.’ Not only does this reassure patients that we’re doing all we can to prevent infections, it acts as a source of pride to staff and reflects the enormous effort they put in.”
Anyone who works for a medium to large-scale organisation will be familiar with the refrain “we do it this way because we’ve always done it this way.” This saying is especially true for an organisation as large and clunky as the National Health Service.
“Since the NHS was set up in 1948, the only way a GP has been able to get a patient an appointment from a consultant has been to send them to an outpatient clinic,” Gerry explains.
“So the patient has to go to their GP, then traipse along to hospital, then get their appointment.
“We’ve made some progress with this in dermatology and plastics with electronic referrals but there’s still a lot of work to be done.
“In surgery, we’ve established a pre-assessment so you’re admitted on the day of surgery rather than the night before. This frees up money from hospitals’ infrastructure to spend on other services.”
Across a wide-ranging, hour-long interview, the same topic comes up again and again: old age.Demographics”The big challenge for this country is going to be demographics,” Mr Marr says.
“It’s going to be a tough road ahead. But I’ve been quoted in the past as saying even if we had all the money in the world it wouldn’t make a difference if it wasn’t used properly.
“We’re living longer and leading good, full lives for longer. That’s a good thing but the workforce is shrinking so we’re going to have to change the way we do things.
“An old person should only ever come into hospital when they need hospital treatment.
“In Northern Ireland, health and social work operate much more closely together,” Mr Watson adds.
“Patients will be discharged within 48 hours and an assessment team visits them at home.
“It’s fascinating to see how few elderly go into residential care.”
NHS Tayside are now running a pilot project in Perth that looks to increase the independence of elderly people.
“Elderly people don’t want to go into care,” Mr Marr says.
“They want to stay in their own home and be as independent as possible.”
Given that he’s only six weeks in post, it’s too early to tell if Gerry Marr will be an effective head of NHS Tayside. But the organisation’s new chief executive is at least refreshingly straight talking.
Quizzed about the upcoming takeover of healthcare in the region’s three prisons which could result in money being taken from other areas to be spent treating criminals he not only pledges to be open about any diversion of funding, he even makes a case for why the NHS should be looking after prisoners.
“These people are only in prison for a period of their lives,” he states.
“Many of them come from broken backgrounds, have drug or alcohol problems and lead chaotic lives.
“It’s for other people to be judgmental about them being prisoners or having broken the law. We’ll be committed to treating the unhealthy lifestyles, which in some cases, are the reason these people end up in prison.”
NHS Tayside takes over the running of healthcare from the Scottish Prison Service in November. The health service will be given extra cash £2.5 million has been mentioned but not confirmed but there’s no guarantee this will be enough to cover the cost of the additional work, leading to speculation money will have to come from other budgets. The headline Prisoners Rob Pensioners almost writes itself.
“Everything we do on this will be transparent and open to the public,” he continues. “We don’t yet know how much money we’ll be given to do this but already the speculation has started that we’ll be taking money from other healthcare budgets.
“That’s why we have to be completely open about the money we’ll be given and how much the actual cost will be. If health services were somehow short changed by this arrangement people might quite rightly worry that’s coming out of the budget for children or the elderly.
“That’s why we’ll be putting everything in the public domain.”Prisoner healthcareThe prisoner healthcare transfer issue is one that has the potential to generate awkward publicity for NHS Tayside and it’s sensible for Mr Marr to handle it very carefully indeed.
But, in the grand scheme of things, any shortfall the health body needs to make up will be a minute part of its £747.8 million budget. A far bigger challenge is finding the £25 million in savings the Scottish Government has ordered.
Mr Marr’s pretty bullish about his organisation’s ability to make those savings without affecting services.
“We’ve balanced our budget every year for 10 years and achieved every government target that has been set for us for 10 years,” he says.
“We will achieve this £25 million saving over 2011/12 and have already identified where we will find it from.”MedicationOne example of where Mr Marr intends to save money and improve healthcare at the same time is medication.
“Too many people are on too many medications 17% of admissions into acute medicine are because of medications elderly people are on,” he said.
“We have 800 people over 80 who are on 21 medications or more. In most cases, they shouldn’t be taking as much medication as that. Some of these are serious drugs and people should only be taking them if they really need them.
“We’re going to make sure geriatricians and GPs are working together to assess people in the most effective way.”
The cut comes at a time when the cost of drugs are going up, the bill for paying staff is rising, VAT has risen and the costs of overheads and fuel are increasing.
Furthermore, it comes when the service is going to have to treat more people than ever before