TRACY Myhill began her role as chief executive of Abertawe Bro Morgannwg University (ABMU) Health Board in February last year.
Here she talks about the past 12 months leading an organisation with 16,000 employees and a £1.3bn annual budget.
Her average day involves meetings with anyone from board colleagues, clinicians to Welsh Government officials, and she tries to ensure she speaks to patients and staff as frequently as possible.
The 54-year-old earns just under £200,000 per year, lives in Penarth, and was formerly Welsh Ambulance Service Trust chief executive.
ABMU covers Swansea, Neath Port Talbot and Bridgend, although Bridgend will transfer to a neighbouring health board in April.
In 2016 ABMU was placed in ‘targeted intevention’ by the Welsh Government to help drive improvements in cancer and stroke care and unscheduled care, among other things.
How would you summarise your first year as chief executive of ABMU?
It has been exciting, genuinely, and a really interesting year. It has been challenging in lots of ways, but above all it has been hugely rewarding.
Exciting because of what we do, the people we have got, and the fantastic innovations we have – and a great opportunity, I think, for this organisation to get the reputation it deserves, not always the reputation it has got.
Challenging because it’s big and complex, demand [for healthcare] is increasing, people are living longer, so there are lots of changes needed.
This year we are also having to exit from Bridgend, which is 28% of our population. That has been a significant focus for us.
The reason the job is rewarding is that I can see the improvement. I can see less noise from staff and we get fantastic feedback from patients.
We are heading in the right direction. That keeps you going.
Has it been different than you expected and if so how?
I have worked in the NHS in Wales for 35 years this year – one year of that was for the Welsh Government in the health department – so I’ve been around the system for quite a long time. From that point of view it was not a total shock.
But it’s not always what it says on the tin. I guess it’s the complexity – 16,000 employees, £1.3bn budget. Even though the geography is tighter, it’s very complex.
What changes have you made or instigated and why did you make them?
When I came in I was very keen to do a lot of listening, a lot of observing, and a lot of learning, notwithstanding I had to do the job from day one.
That has spurred me on to the actions in the first year. Number one – nobody knew where the organisation was going. We didn’t have an organisational strategy. Everybody was focusing on today.
We had targeted intervention around performance, so people were not necessarily looking forward.
People told me: ‘If we know where we’re going, it will help us.’
We agreed an organisational strategy, along with a clinical services plan. I think that’s really important – every organisation needs a firm direction.
The organisational strategy is about the shift out of hospitals, and how we can shift more care and support into the community.
Leadership has been a massive focus for me. When I came here, there were numerous gaps in the executive team. I think an organisation of this size deserves really strong, cohesive leadership and it was not there.
So I focused quite a lot on filling those gaps and recruiting the right people.
You just can’t move an organisation forward at pace unless you have got strong central leadership.
Then with that leadership, a major focus for me was on visibility. I’m not the sort of chief executive who sits in an ivory tower. I get out and about regularly myself and I expect my executives to do the same.
If you could pick three areas that need improving, what are they?
There have been significant improvements in cancer and stroke [care], and in healthcare-acquired infections.
And we have delivered on our treatment time targets.
We have stabilised our unscheduled care system. There are less people waiting four hours to access A&E and less hours being lost to ambulances waiting outside our A&E departments.
So I can see signs of improvement. But the unscheduled care performance of this organisation is not good enough, really.
We also need to make sure we get referral to treatment time performance more stable. While we have made great improvements, some of that has been by outsourcing and buying in those operations.
We have two major responsibilites, I think, as an organisation – one is to improve the health of our population, the second is to provide excellent care for people who need it.
When I came here, I think the majority of focus was on healthcare delivery and not enough focus on helping people improve their health. So much is preventable.
Health is not just about health services. In fact the greatest contribution to health is having a job, good housing, strong neighbours and strong support.
I want to make sure we focus on both, otherwise we won’t cope as people get older and live longer.
What can Morriston Hospital learn from other hospitals, like the University Hospital of Wales (UHW), about A&E waiting times?
I think they (UHW) are probably a year ahead of us in terms of their improvement work.
A team from ABMU has been to Cardiff and Vale. Part of the message is that it’s about the flow of patients through the hospital. If you can improve the flow, you can have more people coming in.
We are learning from other health boards, particularly around the frail and elderly, so it’s about trying to stop people coming into hospital who don’t need to, and helping people through the system so they can get out.
We are working with local authorities on a ‘hospital to home’ service by providing support in the community. It is better for patients. Hospital isn’t the best place – I know because my 86-year-old mother has been in one for 11 weeks.
Also, other health boards are learning from us. We are doing some great things in terms of technology, and some fantastic work with GP clusters.
Why is there a persistent shortage of nurses and if you could wave a magic wand how would you fix it?
Adequate nursing staff is fundamental. Last year we invested £3m into our nursing staff. There is the Nursing Staff Levels Act, which sets minimum numbers, particularly in medical and surgical ward areas.
We have also seen a siginficant reduction in our nursing vacancies and that’s really encouraging. When I came here people kept talking for months about 400 vacancies. The latest numbers are more like 200. There is still more to do but we are going in the right direction.
I don’t think there is a magic wand to be honest but there are a couple of things we need to get right. Part of it is about how we sell the organisation in this part of the world as a fantastic place to live and great place to work.
The other part is keeping the people we have got. You need to make sure their experience is the best it can possibly be.
The other aspect is about training. I think we need to be more flexible.
How has being in ‘targeted intervention’ affected the day-to-day work of the health board?
It has enhanced our focus, because of the scrutiny and regular interaction with the Welsh Government and others, particularly in a number of core performance areas.
I believe it has also been supportive. I think we all want the same thing.
I am confident that we are on the right track. I’m confident that we are making improvements and I would really like to see us in a place where our escalation levels are reduced in the next year.
Do you feel the health board is adequately funded?
If you asked me ‘Do I want some more money?’ I would say ‘Yes please.’
But if you look at all the independent reports about the funding that’s required then we are funded in line with those recommendations.
I think the challenge for ABMU is that we did not start from an even keel.
When I came in here we had a significant deficit (£34m at the end of 2017-18). We have got to reduce that overdraft.
I’m working to deliver a plan for break-even for 2019-20. It’s challenging but that’s what I’m pushing to do.
The latest staff survey had some positive results but also some concerns about bullying and harassment – did that surprise you?
When I arrived I was a bit surprised about the strength of feeling in some parts of the organisation – the number of anonymous comments saying, ‘You don’t know what it’s like to work here, Tracy.’
Before the results came out we had embarked on some work with the trade unions and Acas (Advisory, Conciliation and Arbitration Service) – when the results came out we targeted that Acas work in particular areas.
I have seen a bit less angst and a bit more positivity but there are pockets of this organisation where we need to work harder so our staff have faith in us.
We are putting in place an independent helpline. I think people have felt uneasy in saying where [in the organisation] they work. I want to get away from that.
But there are also staff who can’t be positive enough about their work experience.
How do you see healthcare changing over the next few years and, generally speaking, should people take more responsibility for their health?
I see this as a partnership with our population. Being healthy does not just mean not being ill. Therefore we need to partner like we’ve never partnered before and that’s because of the wider determinants of health.
We do need people to have a few more healthy habits but we need to help and support people to do that.
Technology is going to be massive and there’ll be an increase in digital solutions – counting your steps every day, supporting people at home.
This is not about saving money. It’s about giving people the right care in the right part of the system for their needs.
We’re still doing more in hospital than we need to. We have people in hospital who definitely don’t have to be there.